Sylvia Larsson

Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study

Background: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi‐factorial program including intensified pre‐hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium.

Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux

The aim of this study was to compare the long‐term results of laparoscopic and open antireflux surgery in a randomized clinical trial by investigating subjective and objective outcomes.

Short-term outcome after laparoscopic and open 360 degrees fundoplication - A prospective randomized clinical trial

Background: Despite the lack of randomized trials supporting the laparoscopic approach, laparoscopic antireflux surgery has gained widespread acceptance during the last decade. The aim of this study was to compare the short-term symptomatic and objective outcome after laparoscopic and open 360° fundoplication in a prospective randomized clinical trial. Methods: Sixty patients with GERD were randomized to undergo either laparoscopic (LF) or open 360° fundoplication (OF). Endoscopy, esophageal manometry, 24-h pH monitoring, clinical symptom evaluation, and symptom scoring according to a validated questionnaire (the Gastrointestinal Symptom Rating Scale [GSRS]) was performed preoperatively and 6 months after surgery. Results: Five patients randomized to the laparoscopic group were converted to open surgery. Esophageal acid exposure was restored to normal in all patients. Lower esophageal sphincter length and resting pressure were significantly increased after both laparoscopic and open fundoplication (p <0.001); there were no differences between the groups. No significant differences were seen in symptomatic outcome, although there was a trend toward a higher rate of mild dysphagia (p = 0.051) after laparoscopic surgery. GSRS revealed a decrease in reflux score (p <0.001) and abdominal pain score (p <0.001) postoperatively. There were no significant differences in GSRS scores between the two groups. Conclusion: Laparoscopic 360° fundoplication is as effective in treating reflux disease as open fundoplication. Six months postoperatively, no significant differences were seen in symptomatic or objective outcome. Long-term evaluation is needed.

Randomized clinical trial of laparoscopic versus open fundoplication: evaluation of psychological well-being and changes in everyday life from a patient perspective.

Background: The laparoscopic approach in antireflux surgery might have an impact on the patients daily activities and well-being. Methods: Sixty patients were randomized to laparoscopic or open 360° fundoplication. Data were collected by questionnaires and interviews preoperatively, 1 month and 6 months after operation. Results: Five patients in the laparoscopic group were converted to open surgery. Psychological general well-being increased after surgery and reached norm values in both study groups. No significant differences were found between the two types of surgery in the per protocol analysis, while the domain self-control was significantly better after open surgery in the intention-to-treat analysis. There was improvement of diet and sleep in both study groups; after 6 months, disturbed sleep was significantly more uncommon after open surgery. Dysphagia and flatulence were new symptoms that were reported after surgery. Overall perception of the results of the operation did not differ between the groups. Conclusions: Psychological general well-being, diet and sleep improved after both laparoscopic and open surgery. There were only small differences between the groups, but in some respects the results were better after open surgery.

Intensive care sedation of mechanically ventilated patients: a national Swedish survey

Sedation in critically ill patients is a complex issue and at the same time an important concept for ensuring patient comfort. The aim of this study was to review the current practice of sedation for patients on mechanical ventilation in Swedish intensive care units (ICUs). Questionnaires were sent by post to head nurses in 89 ICUs with mechanically ventilated patients. By August 2000, 87 (98%) questionnaires had been returned. The results show that mechanically ventilated patients were routinely sedated in 91% of ICUs. Midazolam or propofol in combination with an opioid were the drugs preferred by 76%. Heavy sedation was most usual in 63% of ICUs but, when asked about the sedation level preferred by nurses, 78% chose light sedation (P=0.001). Only 16% used sedation scales. This study indicates that local habits and personal attitudes seem to have a great impact on sedation routines. It therefore appears worthwhile for ICUs to review their practice and, if necessary, to consider implementing sedation scales and sedation guidelines. Research pertaining to potential complications and patient comfort in relation to different sedation levels as well as further validation of the efficacy of sedation scales is needed.

Waiting for cardiac surgery—support experienced by next of kin

Background: Next of kin (NoK) play a crucial role for patients waiting for cardiac surgery. Aim: To describe experience of support, in the form of important events, by next of kin while their intimates were waiting for a heart operation. Methods: The design was qualitative and the “critical incident” technique was used. Incidents were collected via interviews with 23 next of kin to patients waiting for heart surgery and the informants were chosen by the patient themselves. Findings: In all, 224 important events, both positive and negative, were identified in the interviews and two main areas emerged in the analysis: internal factors and external factors. Positive internal factors were associated with finding strength, whereas negative factors were associated with uncomfortable feelings. Positive external factors were associated with participating in care and receiving attention, whereas negative factors were associated with dissatisfaction with the health-care organization and failing social network. Conclusion: This study shows that next of kin experienced positive support when they received attention and information and felt involvement in the care. An important implication for the health-care professionals and public authorities is the understanding of the experience of support expressed by next of kin, to provide them with optimal information and support.

Serious complications in connection with cardiac surgery—Next of kin's views on information and support

OBJECTIVE Next of kin (NoK) to patients undergoing cardiac surgery expect successful outcomes but sometimes serious complications occur and this affects their NoK. To describe NoKs experiences of information and support when serious complications occur during the first 30 days after cardiac surgery. METHODS A qualitative, critical incident technique was used. Forty-two NoK were asked to describe their experiences of information and support. RESULTS Three main areas emerged from the analysis. The first main area, Confidence during the waiting period, described how NoK could not participate in the forthcoming operation and how the NoK were informed. The second main area, Involvement during the hospital stay, described how the NoK feel trust in the healthcare professionals and dissatisfaction with the care in relation to the operation. The third main area, Sense of abandonment, described problems with the rehabilitation. CONCLUSIONS These findings show the importance of pre- and post operative contacts between healthcare professionals, patients and NoK. When the NoK and the patients are well informed it constitutes a basis for fruitful conversations between them and the healthcare professionals, and everyone can be better prepared if complications occur.

Postoperative emetic symptoms. Aspects of incidence, causal factors and possible treatment

Despite improvements in anesthetic pharmacology and techniques, postoperative nausea and vomiting are still among the most common and unpleasant side effects of anesthesia and surgery. The present studies were designed to investigate the current incidence of postoperative emesis, causal factors, and patients’ experiences during the first postoperative 24 h, as well as the effects of antiemetics and the impact of different anesthetic methods on the incidence of emetic symptoms after surgery. The incidence of posloperative emetic symptoms was 45% overall, and ranged from 4% to 58% in the various subgroups. The symptoms lasted for less than 3 h among the majority (78%) of patients who only reported nausea, but persisted for more than 9 h in about a third of those who also vomited. Female gender, balanced anesthesia, longer duration of anesthesia and abdominal and orthopedic operations were the factors most frequently associated with postoperative emetic symptoms. About a third of the patients with nausea and vomiting felt psychologically unprepared for the actual course of the postoperative period. The occurrence of nausea and vomiting was associated with that of pain and anxiety. The nurses tended to underestimate the patients’ suffering. Premedication with dixyrazine (Esucos) reduced the incidence of postoperative complaints of nausea and dizziness. When administered at the end of the operation in children undergoing stabismus surgery, dixyrazine also decreased the incidence of postoperative emetic symptoms. Children undergoing strabismus surgery who were anesthetized with propofol suffered significantly less from postoperative emesis than those anesthetized with halothane. This thesis is based on the following studies: I. Larsson S, Lundberg D. A prospective survey ofpostoperative nausea and vomiting with special regard to incidence and relations to patient characteristics, anesthetic routines and surgical procedures. In manuscript. 11. Larsson S, Lundberg D. Patients’ experiences of the first 24 hours after surgery with special reference to nausea and vomiting. In manuscript. 111. Larsson S, Hagerdal M, Lundberg D. Premedication with intramuscular dixyrazine (Esucos): A controlled double-blind comparison with morphine-scopolamine and placebo. Acta Anaesthesiol &and 1988: 32: 13 1-1 34. IV. Larsson S, Jonmarker C. Postoperative emesis after pediatric strabismus surgery: the effect of dixyrazine compared to droperidol. Acta Anaesthesiol &and 1990: 34: 227-230. V. Larsson S, Asgeirsson B, Magnusson J. Propofolfentanyl anesthesia compared to thiopental-halothane with special reference to recovery and vomiting after pediatric strabismus surgery. Acta Anaesthesiol Scand 1992: 36: 182-186. 0 Acta Anaesthesiologica Scandinavica 38 (1994)

1413 Unexpected death after cardiac surgery: Relatives experience of information, perception and care

angiography constituted the study group. Conventional risk factors for atherosclerosis were as follows: Family history in 144 (25%), Diabetes in 87 (15%), Hypertension in 244 (43%), Hyperlipidemia in 180 (31%), Smoking in 281 (49%), and Metabolic syndrome in 171 (30%). Mean body mass index and waist circumference of the study group was 27.8±5.4 kg/m and 98.7±12.5 cm. It was found that, the severity and diffusion of coronary artery involvement were not correlated with these two obesity indexes in our selected group of patients. Correlation of obesity indexes and involvement in the coronary tree –Waist circumference ⁎Sakata score of severty: r=0.0053 ⁎Reardon score of severty: r=−0.001 ⁎Reardon score of diffusion: r=0.018 –BMI ⁎Sakata score of severty: r=−0.005 ⁎Reardon score of severty: r=−0.003 ⁎Reardon score of diffusion: r=0.01.