| 1. |
- Backman, Ann-Sofie
(författare)
-
Emergency care seeking behaviour : in relation to patients' and providers' perceptions and attitudes
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: This study was developed with the main objective of evaluating users of emergency departments (ED) triaged as non-urgent following a period of time when large cutbacks in hospital and ambulatory care were taking place in Sweden. Aim: To analyse patients seeking medical attention for conditions triaged as non-urgent at an ED and patients who used non-scheduled services in primary care (PC) in relation to their symptoms, perceptions and the physicians’ assessments of urgency, and to register their subsequent health care use within one month. The question was; are non-urgent patients at the ED similar to unscheduled PC patients? Methods: In this cross-sectional study subjects from a defined catchment area were identified and interviewed at the time of a non-scheduled PC visit, or a non-referred, non-urgent (triage level 4) ED visit. Structured face-to-face interviews and a concomitant questionnaire to the treating physician were used to collect the data in office hours during a nine-week period. The subjects’ subsequent health care contacts within a month were registered through a population based registry. Results: Of 924 eligible patients, 736 (80%) agreed to participate, 194 at the ED and 542 at the nine PC centres. The two groups shared demographic characteristics except for gender. A majority (47%) of the patients at the PC centres had respiratory symptoms, whereas most non-urgent ED patients (52%) had digestive symptoms, musculoskeletal symptoms, or symptoms due to trauma. Both groups had used health care frequently, but ED patients had previously been more often hospitalized (35%) than PC patients (21%) (p<0.001). ED patients were more anxious about and disturbed by their symptoms and had had a shorter duration of symptoms. Regular monitoring of chronic disease was associated with an increased probability of another physician visit the following month (OR 2.0; CI 95%, 1.2-3.4). The majority of patients was found to have complaints appropriate for the setting, but general practitioners considered to a higher extent than their ED colleagues that patients had chosen an appropriate level of care (p<0.001). General practitioners were older and had longer clinical experience than physicians at the ED. ED patients, having chosen an appropriate care level as judged by the physician, were distinguished by different symptom presentation, shorter duration of symptoms, and more regular previous health care use. Men without previous regular health care use were more likely to present symptoms assessed as inappropriate for the ED (p <0.001), and this group was also less likely to use health information or advice before seeking care (p<0.01). Conclusions: Non-urgent ED patients and PC patients had similar socio-demographic characteristics but differed regarding types of diseases, previous hospitalizations and current perception of symptoms. Patients with disorders that ED physicians considered inappropriate for the setting had low previous regular health care use but their treating physicians were less experienced than the physicians in PC. General practitioners agreed with their patients´ choice of health care level to a large extent. Information concerning appropriate health care level could be targeted to individuals with low previous health care use. No evidence was found for any widespread misuse of the ED service during the time of the study.
|
|
| 2. |
- Bengtsson, Daniel, 1975-, et al.
(författare)
-
Corticotroph Pituitary Carcinoma in a Patient With Lynch Syndrome (LS) and Pituitary Tumors in a Nationwide LS Cohort
- 2017
-
Ingår i: Journal of Clinical Endocrinology and Metabolism. - : OXFORD UNIV PRESS INC. - 0021-972X .- 1945-7197. ; 102:11, s. 3928-3932
-
Tidskriftsartikel (refereegranskat)abstract
- Context: Lynch syndrome (LS) is a cancer-predisposing syndrome caused by germline mutations in genes involved in DNA mismatch repair (MMR). Patients are at high risk for several types of cancer, but pituitary tumors have not previously been reported. Case: A 51-year-old man with LS (MSH2 mutation) and a history of colon carcinoma presented with severe Cushing disease and a locally aggressive pituitary tumor. The tumor harbored a mutation consistent with the patients germline mutation and displayed defect MMR function. Sixteen months later, the tumor had developed into a carcinoma with widespread liver metastases. The patient prompted us to perform a nationwide study in LS. Nationwide Study: A diagnosis consistent with a pituitary tumor was sought for in the Swedish National Patient Registry. In 910 patients with LS, representing all known cases in Sweden, another two clinically relevant pituitary tumors were found: an invasive nonsecreting macroadenoma and a microprolactinoma (i.e., in total three tumors vs. one expected). Conclusion: Germline mutations in MMR genes may contribute to the development and/or the clinical course of pituitary tumors. Because tumors with MMR mutations are susceptible to treatment with immune checkpoint inhibitors, we suggest to actively ask for a family history of LS in the workup of patients with aggressive pituitary tumors.
|
|
| 3. |
- Bryant, Patrick, et al.
(författare)
-
Exome sequencing in a Swedish family with PMS2 mutation with varying penetrance of colorectal cancer : investigating the presence of genetic risk modifiers in colorectal cancer risk
- 2023
-
Ingår i: European Journal of Cancer Prevention. - 0959-8278 .- 1473-5709. ; 32:2, s. 113-118
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Lynch syndrome is caused by germline mutations in the mismatch repair (MMR) genes, such as the PMS2 gene, and is characterised by a familial accumulation of colorectal cancer. The penetrance of cancer in PMS2 carriers is still not fully elucidated as a colorectal cancer risk has been shown to vary between PMS2 carriers, suggesting the presence of risk modifiers.Methods Whole exome sequencing was performed in a Swedish family carrying a PMS2 missense mutation [c.2113G>A, p.(Glu705Lys)]. Thirteen genetic sequence variants were further selected and analysed in a case-control study (724 cases and 711 controls).Results The most interesting variant was an 18 bp deletion in gene BAG1. BAG1 has been linked to colorectal tumour progression with poor prognosis and is thought to promote colorectal tumour cell survival through increased NF-κB activity.Conclusions We conclude the genetic architecture behind the incomplete penetrance of PMS2 is complicated and must be assessed in a genome wide manner using large families and multifactorial analysis.
|
|
| 4. |
- Ludvigsson, Jonas F., 1969-, et al.
(författare)
-
Fracture Risk in Patients With Inflammatory Bowel Disease : A Nationwide Population-Based Cohort Study From 1964 to 2014
- 2019
-
Ingår i: American Journal of Gastroenterology. - : Lippincott Williams & Wilkins. - 0002-9270 .- 1572-0241. ; 114:2, s. 291-304
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Most studies on fractures in inflammatory bowel disease (IBD) are based on patients from tertiary centers or patients followed up before the introduction of immunomodulators or biologics. In addition, the role of corticosteroids in fracture risk has rarely been examined.METHODS: We conducted a nationwide population-based cohort study of 83,435 patients with incident IBD (ulcerative colitis [UC]: n = 50,162, Crohn's disease [CD]: n = 26,763, and IBD unclassified: 6,510) and 825,817 reference individuals from 1964 to 2014. Using multivariable Cox regression, we estimated hazard ratios (HRs) for hip fracture and any fracture and the association with cumulative corticosteroid exposure.RESULTS: During 1,225,415 person-years of follow-up in patients with IBD, there were 2,491 first-time hip fractures (203/100,000 person-years) compared with 20,583 hip fractures during 12,405,642 person-years in reference individuals (159/100,000 person-years). This corresponded to an HR of 1.42 (95% confidence interval [CI] = 1.36-1.48). The risk for hip fracture was higher in CD compared with UC (P < 0.001). Inflammatory bowel disease was also associated with any fracture (IBD: HR = 1.18; 95% CI = 1.15-1.20). Hazard ratios for hip fracture had not changed since the introduction of immunomodulators or biologics. Increasing exposure to corticosteroids was associated with hip fracture in both IBD and non-IBD individuals (P < 0.001), but only in elderly (>60 years) patients with IBD. The association between IBD and hip fracture was nonsignificant among individuals without corticosteroids (HR = 1.11; 95% CI = 0.86-1.44).CONCLUSIONS: Inflammatory bowel disease (CD and UC) is associated with an increased risk of hip fracture and any fracture, but not in individuals without a history of corticosteroid treatment. The association between corticosteroids and hip fracture was restricted to elderly patients with IBD.
|
|
| 5. |
- Thorlacius, Henrik, et al.
(författare)
-
Updated Swedish guidelines for endoscopic surveillance after colorectal polypectomy : [Nya riktlinjer: endoskopisk kontroll efter kolorektal polypektomi]
- 2022
-
Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 119:46-47
-
Tidskriftsartikel (refereegranskat)abstract
- These new guidelines are based on the recommendations published by European Society of Gastrointestinal Endoscopy (ESGE) in 2020. Low risk patients, i.e. after removal of 1-4 <10 mm adenomas with low grade dysplasia (irrespective of villous components), or any serrated lesion (hyperplastic polyp, sessile serrated lesion, or traditional serrated adenoma) <10 mm without dysplasia, are not recommended a surveillance colonoscopy. High-risk patients, i.e. after removal of at least one adenoma ≥10 mm or with high grade dysplasia or any serrated lesion ≥10 mm or with dysplasia, should undergo a surveillance colonoscopy after 3 years. If high-risk lesions are detected at surveillance colonoscopy, a 3-year repetition of the next endoscopic examination is recommended. If a high-risk patient has no high-risk lesions at surveillance colonoscopy, a 5-year period is recommended until the next surveillance colonoscopy. In general, follow-up should be terminated at 80 years of age.
|
|
