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- Bass, Gary Alan, 1979-, et al.
(författare)
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Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study
- 2023
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1615-3146 .- 1863-9941. ; 49, s. 17-32
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods: We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results: Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p < 0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41–0.82), p = 0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11–0.96), p = 0.045] complications could be detected when using energy devices. Conclusions: Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts.
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- Eriksson, Mats, Professor, 1959-, et al.
(författare)
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Pain scales in clinical trials in newborn infants : a mapping of the evidence
- 2019
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Konferensbidrag (refereegranskat)abstract
- Background: Numerous clinical studies have aimed at finding a strategy to reduce the pain newborn infants are subjected to by their medical conditions and also by medical and caring procedures. Little is however known about whether the outcome measures in these trials are valid for the specific type of pain or group of infants included in the studies. There are today over 40 published scales, consisting of behavioral or physiological signals or a combination of both. The aim of this study was to evaluate the reporting of pain scales assessments that were most commonly used in all the published trials examining interventions related to neonatal pain.Methods: A systematic and broad search up to January 2019 was performed in Embase, PubMed, PsycInfo, Cinahl, Cochrane Library, Scopus and Luxid. Randomized and quasi-randomized clinical trials on neonatal pain were included. Title and abstract screening followed by full text screening were performed by two independent researchers using an online tool for the preparation of systematic reviews (Covidence). Disagreements were resolved by a third researcher or in discussions within the group, as recommended in the Cochrane handbook. Data extraction and quality assessment were also performed by two researchers independently. Results: The systematic search retrieved 3715 scientific articles. Following screening, 342 studies with a total of 16210 infants were included, reporting data from the use of at least one neonatal pain assessment scale. Ninety per cent of the studies concerned procedural pain where the most frequently used pain scales were PIPP or PIPP-R (43%), followed by NIPS (17%). For ongoing or post-operative pain there was a more unclear pattern with COMFORT (24%) and NFCS (10%) as the most reported. We observed a wide variation of pain scales (Fig 1) and found numerous studies where pain scales were used that were not validated for the studied population or type of pain. In 11 papers self-constructed study-specific scales were used. The most frequent sources of procedural pain were heel lance (28% of the studies) followed by venipuncture (10%) and ROP-screening (5%).Conclusion: This is the first scoping review reporting systematically how neonatal pain scales are used in clinical trials. There are a few validated pain assessment scales used in most clinical studies. It is crucial to choose an appropriate scale, validated for the type of pain and population of infants included in the study. The inappropriate use of pain scales raises serious concerns on ethical conduct of research and waste of resources.
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- Eriksson, Mats, Professor, 1959-, et al.
(författare)
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Pain scales in clinical trials in newborn infants : a mapping of the evidence
- 2019
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Konferensbidrag (refereegranskat)abstract
- Background: Numerous clinical studies have aimed at reducing pain in newborn infants. Little is known about whether the outcome measures are valid for the specific type of pain or group of infants included. Aim: To evaluate the reporting of pain assessments used in published trials.Methods: A systematic search up to January 2019 was performed in Embase, PubMed, PsycInfo, Cinahl, Cochrane Library, Scopus and Luxid. Randomized and quasi-randomized clinical trials were included. Title and abstract screening followed by full text screening were performed by two independent researchers. Data extraction and quality assessment were also performed by two researchers independently.Results: The search retrieved 3715 articles. 342 studies with a total of 16210 infants were included. 90% of the studies concerned procedural pain where the most frequently used pain scales were PIPP or PIPP-R followed by NIPS For ongoing or post-operative pain COMFORT and NFCS were mostly used. We observed a wide variation of pain scales and found numerous studies where pain scales were used that were not validated for the studied population or type of pain. Conclusion: This is the first scoping review reporting systematically how neonatal pain scales are used in clinical trials. There are a few validated pain assessment scales used in most clinical studies. It is crucial to choose an appropriate scale, validated for the type of pain and population of infants included in the study. The inappropriate use of pain scales raises serious concerns on ethical conduct of research and waste of resources.
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- Forssten, Maximilian Peter, 1996-, et al.
(författare)
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Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective
- 2023
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1615-3146 .- 1863-9941. ; 49, s. 57-67
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods: Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15years who underwent appendectomy for appendicitis (November 2020–May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results: Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion: During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.
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- Khalili, Hosseinali, et al.
(författare)
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Beta-Blocker Therapy in Severe Traumatic Brain Injury : A Prospective Randomized Controlled Trial
- 2020
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Ingår i: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 44:6, s. 1844-1853
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Tidskriftsartikel (refereegranskat)abstract
- Background: Observational studies have demonstrated improved outcomes in TBI patients receiving in-hospital beta-blockers. The aim of this study is to conduct a randomized controlled trial examining the effect of beta-blockers on outcomes in TBI patients.Methods: Adult patients with severe TBI (intracranial AIS >= 3) were included in the study. Hemodynamically stable patients at 24 h after injury were randomized to receive either 20 mg propranolol orally every 12 h up to 10 days or until discharge (BB+) or no propranolol (BB-). Outcomes of interest were in-hospital mortality and Glasgow Outcome Scale-Extended (GOS-E) score on discharge and at 6-month follow-up. Subgroup analysis including only isolated severe TBI (intracranial AIS >= 3 with extracranial AIS <= 2) was carried out. Poisson regression models were used.Results: Two hundred nineteen randomized patients of whom 45% received BB were analyzed. There were no significant demographic or clinical differences between BB+ and BB- cohorts. No significant difference in inhospital mortality (adj. IRR 0.6 [95% CI 0.3-1.4], p = 0.2) or long-term functional outcome was measured between the cohorts (p = 0.3). One hundred fifty-four patients suffered isolated severe TBI of whom 44% received BB. The BB? group had significantly lower mortality relative to the BB- group (18.6% vs. 4.4%, p = 0.012). On regression analysis, propranolol had a significant protective effect on in-hospital mortality (adj. IRR 0.32, p = 0.04) and functional outcome at 6-month follow-up (GOS-E >= 5 adj. IRR 1.2, p = 0.02).Conclusion: Propranolol decreases in-hospital mortality and improves long-term functional outcome in isolated severe TBI. This randomized trial speaks in favor of routine administration of beta-blocker therapy as part of a standardized neurointensive care protocol.Level of evidence: Level II; therapeutic.Study type: Therapeutic study.
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| 8. |
- Olsson, Emma, 1980-, et al.
(författare)
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Nationella riktlinjer för prevention och behandling av smärta i nyföddhetsperioden
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- De riktlinjer som presenteras här syftar till vägledning i den kliniska vardagen. Även om riktlinjerna i första hand riktar sig till avdelningar som bedriver neonatal intensivvård och/eller intermediärvård fungerar de också som vägledning för andra enheter som arbetar med nyfödda barn. Dokumentet kan användas som underlag vid utformning av regionala riktlinjer och utbildningsprogram på respektive vårdinrättning. Vi rekommenderar att med hjälp av dessa riktlinjer lokalt skapa och implementera PM utifrån den kunskap, erfarenhet och de väl inarbetade rutiner och läkemedel som personalen är förtrogen med. Osäkerhet avseende farmakologisk behandling kan medföra såväl underbehandling som felbehandling och kommer inte det sjuka barnet tillgodo. Efter en genomgång av principerna för smärtskattning görs en genomgång av tillgängliga behandlingsalternativ innefattande optimerad vårdmiljö och beteendestödjande åtgärder samt läkemedel. Därefter presenteras de indikationer – kliniska situationer – som möter den personal som arbetar med nyfödda barn, indelat i olika smärttyper.
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| 9. |
- Olsson, Emma, 1980-, et al.
(författare)
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The use and reporting of neonatal pain scales : a systematic review of randomized trials
- 2021
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Ingår i: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 162:2, s. 353-360
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Forskningsöversikt (refereegranskat)abstract
- The burden of pain in newborn infants has been investigated in numerous studies, but little is known about the appropriateness of the use of painscales according to the specific type of pain or infant condition. This systematic review aimed to evaluate the reporting of neonatal pain scales in randomized trials. A systematic search up to March 2019 was performed in Embase, PubMed, PsycInfo, Cinahl, Cochrane Library, Scopus and Luxid. Randomized and quasi-randomized trials reporting neonatal pain scales were included. Screening of the studies for inclusion, data extraction and quality assessment were performed independently by two researchers. Out of 3718 trials found, 352 with 29137 infants and 22 published painscales were included. Most studies (92%) concerned procedural pain, where the most frequently used pain scales were PIPP or PIPP-R (48%), followed by NIPS (23%). Although NIPS is validated only for acute pain, it was also the second most used scale for ongoing and postoperative pain(21%). Only in a third of the trials, blinding for those performing the painassessment was described. In 55 studies (16%), pain scales that were used lacked validation for the specific neonatal population or type of pain. Six validated pain scales were used in 90% of all trials, though not always in the correct population or type of pain. Depending on the type of pain and population of infants included in a study, appropriate scales should be selected. The inappropriate use raises serious concerns about research ethics and use of resources.
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