| 1. |
- Edelheim, Johan, et al.
(author)
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Social Values
- 2022
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In: Teaching Tourism : Innovative, Values-based Learning Experiences for Transformative Practices - Innovative, Values-based Learning Experiences for Transformative Practices. - : Edward Elgar Publishing. - 9781800374553 - 9781800374560 ; , s. 40-49
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Book chapter (peer-reviewed)
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| 2. |
- Joppe, Marion, et al.
(author)
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Professionalism
- 2022
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In: Teaching Tourism : Innovative, Values-based Learning Experiences for Transformative Practices - Innovative, Values-based Learning Experiences for Transformative Practices. - : Edward Elgar Publishing. - 9781800374553 - 9781800374560 ; , s. 107-114
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Book chapter (peer-reviewed)
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| 3. |
- Rubio-San-Simón, Alba, et al.
(author)
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Impact of COVID-19 in paediatric early-phase cancer clinical trials in Europe: A report from the Innovative Therapies for Children with Cancer (ITCC) consortium.
- 2020
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In: European journal of cancer (Oxford, England : 1990). - : Elsevier BV. - 1879-0852 .- 0959-8049. ; 141, s. 82-91
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Journal article (peer-reviewed)abstract
- Data regarding real-world impact on cancer clinical research during COVID-19 are scarce. We analysed the impact of the COVID-19 pandemic on the conduct of paediatric cancer phase I-II trials in Europe through the experience of the Innovative Therapies for Children with Cancer (ITCC).A survey was sent to all ITCC-accredited early-phase clinical trial hospitals including questions about impact on staff activities, recruitment, patient care, supply of investigational products and legal aspects, between 1st March and 30th April 2020.Thirty-one of 53 hospitals from 12 countries participated. Challenges reported included staff constraints (30% drop), reduction in planned monitoring activity (67% drop of site initiation visits and 64% of monitoring visits) and patient recruitment (61% drop compared with that in 2019). The percentage of phase I, phase II trials and molecular platforms closing to recruitment in at least one site was 48.5%, 61.3% and 64.3%, respectively. In addition, 26% of sites had restrictions on performing trial assessments because of local contingency plans. Almost half of the units suffered impact upon pending contracts. Most hospitals (65%) are planning on improving organisational and structural changes.The study reveals a profound disruption of paediatric cancer early-phase clinical research due to the COVID-19 pandemic across Europe. Reported difficulties affected both patient care and monitoring activity. Efforts should be made to reallocate resources to avoid lost opportunities for patients and to allow the continued advancement of oncology research. Identified adaptations to clinical trial procedures may be integrated to increase preparedness of clinical research to futures crises.
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| 4. |
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| 5. |
- Alexandridis, Vasileios, et al.
(author)
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Retropubic slings are more efficient than transobturator at 10-year follow-up : a Swedish register-based study
- 2023
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In: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 34:6, s. 1307-1315
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Journal article (peer-reviewed)abstract
- Introduction and hypothesis: Long-term performance of mid-urethral slings (MUS) and potential differences between the retropubic and the transobturator technique for insertion are scarcely studied. This study aims to evaluate the efficacy and safety 10 years after surgery and compare the two main surgical techniques used. Methods: Women who underwent surgery with a MUS between 2006 and 2010 were identified using the Swedish National Quality Register of Gynecological Surgery and were invited 10 years after the operation to answer questionnaires regarding urinary incontinence and its impact on quality-of-life parameters (UDI-6, IIQ-7) and impression of improvement, as well as questions regarding possible sling-related complications and reoperation. Results: The subjective cure rate reported by 2421 participating women was 63.3%. Improvement was reported by 79.2% of the participants. Women in the retropubic group reported higher cure rates, lower urgency urinary incontinence rates and lower UDI-6 scores. No difference was shown between the two methods regarding complications, reoperation due to complications or IIQ-7 scores. Persisting sling-related symptoms were reported by 17.7% of the participants, most commonly urinary retention. Mesh exposure was reported by 2.0%, reoperation because of the tape by 5.6% and repeated operation for incontinence by 6.9%, significantly more in the transobturator group (9.1% vs. 5.6%). Preoperative urinary retention was a strong predictor for impaired efficacy and safety at 10 years. Conclusions: Mid-urethral slings demonstrate good results for the treatment of stress urinary incontinence and tolerable complication profiles in a 10-year perspective. The retropubic approach displays higher efficacy than the transobturator, with no difference regarding safety.
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| 6. |
- Brunes, Malin, et al.
(author)
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Risk-factors for continuous long-term use of prescription opioid drugs 3 years after hysterectomy : A nationwide cohort study
- 2020
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 99:8, s. 1057-1063
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Journal article (peer-reviewed)abstract
- The widespread misuse of prescription pain medication, including opioids, has serious public health implications. Postoperative pain is a risk factor for persistent or chronic pain unless treated effectively. There are only a few studies that have assessed the use of opioid-containing drugs after gynecological surgery and most of these usually have a short follow-up period. The aim of this study was to identify risk-factors for long-term use of prescription opioid drugs following hysterectomy. Material and methods We performed a nationwide cohort study based on prospectively collected data. Information from two population-based registers, the Swedish National Quality Register of Gynecological Surgery and the Swedish National Drug Register, was linked. The study population consisted of women with benign disease undergoing a total hysterectomy from 1 January 2012 until 31 December 2015. To identify long-term changes in prescription of opioids, individual data were collected from 1 year prior to to 3 years after surgery between 2011 and 2018. Data analysis was performed using multivariable logistic regression models. Results The population included 17 385 women having had hysterectomy for benign disease. Of these women, 4233 (24.4%) were prescribed analgesics continuously for 3 years postoperatively and 1225 (7.1%) used opioids long term. Perioperative predictors of opioid use 3 years after surgery included a diagnosis of adenomyosis (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.2-2.7) and preoperative use of opioids (aOR 29.6, 95% CI 19.7-44.4), psycho- (aOR 3.5, 95% CI 2.4-5.0) and neuroactive drugs (aOR 1.8, 95% CI 1.0-3.1). For women with no opioid prescription preoperatively (n = 260, 1.5%), mild (aOR 2.8, 95% CI 1.1-7.3) and severe (3.0% vs 6.2%: aOR 6.4, 95% CI 1.4-20.0) postoperative complications and preoperative prescription of psychoactive drugs (aOR 4.6, 95% CI 1.9-10.7) were associated with long-term use of drugs containing opioids. Conclusions Long-term use of prescription opioids after hysterectomy is common and is, among other risk factors, strongly associated with preoperative use of opioids, as well as psychoactive drugs and adenomyosis. To avoid opioid misuse disorders among women at risk for long-term opioid drug prescriptions after hysterectomy, further studies and strategies are needed.
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| 7. |
- Edelheim, Johan, et al.
(author)
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Tourism didactics
- 2022
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In: Teaching Tourism. - : Edward Elgar Publishing. - 9781800374553 - 9781800374560 ; , s. 1-12
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Book chapter (other academic/artistic)
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| 8. |
- Ek, Marion
(author)
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Clinical evaluation of transvaginal mesh for pelvic organ prolapse surgery
- 2012
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Doctoral thesis (other academic/artistic)abstract
- The objective of this thesis was to increase the understanding and assess the outcomes in terms of complications, relieve of symptoms and anatomical results of anterior vaginal wall prolapse surgery using either trocar-guided transvaginal mesh or conventional anterior colporraphy, and to identify variables associated with lateral defects. A multicenter randomized controlled trial was performed between December 2007 and December 2008 in the Nordic countries comparing transvaginal mesh surgery for anterior prolapse with the Prolift® mesh kit with traditional anterior colporraphy. Among women undergoing the above randomized controlled trial, 50 women; 27 undergoing anterior colporraphy and 23 anterior trocar guided transvaginal mesh were examined at baseline with urodynamic assessment and at two months. We found that trocar guided transvaginal mesh of anterior vaginal wall prolapse resulting in a lowering of maximal urethral closing pressures (MUCP) and increased risk for de novo stress urinary incontinence compared to colporraphy. A prospective multicenter cohort study was performed between June 2006 and March 2007 throughout 26 clinics in the Nordic countries. 121 patients undergoing anterior transvaginal mesh surgery was prospectively evaluated at baseline and one year after surgery using the Urogenital Distress Inventory (UDI). Overall UDI scores declined from 91 before surgery to 31 one year after surgery (p<0.001). UDI subscales for obstructive and irritative symptoms improved one year after surgery (p<0.001 for both) while stress symptoms did not (p= 0.11). In a subanalysis from the randomized controlled trial of mesh kit versus anterior colporraphy 99 patient were included diagnosed at baseline with a lateral defects in the anterior vaginal wall. 39 patients underwent anterior colporraphy and 60 anterior trocar guided transvaginal mesh surgery and one year after surgery, a persistent lateral defect was significantly more common after colporraphy compared to transvaginal mesh (11/32 (34.4%) vs 1/42 (2.4%), risk ratio 14.4 (95% CI 2.0-106.1) (P<0.001). To determine variables associated with lateral defects a cross-sectional study was performed as subanalysis of a multicenter, randomized, controlled trial. 99 patients classified as having a lateral defect and 203 patients with isolated central defect of the anterior vaginal wall were compared with regard to clinical characteristics and urogenital distress. Among the investigated patient characteristics, only hormone replacement therapy (HRT) use at baseline was associated with lateral defects (OR 2.7, 95% CI 1.2-6.3) whereas previous anterior vaginal wall repair decreased the odds for lateral defects (OR, 0.3, 95% CI 0.1-0.9) in a multivariable model. Patients with lateral defects experienced more symptoms of bulging compare with patients without lateral defects (p=0.02). In conclusion, the four studies in the thesis have shown that transvaginal mesh for anterior pelvic organ prolapse provides satisfactory anatomical and subjective outcome. However, there is an increased risk of problems with stress urinary incontinence after mesh surgery. In comparison with traditional surgery, prolapse surgery with mesh still is a new method with potential risks and benefits, especially in the long term, and must be carefully considered.
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| 9. |
- Joppe, Marion, et al.
(author)
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Knowledge
- 2022
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In: Teaching Tourism : Innovative, Values-based Learning Experiences for Transformative Practices - Innovative, Values-based Learning Experiences for Transformative Practices. - 9781800374553 - 9781800374560 ; , s. 96-106
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Book chapter (peer-reviewed)
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| 10. |
- Joppe, Marion, et al.
(author)
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Knowledge
- 2022
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In: Teaching Tourism. - : Edward Elgar Publishing. - 9781800374553 ; , s. 96-106
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Book chapter (other academic/artistic)
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| 11. |
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| 12. |
- Lundmark Drca, Anna, et al.
(author)
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Dyspareunia and pelvic pain: comparison of mid-urethral sling methods 10 years after insertion
- 2024
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In: International Urogynecology Journal. - 1433-3023.
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Journal article (peer-reviewed)abstract
- Introduction and hypothesisThe mid-urethral sling (MUS) has been used for more than 30 years to cure stress urinary incontinence. The objective of this study was to assess whether surgical technique affects the outcome after more than ten years, regarding dyspareunia and pelvic pain.MethodsIn this longitudinal cohort study we used the Swedish National Quality Register of Gynecological Surgery to identify women who underwent MUS surgery in the period 2006–2010. Out of 4348 eligible women, 2555 (59%) responded to the questionnaire sent out in 2020–2021. The two main surgical techniques, the retropubic and the obturatoric approach, were represented by 1562 and 859 women respectively. The Urogenital Distress Inventory-6 (UDI-6) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), as well as general questions concerning the MUS surgery, were sent out to the study population. Dyspareunia and pelvic pain were defined as primary outcomes. Secondary outcomes included PISQ-12, general satisfaction, and self-reported problems due to sling insertion.ResultsA total of 2421 women were included in the analysis. Among these, 71% responded to questions regarding dyspareunia and 77% responded to questions regarding pelvic pain. In a multivariate logistic regression analysis of the primary outcomes, we found no difference in reported dyspareunia (15% vs 17%, odds ratio (OR) 1.1, 95% CI 0.8–1.5) or in reported pelvic pain (17% vs 18%, OR 1.0, 95% CI 0.8–1.3) between the retropubic and obturatoric techniques among study responders.ConclusionDyspareunia and pelvic pain 10–14 years after insertion of a MUS do not differ with respect to surgical technique.
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