| 1. |
- Al Dabbagh, Zewar, et al.
(author)
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No signs of dose escalations of potent opioids prescribed after tibial shaft fractures : a study of Swedish National Registries
- 2014
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In: BMC Anesthesiology. - London : BioMed Central. - 1471-2253 .- 1471-2253. ; 14, s. 4-
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Journal article (peer-reviewed)abstract
- Background: The pattern of opioid use after skeletal trauma is a neglected topic in pain medicine. The purpose of this study was to analyse the long-term prescriptions of potent opioids among patients with tibial shaft fractures.Methods: Data were extracted from the Swedish National Hospital Discharge Register, the National Pharmacy Register, and the Total Population Register, and analysed accordingly. The study period was 2005-2008.Results: We identified 2,571 patients with isolated tibial shaft fractures. Of these, 639 (25%) collected a prescription for opioids after the fracture. The median follow-up time was 17 (interquartile range [IQR] 7-27) months. Most patients with opioid prescriptions after fracture were male (61%) and the median age was 45 (16-97) years. The leading mechanism of injury was fall on the same level (41%). At 6 and 12 months after fracture, 21% (95% CI 17-24) and 14% (11-17) were still being treated with opioids. Multiple Cox regression-analysis (adjusted for age, sex, type of treatment, and mechanism of injury) revealed that older patients (age >50 years) were more likely to end opioid prescriptions (Hazard ratio 1.5 [95% CI 1.3-1.9]). During follow-up, the frequency of patients on moderate and high doses declined. Comparison of the daily morphine equivalent dose among individuals who both had prescriptions during the first 3 months and the 6th month indicated that the majority of these patients (11/14) did not have dose escalations.Conclusions: We did not see any signs in registry-data of major dose escalations over time in patients on potent opioids after tibial shaft fractures.
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| 2. |
- Christersson, Albert
(author)
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Fractures of the distal radius : Factors related to radiographic evaluation, conservative treatment and fracture healing
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Distal radius fractures (DRFs) are one of the most common injuries encountered in orthopaedic practise. Such fractures are most often treated conservatively, but surgical treatment has become increasingly common. This trend is not entirely scientifically basedThe aims of this thesis were threefold: to increase measurement precision in dorsal angulation (DA) on radiographs and computer tomographies (CTs); to assess the results after shortened plaster cast fixation time in reduced DRFs; and to evaluate the feasibility and safety of applying Augment® (rhPDGF-BB/β-TCP) in DRFs.In Paper I and Appendix 1 and 2, a semi-automatic CT-based three-dimensional method was developed to measure change in DA over time in DRFs. This approach proved to be a better (more sensitive) method than radiography in determining changes in DA in fractures of the distal radius.In Paper II, a CT model was used to simulate lateral radiographic views of different radial directions in relation to the X-ray. Using an alternative reference point on the distal radius, precision and accuracy in measuring DA was increased.Paper III and IV are based on a prospective and randomised clinical study (the GitRa trial) that compares clinical and radiographic outcomes after plaster cast removal at 10 days versus 1 month in 109 reduced DRFs. Three patients in the early mobilised group were excluded because of fracture dislocation (n=2) or a feeling of fracture instability (n=1). For the remaining patients in the early mobilised group (51/54) a limited but temporary gain in range of motion, but a slight increase in radiographic displacement were observed. Our results suggest that plaster cast removal at 10 days after reduction of DRFs is not feasible.Paper V is based on a prospective, randomised clinical study (the GEM trial) in which 40 externally fixated DRFs were randomised to rhPDGF-BB/β-TCP into the fracture gap or to the control group. Augment® proved to be convenient and safe during follow-up (24 weeks). However, because of the nature of the study design, the effect on fracture healing could not be determined. A decrease in pin infections was seen in the Augment® group, a finding we could not explain.
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| 3. |
- Eriksson, Håkan, et al.
(author)
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Det är obalansen som är problemet
- 2004
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In: KommunAktuellt. ; :16, 6 maj
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Journal article (pop. science, debate, etc.)abstract
- Debatten har länge rasat om sjukskrivningarnas kostnader, men sett över en längretid är det arbetslöshetens kostnader som ökat. Det visar en forskarstudie om bruk av offentliga försörjningssystem som tagits fram på initiativ av de samverkande myndigheterna i Västmanland. Den redovisar hur de offentliga försörjningsinkomsterna har utvecklats efter 1990 och hur de är sammansatta och fördelade i befolkningen.
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| 4. |
- Jansson, Karl-Åke, et al.
(author)
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Olycksfall och trauma
- 2009
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In: Prehospital akutsjukvård. - : Stockholm: Liber. - 9789147084487 ; , s. 375-407
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Book chapter (other academic/artistic)
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| 5. |
- Jansson, Karl-Åke
(author)
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On lumbar spinal stenosis and disc herniation surgery
- 2005
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Doctoral thesis (other academic/artistic)abstract
- Patients with spinal stenosis and disc herniation are most common in spine surgery. Few population based studies of these patients have been made and no studies of their health related quality of life (HRQOL) by the EQ-5D has been published. The aim of this thesis is to analyse incidence, readmission, reoperation and mortality in Swedish patients operated on spinal stenosis or disc herniation in the lumbar spine during 19871999 and report the EQ-5D outcome data between 2001-2002. The spinal stenosis cohort and disc herniation cohorts consist of 10,494 and 25,247 patients and the final EQ-5D analysis of 230 and 263 patients. Information from the Swedish Hospital Discharge Register and the Swedish Death Register were linked to analyse the outcomes. A quality register study based on prospectively collected EQ-5D data from the National Swedish Registry for Lumbar Spine surgery was also performed. The mean annual incidence per 100,000 inhabitants of spinal stenosis and disc herniation surgery during the study period was 10 and 24, respectively. The mean age at surgery for spinal stenosis increased from 60 to 67 years but was constant at 42 years for disc herniation. The 30 day mortality rate was 3.5 and 0.5 per 1000 operations, respectively. The mortality rate declined despite ageing spinal stenosis patients. The length of stay after surgery was reduced to half. Patients operated on for spinal stenosis and disc herniation have a risk of being reoperated after one and ten years of 2-3 %, and 10-11 %, respectively. The reoperation rate decreased over time. During the 13 years, 78 % of the disc herniation patients had only one hospitalisation (the operation). The risk of being readmitted was constant over time. Preoperatively the HRQOL was low, poorer than among previously reported for patients with stroke or depression. Patients operated on for spinal stenosis and disc herniation experienced an improved health related quality of life and their EQ5-D score increased from 0.29 to 0.70 and 0.36 to 0.64 one year after surgery. Four out of ten reported considerable improvement while a similar proportion of patients with high preoperative scores were slightly improved. A third group (20 %) was unchanged with low EQ-5D scores, and 45% perceived a decline in their HRQOL. The majority of patients approached but did not reach the level reported by the matched population sample. The studies indicate factors such as male sex, age over 80, fusion procedure, smoking, hospital stays before surgery or long hospital stays at surgery, severe back pain, long duration of pain, short walking ability were risks for a less favourable outcome. The EQ-5D instrument increases the awareness of the importance of health related quality of life when considering surgery and when evaluating treatment. Future studies need to elucidate the gender differences, impact of smoking cessation programs and the cost utility of spine surgery.
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| 6. |
- Sidebäck, Göran, et al.
(author)
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Arbetslösa större problem än sjuka
- 2004
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In: Dagens Nyheter. ; :1 april
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Journal article (pop. science, debate, etc.)abstract
- Debatten har länge rasat om sjukskrivningarna, men arbetslösheten kostar mera. Sjukskrivningarna kostar fortfarande 25 procent mindre än 1990, medan arbetslösheten är 130 procent dyrare. Det visar en ny studie i Västmanland, men utvecklingen är densamma för hela riket. I Västmanland har de årliga utgifterna för a-kassa, sjukpeng, förtidspension och socialbidrag länge legat på oförändrade 4 miljarder kronor, oavsett om tiderna varit goda eller dåliga. Om ansträngningarna att få ned kostnaderna skall lyckas måste i första hand arbetslösheten angripas, skriver bland andra forskarna Göran Sidebäck och Lars Sundbom vid Mälardalens högskola.
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| 7. |
- Thur, Charlotte K., et al.
(author)
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Epidemiology of adult ankle fractures in Sweden between 1987 and 2004 : a population-based study of 91,410 Swedish inpatients
- 2012
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In: Acta Orthopaedica. - New York, USA : Informa Healthcare. - 1745-3674 .- 1745-3682. ; 83:3, s. 276-281
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Journal article (peer-reviewed)abstract
- Background and purpse: Previous national epidemiological data on the characteristics and trends of patients with ankle fractures have been limited. We therefore analyzed data on Swedish inpatients with ankle fractures in this nationwide population study, based on data from 1987 through 2004.Patients and methods: Data on all inpatients aged 15 years and older with ankle fracture were extracted from the Swedish National Patient Register for the period 1987-2004.Results: We identified 91,410 hospital admissions with ankle fracture, corresponding to an annual incidence rate of 71 per 10(5) person-years. During the study period, the number of hospital admissions increased by 0.2% annually, mainly from increase in fracture incidence in the elderly women. Mean age at admission was 45 (SD 19) years for men and 58 (18) for women. The major mechanism of injury was falling at the same level (64%).Interpretation: This nationwide study of inpatients with ankle fractures showed an increase in fracture incidence, particularly in elderly women.
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| 8. |
- Tønnesen, Hanne, et al.
(author)
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Two novel prehabilitation apps to help patients stop smoking and risky drinking prior to hip and knee arthroplasty
- 2023
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In: International Orthopaedics. - : Springer Nature. - 0341-2695 .- 1432-5195. ; 47:11, s. 2645-2653
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Journal article (peer-reviewed)abstract
- PURPOSE: Daily smoking or risky drinking increases the risk of complications after surgery by ~50%. Intensive prehabilitation aimed at complete cessation reduces the complication rate but is time-consuming. The purpose of this study was to carry out preoperative pilot tests (randomized design) of the feasibility (1A) and validation (1B) of two novel prehabilitation apps, habeat® (Ha-app) or rehaviour® (Re-app).METHODS: Patients scheduled for hip or knee arthroplasty with daily smoking, risky drinking, or both were randomised to one of the two apps. In part 1A, eight patients and their staff measured feasibility on a visual analog scale (VAS) and were interviewed about what worked well and the challenges requiring improvement. In part 1B, seven patients and their staff tested the improved apps for up to two weeks before validating the understanding, usability, coverage, and empowerment on a VAS and being interviewed.RESULTS: In 1A, all patients and staff returned scores of ≥5 for understanding the apps and mostly suggested technical improvements. In 1B, the scores varied widely for both apps, with no consensus achieved. Two of four patients (Ha-app) and one-third of the patients (Re-app) found the apps helpful for reducing smoking, but without successful quitting. The staff experienced low app competencies among patients and high time consumption. Specifically, patients most often needed help for the Ha-app, and the staff most often for Re-app; however, the staff reported the Re-app dashboard was more user-friendly. Support and follow-up from an addiction specialist staff member were suggested to complement the apps, thereby increasing the time consumption for staff.CONCLUSIONS: This pilot study to test prototype apps generated helpful feedback for the app developers. Based on the patient and staff comments, multiple improvements in functionality seem required before scaling up the evaluation for effect on prehabilitation and postoperative complications.
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| 9. |
- Weiss, Rüdiger J., et al.
(author)
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Decreasing incidence of tibial shaft fractures between 1998 and 2004 : information based on 10,627 Swedish inpatients
- 2008
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In: Acta Orthopaedica. - Lund : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 79:4, s. 526-533
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Journal article (peer-reviewed)abstract
- Background and purpose There is a lack of national epidemiological data on the characteristics of patients with tibial shaft fractures. We therefore analyzed data on Swedish patients with tibial shaft fractures in this nationwide population study based on data from 1998 through 2004. Methods Data on all patients with tibial shaft fractures were extracted from the Swedish National Hospital Discharge Register. Results We identified 10,627 hospital admissions for tibial shaft fractures, corresponding to an annual incidence rate of 17 per 100,000 person-years (pyr). The number of hospital admissions decreased by 12% during the period 1998-2004, mostly from a reduction in male incidence. The median (SD) age at admission was 28 (22) years for men and 51 (26) years for women. The two major mechanisms of injury were falls on the same level (48%) and transport accidents (21%). Surgical procedures were dominated by osteosynthesis with nail (48%), followed by closed reduction and plaster cast (27%), and external fixation (12%). 12% of all tibial shaft fractures were classified as open, corresponding to an incidence rate of 2.3 per 100,000 pyr, which declined during 1998-2004. Interpretation This nationwide study of tibial shaft fractures shows a falling off of fracture incidence, a finding that can be used to advantage by healthcare providers. In a recent review, the annual incidence of tibial shaft fractures was reported to be 22 per 100,000 inhabitants (Court-Brown and Caesar 2006). To date, rather few epidemiological studies have been undertaken to examine the incidence of this injury (Knowelden et al. 1964, Bengner et al. 1990, Donaldson et al. 1990, Court-Brown and McBirnie 1995, Emami et al. 1996, Singer et al. 1998, van Staa et al. 2001), and with varying results. Most of the earlier epidemiological studies were retrospective or case series from single hospitals, and prior to the present study no analyses on a nationwide basis had been undertaken.Basic epidemiological data on frequency and distribution, mechanisms of injury, surgical procedures, and on temporal variations are of importance in assisting the planning and delivery of healthcare. The purpose of this investigation was to provide an update on incidence, admissions, causes of fracture, and operation of these fractures on a nationwide basis in Sweden during the period 1998-2004.
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| 10. |
- Weiss, Rüdiger J., et al.
(author)
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Long-term follow-up of opioid use in patients with acetabular fractures
- 2012
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In: Injury Extra. - London, United Kingdom : Elsevier. - 1572-3461. ; 43:7, s. 49-53
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Journal article (peer-reviewed)abstract
- Introduction: Chronic pain and the pattern of opioid use after skeletal fractures has been a neglected topic in pain medicine. Pelvic and in particular acetabular fractures represent some of the most troublesome injuries for patients with a high incidence of chronic pain after fracture. We examined the long-term opioid analgesic use among patients with acetabular fractures and analysed if potential risk factors would predict a prolonged opioid therapy.Patients and methods: Data were extracted from medical databases such as the Swedish National Hospital Discharge Register and the National Pharmacy Register. The study period was 2005–2008. Kaplan–Meier analysis constructed the cumulative opioid consumption with 95% confidence intervals (CI). Cox multiple-regression model was used to study risk factors for a prolonged opioid prescription after admission for fracture. An age- and sex-matched control group was included for comparisons.Results: We identified 1017 patients with isolated acetabular fractures. The proportion of dispensing opioids for these patients was 39%, which was 7 times higher than in the age- and sex-matched non-fracture controls (n = 5077). The median follow-up time was 14 (interquartile range [IQR] 5–24) months. Most patients with opioid use after fracture were male (60%) and the median age was 76 (IQR 61–85) years. The leading mechanism of injury was fall on the same level (52%). At 6 and 12 months after fracture, 41% (95% CI 36–47) and 33% (28–39) were still treated with opioids. The multiple Cox regression-analysis (adjusted for age, sex, type of treatment, and mechanism of injury) revealed that younger patients (age <70 compared with ≥70 years) were more likely to end using opioids (Hazard ratio 2.0 [95% CI 1.5–2.7]). The median daily morphine equivalent dose was 22 (IQR 14–42) mg within the first month after fracture.Discussion: During follow-up, the frequency of patients on moderate and high doses was falling off. There was no evidence of analgesic tolerance in the majority of the patients who were treated for at least 6 months. To set our findings into perspective, studies of patterns of chronic opioid use among patients with other types of fractures would be valuable.
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| 11. |
- Weiss, Rüdiger J., et al.
(author)
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National data of 6409 Swedish inpatients with femoral shaft fractures : stable incidence between 1998 and 2004
- 2009
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In: Injury. - : Elsevier BV. - 0020-1383 .- 1879-0267. ; 40:3, s. 304-308
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Femoral shaft fractures are commonly thought to be primarily associated with high-energy trauma in young persons. Only limited attention has been given to low-energy violence as a cause of these fractures among the elderly. National epidemiological data on characteristics of patients with femoral shaft fractures are lacking, so the purpose of this study was to analyse the incidence, admissions, causes of fracture and operations for these fractures on a nationwide basis in Sweden during 1998-2004. PATIENTS AND METHODS: Data on all femoral shaft fractures were extracted from the Swedish National Hospital Discharge Registry. Sex- and age-specific fracture incidence, hospital admissions, mechanisms of injury and surgical procedures were analysed using descriptive analysis, linear-regression analysis and other methods as appropriate. RESULTS: Over a period of 7 years, 6409 patients with femoral shaft fractures were identified, corresponding to an annual incidence of 10 per 100,000 person-years. Men had a younger median age (27 years, IQR 12-68) than women (79 years, IQR 62-86) (p<0.001). Females (54%) generated more admissions than males (46%). The incident rate ratio between men and women was 0.9 (p<0.001). Most hospital admissions were generated among females by the 80-89 years age-group and among males <10 years of age. 2% of the fractures were open fractures. The total number of hospital admissions was stable during 1998-2004. The two major mechanisms of injury were falls on the same level (50%) and transport accidents (17%). A significant number of fractures occurred among elderly patients after low-energy trauma. Osteosynthesis with femoral nail (54%) was the preferred operation, followed by osteosynthesis with plate and screws (16%), skeletal traction (14%) and external fixation (6%). DISCUSSION: This nationwide study on femoral shaft fractures provides an update on incidence, admissions, external causes and surgical procedures. This information assists health-care providers in planning hospital beds, surgical interventions and risk preventions. Moreover, these data can be used for power calculations for further clinical studies.
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| 12. |
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