SOFA score sepsis

Sequential Organ Failure Assessment (SOFA) Score - MDCal

  1. The Sequential Organ Failure Assessment (SOFA) Score is a mortality prediction score that is based on the degree of dysfunction of six organ systems. The score is calculated on admission and every 24 hours until discharge using the worst parameters measured during the prior 24 hours
  2. The SOFA is a validated intensive care unit (ICU) mortality prediction score; the qSOFA was derived by Sepsis-3 to help identify patients with suspected infection who are at high risk for poor outcome (defined as in-hospital mortality or an ICU stay of ≥ 3 days) outside of the ICU
  3. The qSOFA Score was introduced by the Sepsis-3 group as a simplified version of the SOFA Score, a validated ICU mortality prediction score, to help identify patients with suspected infection that are at high risk for poor outcome (defined as in-hospital mortality, or ICU length of stay ≥3 days) outside of the ICU
  4. e rate of organ failure. The sequential organ failure assessment score ( SOFA score ), previously known as the sepsis-related organ failure assessment score, is used to track a person's status during the stay in an intensive care unit (ICU) to deter
  5. Using absolute values or changes over time, the SOFA score appears to be a potentially useful tool for either the clinician during bedside assessment or for purposes of clinical research trials of sepsis. The SOFA score was created by the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, with the intent of creating an objective tool to describe individual and aggregate organ failure
  6. The concept of quick SOFA (qSOFA) was also introduced by the task force of Sepsis-3, keeping into consideration the limitations of using the SOFA score outside ICUs. Therefore, to identify the patients with the highest probability of poor outcome associated with sepsis, a bedside clinical score named as qSOFA was developed, which is based on at.

Sepsis and Septic Shock: The Sofa Score (qSOFA) and Treatment

  1. A change in the SOFA score of 2 or more is now a defining characteristic of the sepsis syndrome, and the European Medicines Agency has accepted that a change in the SOFA score is an acceptable surrogate marker of efficacy in exploratory trials of novel therapeutic agents in sepsis
  2. Recognizing these practical limitations, the 2016 SCCM/ESICM task force described a simplified method termed quick SOFA to facilitate easier identification of patients potentially at risk of dying from sepsis (1-3). This score is a modified version of the Sequential (Sepsis-related) Organ Failure Assessment score (SOFA). qSOFA consists of only three components that are each allocated one point (Table 2). A qSOFA score of ≥2 points indicates organ dysfunction
  3. ), or altered mentation (Glasgow coma scale 15)

Klinische Symptome Sepsis Blutprodukte - EK bei Hb < 7g/dl - TT bei < 10×10 9/L + bei relevanten ± Blutungen/ OP Blutzucker Ziel ≥ 180 mg/dL Kontrolle alle 2-3h Bikarbonat ø wenn pH ≥ 7.15 Sonstiges - ø routinemässigen Immunglobuline - Magenschutz - zeitgerechte Ernährung Fokuskontrolle Therapiemanagement Diagnose qSOFA Score ≥ Objectives: Organ failure worsens outcome in sepsis. The Sequential Organ Failure Assessment (SOFA) score numerically quantifies the number and severity of failed organs. We examined the utility of the SOFA score for assessing outcome of patients with severe sepsis with evidence of hypoperfusion at the time of emergency department (ED) presentation The SOFA score was correlated to the PRISM score (r s =0.59) and the PIM2 score (r s =0.51). In children with infection, the AUC of the SOFA score for predicting mortality was 0.87 compared to an AUC of 0.60 using SIRS. The diagnosis of sepsis applying a SOFA cutoff of 3 points predicted mortality better than both the SIRS and the SOFA cutoff.

The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10. [Citation ends] (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine The Sequential Organ Failure Assessment (SOFA) is a morbidity severity score and mortality estimation tool developed from a large sample of ICU patients throughout the world. Unlike other scoring systems, such as the SAPS II and APACHE II systems, the SOFA was designed to focus on organ dysfunction and morbidity, with less of an emphasis on mortality prediction RAAS (RDW, AGE, APACHE II, SOFA) is a scoring system for the prognosis of patients with sepsis. The establishment of this scoring system quantifies the severity of sepsis, which is of great significance to effectively determine the severity of sepsis patients in the future, improve the success rate of treatment, judge the prognosis of patients, and guide the treatment of doctors

Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units : results of a multicenter, prospective study. Working group on sepsis-related problems of the European Society of Intensive Care Medicine. Vincent JL et coll Crit Care Med. 1998 Nov ;26 (11):1793-800. The use of maximum SOFA score to quantify. Der SOFA-Score ist ein medizinischer Score, der zur Beurteilung von Patienten auf der Intensivstation herangezogen wird. Mit dem SOFA-Score wird der Grad der Organdysfunktion beurteilt und dadurch das Mortalitätsrisiko bestimmt. SOFA ist ein Akronym und steht für Sequential Organ Failure Assessment. 2 Einteilung. Für den SOFA-Score werden sechs Organe bzw. Organsysteme mithilfe spezifischer Parameter beurteilt The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ Dysfunction / failure.Intensive Care Med 1996;22:707-710 2.Ferreira FL , Bota DP , Bross A , C Melot , Vincent JL .Evaluación de serie de la puntuación SOFA para predecir el resultado en pacientes críticamente enfermos.JAMA. 2001 Oct 10; 286 (14) :1754-8 Le score Sepsis-related Organ Failure Assessment a été créé en 1994. Il était prévu qu'il quantifie le degré de dysfonctionnement d'organe chez les patients atteints de septicémie. Il s'est avéré que les possibilités d'application du score SOFA ne se limitaient pas aux patients atteints de septicémie; le score a alors été rebaptisé Sequential Organ Failure Assessment Score

qSOFA (Quick SOFA) Score for Sepsis - MDCal

Total SOFA=..... Les paramètres sont évalués quotidiennement. Référence. JL Vincent et Coll. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ Dysfunction / failure. Intensive Care Med 1996;22:707-710. Ouverture des yeux. Réponse verbale. Meilleure réponse motrice SOFA-scoren udregnes som summen af point givet for 6 forskellige mål for organpåvirkning. SOFA-score kan derfor være 0-24 point. En stigning i SOFA-score på ≥ 2 fra baseline (hos sædvanligvis raske 0) understøtter mistanken om sepsis Die Organdysfunktion kann gemäß den SOFA-Score-Variablen definiert werden. Ein SOFA Score von > 2 Punkten im Rahmen einer vermuteten Infektion geht mit einer 10%igen Krankenhaussterblichkeit einher. Der schlechteste Parameterwert jedes einzelnen Tages wird in die Wertung eingebracht. Der SOFA-Score berechnet sich hierbei aus der Summe der unten aufgeführten Bewertungspunkte der einzelnen Organsysteme

SOFA score - Wikipedi

SOFA-Score ist die Abkürzung für Sepsis-related organ failure assessment score (etwa Maßzahl zur Beurteilung des Organversagens bei Sepsis), manchmal auch Sequential organ failure assessment score (Maßzahl zur wiederholten Beurteilung des Organversagens). Dieser Score wird benutzt, um den Zustand eines Patienten mit Sepsis und das Ausmaß der Organschädigung im Verlauf einer. qSOFA-Score (Vereinfachte Sepsis-Kriterien) Prinzip: Vereinfachter SOFA-Score mit drei Parametern für den präklinischen Einsatz bzw. die Beurteilung von Patienten auf Normalstationen ; Kriterien: Jeweils 1 Punkt pro zutreffendem Kriterium aus der folgenden Gruppe . Atemfrequenz: ≥22/min; Systolischer Blutdruck: 100 mmH

Sepsis: qSOFA Score - YouTube

The Sequential Organ Failure Assessment score for

SOFA scoring system is composed of scores from six organ systems, graded from 0 to 4 according to the degree of dysfunction.Recently, a new bedside clinical. Ziel des Scores ist es, das Risiko für die Entwicklung einer Sepsis schnell und einfach abzuschätzen. Bei Patienten, die zwei der folgenden drei qSOFA-Kriterien erfüllen, ist von einem schlechteren Outcome auszugehen: Atemfrequenz ≥ 22/min. verändertes Bewusstsein ( Glasgow Coma Score < 15) systolischer Blutdruck ≤ 100 mmHg

Sequential Organ Failure Assessment Score. The sequential organ failure assessment score (SOFA Score) predicts mortality by assessing the degree of dysfunction of six organ systems--lungs, brain, liver, kidney, hematologic (platelets), and hemodynamic. From: Abernathy's Surgical Secrets (Seventh Edition), 2018. Related terms: Sepsis; Septic. The Sequential Organ Failure Assessment (SOFA) score was selected as the scoring system to quantify organ dysfunction in the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). 1 The Sepsis-3 Task Force validated the SOFA score in adult patients with suspected infection and found the SOFA system to be either.

It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) scores are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the. qSOFA score. The qSOFA score is a shortened version of the full SOFA criteria.It was developed to allow for the rapid assessment of potential sepsis, based purely on clinical signs.. The qSOFA score permits the diagnosis of potential sepsis to be made prior to any investigations and can be completed by any healthcare professional.. Any patient with a known or suspected infection and a qSOFA.

SOFA Score - an overview ScienceDirect Topic

The SOFA score—development, utility and challenges of

a SOFA score to confirm the diagnosis of sepsis. This recommendation remains controversial, as the qSOFA has been shown to be more predictive than the SOFA outside of the ICU setting. Even if the patient's qSOFA score is initially negative (< 2), i dysfunction (total SOFA score ≥2), we analyzed sepsis management and outcomes and evaluated mortality prediction of the SOFA scores. Organ failure was defined as the maximum SOFA score ≥3 for an individual organ system. Results: From December 2013 to December 2015, 454 adult patients presenting with community-acquired sepsis

SOFA score (0-4) analysis may also result in revision of the limits of the pa- rameters used to score each organ. The relation between the SOFA score on ICU admission and the mortality rate was studied in 1643 patients with sepsis by the Europe- an/North American Study of Severity System (ENAS) Sepsis is a global threat but insufficiently studied in Southeast Asia. The objective was to evaluate management, outcomes, adherence to sepsis bundles, and mortality prediction of maximum Sequential Organ Failure Assessment (SOFA) scores in patients with community-acquired sepsis in Southeast Asia. We prospectively recruited hospitalized adults within 24 h of admission with community-acquired. meer punten op de SOFA-score duidt op levens-bedreigende orgaandisfunctie en wordt gehanteerd om te kunnen spreken van sepsis. Men kan uitgaan van een eerdere SOFA-score van 0 indien de patiënt voorheen niet bekend was met orgaandisfunctie. Voor het berekenen van de SOFA-score zijn relatief veel gegevens nodig, waaronder laboratoriumbepalingen CHOOSING THE SCORING SYATEM. 14. IN THE OLD CRITERIA FOR SEPSIS, SIRS SCORE WAS A MEASURE OF RESPIRATORY RATE, WHITE BLOOD CELL COUNT, HEART RATE, AND FEVER. • THE SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE ( SOFA ) AND THE LOGISTIC ORGAN DYSFUNCTION SYSTEM SCORE ( LODS ) ARE MORE RECENT ,PREDICT ORGAN DYSFUNCTION AND MORTALITY BETTER In contrast, Sepsis Related Organ Failure Assessment-Sepsis Linked Organ Disease Assessment (SOFA) scoring is a repetitive method based on data that is collected sequentially over the first days or throughout the entire ICU stay. Prognostic scoring systems (e.g., APACHE, SAPS) are concerned with predicting mortality, whereas organ dysfunction.

SIRS, qSOFA and new sepsis definitio

test for the detection of sepsis is currently still lacking. Among ICU encounters with suspected infection, the Sepsis-3 Task Force recommended the use of the Sequen-tial (sepsis-related) Organ Failure Assessment (SOFA) score for the identification of septic patients [1, 6]. For the rapid identification of patients with suspected infectio Another method of diagnosis is the SOFA, Sequential (Sepsis-Related) Organ-Failure Assessment, score system. A score of two or more (see chart below) and a suspicion of infection is indicative of sepsis. SOFA is preferred over SIRS since it allows clinicians to identify organ dysfunction and can also account for clinical intervention Sequential [Sepsis-related] Organ Failure Assessment Score (SOFA) is used to define organ dysfunction as an increase in the total SOFA score of 2 points or more. The SOFA requirement is met by a minimum of 1 point increase in at least 2 organ systems or by a 2 point increase (or more) in a single organ system Some scoring systems such as the Modified Early Warning Score (MEWS) and quick Sequential (sepsis-related) Organ Failure Assessment score (qSOFA) are intended for patients with suspected sepsis for prediction of ICU admission. 7,8 Others, such as the SOFA score, Acute Physiologic and Chronic Health Evaluation (APACHE), and Simplified Acute.

Score SOFA. Rea ICU 17 septembre 2021 Dernière mise à jour: 16 octobre 2021. 0 108 Temps de lecture 1 minute. SOFA. Sepsis-related Organ Failure Assessment. ou. Sequential Organ Failure Assessment. Un score supérieur ou égal à deux est associé à un risque de mortalité de 10 % chez les patients pour lesquels une infection est suspectée. Under the new definition, sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, where organ dysfunction is defined as an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%

A positive qSOFA score, implying the presence of 2 or more qSOFA points near the onset of infection, was included in the inclusion criteria in the present study. According to the Sepsis-3 definitions, the diagnostic criteria for sepsis include an increase in the SOFA score of 2 points or more as a result of the current infection Sepsis, a life-threatening organ dysfunction due to a dysregulated host response to infection, is a leading cause of morbidity and mortality worldwide. SOFA score was 11 [8-14], SAPS II was.

qSOFA :: quick Sepsis Related Organ Failure Assessmen

SOFA Score ≥ 2 - DGII

criteria for sepsis. Because SOFA requires laboratory tests, the task force also recommended that clinicians use another scoring tool called quick SOFA (qSOFA) to evaluate patients for possible sepsis outside of the ICU—but only as a screening tool. The task force reported that the qSOFA score, which includes altered mental state, systoli But the SOFA score requires multiple laboratory tests and may not be available in a timely manner. To facilitate simple recognition in prehospital, ward, and the emergency department, the Task Force recommended a prompt called qSOFA for quick sepsis-related organ dysfunction assessment score The sepsis 3 guidelines recommended the use of the Sepsis Related Organ Failure Assessment (SOFA) score for early identification of sepsis in adults (Singer 2016, PMID: 26903338). An abbreviated version of SOFA (Quick SOFA or qSOFA) includes variables available at the bedside in the ED (systolic BP, respiratory rate and mental status). The 2017 pediatric surviving sepsis guidelines acknowledge. The recommendation is to implement the new definitions and diagnostic criteria for sepsis and septic shock, but not the use of the new screening tool for sepsis, quick-SOFA, as it needs prospective validation and since it is not clear if quick-SOFA is more useful than the currently used general triage and early warning score systems The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care.

[Paediatric sequential organ failure assessment (pSOFA

For sample size evaluation, the mean SOFA score in patients with AKI and sepsis, at baseline and during the following four days, was derived from the literature [10]. Assuming a mean mortality. Sirs qsofa and new sepsis definition marik journal of sepsis qsofa score you clinical and laboratory parameters for sirs qsofa scoring qsofa score calculator apps on google play. Whats people lookup in this blog: Qsofa Score Sepsis; Qsofa Score Sepsis Interpretation; Qsofa Score Sepsis 3; Quick Sofa Score Sepsis; Quick Sofa Score Sepsis Pd Reference: Vincent JL et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction / failure. Intensive Care Med. 1996;22:707-71

Sepsis 3Zakkaartje sepsis screening (SOFA score) en behandeling

The sensitivity of qSOFA for the recognition of sepsis was 54.3% (76/140) using a SOFA score ≥2 as a gold standard. In patients with a higher SOFA score (i.e. SOFA score ≥4) compared to patients with a SOFA score of 2 or 3, the sensitivity was significantly higher (72.6% versus 39.7%, p<0.001, compare Fig 8) Through this analysis and research, the factors affecting the prognosis of patients with sepsis in the ICU are concluded, which may include age, PCT, Lac, SOFA score, APACHE-II score, 24 h lactic acid clearance rate, combined fungal infection, Gram-negative bacterial infection, combined AKI/ARDS/DIC, receiving anticoagulation therapy. Der SOFA-Score in der Intensivmedizin ist etwas robuster, erfordert jedoch Labortests (siehe Tabelle Sequenzielle Beurteilung des Organversagens Ergebnis der Bewertung von sequenziellem Organversagen (SOFA) Sepsis ist ein klinisches Syndrom einer lebensbedrohlichen Organdysfunktion, die durch eine dysregulierte Reaktion auf eine Infektion.

Sepsis in adults - Criteria BMJ Best Practic

A recent study using Sepsis-3 reported that presepsin and PCT were superior to CRP and lactate in discriminating sepsis, including shock, from non-sepsis with SIRS and a SOFA score ≥ 2 . The study showed that the AUC values used to discriminate sepsis from non-sepsis were 0.88 for presepsin, 0.81 for PCT, and 0.65 for CRP The Quick SOFA Score can be used to screen a patient for sepsis, from Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3) Sepsis, according to Sepsis-3 criteria, was defined by an acute increase of SOFA score ≥2 points.5 Delta SOFA was assessed at admission in patients with CA or HCA infections, while the time frame for the assessment of delta SOFA was 24 hours for patients with nosocomial infections

Serial Evaluation of the SOFA Score to Predict Outcome in

Sequential Organ Failure Assessment (SOFA) Score Calculato

qSOFA (Quick SOFA) Score for Sepsis Identifies high-risk patients for in-hospital mortality with suspected infection outside the ICU. IMPORTANT We launched a COVID-19 Resource Center , including a critical review of recommended calcs. INSTRUCTIONS Use to predict mortality, NOT to diagnose sepsis, per 2017 Surviving Sepsis Guidelines - organ dysfunction: can be identified as acute change in total SOFA score 2점 이상. The authors of this study sought to review the use of NEWS as an early sepsis screening score, a predictor of severe sepsis/septic shock, and compare it to SIRS and qSOFA in an ED triage setting criteria for sepsis. Because SOFA requires laboratory tests, the task force also recommended that clinicians use another scoring tool called quick SOFA (qSOFA) to evaluate patients for possible sepsis outside of the ICU—but only as a screening tool. The task force reported that the qSOFA score, which includes altered mental state, systoli Glasgow Coma Scale SOFA score 15 0 13-14 +1 10-12 +2 6-9 +3 < 6 +4 Respiratory system Nervous system Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensiv The SOFA score is widely used to indicate of organ damage in critically ill patients. There are many reports on the association of SOFA score and the prognosis of sepsis patients [24, 25]. The latest definition of sepsis, Sepsis-3, also uses an increase in SOFA score to indicate organ damage . The SOFA score is relatively easy and quick to obtain

Sequential Organ Failure Assessment (SOFA) Calculator

5. Raith EP, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R, et al.;Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE). Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit sofa-score-sepsis) was designed to help clinicians recognize possible sepsis in settings other than the ICU.9,12-14 Sepsis should be suspected in patients meeting at least two of th Due to these inaccuracies in the SIRS criteria, the new Sepsis-3 definitions recommend using the SOFA score; however, it is not commonly used or known outside of the critical care world . The SOFA score is an aggregate score, from 0 to 4, for each organ system, including respiratory, coagulation, liver, cardiovascular, renal and central nervous. full SOFA score (AUROC 0.79) and SIRS (AUROC 0.76; Table 3). In contrast, however, in the ICU, the predictive validity for in-hospital mortality was lower for qSOFA (AUROC 0.66) and SIRS (AUROC 0.64) compared with the full SOFA score (AUROC 0.74) [5]. The use of the SOFA score in the Sepsis-3 definition i

Amazing Qsofa Quick Sofa

Scoring system-RAAS for sepsis JI

The Third Consensus Conference (Sepsis-3) established that, in presence of suspected or documented infection, an increase of Sequential Sepsis-related Organ Failure Assessment (SOFA) score in. Objective To compare the daily practice of two emergency departments (ED) in the Netherlands, where systemic inflammatory response syndrome (SIRS) criteria and quick Sequential Organ Failure Assessment (qSOFA) score are used differently as screening tools for culture-positive sepsis. Design A prospective cross-sectional multicentre study. Setting Two EDs at two European clinical teaching. Keywords: pediatric SOFA score; PELOD-2 score; sepsis S epsis is a leading cause of mortality and morbidity in infants and children. There is no gold standard for the diagnosis of sepsis, thus, the definition of sepsis is continually updated. In 2016, the latest international consensu

New definition of sepsis

Score SOFA - Médecine d'urgence - Urgences médicale

Daily scoring of individual and composite scores possible during course of ICU stay: Population outcome comparison: Standardized mortality ratios can be used for large patient populations: No predicted mortality algorithm. In general, higher SOFA score is associated with worse outcome.Treatment effects on SOFA: Individual patient outcome Der qSOFA-Score ist für Präklinik, Notaufnahme und Normalstation gut geeignet. Der SOFA-Score eignet sich für die Intensivstation und insbesondere für die tägliche Beurteilung von Sepsis-Patienten. Wer im qSOFA-Score 2 Kategorien oder mehr erfüllt, hat wahrscheinlich eine Sepsis, und soll entsprechend behandelt werden

Assessment of Sepsis-3 criteria and quick SOFA in patients

Sepsis Score Sofa Calculator On Pc Mac With Appkiwi. Qsofa Score Calculator Formula Definition Omni. Pediatric Clif Sofa Score Is The Best Predictor Of 28 Day. See also Interior Photography Wide Lens. Utility Of Sofa Score Management And Outcomes Sepsis In. Ccs Desember 09 Indd SOFA-score: hulpmiddel bij diagnostiek van sepsis. Een patiënt die verdacht wordt van het hebben van een sepsis (bloedvergiftiging), moet zo vlug als mogelijk behandeld worden. Een sepsis kan namelijk binnen enkele uren ernstig worden, met orgaanfalen en eventueel de dood als gevolg. Om een (ernstige) sepsis snel te diagnosticeren, gebruiken. The task force's new sepsis definitions also draw attention to another important clinical consideration - organ dysfunction, which is the threshold that elevates uncomplicated infection to sepsis. The suggested method to assess for organ dysfunction is Sequential (Sepsis-Related) Organ Failure Assessment (SOFA) BAKGRUND Sepsis och septisk chock är livshotande tillstånd som kräver omedelbart omhändertagande.Sepsis medför en livshotande infektionsutlöst systempåverkan och organdysfunktion. Septisk chock föreligger om patienten har hypotension (medelartärtryck 2 mmol/l trots adekvat vätsketillförsel. Multipel organsvikt orsakad av sepsis utgör en vanlig dödsorsak på.