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- J, Sundman, et al.
(författare)
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Poor interexaminer agreement on Friedman tongue position.
- 2017
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 137:5, s. 554-556
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Tidskriftsartikel (refereegranskat)abstract
- Conclusion: The Friedman tongue position demonstrated only a slight inter-examiner agreement among 15 medical doctors, indicating that the method is difficult to perform and could be an uncertain method to select patients for uvulopalatopharyngoplasty.Objective: The Friedman staging system is a clinical tool for selecting patients with obstructive sleep apnea who are appropriate for uvulopalatopharyngoplasty. The objective of this study was to evaluate the staging system by determining the inter-examiner agreement of one of its key components, the Friedman tongue position.Methods: Eleven residents and four specialists in Otorhinolaryngology were recruited from a course in surgical management of obstructive sleep apnea. They examined each other’s tongue positions, resulting in a total of 210 evaluations. Cohen’s kappa analysis was performed to assess the inter-examiner agreement. The range of kappa is usually between 0–1, where 0 is complete disagreement and 1 is complete agreement.Results: The median kappa was 0.36 (1st and 3rd quartile, 0.23 and 0.42), corresponding to only a slight agreement.
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| 2. |
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| 3. |
- Bizjak, I., et al.
(författare)
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Efficacy and safety of very early medical termination of pregnancy: a cohort study
- 2017
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Ingår i: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 124:13, s. 1993-1999
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 Royal College of Obstetricians and Gynaecologists Objective: To assess the efficacy and safety of medical termination of pregnancy (MTOP) when no intrauterine pregnancy (IUP) is confirmed on ultrasound. Design: Retrospective case-note review. Setting: Two gynaecological clinics in Vienna, Austria, and Gothenburg, Sweden. Population: All women with gestations of ≤49days undergoing an MTOP during 2004–14 (Vienna) and 2012–15 (Gothenburg). Methods: Two study cohorts were created: women with and women without a confirmed IUP. An IUP was defined as the intrauterine location of a yolk sac or fetal structure visible by ultrasound. Women with an IUP were selected randomly and included in the IUP cohort. Main outcome measures: Efficacy of MTOP, defined as no continuing pregnancy and with no need of surgery for incomplete TOP. Results: After excluding 11 women diagnosed with an extra-uterine or molar pregnancy, 2643 cases were included in the final analysis; 1120 (98.2%) had a successful TOP in the no-IUP group, compared with 1458 (97.1%) in the IUP group, with a risk difference of 1.09% (95% confidence interval, 95%CI, −0.14, 2.32%; P=0.077). Significantly more women with confirmed IUP were diagnosed with incomplete TOP, and were treated with either surgery or additional medical treatment of misoprostol [64 (4.3%) versus 21 (1.8%); risk difference −2.42%; 95%CI −3.9, −1.1%; P < 0.001]. Conclusions: There was no difference between the groups in efficacy of MTOP, whereas early treatment resulted in significantly fewer interventions for incomplete TOP. The risk of ectopic pregnancy needs to be considered if treatment is initiated before an IUP is confirmed, but with structured clinical protocols the possibility of the early detection of an ectopic pregnancy in an asymptomatic phase may increase. Tweetable abstract: MTOP before confirmed intrauterine pregnancy is as effective as at later gestation with less incomplete TOP.
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| 4. |
- Browaldh, N, et al.
(författare)
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SKUP(3) RCT; continuous study : Changes in sleepiness and quality of life after modified UPPP.
- 2016
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Ingår i: The Laryngoscope. - : Wiley. - 0023-852X .- 1531-4995. ; 26:6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives/HypothesisOur previous study showed that modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, significantly improved nocturnal respiration in obstructive sleep apnea syndrome (OSAS) patients. This is a continuous study of changes in daytime sleepiness and quality of life.Study DesignProspective randomized controlled trial (RCT), two parallel arms.MethodsSixty‐five patients with apnea‐hypopnea index ≥ 15, body mass index < 36, Epworth Sleepiness Scale (ESS) ≥ 8, Friedman stage I or II, failing nonsurgical treatment. The intervention group (n = 32) underwent surgery, and the controls (n = 33) had no treatment. At baseline and the 7‐month follow‐up, polysomnography, questionnaires, and vigilance tests were implemented.ResultsAll patients answered the questionnaires, and 48 took the vigilance test. Epworth Sleepiness Scale decreased significantly in the intervention group, from a mean (standard deviation) of 12.5(3.2) to 6.8(3.9), but nonsignificantly in the control group, from 12.9(3.1) to 12.5(3.9), a significant group difference (P < 0.001). The physical and mental component score on the Short Form‐36 questionnaire increased significantly in the intervention group, from a mean 47.8(8.3) to 51.2(8.8) and from 42.1(10.6) to 48.1(9.7), respectively, but with nonsignificant changes in the controls: 49.0(9.0) to 48.3(9.1) and 41.0(10.2) to 42.7(11.5), significant group differences (P = 0.007, P = 0.031), respectively. The sleep latency/vigilance test showed a significant mean increase in the intervention group of 7(12.4) minutes and a decrease in the controls of 2.2(10.6), a significant group difference (P = 0.011). There were significant correlations between changes in subjective outcomes and nocturnal respiration.ConclusionThis RCT shows that modified UPPP was effective in improving daytime sleepiness and quality of life in OSAS patients. It strengthens the body of evidence on the potential effect of surgery offered to selected patients.
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| 5. |
- Browaldh, N, et al.
(författare)
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SKUP3 : 6 and 24 months follow-up of changes in respiration and sleepiness after modified UPPP.
- 2018
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Ingår i: The Laryngoscope. - : John Wiley & Sons. - 0023-852X .- 1531-4995. ; 128:5, s. 1238-1244
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveOur previous randomized controlled trial of patients with obstructive sleep apnea syndrome (OSAS) showed that modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, significantly improved nocturnal respiration, daytime sleepiness, and quality of life in the intervention group compared to controls who had delayed surgery after 6 months. This is the continuous report with the 6‐ and 24‐month postoperative results.Study DesignSingle‐center prospective cohort study.MethodsSixty‐five patients with apnea–hypopnea index (AHI) ≥ 15, body mass index (BMI) < 36, Epworth Sleepiness Scale (ESS) ≥ 8, and Friedman stage I or II underwent UPPP after failing nonsurgical treatment. The results from polysomnography and ESS at 6 and 24 months were compared to baseline.ResultsEight percent and 20% dropped out from the 6‐ and 24‐month follow‐ups, respectively. The AHI value decreased significantly from mean (standard deviation) 52.9 (20.5) at baseline to 23.6 (20.2) after 6 months, and to 24.1 (20.9) after 24 months (P < 0.001). Patients with tonsil size 2, and 3 to 4, had significant reductions in the AHI after both follow‐ups. The median ESS score decreased significantly from 13 (range 8–21) to 6.5 (1–18) after 6 months, and to 5 (2–17) after 24 months (P < 0.001). The BMI remained unchanged. There were significant modest correlations for the reductions in AHI and ESS after 24 months.ConclusionModified UPPP was effective in improving nocturnal respiration and daytime sleepiness in OSAS patients at both 6‐ and 24‐month follow‐up. Patients with tonsil size 2, and 3 to 4, benefitted similarly from surgery with improved respiration.
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| 6. |
- Prowse, T., et al.
(författare)
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Arctic Freshwater Synthesis : Summary of key emerging issues
- 2015
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Ingår i: Journal of Geophysical Research - Biogeosciences. - 2169-8953 .- 2169-8961. ; 120:10, s. 1887-1893
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Tidskriftsartikel (refereegranskat)abstract
- In response to a joint request from the World Climate Research Program's Climate and Cryosphere Project, the International Arctic Science Committee, and the Arctic Council's Arctic Monitoring and Assessment Program an updated scientific assessment has been conducted of the Arctic Freshwater System (AFS), entitled the Arctic Freshwater Synthesis (AFS(sigma)). The major reason behind the joint request was an increasing concern that changes to the AFS have produced, and could produce even greater, changes to biogeophysical and socioeconomic systems of special importance to northern residents and also produce extra-Arctic climatic effects that will have global consequences. The AFS(sigma) was structured around six key thematic areas: atmosphere, oceans, terrestrial hydrology, terrestrial ecology, resources, and modeling, the review of each coauthored by an international group of scientists and published as separate manuscripts in this special issue of Journal of Geophysical Research-Biogeosciences. This AFS(sigma) summary manuscript reviews key issues that emerged during the conduct of the synthesis, especially those that are cross-thematic in nature, and identifies future research required to address such issues.
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