| 1. |
- Collins, Elin, et al.
(författare)
-
Physicians' assessment of complications after gynecological surgery in Sweden : The GYNCOM survey
- 2023
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 102:11, s. 1479-1487
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Complications after gynecological surgery in Sweden are registered in the well-established Swedish National Quality Register of Gynecological Surgery, GynOp. The aim of this study was to analyze interrater reliability in assessing complications according to the methods in GynOp, and to explore physicians' perceptions of registering complications.Material and methods: A digital survey was sent to gynecologists and residents in gynecology in Sweden. Participating clinics were recruited through the Swedish network for national clinical studies in Obstetrics and Gynecology, SNAKS. Twenty fictional cases, intended to represent normal postoperative course, failure to cure, and varying degrees of complications, were developed by the research group. The clinical scenarios included abdominal and laparoscopic surgery of the uterus and adnexa, vaginal hysterectomies, as well as hysteroscopy. The respondents graded each case on the presence of a complication (yes/no). Type of complication, severity, and what action the complication required according to Clavien-Dindo was registered if a complication was acknowledged, according to the method in GynOp. Interrater reliability and the opinions of the respondents were presented descriptively. More than 80% of respondents making the same assessment was considered as agreement.Results: The response rate was 41%, with 104 responding physicians from 16 gynecological clinics. Type and severity of complication was considered relevant to register by 88% and 89% of respondents, respectively. Agreement on whether the case described a complication was >80% in 85% (17/20) of cases and agreement using the Clavien-Dindo classification was >90% in 80% (16/20) of cases. There was high agreement in assessments of classically severe complications, such as pulmonary embolism and ureteral damage, in both presence of complication and severity, as well as Clavien-Dindo (>90% for all methods). Cases with agreement <80% on whether the case described a complication were bordering between normal postoperative course and minor complication.Conclusions: This study provides validation for the methods used to register complications after gynecological surgery according to the GynOp register, including the use of Clavien-Dindo in gynecology. However, the results indicate a need to define what should be considered symptoms inherent to each type of surgery.
|
|
| 2. |
- Ehrström, Sophia
(författare)
-
Aspects on chronic stress and glucose metabolism in women with recurrent vulvovaginal candidiasis and in women with localized provoked vulvodynia
- 2007
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To evaluate the degree of stress in women with recurrent vulvovaginal candidiasis (RVVC) and in women with localized provoked vulvodynia (LPV) (former vulvar vestibulitis syndrome) compared with controls. To measure the change of glucose in plasma and in vaginal secretions during oral glucose tolerance testing (OGTT) in women with RVVC, and in healthy control subjects. Material and Methods: Altogether 147 women participated in the studies. A careful vulvovaginal examination was performed and a health questionnaire was completed. In some women, saliva for analysis of cortisol was collected 4 times in the morning and once in the evening. The analysis was performed with a time-resolved fluorescence immunoassay. A questionnaire about perceived stress at work and in private life was completed. Another part of the women underwent OGTT. Vaginal secretion from the proximal part of the vagina was collected on filter papers. Glucose in plasma and in vaginal secretions was measured at fasting and after two hours. In a subgroup of women with RVVC and control subjects, glucose in vaginal secretions and in plasma was collected every half-hour during OGTT. All samples were analysed with the hexokinase method. Results: Blunted morning rise cortisol was registered more often in women with RVVC (p<0.002). Mean levels of salivary cortisol were lower the first 45 minutes after awakening in women with RVVC, compared with controls. Blunted morning rise cortisol was registered more often in women with LPV (p<0.05), compared with controls. Both women with RVVC, and women with LPV reported signs of burnout (p<0.001 and p<0.005), emotional symptoms of stress (p<0.005 and p<0.05), bodily symptoms of stress (p<0.05 and 0.005), and presented type D-personality (p<0.05). Moreover, women with RVVC perceived more worrying factors at work (p<0.05), and an impaired balance between work and leisure time (p=0.01). More women with RVVC than controls reported a history of condyloma (p<0.001), and bacterial vaginosis (p<0.001). No differences were seen between women with RVVC and controls regarding SHBG, DHEA-s, testosterone or HbA1C. In healthy women, the median level of glucose in vaginal secretion was 5.2 mmol /L before and 3.7 mmol /L after OGTT, and plasma glucose was 5.0 mmol /L before and 5.8 mmol /L afterOGTT. No significant difference was seen regarding change of glucose level in vaginal secretions, and plasma glucose after, compared with before OGTT. Neither was there any difference between women with RVVC and controls regarding vaginal and plasma glucose levels every half hour during OGTT. Hemoglobin A1C and body mass index did not differ between the groups. In oral contraceptive users glucose in plasma 60 minutes after intake of 75 g of glucose (p=0.005) was higher than in women not using oral contraceptives. Conclusions: More women with RVVC and LPV than controls showed signs of chronic stress. The evaluation was performed with two different techniques. There were no differences between women with RVVC and control subjects regarding change in glucose level in vaginal secretions or in plasma, during OGTT. Vaginal glucose levels did not rise in oral contraceptive users during OGTT, in spite of higher plasma glucose levels 60 minutes after intake of 75 g of glucose. There were no differences in plasma or vaginal glucose levels before and after OGTT.
|
|
| 3. |
- Ehrström, Sophia, et al.
(författare)
-
Lactic acid bacteria colonization and clinical outcome after probiotic supplementation in conventionally treated bacterial vaginosis and vulvovaginal candidiasis
- 2010
-
Ingår i: Microbes and infection. - : Elsevier BV. - 1286-4579 .- 1769-714X. ; 12:10, s. 691-699
-
Tidskriftsartikel (refereegranskat)abstract
- This randomized double-blind placebo controlled study assessed the vaginal colonization of lactic acid bacteria and clinical outcome. Vaginal capsules containing L gasseri LN40, Lactobacillus fermentum LN99, L. casei subsp. rhamnosus LN113 and P. acidilactici LN23, or placebos were administered for five days to 95 women after conventional treatment of bacterial vaginosis and/or vulvovaginal candidiasis. Vulvovaginal examinations and vaginal samplings were performed before and after administration, after the first and second menstruation, and after six months. Presence of LN strains was assessed using RAPD analysis. LN strains were present 2-3 days after administration in 89% of the women receiving LN strains (placebo: 0%, p < 0.0001). After one menstruation 53% were colonized by at least one LN strain. Nine percent were still colonized six months after administration. Ninety-three percent of the women receiving LN strains were cured 2-3 days after administration (placebo: 83%), and 78% after one menstruation (placebo: 71%) (ns). The intervention group experienced less malodorous discharge 2-3 days after administration (p = 0.03) and after the second menstruation (p = 0.04), compared with placebo. In summary, five days of vaginal administration of LN strains after conventional treatment of bacterial vaginosis and/or vulvovaginal candidiasis lead to vaginal colonization, somewhat fewer recurrences and less malodorous discharge.
|
|
| 4. |
- Stuart, Andrea, et al.
(författare)
-
vNOTES – en ny minimalinvasiv metod för gynekologisk kirurgi
- 2023
-
Ingår i: Lakartidningen. - 0023-7205 .- 1652-7518. ; 120
-
Tidskriftsartikel (refereegranskat)abstract
- vNOTES hysterectomy is a scarless minimally invasive method with a vaginal approach to the abdominal cavity combined with endoscopic overview. Studies have shown that patients who underwent vNOTES hysterectomy had less pain and shorter hospital stay than after laparoscopic hysterectomy.
|
|
