| 1. |
- Oodit, Ravi, et al.
(författare)
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Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries (LMIC's) : Enhanced Recovery After Surgery (ERAS) Society Recommendation
- 2022
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Ingår i: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 46:8, s. 1826-1843
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Forskningsöversikt (refereegranskat)abstract
- Background: This is the first Enhanced Recovery After Surgery (ERAS (R)) Society guideline for primary and secondary hospitals in low-middle-income countries (LMIC's) for elective abdominal and gynecologic care.Methods: The ERAS LMIC Guidelines group was established by the ERAS (R) Society in collaboration with different representatives of perioperative care from LMIC's. The group consisted of seven members from the ERAS (R) Society and eight members from LMIC's. An updated systematic literature search and evaluation of evidence from previous ERAS (R) guidelines was performed by the leading authors of the Colorectal (2018) and Gynecologic (2019) surgery guidelines (Gustafsson et al in World J Surg 43:6592-695, Nelson et al in Int J Gynecol Cancer 29(4):651-668). Meta-analyses randomized controlled trials (RCTs), prospective and retrospective cohort studies from both HIC's and LMIC's were considered for each perioperative item. The members in the LMIC group then applied the current evidence and adapted the recommendations for each intervention as well as identifying possible new items relevant to LMIC's. The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) methodology was used to determine the quality of the published evidence. The strength of the recommendations was based on importance of the problem, quality of evidence, balance between desirable and undesirable effects, acceptability to key stakeholders, cost of implementation and specifically the feasibility of implementing in LMIC's and determined through discussions and consensus.Results: In addition to previously described ERAS (R) Society interventions, the following items were included, revised or discussed: the Surgical Safety Checklist (SSC), preoperative routine human immunodeficiency virus (HIV) testing in countries with a high prevalence of HIV/AIDS (CD4 and viral load for those patients that are HIV positive), delirium screening and prevention, COVID 19 screening, VTE prophylaxis, immuno-nutrition, prehabilitation, minimally invasive surgery (MIS) and a standardized postoperative monitoring guideline.Conclusions: These guidelines are seen as a starting point to address the urgent need to improve perioperative care and to effect data-driven, evidence-based care in LMIC's.
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| 2. |
- Akner, Gunnar, 1953-, et al.
(författare)
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Glucocorticoid receptor inhibits microtubule assembly in vitro.
- 1995
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Ingår i: Molecular and cellular endocrinology. - : Elsevier BV. - 0303-7207 .- 1872-8057. ; 110:1-2, s. 49-54
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Tidskriftsartikel (refereegranskat)abstract
- The effect of glucocorticoid hormones, purified glucocorticoid receptor (GR) and purified heat shock protein M(r) 90,000 (hsp90) on microtubule (MT) assembly in vitro was tested by a spectrophotometric MT assembly assay and electron microscopy. GR significantly prolonged the nucleation phase, slowed down the assembly rate and reduced the maximal amplitude of MT assembly compared with control. The effects were partially reversed by the addition of glucocorticoid hormone. GR associated with MTs. These results indicate that GR affects MT assembly in vitro, which may be a functional correlate to the structural association of GR with MTs. This implies that factors affecting GR may affect MT assembly in vivo.
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| 3. |
- Asklid, Daniel, et al.
(författare)
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Risk Factors for Anastomotic Leakage in Patients with Rectal Tumors Undergoing Anterior Resection within an ERAS Protocol : Results from the Swedish ERAS Database
- 2021
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Ingår i: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 45:6, s. 1630-1641
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Research on risk factors for anastomotic leakage (AL) alone within an Enhanced Recovery After Surgery (ERAS) protocol has not yet been conducted. The aim of this study was to identify risk factors for AL and study short-term outcome after AL in patients operated with anterior resection (AR).METHODS: All prospectively and consecutively recorded patients operated with AR in the Swedish part of the international ERAS® Interactive Audit System (EIAS) between January 2010 and February 2020 were included. The cohort was evaluated regarding risk factors for AL and short-term outcomes, including uni- and multivariate analysis. Pre-, intra- and postoperative compliance to ERAS®Society guidelines was calculated and evaluated.RESULTS: Altogether 1900 patients were included, 155 (8.2%) with AL and 1745 without AL. Male gender, obesity, peritoneal contamination, year of surgery 2016-2020, duration of primary surgery and age remained significant predictors for AL in multivariate analysis. There was no significant difference in overall pre- and intraoperative compliance to ERAS®Society guidelines between groups. Only preadmission patient education remained as a significant ERAS variable associated with less AL. AL was associated with longer length of stay (LOS), higher morbidity rate and higher rate of reoperations.CONCLUSION: Male gender, obesity, peritoneal contamination, duration of surgery, surgery later in study period, age and preadmission patient education were associated with AL in patients operated on with AR. Overall pre- and intraoperative compliance to the ERAS protocol was high in both groups and not associated with AL.
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| 4. |
- Asklid, Daniel, et al.
(författare)
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Short-term outcome in robotic vs laparoscopic and open rectal tumor surgery within an ERAS protocol : a retrospective cohort study from the Swedish ERAS database
- 2022
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Ingår i: Surgical Endoscopy. - : Springer. - 0930-2794 .- 1432-2218. ; 36:3, s. 2006-2017
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Advantages of robotic technique over laparoscopic technique in rectal tumor surgery have yet to be proven. Large multicenter, register-based cohort studies within an optimized perioperative care protocol are lacking. The aim of this retrospective cohort study was to compare short-term outcomes in robotic, laparoscopic and open rectal tumor resections, while also determining compliance to the enhanced recovery after surgery (ERAS)®Society Guidelines.METHODS: All patients scheduled for rectal tumor resection and consecutively recorded in the Swedish part of the international ERAS® Interactive Audit System between January 1, 2010 to February 27, 2020, were included (N = 3125). Primary outcomes were postoperative complications and length of stay (LOS) and secondary outcomes compliance to the ERAS protocol, conversion to open surgery, symptoms delaying discharge and reoperations. Uni- and multivariate comparisons were used.RESULTS: Robotic surgery (N = 827) had a similar rate of postoperative complications (Clavien-Dindo grades 1-5), 35.9% compared to open surgery (N = 1429) 40.9% (OR 1.15, 95% CI (0.93, 1.41)) and laparoscopic surgery (N = 869) 31.2% (OR 0.88, 95% CI (0.71, 1.08)). LOS was longer in the open group, median 9 days (IRR 1.35, 95% CI (1.27, 1.44)) and laparoscopic group, 7 days (IRR 1.14, 95% CI (1.07, 1.21)) compared to the robotic group, 6 days. Pre- and intraoperative compliance to the ERAS protocol were similar between groups.CONCLUSIONS: In this multicenter cohort study, robotic surgery was associated with shorter LOS compared to both laparoscopic and open surgery and had lower conversion rates vs laparoscopic surgery. The rate of complications was similar between groups.
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| 5. |
- Bergh, Andreas, et al.
(författare)
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Municipally Owned Enterprises as Danger Zones for Corruption? : How Politicians Having Feet in Two Camps May Undermine Conditions for Accountabilit
- 2019
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Ingår i: Public Integrity. - : Routledge. - 1099-9922 .- 1558-0989. ; 21:3, s. 320-352
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Tidskriftsartikel (refereegranskat)abstract
- The market-inspired reforms of New Public Management have been particularly pronounced in Swedish local government. Notably, municipally owned enterprises (MOEs) have rapidly grown in numbers. Principal-agent theory gives rise to the hypothesis that the massive introduction of MOEs has impacted negatively on the conditions for accountability in Swedish local government. To study this, social network analysis was employed in mapping networks for 223 MOEs in 11 strategically chosen municipalities, covering a total of 732 politicians. The analysis reveals substantial overlaps between principals (representatives of the ultimate stakeholders, citizens) and agents (the boards of the MOEs). Hence, corporatization of public services seems to imply worrisome entanglements between the politicians who are set to steer, govern, and oversee MOEs on the one hand, and the board members of MOEs on the other. The increasing numbers of MOEs may therefore have adverse effects on accountability in important and growing parts of Swedish local government.
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| 6. |
- Brindle, M., et al.
(författare)
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Recommendations from the ERAS (R) Society for standards for the development of enhanced recovery after surgery guidelines
- 2020
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Ingår i: BJS Open. - : John Wiley & Sons. - 2474-9842. ; 4:1, s. 157-163
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Tidskriftsartikel (refereegranskat)abstract
- Background: ERAS (R) Society guidelines are holistic, multidisciplinary tools designed to improve outcomes after surgery. The enhanced recovery after surgery (ERAS) approach was initially developed for colorectal surgery and has been implemented successfully across a large number of settings, resulting in improved patient outcomes. As the ERAS approach is increasingly being adopted worldwide and new guidelines are being generated for new populations, there is a need to define an ERAS (R) Society guideline and the methodology that should be followed in its development.Methods: The ERAS (R) Society recommended approach for developing new guidelines is based on the creation of multidisciplinary guideline development groups responsible for defining topics, planning the literature search, and assessing the quality of the evidence.Results: Clear definitions for the elements of an ERAS guideline involve multimodal and multidisciplinary approaches impacting on multiple patient outcomes. Recommended methodology for guideline development follows a rigorous approach with systematic identification and evaluation of evidence, and consensus-based development of recommendations. Guidelines should then be evaluated and reviewed regularly to ensure that the best and most up-to-date evidence is used consistently to support surgical patients.Conclusion: There is a need for a standardized, evidence-informed approach to both the development of new ERAS (R) Society guidelines, and the adaptation and revision of existing guidelines.
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| 7. |
- Ekwall, Eva, et al.
(författare)
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Determination of the most effective cooling temperature for the prevention of chemotherapy‑induced alopecia
- 2013
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Ingår i: Molecular And Clinical Oncology. - : Spandidos Publications. - 2049-9450 .- 2049-9469. ; 1:6, s. 1065-1071
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Tidskriftsartikel (refereegranskat)abstract
- Computer‑controlled scalp cooling to prevent alopecia is currently available for patients undergoing chemotherapy. Previous studies have suggested that the temperature should be <22˚C at a depth of 1‑2 mm in the scalp to prevent alopecia. However, the optimal pre‑set temperature of the coolant medium to achieve this temperature requires further investigation. A pre‑study was conducted to investigate which pre‑set coolant temperature of 3 and 8˚C was the most effective in achieving a scalp temperature of <22˚C. The temperature variations at different sites of the scalp and variations within and among the participants at baseline and during the cooling procedure were also evaluated. A randomized main study was then performed to compare the efficacy and side effects of the two temperature levels during paclitaxel/carboplatin chemotherapy. A group of 5 healthy female volunteers participated in a series of scalp temperature measurements during cooling with 3 and 8˚C of the coolant medium. In the randomized main study, a total of 47 patients were included, of whom 43 were evaluable after the first cycle. A pre‑set temperature of 3˚C tended to be the most efficient in achieving a hair follicle temperature of <22˚C. The top of the head was less responsive to scalp cooling. There were no significant differences in the prevention of alopecia between the two temperatures in the main study. However, headache and a feeling of coldness were more common in the 3˚C group. A coolant temperature of 3˚C was more effective in achieving a subcutaneous temperature of <22˚C. However, this finding was not reflected by a significant difference in the prevention of alopecia in this study, although a higher incidence of side effects was associated with a lower temperature level.
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| 8. |
- Gustafsson, Ulf O., et al.
(författare)
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Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery
- 2011
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Ingår i: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 146:5, s. 571-577
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To study the impact of different adherence levels to the enhanced recovery after surgery (ERAS) protocol and the effect of various ERAS elements on outcomes following major surgery. Design: Single-center prospective cohort study before and after reinforcement of an ERAS protocol. Comparisons were made both between and across periods using multivariate logistic regression. All clinical data (114 variables) were prospectively recorded. Setting: Ersta Hospital, Stockholm, Sweden. Patients: Nine hundred fifty-three consecutive patients with colorectal cancer: 464 patients treated in 2002 to 2004 and 489 in 2005 to 2007. Main Outcome Measures: The association between improved adherence to the ERAS protocol and the incidence of postoperative symptoms, complications, and length of stay following major colorectal cancer surgery was analyzed. Results: Following an overall increase in preoperative and perioperative adherence to the ERAS protocol from 43.3% in 2002 to 2004 to 70.6% in 2005 to 2007, both postoperative complications (odds ratio, 0.73; 95% confidence interval, 0.55-0.98) and symptoms (odds ratio, 0.53; 95% confidence interval, 0.40-0.70) declined significantly. Restriction of intravenous fluid and use of a preoperative carbohydrate drink were major independent predictors. Across periods, the proportion of adverse postoperative outcomes (30-day morbidity, symptoms, and readmissions) was significantly reduced with increasing adherence to the ERAS protocol (>70%, >80%, and >90%) compared with low ERAS adherence (<50%). Conclusion: Improved adherence to the standardized multimodal ERAS protocol is significantly associated with improved clinical outcomes following major colorectal cancer surgery, indicating a dose-response relationship.
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| 9. |
- Gustafsson, Ulf O., et al.
(författare)
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Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery : A Retrospective Cohort Study
- 2016
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Ingår i: World Journal of Surgery. - New York, USA : Springer. - 0364-2313 .- 1432-2323. ; 40:7, s. 1741-1747
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Tidskriftsartikel (refereegranskat)abstract
- Background: Surgical stress can influence oncological outcome and survival. The enhanced recovery after surgery (ERAS) protocol is designed to reduce perioperative stress and has been shown to reduce postoperative morbidity. We studied if adherence to ERAS is associated with increased long-term survival.Methods: Between the years 2002 and 2007, 911 consecutive patients, operated with major colorectal cancer surgery at Ersta Hospital, Stockholm, Sweden were analyzed. The histopathological reports of the resected specimen, date, and cause of death of the patients as well as postoperative CRP levels were obtained. The relation between the rate of adherence to the ERAS protocol at the time of surgery, and the short-term outcomes in relation to 5-year overall and colorectal cancer-specific survival was determined in this retrospective cohort study.Results: In patients with ≥70 % adherence to ERAS interventions (N = 273,), the risk of 5-year cancer-specific death was lowered by 42 %, HR 0.58 (0.39-0.88, cox regression) compared to all other patients (<70 % adherence). Significant independent perioperative predictors of increased 5-year survival were avoiding overload of intravenous fluids, HR 0.53 (0.32-0.86); oral intake on the day of operation, HR 0.55 (0.34-0.78); and low CRP levels on postoperative day 1.Conclusion: High adherence to the ERAS protocol may be associated with improved 5-year cancer-specific survival after colorectal cancer surgery.
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| 10. |
- Gustafsson, Ulf O., et al.
(författare)
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Can nutritional supplements and rectal enema be used as bowel cleansing for colonoscopy? : results of a randomized controlled pilot study
- 2014
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Ingår i: Scandinavian Journal of Gastroenterology. - London : Informa Healthcare. - 0036-5521 .- 1502-7708. ; 49:4, s. 485-491
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Currently available preparations for colonoscopy have low tolerability and may cause fluid and electrolyte shifts. An alternative method of bowel cleansing is required.Material and methods. Preparation of the gut using oral nutritional supplements (ONS) and rectal enema was tested as an alternative method of bowel cleansing. During 2008-2012, patients were randomized to oral nutritional supplements (n = 27) for 5 days and rectal enema or polyethylene glycol (PEG) (n = 23) prior to colonoscopy. Blinded endoscopists rated the degree of bowel cleansing according to the Ottawa bowel preparation scale (OBS) (primary outcome). Tolerability of either preparation was also assessed (ClinicalTrials.gov. Identifier no: NCT00123456).Results. Due to a high rate of bowel cleansing failure among patients receiving ONS, the study was interrupted prematurely. Colonoscopies were incomplete due to stools in 6 of 27 patients in the ONS group compared to 1 of 23 in the PEG group (ns). The mean total OBS were 8.3 +/- 3.3 and 5.3 +/- 2.8, respectively (p = 0.002). Four patients (15%) in the ONS group and eight patients (35%) receiving PEG had an OBS score <= 4 (good preparation) (ns). ONS was better tolerated than PEG with more patients reporting acceptable taste (27 of 27 [100%] vs. 15 of 23 [65%], p = 0.001), and fewer reporting difficulties with the intake (0 of 27 [0%] vs. 10 of 23 [43%], p < 0.001) and nausea (5 of 27 [19%] vs. 13 of 23 [57%], p < 0.008).Conclusions. For routine use, ONS with enema instead of traditional preparation for colonoscopy with PEG cannot be generally recommended.
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