| 1. |
- Rystedt, Jenny M.L., et al.
(författare)
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Routine intraoperative cholangiography during cholecystectomy is a cost-effective approach when analysing the cost of iatrogenic bile duct injuries
- 2017
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Ingår i: HPB. - : Elsevier BV. - 1365-182X. ; 19:10, s. 881-888
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Tidskriftsartikel (refereegranskat)abstract
- Background: The total cost of bile duct injuries (BDIs) in an unselected national cohort of patients undergoing cholecystectomy are unknown. The aim was to evaluate costs associated with treatment of cholecystectomy-related BDIs and to calculate cost effectiveness of routine vs. on-demand intraoperative cholangiography (IOC). Methods: Data from Swedish patients suffering a BDI during a 5 year period were analysed. Questionnaires to investigate loss-of-production and health status (EQ-5D) were distributed to patients who suffered a BDI during cholecystectomy and who underwent uneventful cholecystectomy (matched control group). Costs per quality-adjusted-life-year (QALY) gained by intraoperative diagnosis were estimated for two strategies: routine versus on-demand IOC during cholecystectomy. Results: Intraoperative diagnosis, immediate intraoperative repair, and minor BDI were all associated with reduced direct treatment costs compared to postoperative diagnosis, delayed repair, and major BDI (all p < 0.001). No difference was noted in loss-of-production for minor versus major BDIs or between different treatment strategies. The cost per QALY gained with routine intraoperative cholangiography (ICER-incremental cost-effectiveness ratio) to achieve intraoperative diagnosis was €50,000. Conclusions: Intraoperative detection and immediate intraoperative repair is the superior strategy with less than half the cost and superior functional patient outcomes than postoperative diagnosis and delayed repair. The cost per QALY gained (ICER) using routine IOC was considered reasonable.
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| 2. |
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| 3. |
- Al-Harthy, Mohammad, et al.
(författare)
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Cross-cultural differences in types and beliefs about treatment in women with temporomandibular disorder pain
- 2018
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 45:9, s. 659-668
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesWomen with temporomandibular disorder (TMD) pain from three cultures were assessed for type of treatment received and core illness beliefs. MethodsIn a clinical setting, 122 women patients with chronic TMD pain (39 Saudis, 41 Swedes and 42 Italians) were evaluated for patient characteristics, type of practitioner, type of treatment received and beliefs about TMD prior to consultation in TMD specialist centres. Measures included a survey of treatments received and a belief scale regarding contributing, aggravating and treatment-relevant factors related to the pain. All questionnaires were translated from English and culturally adapted. Comparisons among cultural groups were performed using a linear regression model for continuous variables and logistic regression model for dichotomous variables. A P-value
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| 4. |
- Al-Harthy, Mohammad, et al.
(författare)
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Influence of culture on pain comorbidity in women with and without temporomandibular disorder-pain
- 2017
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 44:6, s. 415-425
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Tidskriftsartikel (refereegranskat)abstract
- Evidence on cultural differences in prevalence and impact of common chronic pain conditions, comparing individuals with temporomandibular disorders (TMD) versus individuals without TMD, is limited. The aim was to assess cross-cultural comorbid pain conditions in women with chronic TMD pain. Consecutive women patients (n = 122) with the index condition of chronic TMD pain diagnosed per the research diagnostic criteria for TMD and TMD-free controls (n = 121) matched for age were recruited in Saudi Arabia, Italy and Sweden. Self-report questionnaires assessed back, chest, stomach and head pain for prevalence, pain intensity and interference with daily activities. Logistic regression was used for binary variables, and ancova was used for parametric data analysis, adjusting for age and education. Back pain was the only comorbid condition with a different prevalence across cultures; Swedes reported a lower prevalence compared to Saudis (P < 001). Saudis reported higher prevalence of work reduced >50% due to back pain compared to Italians or Swedes (P < 001). Headache was the most common comorbid condition in all three cultures. The total number of comorbid conditions did not differ cross-culturally but were reported more by TMD-pain cases than TMD-free controls (P < 001). For both back and head pain, higher average pain intensities (P < 001) and interference with daily activities (P < 001) were reported by TMD-pain cases, compared to TMD-free controls. Among TMD-pain cases, Italians reported the highest pain-related disability (P < 001). Culture influences the associated comorbidity of common pain conditions. The cultural influence on pain expression is reflected in different patterns of physical representation.
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| 5. |
- Al-Harthy, Mohammad, et al.
(författare)
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The effect of culture on pain sensitivity
- 2016
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 43:2, s. 81-88
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Tidskriftsartikel (refereegranskat)abstract
- Cross-cultural differences in pain sensitivity have been identified in pain-free subjects as well as in chronic pain patients. The aim was to assess the impact of culture on psychophysical measures using mechanical and electrical stimuli in patients with temporomandibular disorder (TMD) pain and pain-free matched controls in three cultures. This case-control study compared 122 female cases of chronic TMD pain (39 Saudis, 41 Swedes and 42 Italians) with equal numbers of age- and gender-matched TMD-free controls. Pressure pain threshold (PPT) and tolerance (PPTo) were measured over one hand and two masticatory muscles. Electrical perception threshold and electrical pain threshold (EPT) and tolerance (EPTo) were recorded between the thumb and index fingers. Italian females reported significantly lower PPT in the masseter muscle than other cultures (P < 0001) and in the temporalis muscle than Saudis (P = 0003). Swedes reported significantly higher PPT in the thenar muscle than other cultures (P = 0017). Italians reported significantly lower PPTo in all muscles than Swedes (P 0006) and in the masseter muscle than Saudis (P < 0001). Italians reported significantly lower EPTo than other cultures (P = 001). Temporomandibular disorder cases, compared to TMD-free controls, reported lower PPT and PPTo in all the three muscles (P < 0001). This study found cultural differences between groups in the PPT, PPTo and EPTo. Overall, Italian females reported the highest sensitivity to both mechanical and electrical stimulation, while Swedes reported the lowest sensitivity. Mechanical pain thresholds differed more across cultures than did electrical pain thresholds. Cultural factors may influence response to type of pain test.
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| 6. |
- Al-Khotani, Amal A, et al.
(författare)
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Professional knowledge among Swedish and Saudi healthcare practitioners regarding oro-facial pain in children and adolescents
- 2016
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 43:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Oro-facial pain (OFP) and temporomandibular disorders (TMD) in children and adolescents are a growing problem. To meet patients' healthcare needs, professionals must perform their work intuitively and with quality. Therefore, a high degree of professional knowledge is necessary. To investigate the professional knowledge regarding OFP/TMD in children and adolescents among Swedish and Saudi Arabian dental and medical specialists compared with Swedish OFP specialists. One questionnaire including the four domains Chronic pain and behaviour; Aetiology; Diagnosis and classification; Treatment and prognosis was distributed to 383 potential participants, that is physicians and dentists in Sweden and Saudi Arabia. The Swedish OFP/TMD specialists were used as a reference group. The response rates from Sweden and Saudi Arabia were 49% and 86%, respectively. The degree of agreement was highest in the domain Chronic pain and behaviour, especially for the Swedish groups. Regarding the other three domains, the agreement was modest to poor. In general, Swedish groups showed a higher agreement with Swedish OFP/TMD specialists than Saudi Arabian groups. This study shows that professional knowledge regarding OFP/TMD in children and adolescents is limited among Swedish and Saudi Arabian dental and medical professionals compared to Swedish OFP/TMD specialists. In Swedish groups, the professional knowledge is more accurate than in the corresponding Saudi Arabian. With these results in mind, and the frequent prevalence of OFP/TMD in children and adolescents, one can draw the conclusion that there is a need for modern medical education regarding OFP/TMD among both physicians and dentists, especially in Saudi Arabia.
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| 7. |
- Alstergren, Per, et al.
(författare)
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Clinical diagnosis of temporomandibular joint arthritis
- 2018
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 45:4, s. 269-281
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Tidskriftsartikel (refereegranskat)abstract
- Evidence-based clinical diagnostic criteria for temporomandibular joint (TMJ) arthritis are not available. To establish (i) criteria for clinical diagnosis of TMJ arthritis and (ii) clinical variables useful to determine inflammatory activity in TMJ arthritis using synovial fluid levels of inflammatory mediators as the reference standard. A calibrated examiner assessed TMJ pain, function, noise and occlusal changes in 219 TMJs (141 patients, 15 healthy individuals). TMJ synovial fluid samples were obtained with a push-pull technique using the hydroxycobalamin method and analysed for TNF, TNFsRII, IL-1, IL-1ra, IL-1sRII, IL-6 and serotonin. If any inflammatory mediator concentration exceeded normal, the TMJ was considered as arthritic. In the patient group, 71% of the joints were arthritic. Of those, 93% were painful. About 66% of the non-arthritic TMJs were painful to some degree. Intensity of TMJ resting pain and TMJ maximum opening pain, number of jaw movements causing TMJ pain and laterotrusive movement to the contralateral side significantly explained presence of arthritis (AUC 0.72, P<.001). Based on these findings, criteria for possible, probable and definite TMJ arthritis were determined. Arthritic TMJs with high inflammatory activity showed higher pain intensity on maximum mouth opening (P<.001) and higher number of painful mandibular movements (P=.004) than TMJs with low inflammatory activity. The combination TMJ pain on maximum mouth opening and Contralateral laterotrusion <8mm appears to have diagnostic value for TMJ arthritis. Among arthritic TMJs, higher TMJ pain intensity on maximum mouth opening and number of mandibular movements causing TMJ pain indicates higher inflammatory activity.
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| 8. |
- Altamash, M., et al.
(författare)
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Periodontal treatment and HbA1c levels in subjects with diabetes mellitus
- 2016
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 43:1, s. 31-38
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Tidskriftsartikel (refereegranskat)abstract
- It has earlier been reported that individuals with poorly controlled diabetes have severe periodontal disease (PD) compared to well-controlled diabetes. This longitudinal interventional study compared periodontal treatment outcomes with HbA1c level changes in four groups of diabetic and non-diabetic patients with or without PD, respectively. HbA1c, bleeding on probing (BOP), plaque index and periodontal pocket depth (PPD) 4 < 6 mm and >= 6 mm were recorded at baseline to 3 months after non-surgical treatment and 3-6 months for surgical treatment in subjects with or without T2D, and with or without PD. A total of 129 patients were followed from baseline to 6 months. Diabetics with PD and without PD showed reductions in HbA1c levels with a mean value of 0.3% after 3 months and mean values of 1% and 0.8%, respectively, after 6 months. Diabetics with PD showed higher levels of BOP versus non-diabetics without PD (P < 0.01) and versus diabetics without PD (P < 0.05) at baseline. After 6 months, diabetics with PD showed higher number of PPD 4 < 6 mm versus diabetics without PD (P < 0.01) and non-diabetics with PD (P < 0.01). Diabetics without PD showed higher levels of PPD 4 < 6 mm versus non-diabetics without PD (P < 0.01). Surgical and non-surgical periodontal treatment in all groups improved periodontal inflammatory conditions with a decrease in HbA1c levels in a period of three and 6 months. No change was seen in the number of pockets PPD 4 < 6 mm in diabetic subjects with PD after non-surgical and surgical treatment.
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| 9. |
- Andersson, B, et al.
(författare)
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Preoperative prognostic factors associated with early mortality after upfront pancreatoduodenectomy for Pancreatic Adenocarcinoma
- 2018
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Ingår i: HPB. - : Elsevier BV. - 1365-182X. ; 20:Suppl. 2, s. 320-320
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Konferensbidrag (refereegranskat)abstract
- Introduction: Tumour related factors are well known as risk factors for survival after pancreatoduodenectomy (PD). In a time when the role for neoadjuvant treatment is discussed also in primary resectable patients, the influence of preoperative variables is of interest. The aim was to examine preoperative factors influence on early mortality following PD.Materials: Patients registered in the Swedish National Registry for Pancreatic and Periampullary Cancer that underwent PD from January 2010 until October 2017, with pancreatic ductal adenocarcinoma and a follow-up of at least 12 months, were included. Univariable and multivariable logistic regression analysis was performed to evaluate preoperatively registered predictors of early death (within 12 months).Results: In total 2,183 pancreatoduodenectomies were performed and 988 patients met the study criteria. The mean age was 67.8 years and 48% were female. A majority had weight loss (59%) and preoperative biliary drainage (78%). 241 (24%) died within 12 months. In univariable analysis age>75 years (p=0.011), CRP>10 mg/L (p=0.008), diabetes (p=0.033), respiratory disorders (p=0.001), and ASA-score >2 (p>0.001) were prognostic factors for early death. In multivariable analysis age>75 years (OR1.66, CI 1.16–2.37, p=0.006), CRP>10 mg/L (OR 1.51, CI 1.10–2.07, p=0.001), diabetes (OR 1.42, CI 1.01–1.99, p=0.045), and respiratory disorders (OR 2.40 CI 1.38–4.18, p=0.002) were independent factors.Discussion: From a national database older age, elevated CRP, diabetes, and respiratory disorders were identified as independent preoperative risk factors for early mortality following PD. This findings may be used in an individualised treatment plan.
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| 10. |
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