| 1. |
- 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, Olle, et al.
(författare)
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Clinical validation of a novel automated cell-free DNA screening assay for trisomies 21, 13, and 18 in maternal plasma.
- 2019
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Ingår i: Prenatal diagnosis. - : Wiley. - 1097-0223 .- 0197-3851. ; 39:11, s. 1011-1015
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate clinical performance of a new automated cell-free (cf)DNA assay in maternal plasma screening for trisomies 21, 18, and 13, and to determine fetal sex.Maternal plasma samples from 1200 singleton pregnancies were analyzed with a new non-sequencing cfDNA method, which is based on imaging and counting specific chromosome targets. Reference outcomes were determined by either cytogenetic testing, of amniotic fluid or chorionic villi, or clinical examination of neonates.The samples examined included 158 fetal aneuploidies. Sensitivity was 100% (112/112) for trisomy 21, 89% (32/36) for trisomy 18, and 100% (10/10) for trisomy 13. The respective specificities were 100%, 99.5%, and 99.9%. There were five first pass failures (0.4%), all in unaffected pregnancies. Sex classification was performed on 979 of the samples and 99.6% (975/979) provided a concordant result.The new automated cfDNA assay has high sensitivity and specificity for trisomies 21, 18, and 13 and accurate classification of fetal sex, while maintaining a low failure rate. The study demonstrated that cfDNA testing can be simplified and automated to reduce cost and thereby enabling wider population-based screening.
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| 3. |
- Hallenstal, N., et al.
(författare)
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Tonsil surgery in Sweden 2013-2015. Indications, surgical methods and patient-reported outcomes from the National Tonsil Surgery Register
- 2017
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 137:10, s. 1096-1103
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describes how tonsil surgery was performed in Sweden from 2013 to 2015 with data from the National Tonsil Surgery Registry in Sweden (NTSRS). Method: The registry collects data from both professionals and patients through questionnaires. A total of 33,870 tonsil surgeries were analysed, comprising approximately 80% of all tonsil surgeries in Sweden from 2013 to 2015. Results: The two most common procedures were tonsillectomy (41%) and tonsillotomy with adenoidectomy (38%). Tonsillectomy was most commonly performed to treat frequent tonsillitis, while the main indication for tonsil surgery with combined adenoidectomy and for tonsillotomy alone was upper airway obstruction. The most commonly used techniques were cold steel (70%) for tonsillectomy/adenotonsillectomy and radiofrequency (79%) for tonsillotomy/adenotonsillotomy. Ninety-five percent of patients reported symptom relief after 180 d. Day surgery was utilised in 70% of the surgeries. The rate of readmission due to post-tonsillectomy haemorrhage was 5.1%. Male patients more often underwent tonsil surgery at preschool ages due to upper airway obstruction; in comparison, female patients to a larger extent underwent surgery in their early teens because of previous infections. Conclusions: The NTSRS provides an opportunity to survey tonsil surgery in Sweden and to launch and follow up improvement programmes as desired.
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| 4. |
- Hellstrom-Lindahl, E., et al.
(författare)
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Toward molecular imaging of the free fatty acid receptor 1
- 2017
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Ingår i: Acta Diabetologica. - : Springer Science and Business Media LLC. - 0940-5429 .- 1432-5233. ; 54:7, s. 663-668
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Tidskriftsartikel (refereegranskat)abstract
- Molecular imaging of the free fatty acid receptor 1 (FFAR1) would be a valuable tool for drug development by enabling in vivo target engagement studies in human. It has also been suggested as a putative target for beta cell imaging, but the inherent lipophilicity of most FFAR1 binders produces high off-target binding, which has hampered progress in this area. The aim of this study was to generate a suitable lead compound for further PET labeling. In order to identify a lead compound for future PET labeling for quantitative imaging of FFAR1 in human, we evaluated tritiated small molecule FFAR1 binding probes ([H-3]AZ1, [H-3]AZ2 and [H-3]TAK-875) for their off-target binding, receptor density and affinity in human pancreatic tissue (islets and exocrine) and rodent insulinoma. [H-3]AZ1 showed improved specificity to FFAR1, with decreased off-target binding compared to [H-3]AZ2 and [H-3]TAK-875, while retaining high affinity in the nanomolar range. FFAR1 density in human islets was approximately 50% higher than in exocrine tissue. AZ1 is a suitable lead compound for PET labeling for molecular imaging of FFAR1 in humans, due to high affinity and reduced off-target binding.
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| 5. |
- Hessén-Söderman, Anne-Charlotte, et al.
(författare)
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Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis : an analysis of 15734 patients in the National Tonsil Surgery Register in Sweden
- 2015
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Ingår i: Clinical Otolaryngology. - : Wiley. - 1749-4478 .- 1365-2273. ; 40:3, s. 248-254
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To analyse post-tonsillectomy haemorrhage(PTH) rates related to technique for dissection and haemostasis.Study Design: Register study from the National TonsilSurgery Register in Sweden (NTSRS).Methods: All patients, subjected to tonsillectomy (TE)without adenoidectomy from 1 March 2009 to 26 April 2013,were included in the study. The surgeon reports data abouttechnique and early PTH, while late PTH is reported by thepatient in a questionnaire 30 days after surgery.Results: 15734 patients with complete data concerningtechnique for dissec tion and for haemostasis were identifiedin the NTSRS. Techniques used were cold steel dissectionwith uni- or bipolar diathermy haemostasis (65.3%),diathermy scissors (15.7%), coblation (9.1%), cold steeldissection with cold haemostasis (7.4%) and ultrascision(2.5%). Early and late PTH were reported in 3.2% and 9.4% of the cases, respectively, and return to theatre (RTT) in2.7%. The rat es for PTH and RTT related to technique wereanalysed. Compared with cold dissection+ cold haemostasis,late PTH rate was 2.8 times higher after cold dissection + hothaemostasis, 3.2 times higher after coblation, 4.3 timeshigher after diathermy scissors and 5.6 times higher afterultrascision. The risk for RTT was higher for all hottechniques except for coblation, while ultrascision resultedin a lower risk for early PTH.Conclusions: All hot techniques resulted in a higher risk forlate PTH compared with cold steel dissection +coldhaemostasis. The risk for RTT was higher for all hottechniques except for coblation, while ultrascision resultedin a lower risk for early PTH. An early PTH was associatedwith an increased risk for late PTH.
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| 6. |
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| 7. |
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| 8. |
- Odhagen, Erik, et al.
(författare)
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Readmission Rates Due to Post-Tonsillectomy Haemorrhage in Sweden: SIGNIFICANT DIFFERENCES BETWEEN SURGICAL CENTRES : Significant Differences Between Surgical Centres
- 2016
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Konferensbidrag (refereegranskat)abstract
- Objectives: Post-surgical haemorrhage is the major complication of tonsil surgery. Post-tonsillectomy haemorrhage often results in readmission to hospital, sometimes demands return to theatre and can be a life-threatening occurrence. There are large differences in previously reported rates of post-tonsillectomy haemorrhage. The aim of this study is to determine readmission rates due to post-tonsillectomy haemorrhage in Sweden 2012-2014.Method: This is a population-based cohort study based on matched data from two healthcare registries in Sweden; the Swedish National Patient Register (NPR) and the National Tonsil Surgery Register in Sweden (NTSRS). All patients who underwent tonsillectomy, with or without simultaneous adenoidectomy, on benign indications from 2012 to 2014 were included in the study. The unique Personal Identity numbers were used to follow patients over time in NPR and identify readmission due to haemorrhage within 30 days from surgery. In NTSRS, readmission was reported by the patient in a questionnaire 30 days after surgery.Results: By matching the two registries a total of 22 800 unique patients were identified and included in the study. A total of 1726 patients (7.6%) were readmitted to hospital due to post-surgical haemorrhage. Tonsil surgery was conducted at 56 different surgical centres. Readmission rates due to post-tonsillectomy haemorrhage ranged from 0% to 22.4% at different surgical centres. 11 of 56 surgical centres had significant lower readmission rates compared to the average in Sweden. 12 of 56 surgical centres had significant higher readmission rates than the average.Conclusions: The rate of hospital readmissions due to post-surgical haemorrhage following tonsillectomy in Sweden 2012-2014 was 7.6%. There were significant differences in readmission rates between different surgical centres. This suggests that quality improvement interventions should be explored in units with high readmission rates to decrease post-tonsillectomy morbidity.
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| 9. |
- Odhagen, Erik, 1977, et al.
(författare)
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Risk of reoperation after tonsillotomy versus tonsillectomy : a population-based cohort study
- 2016
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Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer. - 0937-4477 .- 1434-4726. ; 273, s. 3263-3268
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Tidskriftsartikel (refereegranskat)abstract
- Tonsil surgery to address upper airway obstruction in children can be performed either as a tonsillectomy (TE) or as a tonsillotomy/intracapsular/partial tonsillectomy (TT). The advantage of TT is a decreased risk of postoperative morbidity. The disadvantage is the risk of tonsil regrowth with recurrence of symptoms and/or problems with future tonsil infections, which may demand a reoperation of the tonsils. The aim of this study is to compare the risk of reoperation of the tonsils following TE and TT in children with tonsil-related upper airway obstruction. This is a retrospective register-based cohort study of the Swedish National Patient Register. All children aged 1–12 years who underwent TE or TT from 2007 to 2012 for the main indication of upper airway obstruction were included in the study. The unique Personal Identity numbers were used to follow patients over time in the register and identify additional tonsil surgery. A total of 27,535 patients were included in the study, contributing 76,054 person-years of follow-up. A total of 684 patients (2.5 %) underwent a second tonsil surgery during follow-up. The incidences of reoperation were 1.94 per 1000 person-years in the TE group and 16.34 per 1000 person-years in the TT group. The risk for reoperation was seven times higher (HR 7.16) after TT compared to TE. Younger age was significantly associated with reoperation for both TE and TT and the difference in risk between TE and TT gradually decreased with time. The most common indication for reoperation after both TE and TT was ‘‘Upper airway obstruction’’.
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| 10. |
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Organ Prospects and Retrospects : Texts and Music in Celebration of Organ Acusticum, Piteå, Sweden
- 2017
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Proceedings (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Organ Acusticum at Luleå University of Technology, built in the years 2009–2012 by Orgelbauwerkstatt Woehl, Marburg, Germany, for the concert hall of Studio Acusticum, Piteå, Sweden, is with 140 stops Sweden’s largest organ and one of the largest in Europe – and, more importantly, perhaps the most thoroughgoing attempt to date to combine several of the most important historical styles in a single instrument, while at the same time opening up possibilities for musical innovation and border-crossing. The inauguration of this unique instrument, on October 13, 2012, was followed by a ten-day organ festival and symposium, to which a number of the world’s foremost performers and scholars in the field contributed. Organ Prospects and Retrospects celebrates Organ Acusticum in written text and sounding music. Following an introductory chapter, fourteen essays of varying length are grouped in four thematic sections: ‘Organ Acusticum’, ‘Organs and Organ Builders’, ‘Organs and Organ Music’, and ‘Bach Reception’. The volume thus covers a wide array of organ-related topics, ranging from the 17th century to the present day, illustrated with music examples, photos and tables. The back matter includes biographies of the contributors, the specification of Organ Acusticum, a bibliography, and an index of names. On the accompanying CD, Organ Acusticum can be heard in recordings from concerts given at the festival. Both texts and music reflect in various ways the versatility of the instrument.
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