| 1. |
- Hagberg, Johan, 1973, et al.
(författare)
-
Konsumtionsrapporten 2023
- 2023
-
Rapport (populärvet., debatt m.m.)abstract
- I Konsumtionsrapporten 2023 sammanfattas och analyseras konsumtionen i Sverige under 2022. I den första delen, ”Hushållens konsumtion” ges en översikt över den privata konsumtionen i Sverige och hur den förändrats. Här beskrivs även skillnader mellan olika hushållstyper och konsumentgrupper, hållbarhetsaspekter på konsumtionen samt hushållens framtidsförväntningar på den egna ekonomin. I andra delen, ”Detaljhandeln” beskrivs försäljning och utveckling inom detaljhandeln under 2022 med fokus på olika delbranscher, kanaler och platser, inom e-handeln respektive den butiksbaserade detaljhandeln. Den andra delen avslutas med handelns framtidsförväntningar. Årets Konsumtionsrapport innehåller två fördjupningsdelar som var en och analyserar aktuella teman inom konsumtion. I den första av fördjupningsdelarna analyserar Emma Björner digitalisering inom turism, besöksnäring och upplevelseekonomi. I den andra fördjupningsdelen analyserar och diskuterar Benjamin Hartmann olika exempel på nostalgisk konsumtion.
|
|
| 2. |
- Hansson, Emma, 1981, et al.
(författare)
-
Systematic review of cost-effectiveness in breast reconstruction: deep inferior epigastric perforator flap vs. implant-based breast reconstruction.
- 2024
-
Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 59
-
Tidskriftsartikel (refereegranskat)abstract
- There are several techniques for reconstructing breasts after mastectomy, but little scientific evidence for which technique is superior. The aim of this systematic review was to compare the cost-effectiveness of implant-based and autologous reconstruction and to evaluate the overall certainty of evidence, as well as the quality of reporting of the included studies.Studies investigating the cost-effectiveness of breast reconstruction with a deep inferior epigastric perforator (DIEP) flap compared to implant-based reconstruction, meeting criteria defined in a PICO (population, intervention, comparison, and outcome), were included. Medline, PubMed, Embase, Cochrane library, CinahL, EconLit, and NHS EED databases were searched. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence, and the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) 2022 was used to evaluate the quality of reporting.A total of 256 abstracts were retrieved from the search, and after scrutiny, seven studies were included. The findings of this present systematic review should be interpreted with caution as the overall certainty of evidence is low (GRADE ƟƟОО). The included studies suggest that DIEP-flaps are cost-effective compared with implant-based breast reconstruction when the applied cost-effectiveness thresholds of $50,000 to $100,000 per quality-adjusted life years are used. It is noteworthy that no high level evidence exists regarding cost-effeciency, to support recommendations and decision in breast reconstruction. Methodological issues that can be improved in future studies are presented.
|
|
| 3. |
|
|
| 4. |
- Löfstrand, Jonas, 1981, et al.
(författare)
-
Comparison of patient-reported achievements of goals and core outcomes with delayed breast reconstruction in irradiated patients: latissimus dorsi with an implant versus DIEP.
- 2023
-
Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 58, s. 74-81
-
Tidskriftsartikel (refereegranskat)abstract
- Different women's individual goals with a breast reconstruction vary, and few studies compare techniques in light of the different goals. This study aimed to compare patient-reported core outcomes in patients reconstructed with deep inferior epigastric artery perforator (DIEP) flaps and latissimus dorsi (LD) flaps. Second, breast-related factors that the patients were particularly satisfied/dissatisfied with were analyzed.This was a retrospective cross-sectional study, which includes women who had undergone mastectomy and radiation, followed by delayed breast reconstructions with either LD flap and implant or DIEP flap during 2007-2017. The patient-reported core outcomes of overall breast-specific quality of life, normality, women's cosmetic satisfaction, self-esteem, emotional well-being, and physical well-being were analyzed using BREAST-Q.The patients were divided into LD and implant (n = 135 patients) and DIEP (n = 118 patients) groups, and both were demographically similar. The median follow-up was 8 years. The DIEP group scored significantly higher than the LD and implant group in five out of six domains. A high satisfaction was reported in questions regarding the feeling or appearance when having clothes on, whereas the greatest dissatisfaction was reported regarding questions entailing symmetry and the appearance without clothes.After 7 years, patients' breast-specific quality of life, normality, women's cosmetic satisfaction, self-esteem, emotional well-being, and physical well-being seem to be higher in irradiated patients who have been reconstructed with DIEP flap as compared to patients reconstructed with LD flap and implant. In both groups, patient satisfaction is high regarding their appearance when clothed, whereas the lowest satisfaction scores were reported in situations without clothing.
|
|
| 5. |
- Löfstrand, Jonas, 1981, et al.
(författare)
-
Donor site satisfaction of DIEP and latissimus dorsi flaps - a comparative cohort study.
- 2023
-
Ingår i: Journal of reconstructive microsurgery. - : Georg Thieme Verlag KG. - 1098-8947 .- 0743-684X. ; 39:6, s. 472-481
-
Tidskriftsartikel (refereegranskat)abstract
- Understanding of donor site morbidity and satisfaction after breast reconstruction is limited. There are few previous studies comparing satisfaction with different donor sites in breast reconstruction. This study aimed to examine the long-term patient-reported satisfaction with the donor site of latissimus dorsi (LD) flaps in comparison to the deep inferior epigastric artery perforator (DIEP) flaps. Further, a systematic review of previously published studies was conducted.In this retrospective cross-sectional study, all women who underwent breast reconstructions with either LD or DIEP flap following mastectomy and radiotherapy between 2007-2017 were included; patient-reported satisfaction was assessed using the BREAST-Q reconstruction module. For the systematic review, studies examining patient-reported abdominal satisfaction and well-being, and meeting the PICO (Population, Intervention, Comparison, and Outcome) criteria were included.Eligible and responding participants were divided into the LD (n=135 patients) and DIEP (n=118 patients) flap groups. Impairment due to muscular weakness of the donor site was more common in the LD group than that of the DIEP group. Bulging was common in the DIEP group and increased over time. Regarding the esthetic appearance of the donor site, the patients in the DIEP group were less satisfied than the LD group. The systematic review showed that most of the patients were dissatisfied with their abdomen after the operation.Patients who have undergone DIEP flap for breast reconstruction are less satisfied with the donor site esthetics than those who have undergone LD flap. Patient-reported abdominal bulging was common in the DIEP group and the number seemed to increase over time. Most patients were not satisfied with their abdominal scarring postoperatively, as per the systematic review. These results may indicate a need for more nuanced preoperative patient information, as well as improvements in the surgical management of the donor site, for DIEP flap reconstructions.
|
|
| 6. |
- Löfstrand, Jonas, 1981, et al.
(författare)
-
Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study.
- 2024
-
Ingår i: The British journal of surgery. - 1365-2168. ; 111:1
-
Tidskriftsartikel (refereegranskat)abstract
- Sacrifice of the latissimus dorsi (LD) muscle might entail donor site morbidity when used in delayed breast reconstruction. Previous studies are small, have short follow-up, and demonstrate diverging results. The aims of this study were to evaluate long-term patient-reported effects on shoulder and back function following LD flap harvest, and to investigate predictors for a worse outcome.This is a retrospective observational case-control cohort study. Cases were all patients who had undergone an LD flap reconstruction during the years 2007-2017. Controls were patients reconstructed with a deep inferior epigastric perforator (DIEP) flap during the same time period. Participants completed two validated questionnaires; the BREAST-Q reconstruction LD domains and the Western Ontario Shoulder Osteoarthritis Index (WOOS).A total of 135 cases (75 per cent) and 118 controls (60 per cent) responded to the questionnaires. The mean follow-up time was 7 years. Patients reconstructed with a LD flap were significantly less satisfied with their back and shoulder function when compared to the DIEP controls, as measured with BREAST-Q and WOOS. Predictors for a poor patient-reported back and shoulder function included axillary surgery and axillary radiotherapy, especially when combined, as well as higher age at reconstruction.Patients who have undergone LD flap for delayed breast reconstruction had a lower satisfaction with back and shoulder function, when compared to patients who had undergone a DIEP reconstruction. Delayed LD reconstruction should be used with care, especially in patients who have undergone axillary surgery and axillary radiotherapy.
|
|
| 7. |
|
|
| 8. |
- Almeland, Stian, et al.
(författare)
-
The effect of microsurgical training on novice medical students’ basic surgical skills—a randomized controlled trial
- 2020
-
Ingår i: European journal of plastic surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 43, s. 459-466
-
Tidskriftsartikel (refereegranskat)abstract
- Background It has been demonstrated that medical students are capable of learning microsurgical techniques. We hypothesize that microsurgical training might give insight into the importance of delicate tissue handling and correct knot tying that could have a positive influence on macrosurgical skills. The primary aim of this study was to evaluate the effect of microsurgical training on macrosurgical suturing skills in novice medical students. Subjects and methods In 2018, 46 novice medical students were enrolled and randomized into two groups. The intervention group received both macro- and microsurgical training and the control group received only microsurgical training. Both groups underwent an assessment test that consisted of macrosurgical tasks of three simple interrupted sutures with a square knot and continuous three-stitch long over-and-over sutures. These tests were individually filmed and assessed using the University of Bergen suturing skills assessment tool (UBAT) and the Objective Structured Assessment of Technical Skill global rating scale (OSATS). Questionnaires regarding future career ambitions and attitudes towards plastic surgery were also completed both prior to and following the tests. Results The intervention group needed a longer time to complete the tasks than the control group (12.2 min vs. 9.6 min, p>0.001), and scored lower on both the UBAT (5.6 vs. 9.0, p>0.001) and the OSATS (11.1 vs. 13.1, p>0.001) assessments. The microsurgery course tended to positively influence the students’ attitudes towards a career in plastic surgery (p=0.002). This study demonstrates poorer macrosurgical skills in the medical students group exposed to microsurgical training. The true effect of microsurgical training warrants further investigation.
|
|
| 9. |
- Brorson, Fredrik, 1965, et al.
(författare)
-
Early complications in delayed breast reconstruction: A prospective, randomized study comparing different reconstructive methods in radiated and non-radiated patients
- 2020
-
Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983. ; 46:12, s. 2208-2217
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There is little high-quality scientific evidence identifying the best and safest methods for delayed breast reconstruction, with most previous studies retrospective in nature. The primary aim was to compare early complication rates for two different breast-reconstructive methods in radiated and non-radiated patients, using a validated scale. The secondary aim was to identify predictors for complications. Materials and methods: This study represents a clinical, randomized, prospective trial (ClinicalTrials.Gov identifier: NCT03963427), where the patients were divided into two study arms: non-radiated and radiated. In the non-radiated arm, patients were randomized to a one-stage lateral thoracodorsal flap with an implant or two-stage expander reconstruction. In the radiated arm, patients were randomized to a latissimus dorsi reconstruction combined with an implant or deep inferior epigastric artery perforator (DIEP) reconstruction. All adverse events were classified according to Clavien-Dindo and summarization of overall morbidity was performed by calculating the Comprehensive Complication Index score. The study was conducted from 2008 to 2020. Results: The complication frequencies were similar for the two surgical methods within each arm. In the non-radiated arm, risk factors for any complication were any comorbidities, and in the radiated arm, factors were a high body mass index and a contralateral operation. Conclusions: The usage of the Clavien-Dindo scale in reconstructive surgery is feasible, but further validation is needed. In non-radiated patients, the frequencies of short-term complications were similar for lateral thoracodorsal flap and expander reconstruction, whereas in radiated patients, they were similar for DIEP and latissimus dorsi. The complication profile of the methods varied.
|
|
| 10. |
- Brorson, Fredrik, 1965, et al.
(författare)
-
Patient reported outcome and quality of life after delayed breast reconstruction - An RCT comparing different reconstructive methods in radiated and non-radiated patients
- 2022
-
Ingår i: Clinical Breast Cancer. - : Elsevier BV. - 1526-8209 .- 1938-0666. ; 22:8, s. 753-761
-
Tidskriftsartikel (refereegranskat)abstract
- Background Health-related quality of life (HRQoL) is one of the core outcomes for breast reconstruction. The aim of this study was to evaluate whether the method of delayed breast reconstruction affects long-term HRQoL. Methods Participants were divided into 2 arms depending on previous radiotherapy, and subsequently randomized between 2 methods of breast reconstruction: a latissimus dorsi flap or a deep inferior epigastric artery perforator flap in the radiated arm and a thoracodorsal flap and implant or an expander in the non-radiated arm. Validated HRQoL instruments were used: BREAST-Q to evaluate breast specific HRQoL and satisfaction, RAND-36 and EQ-5D to evaluate generic HRQoL, and BDI-21 to measure symptoms of depression and anxiety. Results During the recruitment period (2009-2015), 233 patients were randomized. After opt-outs and exclusions, the remaining 107 participants comprise the study sample. Postoperative HrQoL was measured on average 7to 8years post-operatively. Response rates varied between 60 and 82 per cent. The BREAST-Q scores were higher after the reconstruction than before for the great majority of domains in both arms; albeit statistically significant only between the 2 methods for physical well-being chest in the radiated arm. Most participants in both arms had minimal or mild depression both before and after the operation. Conclusion No distinct differences in long-term HrQoL could be seen for different methods There was a clear improvement in HrQoL compared to pre-reconstruction in all groups, but the effect of specific reconstructive methods on scores could not be reliably demonstrated.
|
|
