| 1. |
- Husdal, Rebecka, et al.
(författare)
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Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: A nationwide register-based cohort study
- 2020
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 167
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To examine if personnel resources and organisational features in Swedish primary health-care centres (PHCCs) are associated to all-cause mortality (ACM) in people with type 2 diabetes mellitus (T2DM). Methods: A total of 187,570 people with T2DM registered in the Swedish National Diabetes Register (NDR) during 2013 were included in this nationwide cohort study. Individual NDR data were linked to data from a questionnaire addressing personnel resources and organisational features for 787 (68%) PHCCs as well as to individual data on socio-economic status and comorbidities. Furthermore, data on ACM were obtained and followed up until 30 January 2018. Hierarchical Cox regression analyses were applied. Results: After a median follow-up of 4.2 years, 27,136 (14.5%) participants had died. An association was found between number of whole-time-equivalent (WTE) general practitioner's (GP's) devoted to diabetes care/500 people with T2DM and lower risk of early death (hazard ratio 0.919 [95% confidence interval 0.895–0.945] per additional WTE GP; p = 0.002). No other personnel resources or organisational features were significantly associated with ACM. Conclusions: This nationwide register-based cohort study suggests that the number of WTE GPs devoted to diabetes care have an impact on the risk of early death in people with T2DM. © 2020 Elsevier B.V.
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| 2. |
- Moloney, Maria, et al.
(författare)
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Incidence of distal ulna fractures in a Swedish county: 74/100,000 person-years, most of them treated non-operatively
- 2020
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Ingår i: Acta Orthopaedica. - : TAYLOR & FRANCIS LTD. - 1745-3674 .- 1745-3682. ; 91:1, s. 104-108
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Fractures of the distal ulna can occur in isolation or in conjunction with a distal radius fracture. They may result in incongruence and instability of the distal radioulnar joint. We investigated the incidence of distal ulna fractures, whether any fracture types were more common, and the methods of treatment used. Patients and methods - Data were collected from patients 18 years or older, treated for a fracture of the distal ulna in ostergotland, Sweden, during 2010-2012. Patients were identified in the patient registry. The fractures were classified according to the AO comprehensive classification of fractures. Results - The incidence of distal ulna fractures was 74/100,000 person-years. The most common fracture type was that of the ulnar styloid Q1 (79%), followed by the ulnar neck Q2 (11%). Rarest was ulna head fracture, type Q4 (1%). Incidental findings were a mean age of 63 years (SD 18), a concomitant distal radius fracture in 92% of the patients and that 79% were caused by falling from standing height. Internal fixation was performed in 30% of the Q2-Q6 fractures. This indicates that most were considered stable without internal fixation or stable after fixation of a concomitant radius fracture. Interpretation - Our results show that fractures of the distal ulna are not very common, and some fracture types are even rare. There seem to be no consensus on treatment.
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| 3. |
- Müller, Sebastian A, et al.
(författare)
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Fluoroscopy of the Elbow : A Cadaveric Study Defining New Standard Projections to Visualize Important Anatomical Landmarks
- 2021
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Ingår i: JB & JS open access. - : Lippincott, Williams & Wilkins. - 2472-7245. ; 6:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite new 3-dimensional imaging modalities, 2-dimensional fluoroscopy remains the standard intraoperative imaging modality. The elbow has complex anatomy, and defined standard fluoroscopic projections are lacking. Therefore, the aim of this study was to define standard projections of the elbow for intraoperative fluoroscopy. Methods: This study consisted of 2 parts. In part I, dissected cadaveric elbows were examined under fluoroscopy, and their radiographic anatomical features were assessed, with focus on projections showing defined anatomical landmarks. In part II, projections from part I were verified on entire cadavers to simulate intraoperative imaging. Standard projections for anteroposterior (AP) and lateral views as well as oblique and axial views were recorded. Results: Eight standardized projections could be defined and included 3 AP, 1 lateral, 2 oblique, and 2 axial views. By applying these specific projections, we could visualize the epicondyles, the trochlea with its medial and lateral borders, the capitellum, the olecranon, the greater sigmoid notch, the coronoid process including its anteromedial facet, the proximal radioulnar joint with the radial tuberosity, and the anterior and posterior joint lines of the distal part of the humerus. These standard projections were reliably obtained using a specific sequence. Conclusions: Knowledge about radiographic anatomy and standard projections is essential for visualizing important landmarks. With the presented standard projections of the elbow, important anatomical landmarks can be clearly examined. Thus, fluoroscopic visualization of anatomical fracture reduction and correct implant placement should be facilitated. Clinical Relevance: This basic science cadaveric study defines fluoroscopic standard projections of the elbow essential for visualization of anatomical landmarks during surgery.
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| 4. |
- Nordqvist, Jenny, 1976-, et al.
(författare)
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Heterogeneity among patients with subacromial pain – variabilities within clinical presentation and its impact on daily life
- 2021
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Ingår i: Physiotherapy. - : ELSEVIER SCI LTD. - 0031-9406 .- 1873-1465. ; 112, s. 113-120
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The primary aim was to describe the variability within clinical presentation of patients with subacromial pain in primary care, secondly to investigate associations between clinical presentation and self-reported pain intensity, shoulder function, level of anxiety and depression, and health-related quality of life. Design and setting A cross-sectional study based on data from two clinical studies in primary care, one randomized controlled trial and one implementation study. Three components: active range of motion (AROM), rotator cuff function and scapular kinematics were analyzed to describe variability within clinical presentation and patient-reported measurements were used to investigate the impact on daily life. Participants Patients aged 30-67 years, describing pain for more than two weeks, and positive signs for a minimum of three out of the following five clinical tests: impingement sign according to Neer, impingement test according to Hawkins-Kennedy, Pattes maneuver, Jobe’s test, and painful arc. Results Among the 164 patients included, 24% displayed dysfunction in one, 50% two and 24% in all three components. Limited AROM was seen in 46%, rotator cuff dysfunction in 91% and scapular dyskinesia in 57% of the patients. Conclusions These results reveal a heterogeneity among primary care patients with subacromial pain confirming a large variability regarding the components AROM, rotator cuff function and scapular kinematics. All three components appear unique (not significantly correlated) where a rotator cuff dysfunction is very frequent while limited AROM and scapular dyskinesia are more inconsistent. There are significant, but rather weak, associations between clinical presentation and impact on daily life.
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| 5. |
- Nordqvist, Jenny, 1976-, et al.
(författare)
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The minimal important change for the seven-item disability of the arm, shoulder, and hand (DASH 7) questionnaire - Assessing shoulder function in patients with subacromial pain.
- 2021
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Ingår i: JSES international. - Philadelphia, PA, United States : Elsevier. - 2666-6383. ; 5:3, s. 474-479
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Tidskriftsartikel (refereegranskat)abstract
- Background: The DASH 7 is a recently published activity-related 7-item short form of the disability of the arm, shoulder, and hand (DASH) questionnaire developed to assess shoulder function in patients with subacromial pain. Before implementation in both intervention studies and in clinical practice, it is essential to evaluate its responsiveness. The objective of this study was to determine the minimal important change (MIC) in the DASH 7 questionnaire for patients with subacromial pain after a 3 months exercise intervention in a primary care context.Methods: In this psychometric study the anchor-based MIC-distribution method was used to establish the MIC. The Patient Global Impression of Change (PGIC) was used as external criterion. Data from a clinical implementation study, aimed to implement a specific exercise strategy for patients with subacromial pain among physiotherapists in primary care, were used. Data from 70 patients were included in the analyses.Results: The correlation coefficient between Patient Global Impression of Change and the DASH 7 score change was 0.67 and the area under the curve was 0.94 (95% confidence interval: 0.88-1.0). The MICROC for improvement was detected at a mean change in 6.5 points with the sensitivity at 0.98 (98%) and the specificity at 0.78 (78%), and the MIC95% limit for improvement was detected at a mean change of 25.7 points. There were 77% of the patients who reached at least this MICROC and 51% who reached at least the MIC95% limit after 3 months of exercise intervention.Conclusion: The DASH 7 is responsive to change over time and can discriminate between patients considered to be improved and patients considered not improved. These MIC values for patients with subacromial pain in the primary care setting can be used in clinical practice and in intervention studies as an indication on the patients clinically important level of score change for improvement.
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