| 1. |
- Barenius, Björn, et al.
(författare)
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Increased risk of osteoarthritis after anterior cruciate ligament reconstruction : a 14-year follow-up study of a randomized controlled trial.
- 2014
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Ingår i: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 42:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The reported prevalence of radiological osteoarthritis (OA) after anterior cruciate ligament (ACL) reconstruction varies from 10% to 90%. Purpose/HYPOTHESIS: To report the prevalence of OA after ACL reconstruction and to compare the OA prevalence between quadrupled semitendinosus tendon (ST) and bone-patellar tendon-bone (BPTB) grafts. The hypothesis was that there would be no difference in OA prevalence between the graft types. The secondary aim was to study whether patient characteristics and additional injuries were associated with long-term outcomes.STUDY DESIGN: Randomized controlled trial; Level of evidence, 1.METHODS: Radiological examination results, Tegner activity levels, and Knee injury and Osteoarthritis Outcome Score (KOOS) values were determined in 135 (82%) of 164 patients at a mean of 14 years after ACL reconstruction randomized to an ST or a BPTB graft. Osteoarthritis was defined according to a consensus by at least 2 of 3 radiologists of Kellgren-Lawrence grade ≥2. Using regression analysis, graft type, sex, age, overweight, time between injury and reconstruction, additional meniscus injury, and a number of other variables were assessed as risk factors for OA 14 years after ACL reconstruction.RESULTS: Osteoarthritis of the medial compartment was most frequent, with 57% of OA cases in the ACL-reconstructed knee and 18% of OA cases in the contralateral knee (P < .001). There was no difference between the graft types: 49% of OA of the medial compartment for BPTB grafts and 65% for ST grafts (P = .073). The KOOS results were lower for patients with OA in all subscales, indicating that OA was symptomatic. No difference in the KOOS between the graft types was found. Meniscus resection was a strong risk factor for OA of the medial compartment (odds ratio, 3.6; 95% CI, 1.4-9.3) in the multivariable logistic regression analysis.CONCLUSION: A 3-fold increased prevalence of OA was found after an ACL injury treated with reconstruction compared with the contralateral healthy knee. No differences in the prevalence of OA between the BPTB and quadrupled ST reconstructions were found. An initial meniscus resection was a strong risk factor for OA; the time between injury and reconstruction was not.
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| 2. |
- Bernhoff, Karin, 1972-
(författare)
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Orthopaedic Patients with Lower Limb Vascular Injuries
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Vascular injuries in lower limbs are rare but serious events. If not detected and managed correctly and timely they can lead to permanent functional impairment and even limb loss. The increasing number of orthopaedic interventions, worldwide, makes awareness of this problem among orthopaedic surgeons important.The overall aim of this thesis was to describe lower limb orthopaedic injuries with associated concomitant arterial injuries, especially to the popliteal artery. Epidemiology, mechanisms of injury, management, outcomes and the patient perspective were all addressed. The research questions were generated from clinical praxis. Vascular injuries are rare events, but by using as the National Patient (NPR) and National Vascular registries (Swedvasc) a relatively speaking large cohort was studied. Deep interviews with qualitative study method were used to investigate the patients’ perspective.In papers I and II iatrogenic popliteal artery injuries (PAI) in knee-replacements, and in non-knee-replacements, were investigated. The number of knee arthroplasties in Sweden increased 1987-2008, but not the frequency of iatrogenic PAI. The most common mechanism of injury was sharp, directly to the artery. One third of the injuries resulted in pseudo-aneurysms. This was an unexpected and important finding, since these patients were often diagnosed late, resulting in poor outcome.Paper III. The interviewed patients narrated substantial functional, cosmetic and psychological impairments,4-17 years after their accidents, yet they described their lives as “normal”. Patients with saved limbs reported a need for better interpersonal support in their rehabilitation and adaptation back to “normal” life.Paper IV. Popliteal artery injury is feared in knee dislocations and fractures. The proportion incidence of vascular injury was previously reported to be 2-60%. In this large population-based study, the incidence proportion in knee dislocations was 3.4-8.2%, depending on the definition of dislocation/ligamentous injury. In knee fractures the incidence proportion was lower, only 0.2%. The dominating cause of arterial injury in knee dislocations was fall, in knee fractures it was motor vehicle accidents. Amputation- free survival after arterial injury was inferior in knee fractures compared with knee dislocations.In conclusion, PAI is a serious injury but on sequences can be limited by awareness and timely action.
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| 3. |
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| 4. |
- Ekstrom, Wilhelmina, et al.
(författare)
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Sex effects on short-term complications after hip fracture: a prospective cohort study
- 2015
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Ingår i: Clinical Interventions in Aging. - 1178-1998 .- 1176-9092. ; 10, s. 1259-1266
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate potential sex differences and other factors associated with complications within 4 months after a hip fracture. Methods: A total of 1,915 patients. 65 years (480 men) with hip fracture were consecutively included in a prospective multicenter cohort study. A review of medical records and patient interviews according to a study protocol based on the Standardized Audit of Hip Fractures in Europe (SAHFE, RIKSHOFT) was performed. Sex differences in comorbidity according to the American Society of Anesthesiologists score and complications 4 months after a hip fracture were registered. Multivariate logistic regression analysis was performed to identify factors related to complications. Results: Male sex was associated with worse general health according to the American Society of Anesthesiologists classification (P=0.005) and with more comorbidities (P<0.001). Male sex emerged as a risk factor for developing pneumonia (P<0.001), and additionally, 18% of the men suffered from cardiac complications compared with 13% of the females (P=0.018). Female sex was predisposed for urinary tract infections, 30% vs 23% in males (P=0.001). Mortality was higher in the male vs female group, both within 30 days (15% vs 10%, P=0.001) and at 4 months (24% vs 14%, P=0.001). Conditions associated with pneumonia were male sex, pulmonary disease, and cognitive impairment. Cardiac complications were associated with delayed surgery and cardiovascular and pulmonary disease. Conclusion: Before surgery, men with hip fracture already have a poorer health status and higher comorbidity rate than women, thus resulting in a twofold increased risk of pneumonia. Cognitive dysfunction and pulmonary disease contributed to pneumonia in men. Delayed surgery seems to increase the risk for cardiac complications. It is important to consider the sex perspective early on together with cardiopulmonary comorbidity and cognitive dysfunction to be able to counteract serious complications that may lead to death.
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| 5. |
- Fryden, Hanna, et al.
(författare)
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Roles, tasks and educational functions of postgraduate programme directors : a qualitative study
- 2015
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Ingår i: Postgraduate medical journal. - : Oxford University Press (OUP). - 0032-5473 .- 1469-0756. ; 91:1080, s. 588-593
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Tidskriftsartikel (refereegranskat)abstract
- Background A programme director is often required to organise postgraduate medical education. This leadership role can include educational as well as managerial duties. Only a few published studies have explored programme directors' own perceptions of their role. There is a need to explore the use of theoretical frameworks to improve the understanding of educational roles.Objective To explore programme directors' own perceptions of their role in terms of tasks and functions, and to relate these roles to the theoretical framework developed by Bolman and Deal.Methods Semi-structured interviews were conducted with 17 programme directors between February and August 2013. The data were subjected to content analysis using a deductive approach.Results The various roles and tasks included by participants in their perceptions of their work could be categorised within the framework of functions described by Bolman and Deal. These included: structuring the education (structural function); supporting individuals and handling relations (human resource function); negotiating between different interests (political function); and influencing the culture at the departmental level (symbolic function). The functions most often emphasised by participants were the structural and human resource functions. Some tasks involved several functions which varied over time.Conclusions Programme directors' own perceptions of their roles, tasks and functions varied widely. The theoretical framework of Bolman and Deal might be helpful when explaining and developing these roles.
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| 6. |
- Gustafsson, Birgitta Åkesdotter, et al.
(författare)
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The lived body and the perioperative period in replacement surgery: older people´s experiences
- 2007
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 60:1, s. 20-28
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper is a report of a study to explore older people´s expereinces of their lived bodies during the perioperative period of hip or knee replacement.Background. replacement surgery of a major joint for older people suffering from osteoarthtitis is an established treatment in developed countries. Scientific knowledge is awailable on replacement surgery from several perspectives, but not about older people´s experiences of the entire perioperative period of replacement procedure.Method. A qualitative longitudinal study was conducted between 2002 and 2004. Audiotaped interviews were carried out with 12 older people, on five different occasions during the perioperative period. The data was analysed using latent qualitative content analysis.Findings. The perioperative period of a hip or knee replacement can be regarded as a process of transition which includes six critical phases. The transition was supported with a dream of becoming as able-bodied as previously in life, by having surgery. In addition, our findings revealed that the care recipients lacked knowledge about the surgical intervention as a whole.Conclusion. The meaning of having joint replacement surgery was to overcome the confinement of living with a painful and unreliable body. Furthermore, care recipients struggled to regain a body in charge and control of their lives, yet from a new starting point. The care recipients were not prepared for the transitional changes through the perioperative period. Further research is needed to develop an appropriate programme for patient care during the perioperative period, in order to facilitate the process of transition.
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| 7. |
- Gustafsson Åkesdotter, Birgitta, et al.
(författare)
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In the hands of formal caregivers: older patients' expereinces of care across the perioperative period for hip and knee replacements
- 2010
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Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier BV. - 1878-1241 .- 1878-1292. ; 14:2, s. 96-108
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Tidskriftsartikel (refereegranskat)abstract
- Summary Total joint replacements of the hip or knee have become standard surgicalprocedures and lately more focus has been placed on the patient’s perspective.Aim: The aim of this study was to illuminate the meaning of care from all formalcarers before, during, and after joint replacement surgery of the hip or knee. Study design: A qualitative longitudinal design was chosen to capture thepatients’ experiences from the time they were placed on the waiting list untilone year after the operation. Analysis revealed that, initially, the operation itselfwas regarded as the key for reaching the goal of independence in every-day life.Patients became aware that all care related to the operation was essential. Themeaning of care from formal carers appeared to be: wanting to be ‘in safe hands’with competent formal carers across the entire perioperative period for thereplacement surgery. Conclusion: Our findings indicate that for a good outcome care characterized bycontinuous guidance from formal carers with expert knowledge of care and jointreplacement surgery (competent) was necessary for patients to feel that they were‘in safe hands’ across the perioperative period. This requires organisation of carethat can offer guidance across the perioperative period.
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| 8. |
- Gustafsson Åkesdotter, Birgitta, et al.
(författare)
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The hip and knee replacement operation: : a throrough life event
- 2010
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 24:4, s. 663-670
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Tidskriftsartikel (refereegranskat)abstract
- Background: A total hip replacement and a total knee replacement have shown to effectively reduce pain and disability in patients with osteoarthritis of the hip and knee joint despite associated risks. Even though the intervention primarily concerns older people with additional health problems, the patients stand on their feet the day after the operation and are discharged a few days later. Previous research indicates that reflections about life are related to the operation.Aim: The aim of this study was to illuminate the meaning of reflections related to hip and knee replacement surgery.Method: A phenomenological hermeneutical approach with a longitudinal design was chosen in order to study the participants’ experiences of the hip and knee replacement intervention across the entire perioperative period.Findings: Four themes emerged from the structural analysis; choosing the challenge, past memories connect to the current situation, moving from happiness to ordinary everyday life and moving from despair towards reluctant acceptance of unexpected bad conditions for everyday life. There was inner negotiations about having surgery or not, and existential anxiety that reminded people that life cannot be taken for granted.Conclusion: Our findings indicate the operation was seen as an extensive life event including reflections about life and death and about hope and fear. Previous bad experiences of care seemed to influence the way patients dealt with fear and hope. Fear had to be overcome by inner negotiations about undergoing surgery or not. Relief was expressed about surviving the actual operation, but soon after fears arose about how to manage on the actual road to recovery. Hope for a good life grew either stronger or weaker, depending on the progress following the operation. The outcome eventually generated a transition from happiness to ordinary everyday life, or a transition from despair towards reluctant acceptance of unfulfilled expectations.
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| 9. |
- Hylin, Uffe, et al.
(författare)
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Interprofessional training in clinical practice on a training ward for healthcare students : a two-year follow-up
- 2007
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Ingår i: Journal of Interprofessional Care. - : Informa UK Limited. - 1356-1820 .- 1469-9567. ; 21:3, s. 277-88
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Tidskriftsartikel (refereegranskat)abstract
- This follow-up study describes the former students' lasting impressions of a two-week interprofessional course on a training ward aimed at enhancing the understanding of the roles of other professions and the importance of communication for teamwork and for patient care as well as providing an opportunity for profession-specific training. A questionnaire with both closed and open-ended questions was sent to 633 former students two years after the course and 348 (55%) responded. The course was rated as very good and most of the former students had lasting and positive impressions. Ninety-two percent of respondents encouraged teamwork in their present work and 90% wanted to retain the course. The qualitative analysis of the open-ended questions resulted in five categories describing students' perceptions: professional role development, working in teams, tutoring, patient care and future aspects of the course and real world practice. Our results suggest that interprofessional training during undergraduate education provides lasting impressions that may promote teamwork in students' future occupational life.
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| 10. |
- Juto, Hans, 1975-
(författare)
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Studies of ankle fractures : classification, epidemiology, complications and results
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The ankle fracture is one of the most common fractures in adult patients and is a heterogeneous group of fractures. From the fully stable fracture on the most distal part of thefibula to severely unstable and even dislocated ankles. Patients with ankle fractures often report a good result after treatment, but a small group have persistent problems.The purpose of the dissertation is to investigate classification, epidemiology, complications, and results in order to improve knowledge and management of ankle fractures.This dissertation is mainly based on data from the Swedish Fracture Register (SFR).In Study I the accuracy of the AO/OTA classification, version 2007, of ankle fractures in the SFR was examined. Entry of data into the SFR is mainly performed by the attending doctors at the accident and emergency departments, often with varying experience of fracture classification. Classification of fractures can in some cases bedifficult even for experienced orthopaedic surgeons. This is because the fractures to be categorized can be seen being on a spectrum and there will always be cases which is on the border between different categories. We created a reference group that classified several randomly selected ankle fractures from the SFR based on X-rays from treatingorthopedic departments. The assessment that was then agreed upon was considered to be the gold standard classification and could in turn be compared to the classification found in the SFR. The agreement between the classification in the SFR and the classification of the reference group was 88% for AO/OTA type level and 74% for AO/OTAgroup level. This corresponded to a kappa value of 0.77 and 0.66 respectively. The findings were equivalent to or higher than in previous studies.In study II the aim was to examine the incidence of ankle fractures in Norrbotten county, as well as the relationship between AO/OTA-classes of ankle fractures with age, gender and low-energy trauma. Ankle fractures are increasing in an ageing population but are not generally seen as a fragility fracture. All ankle fractures treated at a hospital in the county were retrospectively identified, X-rays were inspected and classified, and the medical record reviewed. The study found 1,756 ankle fractures corresponding to an incidence of 179 per 100,000 person-years. Females had an increasing incidence with age while among males the incidence was more evenly distributed. The type B fractures showed a slightly higher proportion of low-energy trauma and increased substantially with age. In contrast were the A21-subgroup and type C ankle fractures which had a lower mean age and proportion of women.Study III investigated the association between the incidence of venous thromboembolic event (VTE) and the use of low-molecular-weight heparin (LMWH) prophylaxis following an ankle fracture, as well as factors affecting the risk of VTE. VTE is a well-known complication after ankle fracture and especially after ankle fracture surgery. The use of LMWH prophylaxis is debated. Data on ankle fracture treatment from the Swedish Fracture Register was linked to data for VTE diagnosis and LMWH prescription from the Swedish National Patient Register and the Swedish Prescribed Drug Register. Cases of diagnosed VTE were identified among 222 of 14,954 ankle fractures. Orthopaedic departments with higher-than-average use of LMWH prophylaxis among non-operatively treated ankle fractures had a lower incidence of VTE (OR 0.60, 95% CI, 0.39-0.92). Among patients treated operatively at departments with guidelines for routine use of LMWH prophylaxis there was an incidence of VTE of 1.6%, compared to 2,7% at departments without routine use of LMWH prophylaxis (OR 0.56, 95% CI, 0.37-0.86). During the first two weeks following injury, there was only one case of VTE in 5,332 patients with prescribed LMWH, compared to 39 cases of VTE among 9,622 patients without prescription.Study IV examined the variations in the length of sick leave in ankle fracture patients. Even though most patients with an ankle fracture report a satisfactory outcome there are still a number of patients with persistent pain and functional impairment. The aim of the study was to analyse how treatment, different types of ankle fracture and patients-related factors were associated with the length of sick leave by combining data from the SFR and Swedish Social Insurance Agency (SSIA). Fifty-three per cent of patients registered with an ankle fracture in the SFR had a period of paid sick leave from the SSIA. There was an association between the length of the sick leave and the severity of the fracture. A correlation was also seen between the length of the sick leave and a worse patient-reported outcome.
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