Evaluation of thromboprophylactic therapy at Landspítali - The National University Hospital of Iceland; a cross-sectional study on acute wards

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full textOBJECTIVE: Venous thromboembolic disease is a serious and often fatal complication following hospital admission. Studies show that thromboprophylactic therapy for this condition is often underutilized. The aim of this study was to evaluate the performance of thromboprophylactic therapy at Landspítali - The University Hospital of Iceland in adult patients admitted to acute wards. METHODS AND MATERIALS: On 2 December 2009 hospital charts of admitted patients on acute wards were reviewed and assessed for appropriate thromboprophylactic treatment according to the 2008 guidelines from The American College of Chest Physicians. The results were compared to those of other countries from the multinational Endorse study from 2008. RESULTS: 251 patient were included of whom 47% were considered at risk for venous thromboembolic disease. Of those 57% received appropriate thromboprophylactic treatment or 78% of surgical and 26% of medical patients. CONCLUSIONS: Adherence to clinical guidelines for thromboprophylactic treatment at surgical wards of Landspítali - The National University Hospital of Iceland was good and well above the average compared to the results of the Endorse study. Performance on the medical wards was on the other hand below average. Our results show that application of thromoboprophylactic treatment at Landspítali could be improved and thereby enhance patient safety.Tilgangur: Bláæðasegasjúkdómar eru alvarlegir og geta verið banvænir fylgikvillar sjúkrahúsinnlagna. Erlendar rannsóknir sýna að forvarnarmeðferð gegn bláæðasegum er víða ábótavant. Markmið þessarar rannsóknar var að meta frammistöðu Landspítala í forvörnum gegn bláæðasegasjúkdómum hjá inniliggjandi sjúklingum á bráðadeildum fullorðinna. Efniviður og aðferðir: Þann 2. desember 2009 var farið yfir sjúkraskrár allra inniliggjandi sjúklinga bráðadeilda Landspítala. Kannað var hvort viðkomandi fengi fyrirbyggjandi meðferð gegn bláæðasegasjúkdómum samkvæmt leiðbeiningum American College of Chest Physicians frá 2008. Niðurstöðurnar voru bornar saman við árangur annarra landa úr fjölþjóðarannsókninni Endorse frá 2008. Niðurstöður: Inntökuskilyrði uppfyllti 251 sjúklingur. Inniliggjandi sjúklingar á Landspítala höfðu í 47% tilfella ábendingu fyrir forvarnarmeðferð gegn bláæðasegasjúkdómum. Af þessum áhættusjúklingum fengu 57% forvörn, eða í 78% tilfella á skurðlækningadeildum og í 26% tilfella á lyflækningadeildum. Ályktanir: Árangur skurðlækningadeilda Landspítala var góður þegar niðurstöður úr Endorse-rannsókninni voru hafðar til samanburðar. Árangur lyflækningadeilda var hins vegar verri við hliðstæðan samanburð. Niðurstöður okkar gefa til kynna að bæta mætti frammistöðu Landspítala í forvörnum gegn bláæðasegasjúkdómum og auka þar með sjúklingaöryggi

Craniopharyngioma. Morbidity and Structural Changes in the Brain

Hypothalamus (HT) is a brain structure which serves as a coordination center for several vital body functions. Craniopharyngioma (CP) is a pituitary tumor with high morbidity, primarily due to HT lesion. Among important consequences of CP are cognitive dysfunction and intractable weight gain due to HT obesity, resulting in high cardiovascular (CV) risk. A better understanding of the structural brain damage due to the tumor growth and/or its treatment, is a prerequisite for improved treatment and follow-up care of patients with CP. The focus of this thesis is to explore structural brain alterations and whether these may be associated with a) cognitive dysfunction b) metabolism. We begin by analyzing which cognitive domains are affected (paper I). We proceed to apply diffusion tensor imaging, a new technique in the field of magnetic resonance imaging to analyse the integrity of white matter (WM) neural pathways, as well as the HT (paper II-III). In addition, hippocampal volume was measured (paper II). The HT volume was explored in relation to anthropometric features and neuropeptides important in obesity. Postoperative risk stratification based on HT volume is proposed as a tool for improved postoperative follow-up care (paper IV). Finally, we analyse brain white matter lesions (WML) caused by chronic microvasculature hypoperfusion which may serve as a marker of increased risk for CV diseases and stroke (paper V). Our most important findings are that CP patients have impaired memory, disturbed attention and processing speed. WM alterations in the uncinate fasciculus are associated with worse general knowledge. The strongest correlation was found between visual memory and WM alterations in the cingulum. A smaller hippocampus, as well as WM alterations in the hippocampus, are associated with worse general knowledge. A decrease in HT volume is associated with increased fat mass and leptin among patients and we present a new method which may be valuable for postoperative risk assessment. CP patients have a significant increase in total WML volume which is associated with HT volume and cranial radiotherapy. In conclusion, there is an association between cognitive dysfunction and WM alterations among patients with CP. HT volume may serve as a tool for postoperative risk assessment. WML may be valuable for identification of high-risk CP patients providing an opportunity for early preventive treatment of CV diseases and stroke

Evaluation of thromboprophylactic therapy at Landspítali - The National University Hospital of Iceland; a cross-sectional study on acute wards

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full textOBJECTIVE: Venous thromboembolic disease is a serious and often fatal complication following hospital admission. Studies show that thromboprophylactic therapy for this condition is often underutilized. The aim of this study was to evaluate the performance of thromboprophylactic therapy at Landspítali - The University Hospital of Iceland in adult patients admitted to acute wards. METHODS AND MATERIALS: On 2 December 2009 hospital charts of admitted patients on acute wards were reviewed and assessed for appropriate thromboprophylactic treatment according to the 2008 guidelines from The American College of Chest Physicians. The results were compared to those of other countries from the multinational Endorse study from 2008. RESULTS: 251 patient were included of whom 47% were considered at risk for venous thromboembolic disease. Of those 57% received appropriate thromboprophylactic treatment or 78% of surgical and 26% of medical patients. CONCLUSIONS: Adherence to clinical guidelines for thromboprophylactic treatment at surgical wards of Landspítali - The National University Hospital of Iceland was good and well above the average compared to the results of the Endorse study. Performance on the medical wards was on the other hand below average. Our results show that application of thromoboprophylactic treatment at Landspítali could be improved and thereby enhance patient safety.Tilgangur: Bláæðasegasjúkdómar eru alvarlegir og geta verið banvænir fylgikvillar sjúkrahúsinnlagna. Erlendar rannsóknir sýna að forvarnarmeðferð gegn bláæðasegum er víða ábótavant. Markmið þessarar rannsóknar var að meta frammistöðu Landspítala í forvörnum gegn bláæðasegasjúkdómum hjá inniliggjandi sjúklingum á bráðadeildum fullorðinna. Efniviður og aðferðir: Þann 2. desember 2009 var farið yfir sjúkraskrár allra inniliggjandi sjúklinga bráðadeilda Landspítala. Kannað var hvort viðkomandi fengi fyrirbyggjandi meðferð gegn bláæðasegasjúkdómum samkvæmt leiðbeiningum American College of Chest Physicians frá 2008. Niðurstöðurnar voru bornar saman við árangur annarra landa úr fjölþjóðarannsókninni Endorse frá 2008. Niðurstöður: Inntökuskilyrði uppfyllti 251 sjúklingur. Inniliggjandi sjúklingar á Landspítala höfðu í 47% tilfella ábendingu fyrir forvarnarmeðferð gegn bláæðasegasjúkdómum. Af þessum áhættusjúklingum fengu 57% forvörn, eða í 78% tilfella á skurðlækningadeildum og í 26% tilfella á lyflækningadeildum. Ályktanir: Árangur skurðlækningadeilda Landspítala var góður þegar niðurstöður úr Endorse-rannsókninni voru hafðar til samanburðar. Árangur lyflækningadeilda var hins vegar verri við hliðstæðan samanburð. Niðurstöður okkar gefa til kynna að bæta mætti frammistöðu Landspítala í forvörnum gegn bláæðasegasjúkdómum og auka þar með sjúklingaöryggi