Hirsla Community:

Users of hospital emergency department who are discharged home

Fri, 27 Jan 2012 00:00:00 GMT

Title: Users of hospital emergency department who are discharged home Authors: Oddný Sigurborg Gunnarsdóttir Abstract: The overall aim of the studies was to determine characteristics and prognosis of Emergency Department users, who were discharged home. The specific aims were to record the annual number of discharged users of the ED according to age and gender, their annual number of visits and to assess whether a higher frequency of visits predicted higher mortality; to describe the pattern of discharged diagnoses; to evaluate the association of non-causative diagnoses with mortality in general, and in particular with external causes of death, drug intoxication and suicide; to evaluate risk factors for suicide and fatal drug poisoning; to evaluate the association between death within eight days after discharge home from the ED and non-causative discharge diagnoses. Material and Methods: The data were records of patients, 18 years and older, who attended the Landspitali ED during the years 1995 to 2001. The main diagnoses were registered according to the International Classification of Diseases (ICD). Annual increase in visits was evaluated in relation to the annual population of Reykjavik capital area using the Poisson regression model and 95% Confidence Interval (CI). The pattern of each diagnosis category during the period was analyzed by calculating chi-squares for the linear trend (Mantel extension). Patients’ vital status was obtained by record linking to Statistics Iceland. The mortality of ED users was compared with the mortality of the general population of Iceland using conventional methods of calculating the standard mortality ratio (SMR) and 95% CI. The Hazard ratios (HR) and 95% CI were calculated for all causes and selected causes of death in a time-dependent analysis in which annual visits to the ED were taken into account. Furthermore, the same method was used when comparing groups with different diagnoses at discharge. In the case control studies the discharged diagnoses of mental disorders, use of alcohol, drug intoxication, non-causative diagnoses and factors influencing health status were risk factors for suicide and fatal drug poisoning, and were calculated in a multivariate logistic regression analysis. The adjusted Odd ratio (OR) and exact computation of 95% CI were calculated. Deaths within 8, 15 and 30 days among individuals with a non-causative diagnosis were compared with deaths among those with a causative diagnosis. HR and 95% CI were computed for all causes of death in a time-dependent analysis. Results: Of all visits to the ED in the year 1995, 2,888 or 54.5% resulted in discharge and of all visits in the year 2001, 5,604 or 72.5% resulted in discharge. Discharged patients in total over the study period numbered 19,259 and they made 30,221 visits, with visits by women slightly more frequent than by men. About 84% of users made one visit in a calendar year and 1.5% of users made four or more visits per calendar year. The annual increase of visits to the ED was 7% to 14% depending on the age group, with the highest increase among older men. The most frequent diagnostic category was non-causative diagnoses (R00-R99), accounting for 20% average, and increasing over the period. SMR for all causes of death was 1.81 (95% CI, 1.71 to 1.92) for men and 1.93 (95% CI, 1.81.to 2.05) for women. For patients with non-causative diagnoses, SMR for all causes of death was 1.57 (95% CI, 1.39 to 1.77) for men and 1.83 (95% CI, 1.61 to 2.08) for women; furthermore, for those diagnosed with mental disorders, SMR was 3.72 (95% CI, 2.72 to 4.98) for men and 2.45 (95% CI, 1.76 to 3.36) for women. The most common causes of death were malignant neoplasm, ischemic heart diseases, cerebrovascular disease, and the category of chronic lower respiratory diseases; by adding the category of external causes, these accounted for over 73% of the overall deaths, a total of 2,105. HR for all causes of death was 1.4 (95% CI, 1.2 to 1.5) among patients with two visits in a calendar year and 1.7 (95% CI, 1.4 to 2.0) among those with three or more visits in a calendar year. Comparing those with non-causative diagnoses to those having causative physical diagnoses, the HR for all causes of death was 0.84 (95% CI, 0.76 to 0.93). On the other hand, the HR for the category of external causes was 1.64 (95% CI, 1.07 to 2.52); HR for accidental poisoning was 1.51 (95% CI, 0.56 to 4.08); and the HR for suicide was 2.08 (95% CI, 1.02 to 4.24), all adjusted for age and gender. The OR for suicide among cases and controls was 7.84 (95% CI, 1.66 to 37.06) for patients with mental disorders, 96.89 (95% CI, 11.14 to 843) for those with use of alcohol, 24.51 (95% CI, 6.11 to 98.25) for those with drug intoxications and 2.69 (95% CI, 1.04 to 6.95) for those with non-causative diagnoses. The OR for fatal drug poisoning among cases and controls was 12.26 (95% CI, 2.10 to 71.76) for patients with use of alcohol, 37.22 (95% CI, 3.57 to 388.29) for those with drug intoxications, 5.76 (95% CI, 1.23 to 26.95), for those with factors influencing health status. The HR for non-causative diagnoses was 0.44 (95% CI, 0.20 to 0.96) for death within eight days when compared to causative diagnoses, adjusted for gender and age. Conclusion: There was an increase in visits to the ED in relation to the population of the Reykjavik capital area and this increase contributed to an increased burden at the ED. The most frequent diagnoses were non-causative diagnoses. Number of visits predicted higher mortality. The most common causes of death were due to malignant neoplasm, ischemic heart diseases, cerebrovascular diseases, chronic lower respiratory diseases, and external causes. Mortality was higher among ED users than in the general population. Users with non-causative diagnoses had higher mortality due to external causes, accidental poisoning, and suicide. Frequent visits to the ED were a strong risk factor for suicide and fatal drug poisoning . The discharged diagnoses of mental disorders, alcohol use, drug intoxication and non-causative diagnoses were independent risk factors for suicide. The discharge diagnoses of alcohol use, drug intoxication and factors influencing health status were independent risk factors for fatal drug poisoning. Health professionals at EDs should be careful when users have a number of discharged visits and they need to be aware that patients who have been discharged home present with new risk factors for suicide and fatal drug poisoning. The association of non-causative diagnoses with death within eight days after discharge can be used to evaluate the performance of the ED.; Aðalmarkmið rannsóknarinnar var að lýsa einkennum og afdrifum notenda bráðamóttöku, sem voru útskrifaðir heim. Önnur markmið voru að lýsa árlegum fjölda útskrifaðra heim af bráðamóttöku (BM); lýsa mynstri útskriftasjúkdómsgreininga; flokka notendur eftir aldri og kyni, kanna árlegan komufjölda þeirra og hvort hann hafi forspárgildi um dánartíðni; meta tengsl einkenna sjúkdómsgreininga við dánartíðni almennt og sérstaklega vegna dánarmeina af ytri orsökum, lyfjaeitrunum og sjálfsvígum; greina áhættuþætti sjálfsvíga og banvænna lyfjaeitrana; meta tengsl andláts innan átta daga eftir útskrift heim af BM við einkenna sjúkdómsgreiningar. Aðferðir: Efniviður var rafrænar skrár sjúklinga 18 ára og eldri, sem komu á BM Landspítala á árunum 1995 til 2001. Aðalsjúkdómsgreiningar voru skráðar samkvæmt Alþjóðlegri tölfræðiflokkun sjúkdóma og skyldra heilbrigðisvandamála. Til að meta árlega aukningu í komum voru þær bornar saman við mannfjölda á Stór- Reykjavíkursvæðinu, gerð var Poisson aðhvarfsgreining og 95% öryggismörk (ÖM) reiknuð. Breytingar á sjúkdómsgreiningum var metin með kí- kvarðaprófi fyrir línulega leitni (Mantel extension). Afdrif sjúklinga voru fengin með samkeyrslu við skrár Hagstofu Íslands. Dánartíðni hópsins var borin saman við dánartíðni þjóðarinnar með hefðbundnum aðferðum við útreikning á stöðluðu dánarhlutfalli (SMR) og 95% ÖM. Hættuhlutfall (HR) með 95% ÖM var reiknað fyrir öll dánarmein og valin dánarmein í tímaháðri margþátta aðhvarfsgreiningu að teknu tilliti til hversu oft sjúklingar komu á BM á almanaksári og þegar bornir voru saman hópar sjúklinga með mismunandi sjúkdómsgreiningar við útskrift. Í tilfella- viðmiðarannsóknum voru sjálfsvíg og banvænar eitranir athugaðar m.t.t. fimm sjúkdómsgreininga, það er að segja geðraskana, áfengisnotkunar, lyfjaeitrana, einkenna sjúkdómsgreininga og þátta sem hafa áhrif á heilbrigðisástand. Reiknað var margþátta lógístik aðhvarfsgreining með líkindahlutfalli (OR) og 95% ÖM. Dánartíðni innan átta daga meðal sjúklinga með einkenna sjúkdómsgreiningu var borin saman við dánartíðni annarra sem leituðu á BM. HR og 95% ÖM var reiknað fyrir öll dánarmein í tímaháðri greiningu. Niðurstöður: Komur á BM sem leiddu til útskriftar voru 2.888 árið 1995 eða 54.5% af öllum komum á BM og árið 2001 var fjöldinn 5.604 eða 72.5% af öllum komum. Komur sem leiddu til útskriftar voru 30.221 en fjöldi sjúklinga var 19.259 kynjaskipting var u.þ.b. jöfn. Hlutfall sjúklinga sem komu einu sinni á ári voru 84% en 1.5% sjúklinga komu fjórum sinnum eða oftar á ári. Árleg aukning var 7 – 14%, en hæst meðal eldri karla. Algengasta sjúkdómsgreiningin við útskrift eða 20% að meðaltali var einkenna sjúkdómsgreining (R00-R99) og hafði hún aukist yfir tímabilið. SMR vegna allra dánarmeina var 1.81 (95% CI, 1.71 til 1.92) hjá körlum og 1.93 (95% CI, 1.81 til 2.05) hjá konum. SMR sjúklinga með einkenna sjúkdómsgreiningu var 1.57 (95% CI, 1.39 til 1.77) hjá körlum og 1.83 (95% CI, 1.61 til 2.08) hjá konum, enn fremur var SMR 3.72 (95% CI, 2.72 til 4.98) hjá körlum með geðraskanir en 2.45 (95% CI, 1.76 til 3.36) hjá konum. Algengustu dánarmein voru illkynja æxli, blóðþurrðarhjartasjúkdómar, heilaæðasjúkdómar, langvinnir neðri öndunarfærasjúkdómar og að viðbættum flokknum ytri orsökum og töldust þau vera 73% þeirra 2.105 sem létust á fylgni tíma. HR allra dánarmeina var 1.4 (95% CI, 1.2 til 1.5) hjá þeim sem komu tvisvar á almanaksári og 1.7 (95% CI, 1.4 til 2.0) hjá þeim sem komu þrisvar eða oftar á almanaksári. Þeir sem fengu einkenna sjúkdómsgreiningu höfðu HR 0.84 (95% CI, 0.76 til 0.93) vegna allra dánarmeina samanborið við þá með líkamlegar sjúkdómsgreiningar. HR vegna ytri orsaka var 1.64 (95% CI, 1.07 til 2.52) og 2.08 (95% CI, 1.02 til 4.24), vegna sjálfsvíga að teknu tilliti til aldurs og kyns. Vegna sjálfsvíga hjá þeim sem greindir voru með geðraskanir var OR 7.84 (95% CI, 1.66 til 37.06), 96.89 (95% CI, 11.14 til 843) með áfengisnotkun, 24.51 (95% CI, 6.11 til 98.25) með lyfjaeitranir og 2.69 (95% CI, 1.04 til 6.95) með einkenna sjúkdómsgreiningar. Vegna banvænna eitrana var OR 12.26 (95% CI, 2.10 til 71.76) fyrir þá sem greindir voru með áfengisnotkun, 37.22 (95% CI, 3.57 til 388.29) með lyfjaeitranir, 5.76 (95% CI, 1.23 til 26.95), með sjúkdómsgreininguna þættir sem hafa áhrif á heilbrigðisástand. Þeir sem voru með einkenna sjúkdómsgreiningu voru með HR 0.44 (95% CI, 0.20 til 0.96) vegna allra dánarmeina innan átta daga þegar þeir voru bornir saman við þá sem fengu aðrar sjúkdómsgreiningar að teknu tilliti til kyns og aldurs. Ályktun: Aukning í heimsóknum var umfarm mannfjöldaaukningu á Stór- Reykjavíkursvæðinu, sem leiddi til aukins álags á BM. Einkenna sjúkdómsgreining var algengasta útskriftargreiningin. Fjöldi heimsókna hafði forspárgildi fyrir hærri dánartíðni. Algengustu dánarmein voru illkynja æxli, blóðþurrðarhjartasjúkdómar, heilaæðasjúkdómar, langvinnir neðri öndunarfærasjúkdómar og ytri orsakir. Dánartíðin sjúklinga sem voru með einkenna sjúkdómsgreiningar var hærri en dánartíðni annarra sjúklinga vegna ytri orsaka, óhappaeitrana og sjálfsvíga. Endurteknar komur á BM voru sterkir áhættuþættir sjálfsvíga og banvænna eitrana. Sjálfstæðir áhættuþættir sjálfsvíga voru geðraskanir, áfengisnotkun og lyfjaeitrun auk einkenna sjúkdómsgreiningar. Sjálfstæðir áhættuþættir fyrir banvænar eitranir voru áfengisnotkun, lyfjaeitranir og sjúkdómsgreiningin: þættir sem hafa áhrif á heilbrigðisástand. Starfsfólk BM ætti að vera vakandi fyrir sjúklingum sem koma oft á BM og eru útskrifaðir heim auk þeirra sem útskrifaðir eru með hina nýju áhættuþætti sjálfsvíga og banvænna eitrana. Tengsl einkenna sjúkdómsgreiningar við andlát innan átta daga eftir útskrift er hægt að nota til að meta skilvirkni BM. Description: Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full text. To access full text version of this article. Please click on the hyperlink "View/open" at the bottom of this page

Icelandic Nursing Home residents : Their mortality, health, functional profile, and care quality, using the Minimum Data Set over time

Fri, 27 Jan 2012 00:00:00 GMT

Title: Icelandic Nursing Home residents : Their mortality, health, functional profile, and care quality, using the Minimum Data Set over time Authors: Ingibjörg Hjaltadóttir Abstract: The overall aim of this thesis was to investigate trends over time in residents‟ health status, functional profile and predictors of mortality at admission to Icelandic nursing homes and in addition to determine upper and lower thresholds for Minimum Data Set (MDS) Quality Indicators, to investigate the prevalence of quality indicators over time and their association with the health status and functional profile of residents in Icelandic nursing homes. Studies I and II included 2,206 persons assessed over 11 years (1996-2006). In study III a modified Delphi method and a panel of 12 members were used to determine the thresholds for Minimum Data Set Quality Indicators. Data from residents (N=2,247 representing 47 nursing homes) were analysed, applying the thresholds developed. In study IV the sample was 11,034 MDS assessments of 3,694 residents (2003-2009) and in the framework the sample was 11,912 MDS assessments of 3,704 residents (1999-2009). Study I showed that 28.6-61.4% of residents had intact cognitive performance and 42.5-68% were independent in ADL performance. A weak, but significant, linear trend over the eleven years was seen in residents' health becoming less stable, their cognitive performance improving, more pain being reported and greater participation in social activities. Study II showed that the median survival time was 31 months. No significant difference was detected in the mortality rate between cohorts. Age, gender (HR 1.52), place admitted from (HR 1.27), ADL functioning (HR 1.33-1.80), health stability (HR 1.61-16.12) and ability to engage in social activities (HR 1.51-1.65) were significant predictors of mortality. In study III upper and lower thresholds for 20 Minimum Data Set Quality Indicators were established. Residents not having a quality indicator present numbered from 32.5-99.3% depending on the indicator in question. The quality indicators with the median value above the upper threshold, indicating poor care, were: depression (49.4%); symptoms of depression without antidepressant (18.2%); use of 9 or more medications (63.8%); anti-anxiety or hypnotic drug use (69.2%); little or no activity (52.5%). Findings from study IV showed that 16 out of 20 quality indicators increased in prevalence, indicating a decline in quality of care (p< 0.05) over the study period. In 12 out of 20 indicators the prevalence was lower than 25%. One quality indicator showed improvement, i.e. „Bladder and bowel incontinence without a toileting plan‟ from 17.4% in 2003 decreasing to 11.5% in 2009 (p<0.001). Residents‟ health and functional status partially explained the increased prevalence of the quality indicators over time. At admittance many residents had a relatively high level of independence, the mortality rate did not change over the study period and health stability and ADL performance were strong predictors of mortality. More than 50% died within 3 years, and almost a third of the residents may have needed palliative care within a year of admission. Pain management, social engagement and palliative care are areas where more staff knowledge seems to be needed. The thresholds established aims for Icelandic nursing homes, uncovering areas of care requiring improvement. Icelandic nursing homes seem to be doing best in handling incontinence and nutritional care, and in several quality indicators the prevalence was quite low. The areas of care that indicated poor care and needed improvement included treatment of depression, number of medications and resident activity level. Quality Indicator results and trends over time can be used for improvement, planning of services and staff knowledge. Description: To access full text version of this article. Please click on the hyperlink "View/open" at the bottom of this page

Svæfingar við líffæraflutninga : siðferðileg álitamál [M.A. ritgerð]

Mon, 01 Mar 2010 00:00:00 GMT

Title: Svæfingar við líffæraflutninga : siðferðileg álitamál [M.A. ritgerð] Authors: Guðbjörg Svava Ragnarsdóttir. Abstract: This dissertation seeks answers to the question “ What moral questions rise among nurse anesthetists when they provide anesthesia to a donor who has been clarified brain dead?” To be able to answer this question fully, material from academic resources was explored and a qualitative research among nurse anesthetists who have given anesthesia to an organ donor was undertaken. In the litterature review, attitutes toward death and how they have changed through the centuries were examined. Moreover, the evolution of research of the human body was covered as well as the history of organ transplantations. Exploring the litterature of organ transplantations, it became evident that the ethics of organ transplantations came afterwards the operations themselves and many ethical mistakes were made during the early days of organ transplantations. It is arguable when a person who has been declared braindead is considered deceased. My conclusion, which is based on the reading of academic resources and the findings of the study, is that if a person can never gain consciousness again and all mental life has vanished it does not change the fate of the individual whether he is considered deceased, dying or alive. The person will not be able to wake up again. On the other hand it matters from a legal and ethical point of view. Some have gone as far as saying that we are removing organs from a living human that will not gain consciousness again. In the litterature review organ transplantation from non heartbeating donors where looked into. In those articles, very different opinions on this sensitive topic where introduced. Under those circumstances the time from which the person is declared dead until the transplantation begins must be very short. What matters concerning organ transplantation after cardiac arrest is whether it has been decided to bring the patient back to life and what kind of treatment he has been undergoing. Full treatment, full treatment but no resuscitation or is the person receiving palliative care. The time from cardiac arrest to organ removal is variable between countries. Shorter time benefits those waiting for organs while a longer time provides the patient with more security. Therefore a very clear and firm boundary which cannot be crossed is needed. In Iceland organ transplantation after cardiac arrest is very rare so there is no information on that in the study. Furthermore, in the litterature review, facts about organ transplantation, reasons for organ donation and arrangement of priority in choosing candidates for organ transplantation are looked upon. The results from the study itself where the following themes: sorrow, respect, doubt, justification and solitude. The participants experienced sorrow because of the course of events that lead to the organ donation. Respect for the donor and the relatives and their suffering was a keystone. Doubt of whether being doing the right thing or not came to most minds but some considered it a necessity to examine things carefully. The justification for organ transplantation is that others can obtain a new life. It was essential for the participants to gain this acknowledgement by getting some information about the utiliation of the organs, how many patients had organ transplants from the individual they anesthetized. The solitude consisted in not being able to talk about their experience to other people. The nurse anesthetists talked to each other though. Solitude sometimes also consisted in feeling and seeing the donors body fade away and die without others seeming to notice. Regarding the research question“ What moral questions rise among nurse anesthetists when they provide anesthesia to a donor who has been clarified brain dead?”, the study revealed following: Is it certain that the individual is brain dead and will never be able to gain consciousness again? Is it justifiable to remove the organs? In the light of these questions it is my belief that perhaps more education on organ transplantation is needed for nurse anesthetists. Further studies might then regularly observe how these nurses look at participating in these operations and wheter a choice should be given never to involve in organ transplantation. Description: Neðst á síðunni er hægt að nálgast ritgerðina í heild sinni með því að smella á hlekkinn Skoða/Opna (e.View/Open)

Symptoms and quality of life : a cross-sectional, descriptive, correlation study, evaluating the relationship between symptoms and quality of life in patients on opioids with advanced cancer [M.S. Thesis]

Wed, 01 Oct 2008 00:00:00 GMT

Title: Symptoms and quality of life : a cross-sectional, descriptive, correlation study, evaluating the relationship between symptoms and quality of life in patients on opioids with advanced cancer [M.S. Thesis] Authors: Sigríður Zoëga Abstract: B A C K G R O U ND : Cancer patients experience multiple symptoms that affect their quality of life (QOL). Cancer related symptoms may be caused by the disease itself or its treatment, but factors like age, gender, and concurrent diseases may also influence the symptomatology. The symptoms-quality of life model shows the relationship between symptoms and QOL in cancer patients. G O A L OF P R O J E C T: To review the literature on quality of life and symptomatology among cancer patients, to pull together a model that explains the relationship between symptoms and quality of life and to test selected aspects of the model. P A R T I C I P A N T S: 150 cancer patients on opioids, 62 (41%) men and 88 (59%) women, all Caucasians. The patients ranged in age from 20-92 years with a mean (SD) age of 64,7 (12,7) years. R E S E A R C H D E S I G N: Descriptive, cross-sectional, and correlational. R E S U L T S: The mean (SD) number of symptoms in the past 24 hours was 6,2 (2,5), and 9,0 (3,3) in the past week. The most common symptoms were fatigue, pain, and weakness. Mean (SD) symptom severity was 0,7 (0,4) in v the past 24 hours and 0,9 (0,5) in the past week on a scale from 0-3. Gender and concurrent diseases were not related to number of symptoms, symptom severity or QOL, but increased age was associated with fewer symptoms and less symptom severity although age difference was not found for global health/QOL score. Adjusted for age and gender, number of symptoms explained 25,8% of the variance in global health/QOL. Also adjusting for age and gender, pain, fatigue, insomnia, and depression explained 33,6% of the variance in global health/QOL. C O N C L U S I O N: The symptomatology of Icelandic cancer patients is similar to cancer patients in other countries. Number of symptoms and the individual symptoms of pain and notably fatigue are associated with diminished QOL. Surprisingly insomnia and depression did not add significantly to the regression model. These results indicate that QOL of cancer patients may be improved by assessing and treating cancer related symptoms.; B A K G R U N N U R: Sjúklingar með krabbamein finna fyrir mörgum einkennum sem hafa áhrif á lífsgæði þeirra. Krabbameinstengd einkenni orsakast ýmist af sjúkdómnum sjálfum eða meðferð hans, en þættir eins og aldur, kyn og aðrir sjúkdómar geta einnig haft áhrif á einkennamyndina. Einkenna-lífsgæðamódelið sýnir tengslin milli einkenna og lífsgæða hjá sjúklingum með krabbamein. T I L G A N G U R V E R K E F N I S: Að skoða hugtakið lífsgæði og einkennamynd krabbameinssjúklinga, að setja fram módel til að lýsa tengslunum milli einkenna og lífsgæða og að prófa ákveðna þætti módelsins. Þ Á T T T A K E N D U R: 150 krabbameinssjúklingar á ópíoíðum. Karlar voru 62 talsins (41%) en konur 88 (59%). Allir þátttakendur voru hvítir. Aldur þátttakenda var á bilinu 20-92 ár en meðalaldur (SF) var 64,7 (12,7) ár. R A N N S Ó K N A R S N I Ð: Lýsandi, þversniðs, fylgnirannsóknarsnið. Niðurstöður: Meðalfjöldi (SF) einkenna síðasta sólarhringinn var 6,2 (2,5) en 9,0 (3,3) síðastliðna viku. Algengustu einkenni voru þreyta, verkir og slappleiki. Meðalstyrkur (SF) einkenna var 0,7 (0,4) síðasta sólarhringinn en 0,9 (0,5) síðastliðna viku á skalanum 0-3. Fjöldi einkenna, styrkur þeirra og heilsu/lífsgæðaskor var ekki tengt kyni eða tilvist annarra sjúkdóma. Fjöldi einkenna og styrkur einkenna minnkaði hins vegar með hækkandi aldri þótt heilsu/lífsgæðaskor væri óháð aldri. Fjöldi einkenna skýrði 25,8% af dreifingunni í heilsu/lífsgæðum þegar leiðrétt hafði verið fyrir aldri og kyni. Annað aðhvarfsgreiningarmódel, einnig leiðrétt fyrir aldri og kyni, sýndi að verkir, þreyta, svefnleysi og depurð skýrðu 33,6% af drefingunni í heilsu/lífsgæðum. iv Á L Y K T A N I R: Einkennamynd íslenskra krabbameinssjúklinga á ópíoíðum svipar til krabbameinssjúklinga í öðrum löndum. Fjöldi einkenna sem og verkir, og einkum þreyta, eru tengd skertum lífsgæðum. Á óvart kom að svefnleysi og depurð höfðu ekki marktæk áhrif í aðhvarfsgreiningarmódeli. Niðurstöðurnar benda til þess að hægt sé að stuðla að bættum lífsgæðum krabbameinssjúklinga með því að meta og meðhöndla krabbameinstengd einkenni. Description: Neðst á síðunni er hægt að nálgast ritgerðina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)