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A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors.

https://arctichealth.org/en/permalink/ahliterature99824
Source
Crit Care Med. 2010 Dec 16;
Publication Type
Article
Date
Dec-16-2010
Author
Oystein Tømte
Tomas Drægni
Arild Mangschau
Dag Jacobsen
Bjorn Auestad
Kjetil Sunde
Author Affiliation
From the Department of Anesthesiology (OT, TD), Institute for Experimental Medical Research (OT), Department of Cardiology (AM), Department of Acute Medicine (DJ), and Surgical Intensive Care Unit (KS), Oslo University Hospital, Oslo; and Department of Mathematics and Natural Sciences (BA), University of Stavanger, Stavanger, Norway.
Source
Crit Care Med. 2010 Dec 16;
Date
Dec-16-2010
Language
English
Publication Type
Article
Abstract
OBJECTIVES:: Mild therapeutic hypothermia after out-of-hospital cardiac arrest is usually achieved either by surface cooling or by core cooling via the patient's bloodstream. We compared modern core (Coolgard) and surface (Arctic Sun) cooling devices with a zero hypothesis of equal cooling, complications, and neurologic outcomes. DESIGN:: Single-center observational study. SETTING:: University hospital medical and cardiac intensive care units. PATIENTS:: One hundred sixty-seven consecutive patients comatose after out-of-hospital cardiac arrest of all causes treated with mild therapeutic hypothermia in a 5-yr period. INTERVENTIONS:: Nonrandomized allocation to core or surface cooling depending on availability and physician preference. MEASUREMENTS AND MAIN RESULTS:: All out-of-hospital cardiac arrest patients' records were reviewed for relevant data regarding medical history, cardiac arrest event, prehospital care, in-hospital treatment, and complications. Survivor neurologic function was reassessed at follow-up after 6 to 12 months. Baseline patient and arrest episode characteristics were similar in the treatment groups. There was no significant difference in survival with good neurologic function, either to hospital discharge (surface, 34/90, 38%; core, 34/75, 45%; p = .345) or at follow-up (surface, 34/88, 39%; core, 34/75, 45%; p = .387). Time from cardiac arrest to achieving mild therapeutic hypothermia was equal with both devices (surface, 273 min, interquartile range 158-330; core, 270 min, interquartile range 190-360; p = .479). There were significantly more episodes of sustained hyperglycemia among the surface-cooled patients (surface, 64/92, 70%; core, 36/75, 48%; p = .005) and significantly more hypomagnesaemia among core-cooled patients (surface, 16/87, 18%; core, 27/74, 37%; p = .01). CONCLUSIONS:: In this study, surface and core cooling of out-of-hospital cardiac arrest patients following the same established postresuscitation treatment protocol resulted in similar survival to hospital discharge and comparable neurologic function at follow-up.
PubMed ID
21169821 View in PubMed
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Evaluation of a defibrillator-basic cardiopulmonary resuscitation programme for non medical personnel.

https://arctichealth.org/en/permalink/ahliterature53596
Source
Resuscitation. 2003 Feb;56(2):167-72
Publication Type
Article
Date
Feb-2003
Author
Lars Wik
Elizabeth Dorph
Bjørn Auestad
Petter Andreas Steen
Author Affiliation
Department of Emergency Medical Services, Division of Surgery, Ulleval University Hospital, N-0407 Oslo, Norway. lars@nakos.org
Source
Resuscitation. 2003 Feb;56(2):167-72
Date
Feb-2003
Language
English
Publication Type
Article
Keywords
Cardiopulmonary Resuscitation - education - methods
Comparative Study
Educational Measurement
Electric Countershock
Female
Heart Arrest - therapy
Humans
Male
Manikins
Norway
Probability
Professional Competence
Program Development
Research Support, Non-U.S. Gov't
Statistics, nonparametric
Ventricular Fibrillation - therapy
Voluntary Workers
Abstract
To improve the outcome for out-of-hospital patients with ventricular fibrillation/pulseless ventricular tachycardia (VF/VT), the use of automated external defibrillators (AEDs) by first responders including non-medical personnel with a duty to respond to an emergency is recommended. A special CPR-AED course has been developed. We wanted to test the results (quality and speed of operating an AED and CPR) after completion of such a course and retention after approximately 1-year. At the same time we wanted to see if personnel could use an AED after receiving written information without having attended the course. Study subjects were divided randomly into groups, and tested pre-course (n=54), post-course (n=50), and unannounced 10+/-3 months after the course (retention group, n=61). For statistical analysis two sample tests for binomial proportions and Wilcoxon-Mann-Whitney test was used as appropriate. Fifteen of the 27 pairs (56%) in the pre-course group with no previous exposure to an AED decided to use it. There was no difference between the groups in electrode pad positioning, and all stayed clear of the manikin during the process of AED charging and shock delivery. The post-course group had a higher rate of checking for responsiveness (vs. pre-course), not to check for a pulse (vs. both other groups), the shortest time interval from arrival on scene to start of CPR and shock delivery, and in parallel the shortest hands-off interval (without chest compressions and ventilations) before shock delivery. The quality of chest compressions was improved by the course but decreased to a similar standard as in the pre-course when tested 10+/-3 months later, except for correct depth which was similar to post course. Most ventilation attempts in all groups were scored as incorrect due to the high incidence of excessively rapid inflations. The retention group had a lower frequency of correct inflations than the pre-course group, and the post-course group the highest number of correct ventilations per minute. These findings suggest that use of an AED by untrained laypersons may be feasible and that complex and time-consuming training programmes may not be necessary. The present study also supports the need for annual training and recertification.
PubMed ID
12589990 View in PubMed
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Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcome.

https://arctichealth.org/en/permalink/ahliterature126256
Source
Am J Psychiatry. 2012 Apr;169(4):374-80
Publication Type
Article
Date
Apr-2012
Author
Wenche Ten Velden Hegelstad
Tor K Larsen
Bjørn Auestad
Julie Evensen
Ulrik Haahr
Inge Joa
Jan O Johannesen
Johannes Langeveld
Ingrid Melle
Stein Opjordsmoen
Jan Ivar Rossberg
Bjørn Rishovd Rund
Erik Simonsen
Kjetil Sundet
Per Vaglum
Svein Friis
Thomas McGlashan
Author Affiliation
Division of Psychiatry, Stavanger University Hospital, Regional Center for Clinical Research in Psychosis, Health West, Norway. wenchetenvelden@me.com
Source
Am J Psychiatry. 2012 Apr;169(4):374-80
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Adult
Denmark
Early Diagnosis
Female
Follow-Up Studies
Humans
Male
Norway
Outcome and Process Assessment (Health Care) - statistics & numerical data
Prognosis
Psychotic Disorders - diagnosis
Abstract
Early detection in first-episode psychosis confers advantages for negative, cognitive, and depressive symptoms after 1, 2, and 5 years, but longitudinal effects are unknown. The authors investigated the differences in symptoms and recovery after 10 years between regional health care sectors with and without a comprehensive program for the early detection of psychosis.
The authors evaluated 281 patients (early detection, N=141) 18 to 65 years old with a first episode of nonaffective psychosis between 1997 and 2001. Of these, 101 patients in the early-detection area and 73 patients in the usual-detection area were followed up at 10 years, and the authors compared their symptoms and recovery.
A significantly higher percentage of early-detection patients had recovered at the 10-year follow-up relative to usual-detection patients. This held true despite more severely ill patients dropping out of the study in the usual-detection area. Except for higher levels of excitative symptoms in the early-detection area, there were no symptom differences between the groups. Early-detection recovery rates were higher largely because of higher employment rates for patients in this group.
Early detection of first-episode psychosis appears to increase the chances of milder deficits and superior functioning. The mechanisms by which this strategy improves the long-term prognosis of psychosis remain speculative. Nevertheless, our findings over 10 years may indicate that a prognostic link exists between the timing of intervention and outcome that deserves additional study.
Notes
Comment In: Am J Psychiatry. 2012 Sep;169(9):992; author reply 992-322952080
Comment In: Am J Psychiatry. 2012 Apr;169(4):345-722476671
PubMed ID
22407080 View in PubMed
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Predictors of involuntary hospitalizations to acute psychiatry.

https://arctichealth.org/en/permalink/ahliterature116463
Source
Int J Law Psychiatry. 2013 Mar-Apr;36(2):136-43
Publication Type
Article
Author
Kjetil Hustoft
Tor Ketil Larsen
Bjørn Auestad
Inge Joa
Jan Olav Johannessen
Torleif Ruud
Author Affiliation
Stavanger University Hospital, Division of Psychiatry, Armauer Hansensvei 20, Post Office Box 8100, N-4068 Stavanger, Norway. khu2@sus.no
Source
Int J Law Psychiatry. 2013 Mar-Apr;36(2):136-43
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aggression - psychology
Commitment of Mentally Ill - legislation & jurisprudence
Community Mental Health Centers - legislation & jurisprudence
Female
General Practice - legislation & jurisprudence
Humans
Male
Mental Disorders - diagnosis - psychology - rehabilitation
Middle Aged
Motivation
Norway
Personality Assessment - statistics & numerical data
Psychiatric Department, Hospital - legislation & jurisprudence
Psychometrics - statistics & numerical data
Referral and Consultation - legislation & jurisprudence
Sex Factors
Social Adjustment
Substance-Related Disorders - diagnosis - psychology - rehabilitation
Young Adult
Abstract
There is little knowledge of predictors for involuntary hospitalizations in acute psychiatric units.
The Multi-center study of Acute Psychiatry included all cases of acute consecutive psychiatric admissions in twenty acute psychiatric units in Norway, representing about 75% of the acute psychiatric units during 2005-2006. Data included admission process, rating of Global Assessment of Functioning and Health of the Nation Outcome Scales.
Fifty-six percent were voluntary and 44% involuntary hospitalized. Regression analysis identified contact with police, referral by physicians who did not know the patient, contact with health services within the last 48 h, not living in own apartment or house, high scores for aggression, level of hallucinations and delusions, and contact with an out-of office clinic within the last 48 h and low GAF symptom score as predictors for involuntary hospitalization. Involuntary patients were older, more often male, non-Norwegian, unmarried and had lower level of education. They more often had disability pension or received social benefits, and were more often admitted during evenings and nights, found to have more frequent substance abuse and less often responsible for children and were less frequently motivated for admission. Involuntary patients had less contact with psychiatric services before admission. Most patients were referred because of a deterioration of their psychiatric illness.
Involuntary hospitalization seems to be guided by the severity of psychiatric symptoms and factors "surrounding" the referred patient. Important factors seem to be male gender, substance abuse, contact with own GP, aggressive behavior, and low level of social functioning and lack of motivation. There was a need for assistance by the police in a significant number of cases. This complicated picture offers some important challenges to the organization of primary and psychiatric health services and a need to consider better pathways to care.
PubMed ID
23395506 View in PubMed
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Strong and weak aspects of an established post-resuscitation treatment protocol-A five-year observational study.

https://arctichealth.org/en/permalink/ahliterature133995
Source
Resuscitation. 2011 Sep;82(9):1186-93
Publication Type
Article
Date
Sep-2011
Author
Oystein Tømte
Geir Øystein Andersen
Dag Jacobsen
Tomas Drægni
Bjørn Auestad
Kjetil Sunde
Author Affiliation
Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway. oystetom@medisin.uio.no
Source
Resuscitation. 2011 Sep;82(9):1186-93
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Cardiopulmonary Resuscitation - methods - mortality
Cause of Death
Clinical Protocols - standards
Emergency Service, Hospital - standards
Female
Follow-Up Studies
Hospital Mortality - trends
Hospitals, University
Humans
Hypothermia, Induced - methods - mortality
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Multivariate Analysis
Norway
Out-of-Hospital Cardiac Arrest - diagnosis - mortality - therapy
Quality Improvement
Registries
Retrospective Studies
Risk assessment
Severity of Illness Index
Sex Factors
Survival Analysis
Time Factors
Abstract
Favourable hospital survival increased from 26% to 56% in the implementation phase of a new standard operating procedure (SOP) for treatment after out-of hospital cardiac arrest (OHCA) in 2003. We now evaluate protocol adherence and survival rates after five years with this established SOP.
This observational study is based on prospectively collected registry data from all OHCA patients with cardiac aetiology admitted with spontaneous circulation to Ulleval Hospital between September 2003 and January 2009. Three patient categories are described based on early assessment in the emergency department: conscious, comatose, and comatose patients receiving only palliative care, with main focus on comatose patients receiving active treatment.
Of 248 patients, 22% were consciousness on admission, 70% were comatose and received active treatment, while 8% received only palliative care. Favourable survival from admittance to discharge remained at 56% throughout the study period. Among actively treated patients 83% received emergency coronary angiography and 48% underwent subsequent percutaneous coronary intervention. In this cohort 63% had an acute myocardial infarction, ten of whom did not receive emergency coronary angiography. Among actively treated comatose patients, 6% survived with unfavourable neurology, while 51% of the deaths followed treatment withdrawal after prognostication of severe brain injury.
The previously reported doubling in survival rate remained throughout a five-year study period. Establishing reliable indication for emergency coronary angiography and interventions and validating prognostication rules in the hypothermia era are important challenges for future studies.
Notes
Comment In: Resuscitation. 2011 Sep;82(9):1126-721741745
PubMed ID
21636202 View in PubMed
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Treatment and violent behavior in persons with first episode psychosis during a 10-year prospective follow-up study.

https://arctichealth.org/en/permalink/ahliterature259887
Source
Schizophr Res. 2014 Jul;156(2-3):272-6
Publication Type
Article
Date
Jul-2014
Author
Johannes Langeveld
Stål Bjørkly
Bjørn Auestad
Helene Barder
Julie Evensen
Wenche Ten Velden Hegelstad
Inge Joa
Jan Olav Johannessen
Tor Ketil Larsen
Ingrid Melle
Stein Opjordsmoen
Jan Ivar Røssberg
Bjørn Rishovd Rund
Erik Simonsen
Per Vaglum
Thomas McGlashan
Svein Friis
Source
Schizophr Res. 2014 Jul;156(2-3):272-6
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Adult
Antipsychotic Agents - therapeutic use
Crime
Denmark - epidemiology
Follow-Up Studies
Humans
Logistic Models
Middle Aged
Multivariate Analysis
Norway - epidemiology
Prevalence
Prospective Studies
Psychiatric Status Rating Scales
Psychotherapy
Psychotic Disorders - diagnosis - epidemiology - therapy
Risk
Substance-Related Disorders - epidemiology
Violence
Young Adult
Abstract
First episode psychosis (FEP) patients have an increased risk for violence and criminal activity prior to initial treatment. However, little is known about the prevalence of criminality and acts of violence many years after implementation of treatment for a first episode psychosis.
To assess the prevalence of criminal and violent behaviors during a 10-year follow-up period after the debut of a first psychosis episode, and to identify early predictors and concomitant risk factors of violent behavior.
A prospective design was used with comprehensive assessments of criminal behavior, drug abuse, clinical, social and treatment variables at baseline, five, and 10-year follow-up. Additionally, threatening and violent behavior was assessed at 10-year follow-up. A clinical epidemiological sample of first-episode psychosis patients (n=178) was studied.
During the 10-year follow-up period, 20% of subjects had been apprehended or incarcerated. At 10-year follow-up, 15% of subjects had exposed others to threats or violence during the year before assessment. Illegal drug use at baseline and five-year follow-up, and a longer duration of psychotic symptoms were found to be predictive of violent behavior during the year preceding the 10-year follow-up.
After treatment initiation, the overall prevalence of violence in psychotic patients drops gradually to rates close to those of the general population. However, persistent illicit drug abuse is a serious risk factor for violent behavior, even long after the start of treatment. Achieving remission early and reducing substance abuse may contribute to a lower long-term risk for violent behavior in FEP patients.
PubMed ID
24837683 View in PubMed
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6 records – page 1 of 1.