| 1. |
- Maron, Eduard, et al.
(författare)
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Manifesto for an international digital mental health network
- 2019
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Ingår i: Digital Psychiatry. - 2575-517X. ; :1
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Tidskriftsartikel (refereegranskat)abstract
- Current mental health services across the world remain expert-centric and are based on traditional workflows, mostly using impractical and ineffective electronic record systems or even paper-based documentation. The international network for digital mental health (IDMHN) is comprised of top-level clinicians, regulatory and ICT experts, genetic scientists, and support organizations. The IDMHN has been formed to enable the implementation of digital innovations in clinical practice, hereby facilitating the transformation of current mental health services to be more personalized and more responsive to patients and healthcare needs. This consensus statement summarizes the consortium’s vision and strategy for further development of digital mental Health.
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| 2. |
- Enochsson, Lars, et al.
(författare)
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Inversed relationship between completeness of follow-up and coverage of postoperative complications in gallstone surgery and ERCP : a potential source of bias in patient registers
- 2018
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyse the completeness in GallRiks of the follow-up frequency in relation to the intraoperative and postoperative outcome.Design: Population-based register study.Setting: Data from the national Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (ERCP), GallRiks.Population: All cholecystectomies and ERCPs recorded in GallRiks between 1 January 2006 and 31 December 2014.Main outcome measures: Outcomes for intraprocedural as well as postprocedural adverse events between units with either a 30-day follow-up of AO% compared with those with a less frequent follow-up (<90%).Results: Between 2006 and 2014, 162 212 cholecystectomies and ERCP procedures were registered in GallRiks. After the exclusion of non-index procedures and those with incomplete data 152 827 procedures remained for final analyses. In patients having a cholecystectomy, there were no differences regarding the adverse event rates, irrespective of the follow-up frequency. However, in the more complicated endoscopic ERCP procedures, the postoperative adverse event rates were significantly higher in those with a more frequent and complete 30-day follow-up (OR 1.92; 95% Cl 1.76 to 2.11).Conclusions: Differences in the follow-up frequency in registries affect the reported outcomes as exemplified by the complicated endoscopic ERCP procedures. A high and complete follow-up rate shall serve as an additional quality indicator for surgical registries.
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| 3. |
- Fabritz, Larissa, et al.
(författare)
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Dynamic risk assessment to improve quality of care in patients with atrial fibrillation : the 7th AFNET/EHRA Consensus Conference
- 2021
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Ingår i: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 23:3, s. 329-344
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Tidskriftsartikel (refereegranskat)abstract
- AimsThe risk of developing atrial fibrillation (AF) and its complications continues to increase, despite good progress in preventing AF-related strokes.Methods and resultsThis article summarizes the outcomes of the 7th Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA) held in Lisbon in March 2019. Sixty-five international AF specialists met to present new data and find consensus on pressing issues in AF prevention, management and future research to improve care for patients with AF and prevent AF-related complications. This article is the main outcome of an interactive, iterative discussion between breakout specialist groups and the meeting plenary. AF patients have dynamic risk profiles requiring repeated assessment and risk-based therapy stratification to optimize quality of care. Interrogation of deeply phenotyped datasets with outcomes will lead to a better understanding of the cardiac and systemic effects of AF, interacting with comorbidities and predisposing factors, enabling stratified therapy. New proposals include an algorithm for the acute management of patients with AF and heart failure, a call for a refined, data-driven assessment of stroke risk, suggestions for anticoagulation use in special populations, and a call for rhythm control therapy selection based on risk of AF recurrence.ConclusionThe remaining morbidity and mortality in patients with AF needs better characterization. Likely drivers of the remaining AF-related problems are AF burden, potentially treatable by rhythm control therapy, and concomitant conditions, potentially treatable by treating these conditions. Identifying the drivers of AF-related complications holds promise for stratified therapy.
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| 4. |
- Gilg, Stefan, et al.
(författare)
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Molecular adsorbent recirculating system treatment in patients with post-hepatectomy liver failure : Long-term results of a pilot study
- 2022
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Ingår i: Scandinavian Journal of Surgery. - : SAGE Publications. - 1457-4969 .- 1799-7267. ; 111:3, s. 48-55
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Tidskriftsartikel (refereegranskat)abstract
- Background: Post-hepatectomy liver failure (PHLF) is the leading cause of postoperative mortality following major liver resection. Between December 2012 and May 2015, 10 consecutive patients with PHLF (according to the Balzan criteria) following major/extended hepatectomy were included in a prospective treatment study with the molecular adsorbent recirculating system (MARS). Sixty- and 90-day mortality rates were 0% and 10%, respectively. Of the nine survivors, four still had liver dysfunction at 90 days postoperatively. One-year overall survival (OS) of the MARS-PHLF cohort was 50%. The present study aims to assess long-term outcome of this cohort compared to a historical control cohort.Methods: To compare long-term outcome of the MARS-PHLF treatment cohort with PHLF patients not treated with MARS, the present study includes all 655 patients who underwent major hepatectomy at Karolinska University Hospital between 2010 and 2018. Patients with PHLF were identified according to the Balzan criteria.Results: The cohort was split into three time periods: pre-MARS period (n = 192), MARS study period (n = 207), and post-MARS period (n = 256). The 90-day mortality of patients with PHLF was 55% (6/11) in the pre-MARS period, 14% during the MARS study period (2/14), and 50% (3/6) in the post-MARS period (p = 0.084). Median OS (95% confidence interval (CI)) was 37.8 months (29.3–51.7) in the pre-MARS cohort, 57 months (40.7–75.6) in the MARS cohort, and 38.8 months (31.4–51.2) in the post-MARS cohort. The 5-year OS of 10 patients included in the MARS study was 40% and the median survival 11.6 months (95% CI: 3 to not releasable). In contrast, for the remaining 21 patients fulfilling the Balzan criteria during the study period but not treated with MARS, the 5-year OS and median survival were 9.5% and 7.3 months (95% CI, 0.5–25.9), respectively (p = 0.138)).Conclusions: MARS treatment may contribute to improved outcome of patients with PHLF. Further studies are needed.The initial pilot study was registered at ClinicalTrials.gov (NCT03011424).
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| 5. |
- Holmberg, Jonas, 1976-, et al.
(författare)
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Machining of additively manufactured alloy 718 in as-built and heat-treated condition: surface integrity and cutting tool wear
- 2024
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Ingår i: The International Journal of Advanced Manufacturing Technology. - : Springer Nature. - 0268-3768 .- 1433-3015. ; 130:3-4, s. 1823-1842
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Tidskriftsartikel (refereegranskat)abstract
- Additive manufacturing (AM) using powder bed fusion is becoming a mature technology that offers great possibilities and design freedom for manufacturing of near net shape components. However, for many gas turbine and aerospace applications, machining is still required, which motivates further research on the machinability and work piece integrity of additive-manufactured superalloys. In this work, turning tests have been performed on components made with both Powder Bed Fusion for Laser Beam (PBF-LB) and Electron Beam (PBF-EB) in as-built and heat-treated conditions. The two AM processes and the respective heat-treatments have generated different microstructural features that have a great impact on both the tool wear and the work piece surface integrity. The results show that the PBF-EB components have relatively lower geometrical accuracy, a rough surface topography, a coarse microstructure with hard precipitates and low residual stresses after printing. Turning of the PBF-EB material results in high cutting tool wear, which induces moderate tensile surface stresses that are balanced by deep compressive stresses and a superficial deformed surface that is greater for the heat-treated material. In comparison, the PBF-LB components have a higher geometrical accuracy, a relatively smooth topography and a fine microstructure, but with high tensile stresses after printing. Machining of PBF-LB material resulted in higher tool wear for the heat-treated material, increase of 49%, and significantly higher tensile surface stresses followed by shallower compressive stresses below the surface compared to the PBF-EB materials, but with no superficially deformed surface. It is further observed an 87% higher tool wear for PBF-EB in as-built condition and 43% in the heat-treated condition compared to the PBF-LB material. These results show that the selection of cutting tools and cutting settings are critical, which requires the development of suitable machining parameters that are designed for the microstructure of the material.
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| 6. |
- Jonas, Eduard
(författare)
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Image-based dynamic liver testing : studies of segmental hepatic parenchymal function and biliary flow using dynamic 99Tcm-HIDA SPECT
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the study was to create a dynamic liver function test using a tomographic imaging procedure as sampling method. The liver has multiple and complex functions. It is obvious that no single test can give a comprehensive measurement of total liver function. Currently available tests, including analyte measurements and clearance tests, give limited information. Furthermore, no test is able to measure function on a segmental level. The ultimate liver function test is probably multi-compartment quantitative analysis (QA) of a dynamic test. This requires a safe, well tolerated test substance, not influenced by diet, drugs or genetic factors. As a dynamic test requires repetitive sampling, the sampling method should be noninvasive and able to detect the test substance in all compartments involved in the kinetics of the test substance. We have developed a technique of dynamic 99Tcm-HIDA SPECT (single photon emission computed tomography) allowing creation of time-activity curves for the isotope in individual liver segments. QA of these curves can measure uptake and excretion of the isotope as an indication of function on a segmental level. In principle, the test is a dynamic liver function test using an imaging modality (SPECT) as sampling device. The concept was simulated in a 3-D virtual reality liver model. Advancing the dynamic SPECT technique according to the model, we separated activity for parenchyma and bile ducts and created separate dynamic studies for these structures. This refinement, being a step in the direction of a true multi-compartmental dynamic test, using image sampling, was tested in a normal volunteer population and in patients with primary sclerosing cholangitis (PSC). The complicated management of PSC stresses the limitations of currently used liver function tests. In patients with PSC, QA of the dynamic SPECT data correlated statistically significantly with biochemical parameters and the revised Mayo prognostic score. On a segmental level, the scintigraphic data reflecting biliary flow correlated with cholangiographic findings. A method capable of evaluating liver function and quantifying bile flow on a segmental level has several possible applications, particularly in segmental liver diseases. It may aid in predicting prognosis and selecting and timing of various treatment options. Specifically, the importance of radiologically detected strictures in terms of flow obstruction can be quantified and the outcome of intervention measured. Our data suggest differences in liver function between different segments in normal livers. Expressing total liver function as the total of the product of volume and segmental function in individual segments, may give a more accurate estimate of total liver function. Physiological differences between the left and right hemi-livers, as indicated by our results, may play a role in the non-homogeneity and hemi-liver preferences of some liver diseases.
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| 7. |
- Kaarre, Janina, 1996, et al.
(författare)
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Differences in postoperative knee function based on concomitant treatment of lateral meniscal injury in the setting of primary ACL reconstruction.
- 2023
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Ingår i: BMC musculoskeletal disorders. - 1471-2474. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Concomitant lateral meniscal (LM) injuries are common in acute anterior cruciate ligament (ACL) ruptures. However, the effect of addressing these injuries with various treatment methods during primary ACL reconstruction (ACLR) on patient-reported outcomes (PROs) is unknown. Therefore, the purpose of this study was to compare postoperative Knee injury and Osteoarthritis Outcome Score (KOOS) at 2-, 5-, and 10-years after isolated primary ACLR to primary ACLR with various treatment methods to address concomitant LM injury.This study was based on data from the Swedish National Knee Ligament Registry. Patients≥15years with data on postoperative KOOS who underwent primary ACLR between the years 2005 and 2018 were included in this study. The study population was divided into five groups: 1) Isolated ACLR, 2) ACLR+LM repair, 3) ACLR+LM resection, 4) ACLR+LM injury left in situ, and 5) ACLR+LM repair+LM resection. Patients with concomitant medial meniscal or other surgically treated ligament injuries were excluded.Of 31,819 included patients, 24% had LM injury. After post hoc comparisons, significantly lower scores were found for the KOOS Symptoms subscale in ACLR+LM repair group compared to isolated ACLR (76.0 vs 78.3, p=0.0097) and ACLR+LM injury left in situ groups (76.0 vs 78.3, p=0.041) at 2-year follow-up. However, at 10-year follow-up, no differences were found between ACLR+LM repair and isolated ACLR, but ACLR+LM resection resulted in significantly lower KOOS Symptoms scores compared to isolated ACLR (80.4 vs 82.3, p=0.041).The results of this study suggest that LM injury during ACLR is associated with lower KOOS scores, particularly in the Symptoms subscale, at short- and long-term follow-up. However, this finding falls below minimal clinical important difference and therefore may not be clinically relevant.III.
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| 8. |
- Kirchhof, Paulus, et al.
(författare)
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A roadmap to improve the quality of atrial fibrillation management : proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference
- 2016
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Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 18:1, s. 37-50
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Tidskriftsartikel (refereegranskat)abstract
- At least 30 million people worldwide carry a diagnosis of atrial fibrillation (AF), and many more suffer from undiagnosed, subclinical, or 'silent' AF. Atrial fibrillation-related cardiovascular mortality and morbidity, including cardiovascular deaths, heart failure, stroke, and hospitalizations, remain unacceptably high, even when evidence-based therapies such as anticoagulation and rate control are used. Furthermore, it is still necessary to define how best to prevent AF, largely due to a lack of clinical measures that would allow identification of treatable causes of AF in any given patient. Hence, there are important unmet clinical and research needs in the evaluation and management of AF patients. The ensuing needs and opportunities for improving the quality of AF care were discussed during the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference in Nice, France, on 22 and 23 January 2015. Here, we report the outcome of this conference, with a focus on (i) learning from our 'neighbours' to improve AF care, (ii) patient-centred approaches to AF management, (iii) structured care of AF patients, (iv) improving the quality of AF treatment, and (v) personalization of AF management. This report ends with a list of priorities for research in AF patients.
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| 9. |
- Kotecha, Dipak, et al.
(författare)
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Integrating new approaches to atrial fibrillation management : the 6th AFNET/EHRA Consensus Conference.
- 2018
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Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 20:3, s. 395-407
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Tidskriftsartikel (refereegranskat)abstract
- There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.
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| 10. |
- Kullman, Eric, et al.
(författare)
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Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study
- 2010
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Ingår i: GASTROINTESTINAL ENDOSCOPY. - : Elsevier Science B. V., Amsterdam. - 0016-5107 .- 1097-6779. ; 72:5, s. 915-923
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Tidskriftsartikel (refereegranskat)abstract
- Background: Covered biliary metal stents have been developed to prevent tumor ingrowth. Previous comparative studies are limited and often include few patients. Objective: To compare differences in stent patency, patient survival, and complication rates between covered and uncovered nitinol stents in patients with malignant biliary obstruction. Design: Randomized, multicenter trial conducted between January 2006 and October 2008. Setting: Ten sites serving a total catchment area of approximately 2.8 million inhabitants. Patients: A total of 400 patients with unresectable distal malignant biliary obstruction. Interventions: ERCP with insertion of covered or uncovered metal stent. Follow-up conducted monthly for symptoms indicating stent obstruction. Main Outcome Measurements: Time to stent failure, survival time, and complication rate. Results: The patient survival times were 116 days (interquartile range 242 days) and 174 days (interquartile range 284 days) in the covered and uncovered stent groups, respectively (P = .320). The first quartile stent patency time was 154 days in the covered stent group and 199 days in the uncovered stent group (P = .326). There was no difference in the incidence of pancreatitis or cholecystitis between the 2 groups. Stent migration occurred in 6 patients (3%) in the covered group and in no patients in the uncovered group (P = .030). Limitations: Randomization was not blinded. Conclusions: There were no significant differences in stent patency time, patient survival time, or complication rates between covered and uncovered nitinol metal stents in the palliative treatment of malignant distal biliary obstruction. However, covered stents migrated significantly more often compared with uncovered stents, and tumor ingrowth was more frequent in uncovered stents.
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