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- Alm, Fredrik, 1983-, et al.
(författare)
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Adherence to Swedish Guidelines for Pain Treatment in Tonsil Surgery in Pediatric Patients
- 2016
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Konferensbidrag (refereegranskat)abstract
- Objective: As shown by data from the National Tonsil Surgery Register in Sweden, tonsil surgery often causes severe pain that lasts for many days. The register data demonstrate the necessity for better evidence-based pain treatment guidelines for tonsil surgery. The guidelines, introduced in 2013, consist of both pharmacological and non-pharmacological recommendations. In the guidelines, a multimodal analgesic approach and combination of analgesics are recommended to provide effective pain treatment with limited side effects. Two national multi-professional education days on pain, pharmacology and the guidelines were offered. Web-based information about pharmacological treatment (www.tonsililloperation.se) was designed for patients and next-of-kin. The current aims were to describe adherence to the Swedish guidelines for pain treatment in tonsil surgery in pediatric patients < 18 yearsMethod: An inter-professional questionnaire was developed, including questions linked to the relevant guidelines. The questions came from a national mapping before the guidelines were designed. The items were discussed by an expert group, and content validity was evaluated using the content validity index.ENT-and anesthesia physicians and nurses from all 50 ENT clinics in Sweden were enrolled.Results: Most clinics had received the guidelines, but there was a discrepancy between the professions. More than half had perused the literature review performed before the guidelines were designed, and attended themulti-professional education day. Pre- and perioperative treatment usually included paracetamol, clonidine and betamethasone. A multimodal pain approach after discharge from hospital (tonsillectomy and tonsillotomy) was used, combining paracetamol with cox-inhibitors. Most clinics used paracetamol, with a higher dose for the first 3 days (healthy children and acceptable nutrition), and a reduced dose from day 4.In case of inadequate analgesia after tonsillectomy, oral clonidine or opioids were used. Several clinics followed the recommendation to use clonidine as first choice and secondly an opioid. No respondents prescribed codeine compared to 80% at the mapping before the guidelines were designed. The guidelines were experienced as clear, safe and sufficient. The web-based information was used by most of the clinics to improve quality of care and provide facilitating tools for patients, relatives and caregivers.Conclusion: Swedish guidelines for tonsil surgery provide practical evidence-based pain treatment recommendations. To achieve a change, multi-professional education is necessary. This needs to be repeated for a wider spread.Future research should include evaluation through pain diaries and questionnaires to next-of-kin and children. There should be matching of data from the quality registers at each clinic, with pain variables such as unplanned health care contacts due to pain, number of days with analgesics, and return to normal diet
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| 2. |
- Ericsson, Elisabeth, 1959-, et al.
(författare)
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Kirurgisk behandling av barn med sömnrelaterade andningsstörningar
- 2009
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Ingår i: Kirurgisk behandling av barn med sömnrelaterade andningsstörningar.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Kirurgisk behandling av barn med sömnrelaterade andningsstörningar Moderator: Danielle Friberg, överläkare, Karolinska Huddinge I panelen: Elisabet Ericsson, disputerad sjuksköterska, Hälsohögskolan, Jönköping, Claes Hemlin, överläkare, Sophiahemmet, Anne-Charlotte Hessén Söderman, överläkare, Karolinska Danderyd, Elisabeth Hultcrantz, professor, Universitetssjukhuset, Linköping, Pia Nerfeldt, disputerad specialistläkare, Karolinska Huddinge, Joacim Stalfors, överläkare, Sahlgrenska, Göteborg. Bakgrund: Barn med sömnrelaterade andningsstörningar (SRBD) o/e obstruktivt sömnapnésyndrom (OSAS) behandlas primärt med kirurgi (adenotonsillektomi), varav cirka 80 % blir botade. Det finns flera riskfaktorer till SRBD/OSAS: kraniofaciala missbildningar, neuromuskulära sjukdomar samt övervikt/fetma, som ökar även bland barn. Cirka 1-3 % av barnen har OSAS och 12 % har SRBD och dessa barn löper ökad risk för inlärningssvårigheter, dålig viktsutveckling, hjärtkärlsjukdomar och dödlighet. Fram till nu har dessa barn blivit styvmoderligt behandlade i rutinsjukvården. Detta symposium vill belysa hur vi kan förbättra oss. Material och metod: Med mentometerknappar inbjuds auditoriet att delta i kliniska frågeställningar. Typfall demonstreras. Nya kirurgiska metoder presenteras; tonsillotomi, tonsillektomi med coblation eller radiofrekvens, vilka har utvärderats gentemot sedvanlig ”kall” tonsillektomi. Resultat från Kvalitetsregister för tonsilloperation kommer att redovisas. Likaså den nyvaliderade OSA-18, som är ett sjukdomsspecifikt hälsorelaterat livskvalitetsformulär för barn med misstänkt SRBD/OSAS. Ett polysomnografilab för barn har nyligen startats på Karolinska Huddinge, där flera studier planeras. Resultat: Panelmedlemmarna presenterar sina resultat för auditoriet, vilka sen får delta i diskussionen med eller utan mentometer. Diskussion: Hur kan vi förbättra omhändertagandet av barn med SRBD/OSAS? Hur ska vi välja ut de som ska opereras? Hur fungerar OSA-18 och hur kan vi använda formuläret i vår vardag? Vilken operationsmetod är att föredra på vilket barn? Vilka frågor kan det förnyade tonsilloperationsregistret besvara? Vilka barn ska följas upp efter kirurgi? Barn med riskfaktorer, hur ska vi hantera dem? Kan vi erbjuda de barn som inte blir bra på kirurgi alternativ behandling? Vilken ytterligare forskning behövs?
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| 3. |
- Ericsson, Elisabeth, 1959-, et al.
(författare)
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Kvalitetsregistret för tonsilloperation
- 2014
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Ingår i: Nationellt kvalitetsregister Öron- Näs och Halssjukvård - Årsrapport 2013. - : Västra Götalandsregionen. ; , s. 34-97
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 4. |
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| 5. |
- Ericsson, Elisabeth, et al.
(författare)
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Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år)
- 2013
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Ingår i: Svensk ÖNH-tidskrift. - Stockholm : Scandinavian University Press. - 1400-0121. ; 30:3, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- Riktlinjerna är framtagna av referensgruppen för Tonsilloperation. Syftet med dessa riktlinjer är att optimera det perioperativa omhändertagandet (premedicinering - peroperativt - postoperativt smärtomhändertagande) i samband med tonsilloperationer på barn och ungdomar. Bakgrund och referenser till riktlinjerna finns i ett separat dokument.Riktlinjerna gäller för friska barn. Finns det riskfaktorer som ex grav sömnapné, kraftig övervikt, komplicerande sjukdomstillstånd eller organpåverkan behöver den farmakologiska behandlingen anpassas efter situationen.Tonsillkirurgi medför svår och långvarig smärta samt hög frekvens av illamående. Smärtan är ofta värst dag 3 till 5 efter tonsillektomi. Tonsillotomi ger generellt upphov till mindre smärta än tonsillektomi. För att uppnå effekt behöver den farmakologiska smärtbehandlingen påbörjas redan vid premedicineringen och fortlöpa under själva anestesin/ingreppet. En multimodal behandling ska eftersträvas och målsättningen är att uppnå en för individen acceptabel smärtnivå i det postoperativa skedet och i hemmet.Den farmakologiska behandlingen ska kombineras med preoperativ information om ingreppet till patienten och vårdnadshavare. En lugn och trygg situation före anestesistart ökar chanserna för ett lugnt postoperativt förlopp.
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| 8. |
- Ericsson, Elisabeth, 1959-, et al.
(författare)
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The role of information and instruction to children and parents in homemanagement after tonsil surgery - what is it helpful for them to know?
- 2010
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Konferensbidrag (refereegranskat)abstract
- OBJECTIVES To create national recommendations for information after tonsil surgery to improve the management ofchildren. METHODS 1. A search of Medline addressing evidence on expectations and advice about medication and nonpharamacological techniques to relieve pain after tonsil surgery and 2. A questionnaire focusing on the routines for information before and after tonsil surgery was administrated to all ENT-clinics in Sweden with 99% response rate. RESULTS There is evidence that information has an empowering effect upon parents to feel more control over their child’s care. Lack of information leads to anxiety and increased perception of pain in the child. Children and parents who were given specific information related to pain and morbidity, reported less pain and were less anxious than those with no or insufficient information. Constructive information should be given gradually, starting preoperatively, to parents and children. A leaflet should contain sufficient information about what happens before, during and is to be expected after surgery, the risks and possible complications, and advice and recommendation of medication and non-pharmacological techniques. Results from the national enquiry (N=48) showed the provision of a variety of different written information from the various clinics, often insufficient. Based on these findings, an information leaflet for patients and a checklist based on the literature for the staff to use at discharge were developed (both will be available). CONCLUSIONS A checklist for the staff insures that parents and children get consistent advice. A leaflet provided before surgery helps children and parents with methods to relieve pain. This could decrease the number of complications and later consultations and give shorter recovery.
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| 10. |
- Eriksson, Carl, 1981-, et al.
(författare)
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Long-term effectiveness of vedolizumab in inflammatory bowel disease : a national study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)
- 2017
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis. - 0036-5521 .- 1502-7708. ; 52:6-7, s. 722-729
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Clinical trials have demonstrated the efficacy of vedolizumab in inflammatory bowel disease (IBD). However, these findings may not reflect the clinical practice. Therefore, we aimed to describe a vedolizumab-treated patient population and assess long-term effectiveness.Materials and methods: Patients initiating vedolizumab between 1 June 2014 and 30 May 2015 were identified through the Swedish National Quality Registry for IBD. Prospectively collected data on treatment and disease activity were extracted. Clinical remission was defined as Patient Harvey Bradshaw index<5 in Crohn's disease (CD) and Patient Simple Clinical Colitis Activity index<3 in ulcerative colitis (UC).Results: Two-hundred forty-six patients (147CD, 92 UC and 7 IBD-Unclassified) were included. On study entry, 86% had failed TNF-antagonist and 48% of the CD patients had undergone1 surgical resection. After a median follow-up of 17 (IQR: 14-20) months, 142 (58%) patients remained on vedolizumab. In total, 54% of the CD- and 64% of the UC patients were in clinical remission at the end of follow-up, with the clinical activity decreasing (p<.0001 in both groups). Faecal-calprotectin decreased in CD (p<.0001) and in UC (p=.001), whereas CRP decreased in CD (p=.002) but not in UC (p=.11). Previous anti-TNF exposure (adjusted HR: 4.03; 95% CI: 0.96-16.75) and elevated CRP at baseline (adjusted HR: 2.22; 95% CI: 1.10-4.35) seemed to be associated with discontinuation because of lack of response. Female sex was associated with termination because of intolerance (adjusted HR: 2.75; 95% CI: 1.16-6.48).Conclusion: Vedolizumab-treated patients represent a treatment-refractory group. A long-term effect can be achieved, even beyond 1 year of treatment.
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