Much ado about mercury: Evaluation of treatment options for mercury contaminated soil @ BNL

Preliminary Program for Conference on Geology of Long Island and Metropolitan New Yor

Läkares och patienters bedömningar av smärta med VAS och Borg CR100 skalan®

Smärta är det vanligaste symptomet som rapporteras till vårdgivare, därför är det viktigt att studera hur vårdgivare och patienter skattar upplevelsen av symptom såsom smärta. Underskattning av smärta hos patienterna kan i värsta fall leda till underbehandling och sämre resultat av behandling. Syftet med föreliggande studie var att undersöka om det fanns skillnader mellan hur läkare och patienter bedömer patientens upplevda smärta på en VAS- respektive Borg CR100-skala, samt skillnader i resultatet mellan de två skalorna. 36 kvinnliga patienter och 8 läkare på kvinnoklinikens gynmottagning vid Norra Älvsborgs länssjukhus och Uddevalla sjukhus deltog i studien. Både läkare och patienter skattade patientens upplevda smärta både innan och efter patientens läkarbesök på en VAS- respektive Borg CR100-skala. Resultatet visade att det fanns en signifikant skillnad i hur läkare och patienter skattade patienternas upplevda smärta, samt skillnader mellan de två skalorna. Läkare skattade patienternas smärta som lägre än patienterna själva, och skalan som föredrogs av patienterna och som visar på fler fördelar då man skall skatta smärta visades vara Borg CR100-skalan.

Rotational Thromboelastometry predicerar vårdnivå vid COVID-19

The objective of the study was to test whether Rotational Thromboelastometry (ROTEM) indicate hypercoagulopathy at hospitalization of COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients. The study was designed as a prospective observational study where COVID-19 positive patients over 18 years admitted to Capio St Göran’s Hospital in Stockholm, Sweden, were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards (40 patients) or 2) wards with specialized ventilation support (20 patients). ROTEM and other coagulation tests (see table for a list and explanation of variables) was taken after admission and the data were compared with ROTEM in healthy controls. Conclusion ROTEM variables (EXTEM-MCF, FIBTEM-MCF, EXTEM-CT, EXTEM-CFT) were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis could be a potentially useful predictor of thromboembolic complications and mortality in these patients. For details, see preprint at: https://www.medrxiv.org/content/10.1101/2020.06.11.20128710v2 See preprint for details: https://www.medrxiv.org/content/10.1101/2020.06.11.20128710v2Syftet med studien var att testa om Rotational Thromboelastometry (ROTEM) indikerar att patienter med COVID-19 är benägna att bilda blodproppar. Även om provet skiljer sig åt beroende på om patienter på vanlig vårdavdelning testas jämfört med patienter på mer avancerade vårdavdelningar. Se utförligare beskrivning i den engelska versionen av katalogposten. För detaljer se preprint: https://www.medrxiv.org/content/10.1101/2020.06.11.20128710v

Monitoring the Nociception Level Intraoperatively - An Initial Experiences Monitoring the Nociception Level Intraoperatively - An Initial Experiences

Abstract Background: Estimating pain stimuli in the anesthetized patient can be difficult when based solely upon physiological parameters, especially when vasopressors are used as well. There is an increasing interest during general anesthesia to understand how optimal anesthesia changes by the level of noxious stimulation. Objectively, noxious stimulation measurement monitoring techniques are gaining interest. Although currently, its exact use in routine clinical practice is still not well proven. The aim of this study was to identify relationships between PMD 200 monitoring, Nociception Level (NOL-index) and monitored known physiological signs as well as outcomes during general anesthesia. Method: Eight patients between the ages of 43 and 83 years old and scheduled for major head and neck surgery under general anesthesia were observed in this study. NoL index sensor was placed on one of the patient’s fingers before anesthesia was induced, and values were extracted during the intraoperative period. Results: NoL index values increased intraoperatively during nociceptive stimuli such as jaw lift, endotracheal intubation, catheterization of the bladder, and with surgical skin incision. NoL index increased at several occasions faster, and were more prominent than physiological parameters (BP, HR). Conclusion: There are identified relationships between PMD 200 monitoring, NOL-index and nociceptive stimulation. NoL index tends to indicate nociceptive responses earlier and more often than hemodynamic outcomes. NoL index can be a physiological marker for optimal analgesic administration and an interesting complement to monitoring equipment intraoperatively worth further studies

Rotational Thromboelastometry predicts care level in COVID-19

AbstractBackgroundHigh prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment.ObjectivesTo test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients.MethodsThe study was designed as a prospective observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken after admission and the data were compared with ROTEM in healthy controls.ResultsThe ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with healthy controls (p&lt;0.001) and higher in severely ill patients compared with patients at regular wards (p&lt;0.05). Coagulation Time (EXTEM-CT) was longer and Clot Formation Time (EXTEM-CFT) shorter in COVID-19 patients compared with healthy controls. Our results suggest that hypercoagulopathy is present in hospitalized patients with mild to severe COVID-19 pneumonia.ConclusionROTEM variables were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis may be useful to predict thromboembolic complications in these patients.</jats:sec

A retrospective register study comparing fibrinogen treated trauma patients with an injury severity score matched control group

AbstractBackgroundFibrinogen concentrate (FC) is frequently used to treat bleeding trauma patients, although the clinical effects are not well known. In this study we describe demographic and clinical outcome data in a cohort of trauma patients receiving FC, compared to a matched control group, who did not receive FC.MethodsThis retrospective, single-center, observational study included adult trauma patients admitted to a level 1-trauma center in Sweden between January 2013 and June 2015. The study population consisted of patients to whom FC was administrated within 24 h (n = 138, “Fib+”). Patients with Injury Severity Score (ISS) &gt; 49 and/or deceased within 1 h from arrival were excluded (n = 30). Controls (n = 108) were matched for age, gender and ISS (“Fib-“). Primary outcome was mortality (24 h−/30 days−/1 year-), and secondary outcomes were blood transfusions, thromboembolic events and organ failure.ResultsThe Fib+ group, despite having similar ISS as Fib-, had higher prevalence of penetrating trauma and lower Glasgow Coma Scale (GCS), indicating more severe injuries. Patients receiving FC had a higher mortality after 24 h/ 30 days/ 1 year compared to controls (Fib-). However, in a propensity score matched model, the differences in mortality between Fib+ and Fib- were no longer significant. Blood transfusions were more common in the Fib+ group, but no difference was observed in thromboembolic events or organ failure. In both groups, low as well as high P-fibrinogen levels at arrival were associated with increased mortality, with the lowest mortality observed at P-fibrinogen values of 2–3 g/l.ConclusionsDespite equal ISS, patients receiving FC had a higher mortality compared to the control group, presumably associated to the fact that these patients were bleeding and physiologically deranged on arrival. When applying a propensity score matching approach, the difference in mortality between the groups was no longer significant. No differences were observed between the groups regarding thromboembolic events or organ failure, despite higher transfusion volumes in patients receiving FC.</jats:sec