Once after a full moon : acute type A aortic dissection and lunar phases

Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.OBJECTIVES: Acute type A aortic dissection (ATAAD) is a rare but severe condition, routinely treated with emergent cardiac surgery. Many surgeons have the notion that patients with ATAAD tend to come in clusters, but no studies have examined these observations. This investigation was undertaken to study the potential association between the lunar cycle and the incidence of ATAAD. METHODS: We collected information on 2995 patients who underwent ATAAD surgery at centres from the Nordic Consortium for Acute Type A Aortic Dissection collaboration. We cross-referenced the time of surgery with lunar phase using a case-crossover design with 2 different definitions of full moon (>99% illumination and the 7-day full moon period). RESULTS: The period when the moon was illuminated the most (99% definition) did not show any significant increase in incidence for ATAAD surgery. However, when the full moon period was compared with all other moon phases, it yielded a relative risk of 1.08 [95% confidence interval (CI) 1.00-1.17, P = 0.057] and, compared to waxing moon, only the relative risk was 1.11 (95% CI 1.01-1.23, P = 0.027). The peak incidence came 4-6 days after the moon was fully illuminated. CONCLUSIONS: This study found an overrepresentation of surgery for ATAAD during the full moon phase. The explanation for this is not known, but we speculate that sleep deprivation during full moon leads to a temporary increase in blood pressure, which in turn could trigger rupture of the aortic wall. While this finding is interesting, it needs to be corroborated and the clinical implications are debateable.Peer reviewe

Temperature effects on incidence of surgery for acute type A aortic dissection in the Nordics

Peer reviewe

Impact of national holidays and weekends on incidence of acute type A aortic dissection repair

Publisher Copyright: © 2022, The Author(s).Previous studies have demonstrated that environmental and temporal factors may affect the incidence of acute type A aortic dissection (ATAAD). Here, we aimed to investigate the hypothesis that national holidays and weekends influence the incidence of surgery for ATAAD. For the period 1st of January 2005 until 31st of December 2019, we investigated a hypothesised effect of (country-specific) national holidays and weekends on the frequency of 2995 surgical repairs for ATAAD at 10 Nordic cities included in the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) collaboration. Compared to other days, the number of ATAAD repairs were 29% (RR 0.71; 95% CI 0.54–0.94) lower on national holidays and 26% (RR 0.74; 95% CI 0.68–0.82) lower on weekends. As day of week patterns of symptom duration were assessed and the primary analyses were adjusted for period of year, our findings suggest that the reduced surgical incidence on national holidays and weekends does not seem to correspond to seasonal effects or surgery being delayed and performed on regular working days.Peer reviewe

Once after a full moon: acute type A aortic dissection and lunar phases

OBJECTIVESAcute type A aortic dissection (ATAAD) is a rare but severe condition, routinely treated with emergent cardiac surgery. Many surgeons have the notion that patients with ATAAD tend to come in clusters, but no studies have examined these observations. This investigation was undertaken to study the potential association between the lunar cycle and the incidence of ATAAD.METHODS We collected information on 2995 patients who underwent ATAAD surgery at centres from the Nordic Consortium for Acute Type A Aortic Dissection collaboration. We cross-referenced the time of surgery with lunar phase using a case-crossover design with 2 different definitions of full moon (>99% illumination and the 7-day full moon period).RESULTS The period when the moon was illuminated the most (99% definition) did not show any significant increase in incidence for ATAAD surgery. However, when the full moon period was compared with all other moon phases, it yielded a relative risk of 1.08 [95% confidence interval (CI) 1.00-1.17, P = 0.057] and, compared to waxing moon, only the relative risk was 1.11 (95% CI 1.01-1.23, P = 0.027). The peak incidence came 4-6 days after the moon was fully illuminated.CONCLUSIONSThis study found an overrepresentation of surgery for ATAAD during the full moon phase. The explanation for this is not known, but we speculate that sleep deprivation during full moon leads to a temporary increase in blood pressure, which in turn could trigger rupture of the aortic wall. While this finding is interesting, it needs to be corroborated and the clinical implications are debateable.</p

Att arbeta med elevers sociala förmågor : lärares strävan efter ett gott gruppklimat

Validerat; 20101217 (root

Individuellt anpassad samplanering – en framkomlig väg att förbättra vården för akutmottagningens mångbesökare?

Personer som ofta söker vård på akutmottagning har vanligtvis även kontakt med andra vårdgivare såsom psykiatri, primärvård, socialtjänst. I denna artikel redovisas erfarenheter från ett försök med samplanering. Vuxna patienter, som besökt akutmottagningen på ett universitetssjukhusminst fyra gånger på 12 månader erbjöds att tillsammans med sina aktuella vårdgivare delta i utformandet av en vårdplan för det kommande året. Av 25 mångbesökare accepterade 18 sådan samplanering. Alla vårdplaner utom två kom att innehålla såväl medicinska som psykiatriska och sociala insatser i olika kombinationer. Majoriteten av patienterna fullföljde sina vårdplaner och ansåg att samplanering var till nytta för dem och gruppens akutbesök minskade. Trots att samplaneringen var tidskrävande, satte även vårdgivarna värde på den, eftersom de ansåg att patienternas problem och behov genom denna samverkan framträdde tydligare. Individuellt anpassad samplanering där patienten deltar tillsammans med sina vårdgivare visade sig i denna småskaliga studie vara genomförbar, väl accepterad av både patienter och vårdgivare och leda till god helhetsbild av patientens behov

Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers

Background: Advocates for quality and safety havecalled for healthcare that is patient-centred anddecision-making that involves patients.Objective: The aim of the paper is to explore thebarriers and facilitators to patient-centred care in thehospital discharge process.Methods: A qualitative study using purposive samplingof 192 individual interviews and 26 focus groupinterviews was conducted in five European Unioncountries with patients and/or family members,hospital physicians and nurses, and community generalpractitioners and nurses. A modified Grounded Theoryapproach was used to analyse the data.Results: The barriers and facilitators were classified into15 categories from which four themes emerged:(1) healthcare providers do not sufficiently prioritisedischarge consultations with patients and family membersdue to time restraints and competing care obligations;(2) discharge communication varied from instructingpatients and family members to shared decision-making;(3) patients often feel unprepared for discharge, andpostdischarge care is not tailored to individual patientneeds and preferences; and (4) pressure on availablehospital beds and community resources affect thedischarge process.Conclusions: Our findings suggest that involvement ofpatients and families in the preparations for discharge isdetermined by the extent towhich care providers arewillingand able to accommodate patients’ and families’ capabilities,needs and preferences. Future interventions should bedirected at healthcare providers’ attitudes and theirorganisation’s leadership, with afocus on improvingcommunication among care providers, patients and families,and between hospital and community care providers