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Article ; Online: [No title information]

Kongsgaard, Ulf E / Kristiansen, Thomas

Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke

2023 Volume 143, Issue 10

Title translation	Selvkirurgi.
Language	Norwegian
Publishing date	2023-06-26
Publishing country	Norway
Document type	Journal Article
ZDB-ID	603504-8
ISSN	0807-7096 ; 0029-2001
ISSN (online)	0807-7096
ISSN	0029-2001
DOI	10.4045/tidsskr.23.0158
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Article ; Online: Letter to the Editor regarding "CT guided neurolytic blockade of the coeliac plexus in patients with advanced and intractably painful pancreatic cancer".

Kongsgaard, Ulf E

Scandinavian journal of pain

2018 Volume 18, Issue 4, Page(s) 759

MeSH term(s)	Autonomic Nerve Block ; Celiac Plexus ; Humans ; Pain ; Pancreatic Neoplasms ; Tomography, X-Ray Computed
Language	English
Publishing date	2018-07-26
Publishing country	Germany
Document type	Letter ; Comment
ZDB-ID	2515451-5
ISSN	1877-8879 ; 1877-8860
ISSN (online)	1877-8879
ISSN	1877-8860
DOI	10.1515/sjpain-2018-0110
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Article ; Online: Skin conductance algesimeter is unreliable during sudden perioperative temperature increases.

Kongsgaard, Ulf E / Menchini, Robin Johansen / Larsen, Stein Gunnar / Juul-Hansen, Knut Erling

Scandinavian journal of pain

2024 Volume 24, Issue 1

Abstract: Objectives: Pain assessment in anesthetized and non-communicative patients remains a challenge. Clinical signs such as tachycardia, hypertension, sweat and tears, have a low specificity for pain and should therefore ideally be replaced by more specific ... ...

Abstract	Objectives: Pain assessment in anesthetized and non-communicative patients remains a challenge. Clinical signs such as tachycardia, hypertension, sweat and tears, have a low specificity for pain and should therefore ideally be replaced by more specific monitoring techniques. Skin conductance variability has been demonstrated to establish a patients' sensitivity to pain, but may be influenced by temperature changes that leads to profuse sweating. The aim of this pilot study was to test skin conductance changes during sudden temperature changes due to hyperthermic intraperitoneal chemotherapy (HIPEC) perfusation. Methods: We investigated skin conductance algesimeter (SCA) in ten consecutive patients undergoing cytoreductive surgery and HIPEC. Results from the SCA was compared to other standard physiological variables at seven time points during the surgical procedure, in particular during the period with hyperthermic intraabdominal perfusion leading to an increase in the patients core temperature. Results: Nine out of ten patients had an increase in the SCA measurements during the HIPEC phase correlating the increase in temperature. Conclusion: SCA is unreliable to detect increased pain sensation during sudden perioperative temperature changes in adult patients.
MeSH term(s)	Adult ; Humans ; Pilot Projects ; Temperature ; Pain ; Pain Measurement ; Pain Perception
Language	English
Publishing date	2024-04-12
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2515451-5
ISSN	1877-8879 ; 1877-8860
ISSN (online)	1877-8879
ISSN	1877-8860
DOI	10.1515/sjpain-2023-0106
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Article ; Online: Oxycodone, Morphine, and Fentanyl in Patients With Chronic Pain: Proposal of Dose-Specific Concentration Ranges.

Thaulow, Cecilie Hasselø / Helland, Arne / Kongsgaard, Ulf Erik / Høiseth, Gudrun

Therapeutic drug monitoring

2023 Volume 45, Issue 6, Page(s) 777–785

Abstract: Background: Interpreting opioid concentrations is challenging because of the lack of reference ranges. Therefore, the authors aimed to propose dose-specific concentration ranges in serum for oxycodone, morphine, and fentanyl in patients with chronic ... ...

Abstract	Background: Interpreting opioid concentrations is challenging because of the lack of reference ranges. Therefore, the authors aimed to propose dose-specific concentration ranges in serum for oxycodone, morphine, and fentanyl in patients with chronic pain, based on concentration measurements from a large number of patients and supported by theoretical pharmacokinetic calculations and previously published concentrations. Methods: The opioid concentrations in patients undergoing therapeutic drug monitoring (TDM) for various indications (TDM group) and patients with cancer (cancer group) were investigated. Patients were divided based on the daily opioid doses, and the 10th and 90th percentiles of the concentrations in each dose interval were evaluated. In addition, the expected average serum concentrations were calculated for each dose interval based on published pharmacokinetic data, and a targeted literature search for previously reported dose-specific concentrations was performed. Results: The opioid concentrations in 1054 patient samples were included: 1004 in the TDM group and 50 in the cancer group. In total, 607 oxycodone, 246 morphine, and 248 fentanyl samples were evaluated. The authors proposed dose-specific concentration ranges based mainly on 10th-90th percentiles of the concentrations measured in patient samples, whereas the calculated average concentrations and previously published concentrations were used to adjust the ranges. In general, results from calculations and concentrations retrieved from previous literature were within the 10th-90th percentiles of concentrations from patient samples. However, the lowest calculated average concentrations of fentanyl and morphine were below the 10th percentiles of patient samples in all dose groups. Conclusions: The proposed dose-specific ranges may be useful for interpreting steady-state opioid serum concentrations in clinical and forensic settings.
MeSH term(s)	Humans ; Fentanyl/adverse effects ; Oxycodone/therapeutic use ; Oxycodone/pharmacokinetics ; Analgesics, Opioid/adverse effects ; Morphine/therapeutic use ; Morphine/pharmacokinetics ; Chronic Pain/drug therapy ; Neoplasms/drug therapy
Chemical Substances	Fentanyl (UF599785JZ) ; Oxycodone (CD35PMG570) ; Analgesics, Opioid ; Morphine (76I7G6D29C)
Language	English
Publishing date	2023-06-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	424443-6
ISSN	1536-3694 ; 0163-4356
ISSN (online)	1536-3694
ISSN	0163-4356
DOI	10.1097/FTD.0000000000001112
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Article ; Online: Measuring outcomes of pain management.

Kongsgaard, Ulf E

Scandinavian journal of pain

2016 Volume 13, Page(s) 173–174

MeSH term(s)	Outcome Assessment, Health Care ; Pain Management ; Pain Measurement
Language	English
Publishing date	2016-09-20
Publishing country	Germany
Document type	Journal Article ; Comment
ZDB-ID	2515451-5
ISSN	1877-8879 ; 1877-8860
ISSN (online)	1877-8879
ISSN	1877-8860
DOI	10.1016/j.sjpain.2016.09.003
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Article ; Online: Dynamic assessment of the pupillary reflex in patients on high-dose opioids.

Kongsgaard, Ulf E / Høiseth, Gudrun

Scandinavian journal of pain

2019 Volume 19, Issue 3, Page(s) 465–471

Abstract: Background and aims Pupil size and reaction are influenced by opioids, an effect that is not considered to be affected by opioid tolerance. As clinicians have observed patients on high-dose opioids who exhibited seemingly normal pupil sizes, we wanted to ...

Abstract	Background and aims Pupil size and reaction are influenced by opioids, an effect that is not considered to be affected by opioid tolerance. As clinicians have observed patients on high-dose opioids who exhibited seemingly normal pupil sizes, we wanted to dynamically assess the pupillary reflex in cancer patients on high-dose opioids. Methods We performed a dynamic assessment of the pupillary reflex in cancer patients on high-dose opioids and a control group of healthy volunteers using a portable, monocular, infrared pupillometer. We also performed a clinical examination and measured blood concentrations of opioids and their active metabolites. Results Sixty three patients who were on opioids for 2 months (median time) and on an oral morphine equivalent dose of 250 mg (median dose) were investigated. Most patients used more than one opioid. When correcting for age, pupil size in the group that had received no increase of opioid dose over the last 14 days was not significantly different from pupil size in the healthy volunteer group (p = 0.76), while the group that had increased the dose of opioids differed significantly from healthy volunteers (p = 0.006). We found no statistically significant correlation between total oral morphine equivalents and pupillary reactions or between blood opioid or opioid metabolite concentrations and baseline pupillary changes. Conclusion Pupillary changes do take place in patients on opioids. However, tolerance to these changes occurs when medication is not increased over time. Dynamic pupillometry can give additional information about the degree of tolerance to opioids. Implications These findings elucidate previous misconceptions regarding pupillary effects and tolerance to opioids.
MeSH term(s)	Analgesics, Opioid/administration & dosage ; Drug Tolerance ; Female ; Humans ; Male ; Middle Aged ; Morphine/administration & dosage ; Neoplasms/blood ; Neoplasms/drug therapy ; Norway ; Reflex, Pupillary/drug effects
Chemical Substances	Analgesics, Opioid ; Morphine (76I7G6D29C)
Language	English
Publishing date	2019-04-09
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2515451-5
ISSN	1877-8879 ; 1877-8860
ISSN (online)	1877-8879
ISSN	1877-8860
DOI	10.1515/sjpain-2019-0032
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Article ; Online: Potentially Severe Incidents During Interhospital Transport of Critically Ill Patients, Frequently Occurring But Rarely Reported: A Prospective Study.

Eiding, Helge / Røise, Olav / Kongsgaard, Ulf E

Journal of patient safety

2020 Volume 18, Issue 1, Page(s) e315–e319

Abstract: Objectives: The out-of-hospital environment can pose significant challenges to the quality and safety of interhospital transport of critically ill patients. Because we lack knowledge of the occurrence of incidents, their potential consequences, and ... ...

Abstract	Objectives: The out-of-hospital environment can pose significant challenges to the quality and safety of interhospital transport of critically ill patients. Because we lack knowledge of the occurrence of incidents, their potential consequences, and whether they are actually reported, this study was initiated. Methods: Two different services in Norway were asked to self-report incidents after every interhospital transport of critically ill patients. Sampling lasted for 12 and 8 months, respectively. An expert group evaluated each incident for severity and demand for reporting into the hospital's electronic incident reporting system. One year later, the hospital's reporting system was scrutinized to determine the number of incidents actually reported. Results: A total of 455 transports of critically ill patients were performed, resulting in 294 unique incidents reported: medical (15%), technical (25%), missing equipment (17%), and personal failures and communication difficulties (42%). Only 3 (1%) of the 294 unique incidents were actually reported in the hospital's electronic incident reporting system. The experts were inconsistent in which incidents should have been reported and to what degree checklists, standard operating procedures, simulation, and training could have prevented the incidents. Conclusions: This study of interhospital transports of critically ill patients reveals a very high number of incidents. Despite this fact, these incidents are severely underreported in the hospital's electronic incident reporting system. This suggests that learning is lost and errors with predominant probability are repeated. These results emphasize the existing challenges in regard to the quality and safety of interhospital transport of critically ill patients.
MeSH term(s)	Checklist ; Communication ; Critical Illness ; Humans ; Prospective Studies ; Risk Management
Language	English
Publishing date	2020-09-25
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2394324-5
ISSN	1549-8425 ; 1549-8417
ISSN (online)	1549-8425
ISSN	1549-8417
DOI	10.1097/PTS.0000000000000769
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Article ; Online: Interhospital transport of critically ill patients: A prospective observational study of patient and transport characteristics.

Eiding, Helge / Kongsgaard, Ulf E / Olasveengen, Theresa M / Heyerdahl, Fridtjof

Acta anaesthesiologica Scandinavica

2021 Volume 66, Issue 2, Page(s) 248–255

Abstract: Background: The cohort of critically ill patients transported between Intensive Care Units (ICUs) in Norway has not been studied previously. The aim of this study was to describe the characteristics of patients and transports for different types of ... ...

Abstract	Background: The cohort of critically ill patients transported between Intensive Care Units (ICUs) in Norway has not been studied previously. The aim of this study was to describe the characteristics of patients and transports for different types of interhospital transfers and explore whether there were differences in morbidity and mortality between the different transfer categories and the general Norwegian ICU population. Methods: All transports of critically ill adult patients transferred between two geographically different Intensive Care Units during a one-year period were registered. Patient and transport data were obtained from The Norwegian Intensive Care Registry, The Norwegian Cause of Death Registry, the hospital Electronic Patient Journal, the Air Ambulance Journal System, and the Emergency Medical Communication Centre database. Results: 821 transports of 788 surgical and medical patients were enrolled. Simplified Acute Physiology Scores (SAPSII) were 43, 36 and 38 for urgent secondary transport, non-urgent secondary transport and return transfers, respectively. These were comparable to nationwide SAPSII scores that were 40 for university hospitals and 34 for local hospitals during the same time period. The return transfers had a median SOFA-score of 4.7 and 53% were mechanically ventilated. Only 33% of return transfers were performed by established teams. Conclusion: Intensive care patients transferred between ICUs are as critically ill as the rest of the ICU population, with a similar morbidity and mortality. The return transfers of ICU-patients appear under-triaged compared to secondary transports in terms of allocated resources.
MeSH term(s)	Adult ; Critical Care ; Critical Illness ; Hospitals, University ; Humans ; Intensive Care Units ; Patient Transfer ; Retrospective Studies
Language	English
Publishing date	2021-12-02
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	80002-8
ISSN	1399-6576 ; 0001-5172
ISSN (online)	1399-6576
ISSN	0001-5172
DOI	10.1111/aas.14005
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Article ; Online: Interhospital transport of critically ill patients: experiences and challenges, a qualitative study.

Eiding, Helge / Kongsgaard, Ulf E / Braarud, Anne-Cathrine

Scandinavian journal of trauma, resuscitation and emergency medicine

2019 Volume 27, Issue 1, Page(s) 27

Abstract: Background: No consensus based national standard for interhospital transports of critically ill patients exists in Norway. The local hospitals are responsible for funding, organizing and performing these transports, resulting in potentially different ... ...

Abstract	Background: No consensus based national standard for interhospital transports of critically ill patients exists in Norway. The local hospitals are responsible for funding, organizing and performing these transports, resulting in potentially different level of care for the critically ill patients depending on local hospital resources and not the level of severity in the patient's condition. The aim of this study was to examine how these transports are executed and to discover challenges during transports and potentials of improvement. Methods: A qualitative study with 20 semi-structured interviews of doctors, nurses and ambulance personnel representing a wide range in experience and formal education, reflecting the different compositions of crews performing interhospital transports was conducted. A systematic text condensation of the interviews was performed to describe personal experiences and values. Results: Few interviewees reported special adverse events when asked. Instead they chose to describe more general characteristics of the working environment, their own positive emotions or fears and the strengths and weaknesses of the organizational system. The prehospital working environment was described as different from the in-hospital environment. The personnel experienced being on their own during transports, lack of procedures and checklists and often no systematic education or demanded preparedness for participating. The resident doctors described pressure from elderly colleagues to participate in the transports. At the same time, all interviewees reported a self-interest in participating in these transports. Conclusions: Safe interhospital transports of the critically ill patients are challenged by the characteristics of the out of hospital environment. The transports are described as potentially unsafe for both patients and personnel. Systematic education is warranted, highlighting the use of checklists and special educational programs in prehospital critical care medicine. The strong personal interest to participate in these transports may serve as a barrier against changing todays system. To ensure the right level of competence and safety for each unique patient, it is imperative to standardize the interhospital transports on a national level, built on consensus from experienced prehospital personnel. Trial registration: The trial is approved and registered by the local representative for the Norwegian Data Protection Authority as trial 13-7751.
MeSH term(s)	Adult ; Ambulances ; Consensus ; Critical Care/standards ; Critical Illness/therapy ; Female ; Hospitals/statistics & numerical data ; Humans ; Male ; Middle Aged ; Norway ; Qualitative Research ; Transportation of Patients/standards
Language	English
Publishing date	2019-03-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-019-0604-8
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Article ; Online: Frédéric Chopin and his suffering.

Kongsgaard, Ulf E

Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke

2011 Volume 131, Issue 7, Page(s) 707–710

Abstract: Background: In 2010 we celebrated the bicentennial of Chopin's birth. He left more than 230 fantastic compositions, often described as romantic, emotional and poetic. Chopin composed almost exclusively for piano solo and has been called the pianists' ... ...

Abstract	Background: In 2010 we celebrated the bicentennial of Chopin's birth. He left more than 230 fantastic compositions, often described as romantic, emotional and poetic. Chopin composed almost exclusively for piano solo and has been called the pianists' composer. From his teens he suffered from respiratory tract infections, gradually accompanied by haemoptysis, pronounced breathing problems, diarrhoea and loss of weight. He experienced part of his adult life as a period of great suffering. He was 39 years old when he died. The assumed cause of death was tuberculosis, but other possible differential diagnoses have been suggested in recent years. Material and method: In order to examine the different diagnostic alternatives, a non-systematic search of the literature was carried out in PubMed, Embase, Current Contents, Google and relevant reference books. Results: The official cause of death was tuberculosis, but the autopsy report has never been found. Both cystic fibrosis and alpha-1-antitrypsin deficiency are possible differential diagnoses that can explain his symptoms. Interpretation: In spite of a disabling disease, Chopin was musically creative right to the end of his life. His suffering must have influenced his musical expression, which is characterised by intimacy and sentimentality. It is unlikely that we will ever find the true cause of death.
MeSH term(s)	Adult ; Cause of Death ; Cystic Fibrosis/diagnosis ; Diagnosis, Differential ; Diarrhea/diagnosis ; Famous Persons ; Hemoptysis/history ; History, 19th Century ; Humans ; Music/history ; Paris ; Poland ; Respiratory Tract Infections/history ; Spain ; Tuberculosis, Pulmonary/diagnosis ; Tuberculosis, Pulmonary/history ; alpha 1-Antitrypsin Deficiency/diagnosis
Language	Norwegian
Publishing date	2011-04-08
Publishing country	Norway
Document type	Biography ; Historical Article ; Journal Article ; Portraits
ZDB-ID	603504-8
ISSN	0807-7096 ; 0029-2001
ISSN (online)	0807-7096
ISSN	0029-2001
DOI	10.4045/tidsskr.10.1056
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