| 1. |
- Mukka, Sebastian, 1987-
(författare)
-
Aspects on treatment of femoral neck fractures : studies on treatment methods, surgical approach and external validity
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Femoral neck fracture (FNF) is a great challenge for today´s health care and is associated with high mortality and morbidity in the elderly. In the short term several studies in the literature have demonstrated improved hip function, quality of life and fewer re-operations in elderly patients treated with total hip arthroplasty (THA) instead of internal fixation (IF). There are few reports on the long-term outcome comparing IF and THA. The vast majority of orthopaedic departments in Sweden use the direct lateral (DL) or posteriolateral (PL) approaches for hip arthroplasty. The PL approach has been linked to an increased risk of dislocation of the prosthesis and a higher rate of revision surgery in comparison to the DL approach. There are few reports focusing on radiological risk factors for prosthetic dislocation and patient reported hip function comparing the two surgical approaches for hip arthroplasty in FNF.The randomized controlled trial (RCT) is the gold standard for evaluating medical or surgical interventions. An RCT of high quality has to be internally and externally valid. Internal validity refers to a correct study design to avoid bias skewing the results. External validity (EV) refers to whether the results will be clinically relevant to a definable group of patients and can be extrapolated to the general health care situation. There are only a few reports in the orthopaedic literature focusing on the EV of published studies and none in the field of hip fractures.Study I: This is a RCT of 100 patients with a displaced FNF comparing THA and IF. Follow-up evaluations were performed at three months and 1, 2, 4, 11 and 17 years. It was found that the Harris hip score (HHS) was higher and the rate of reoperations lower for patients treated with THA.Study II: This is a prospective cohort study of 185 hips, comparing the DL and the PL approaches in patients treated with a hemiarthroplasty (HA) for a displaced FNF. Follow-up was after 1 year. There was no difference in patient reported outcome between the groups measured with the HHS and WOMAC index. The PL approach resulted in a higher re-operation rate while the DL approach in a higher incidence of limping.Study III: This is a retrospective cohort study of 373 patients with a cemented bipolar HA using a PL approach for a FNF with a follow-up ranging from 6 months to 7 years. Radiographs and all surgical records were reviewed regarding femoral offset (FO), leg length discrepancy (LLD) and Wiberg angle. Patients with recurrent dislocations had a decreased postoperative FO, LLD and shallower acetabulum on the operated side compared with their controls.Study IV: This is a prospective cohort study of 840 hips comparing patients included in a RCT with those that did not give their informed consent (NC) or did not fulfill the criteria for participating in the trial (MS). Patients in the NC and MS groups had an increased mortality rate in comparison to those included in the study. We did not find any differences in hip function between these groups.The main conclusions of this thesis are: Healthy and lucid elderly patients with good hip function preoperatively, should be treated with THA for a displaced FNF.The DL approach is favourable in treating displaced FNF with HA due to its decreased risk of reoperation but with an identical hip function outcome as the PL approach.Care should be taken to restore the LLD and FO otherwise this may increase the risk of recurrent dislocation of a HA.Our findings suggest that trial participants had a lower mortality rate than non-participants but the functional outcome of non-participants appeared to be satisfactory. This is important to take into consideration when extrapolating study results to a health care system.
|
|
| 2. |
- Sadeghian, Parastoo
(författare)
-
Computational fluid dynamics application in indoor air quality and health
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Indoor air quality directly affects the comfort, performance, and well-being of occupants. Indoor pollution can cause immediate or long-term health effects and has been responsible for 4.1% of global deaths in recent decades. In operating rooms, providing a high indoor air quality is especially critical as surgical site infection can occur in patients due to air contamination in operating rooms.Surgical site infections due to antibiotic resistant bacteria may threaten the safety and lives of millions of people each year. To moderate and reduce indoor contamination, it is necessary to select a proper ventilation strategy.Improving ventilation system performance requires a deep understanding of airflow patterns and contamination distribution.This thesis adopted computational fluid dynamics to evaluate airflow patterns and the spread of airborne contaminations in indoor environments. Moreover, we sought to provide an approach to facilitate transferring the obtained knowledge to medical experts and decisionmakers to reduce the infection risk after the surgery.The use of warming blankets has raised the concern about surgical site infections. Warming blankets are used to prevent hypothermia in patients during surgery. However, our results showed that these warming blankets reduce the bacteria-carrying particles level at the wound due to warm upward airflows.Surgical lamps can block the airflow and generate a low-velocity area under the lamp that increases the accumulation of contaminants. The simulation results revealed that a novel fan-mounted surgical lamp reduced the contamination level to an acceptable range for infection-prone surgeries. This novel surgical lamp successfully reduced contamination in the operating room supplied with both turbulent mixing and laminar airflow ventilations.In another study, we implemented a protective curtain and showed that this strategy could significantly reduce the exposure level of the medical team to a patient with infectious respiratory disease. This novel protective curtain is located between the patient’s upper body and the lower part during surgery. We found a 57% reduction in bacteria-carrying particle concentration at the wound by adopting this curtain. Thus, using this protective curtain can reduce the exposure level of both patient and surgical team in the operating room.Besides investigating the performance of ventilation systems in hospitals, we investigated the application of diffuse ceilings ventilations in clinics, especially waiting rooms. Diffuse ceiling ventilation systems are common air distribution systems in offices and schools. Based on simulation results, a diffuse ceiling with a central opening and evenly distributed heat loads resulted in the highest cooling capacity and thermal comfort in clinic waiting rooms.We have visualised the airflow field and airborne particles in operating rooms with the help of virtual reality techniques. We found the virtual reality environment more engaging to understand the airflow field and particle movements in operating rooms.
|
|
| 3. |
- Mahdi, Aamir, 1976-
(författare)
-
Psychological distress and contentment after primary total knee replacement
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study patients with anxiety/depression symptoms before and after primary total knee replacement, particularly in terms of improvements in patients-reported outcomes, and particularly among those who were discontent with the surgery. This could hopefully improve patients' contentment after TKR.Study I investigated the prevalence of knee symptom improvement among patients with preoperative anxiety and/or depression in comparison to patients who did not have anxiety/depression. Study II investigated changes in the prevalence of anxiety and depression one year after primary TKR. Study III investigated how TKR surgeons in Sweden informed their patients preoperatively, and what kind of information they gave. Study IV used face-to-face interviews to capture experiences of discontentment one year after TKR among patients without documented complications.The main findings were that: 1. All patients improved in outcome measures one year after TKR, regardless of presurgical psychological state. 2. Among the 15% of patients with anxiety symptoms before surgery, 59% had improved in these symptoms one year after surgery; while among the 10% with depression symptoms before surgery, 60% had improved one year after surgery. 3. Knee surgeons in Sweden have considerable awareness of the importance of preoperative patient information, the impact of patient expectations, and psychiatric illness. However, they need to improve their preoperative routines when it comes to providing written information, asking about the patient’s expectations, and psychiatric assessment. 4. The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking relational support.
|
|
