| 1. |
- Thomas, HS, et al.
(author)
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- 2019
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swepub:Mat__t
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| 2. |
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| 3. |
- Ademuyiwa, Adesoji O., et al.
(author)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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In: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Journal article (peer-reviewed)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 4. |
- Fiorillo, A., et al.
(author)
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How to improve clinical practice on involuntary hospital admissions of psychiatric patients : suggestions from the EUNOMIA study
- 2011
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In: European psychiatry. - : Elsevier. - 0924-9338 .- 1778-3585. ; 26:4, s. 201-207
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Journal article (peer-reviewed)abstract
- Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients’ rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.
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| 5. |
- Fiorillo, A., et al.
(author)
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Patient characteristics and symptoms associated with perceived coercion during hospital treatment
- 2012
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In: Acta Psychiatrica Scandinavica. - Malden, USA : Wiley-Blackwell. - 0001-690X .- 1600-0447. ; 125:6, s. 460-467
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Journal article (peer-reviewed)abstract
- Objective: Large numbers of psychiatric patients either are involuntarily admitted to hospital treatment or feel coerced despite a legally voluntary admission. For ethical and clinical reasons, their perceived coercion should be reduced as far as possible. There is however limited evidence on patient characteristics associated with perceived coercion during hospital treatment. This study aimed to identify i) sociodemographic and clinical characteristics associated with perceived coercion at admission and ii) changes in symptoms and global functioning associated with changes in perceived coercion over time.Method: Three thousand and ninety three in-patients who were involuntarily admitted or felt coerced to hospital treatment despite a legally voluntary admission were recruited in the European evaluation of coercion in psychiatry and harmonization of best clinical practice EUNOMIA project in 11 European countries. Perceived coercion, global functioning and symptoms were assessed after admission and at a 3-month follow-up.Results: Involuntary admission, female gender, poorer global functioning and more positive symptoms were associated with higher levels of perceived coercion at admission. Perceived coercion significantly decreased over time, and the improvements in global functioning and positive symptoms were associated with reduction in perceived coercion.Conclusion: Female patients perceive more coercion in psychiatric hospital treatment. Effective treatment for positive symptoms and improving patients global functioning may lead to a reduction in perceived coercion.
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| 6. |
- Andersson, M., et al.
(author)
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A New Class of Labile Surfactants that Break Down to Non-surface Active Products upon Heating or after a Pre-set Time, without the Need for a pH Change
- 2007
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In: Tenside Surfactants Detergents. - : Walter de Gruyter GmbH. - 0932-3414 .- 2195-8564. ; 44:6, s. 366-372
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Journal article (peer-reviewed)abstract
- A new class of labile surfactants that break down at a controllable rate without the need for a change in pH will be presented. The invention has been patented by YKI Institute for Surface Chemistry, and is based on use of β-keto acids or their salts as surface-active compounds. These surfactants spontaneously break down through decarboxylation, to form an oil-like ketone and CO 2/HCO 3 -/CO 32 - depending on pH. The rate of breakdown can be controlled within a wide range by temperature or by certain additives, but, unlike most cleavable surfactants, a change in pH is not needed. Furthermore the surfactants can be conveniently activated from a stabile precursor just before use, and one (of many possible) precursors of this kind is already available on the industrial scale in the form of a wellknown chemical that is FDA-approved in other, non-surfactant, applications. The compound in question, alkyl ketene dimer (AKD), is produced in large scale by a number of large chemical producers today, and used for hydrophobization of paper. The present article gives an overview of the surfactant chemistry, with focus on recent studies of the kinetics of activation of the surfactant precursor and breakdown kinetics of the labile surfactant at different conditions. Furthermore, possible industrial applications of the surfactant will be discussed, with one example taken from a recent feasibility study performed within the car washing area. © Carl Hanser Publisher.
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| 10. |
- Lindquist, T., et al.
(author)
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A novel modular and dispatchable CSP Stirling system : Design, validation, and demonstration plans
- 2019
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In: AIP Conference Proceedings. - : American Institute of Physics (AIP).
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Conference paper (peer-reviewed)abstract
- This paper summarizes the preliminary results from the on-going development of a novel modular dispatchable solar power plant concept. The work encompasses techno-economic feasibility assessment, concept design, full scale sub-system tests and validation work, and ultimately plans for a fully integrated demonstration of the system. The proposed solar power plant concept consists of a heliostat field that powers a latent heat thermal energy storage (TES), fitted on a small tower. The solar receiver located underneath the TES tank, is an optical cavity with a small aperture that enables the concentrated sunlight to be emitted directly on the solar absorber surface while ensuring low convective and radiative losses. The stored thermal energy is provided to the engine, in proximity to the latent heat storage, with a pumped heat transfer fluid (HTF). The Stirling engine with a rated power of 13 kW has been modified and optimised for the operational conditions that the eutectic aluminum-silicon latent heat storage provides. For example, a new engine tubular gas heater has been developed for the HTF (i.e. sodium) and the expansion cylinder has been enlarged to improve both efficiency and power output as the temperature of the working gas is somewhat lower than in previous dish Stirling application. The choice of eutectic aluminum-silicon as TES media resulted from a thorough assessment of several phase change materials throughout the design phase of the project. Indeed, such a TES media selected would benefit from a suitable melting temperature of around 580°C, high energy density, high thermal conductivity, and low cost.
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| 11. |
- Welinder-Olsson, Christina, 1959, et al.
(author)
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EHEC outbreak among staff at a children's hospital--use of PCR for verocytotoxin detection and PFGE for epidemiological investigation.
- 2004
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In: Epidemiology and infection. - 0950-2688. ; 132:1, s. 43-9
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Journal article (peer-reviewed)abstract
- This is the first report of a major foodborne outbreak of enterohaemorrhagic Escherichia coli (EHEC) in Sweden. It occurred among the nursing staff at a children's hospital with approximately 1600 employees. Contaminated lettuce was the most likely source of infection. Nine persons were culture-positive for Escherichia coli (E. coli) O157 and verocytotoxin-positive by PCR and a further two were verocytotoxin-positive by PCR only. All 11 EHEC-positive individuals had attended a party for approximately 250 staff members, which was held at the hospital. In a questionnaire 37 persons stated that they had symptoms consistent with EHEC infection during the weeks after the party. There was no evidence of secondary transmission from staff to patients. The value of PCR as a sensitive and fast method for diagnosis is discussed in this paper. Pulsed-field gel electrophoresis (PFGE) was used to ascertain that staff members were infected by the same clone, and that two patients with E. coli O157 infection were not.
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| 12. |
- Andersson, Mats, 1954, et al.
(author)
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Characteristics of timed barium esophagogram in newly diagnosed idiopathic achalasia: clinical and manometric correlates
- 2007
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In: Acta Radiol. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 48:1, s. 2-9
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Journal article (peer-reviewed)abstract
- PURPOSE: To describe timed barium esophagogram (TBE) characteristics in patients with newly diagnosed idiopathic achalasia, and to correlate these with clinical and manometric variables. MATERIAL AND METHODS: Forty-six consecutive patients with newly diagnosed achalasia were examined with TBE. Esophageal emptying was assessed using the height, area, and volume of the barium column. Subjective evaluation was performed according to a standardized protocol in all patients. Objective diagnostic evaluation included manometry. RESULTS: At the 1-min time point after contrast ingestion, the static parameters median height, maximum, and mean width of the barium column were 16.0, 4.4, and 3.3 cm, respectively. Emptying, expressed as volume of barium, showed significant inverse correlation with the resting and the maximal relaxing pressure of the lower esophageal sphincter (LES) (R = -0.34 and R = -0.54, respectively). There was also an inverse correlation between emptied volume at TBE and the duration of symptoms (R = -0.36), and between barium column width and postprandial chest pain (R = -0.44). CONCLUSION: All patients with newly diagnosed achalasia presented with delayed emptying of barium the esophagus at TBE. The estimated emptied volume of barium (related to the ingested volume) correlated inversely with the basal tone and the relaxation pressure of the LES. Including estimation of the volume of emptied barium at TBE resulted in closer correlation with manometric values of LES tone than using the parameters traditionally recorded.
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| 13. |
- Andersson, Mats, 1954, et al.
(author)
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Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial.
- 2009
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In: Diseases of the Esophagus. - : Oxford University Press (OUP). - 1442-2050 .- 1120-8694. ; 22:3, s. 264-73
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Journal article (peer-reviewed)abstract
- To choose which treatment would be most effective for the individual patient with newly diagnosed achalasia is difficult for the tending physician. A diagnostic tool that would allow prediction of the symptomatic and functional response after treatment for achalasia is therefore needed. The timed barium esophagogram (TBE) is a method that allows objective assessment of esophageal emptying, but the value of TBE in the clinical management of achalasia remains to be clarified. The aim of this study was first, to assess the ability of TBE to predict symptoms and treatment failure during post-treatment follow-up. Second, to determine whether esophageal emptying as assessed by TBE differs after treatment with pneumatic dilatation or laparoscopic myotomy. Fifty-one patients with newly diagnosed achalasia were prospectively randomized to pneumatic dilatation (n = 26) or laparoscopic myotomy (n = 25). Evaluation with TBE was performed before (n = 46) and after treatment (n = 43). The median interval between treatment and post-treatment TBE was 6 months, and the median follow-up time after the post-treatment TBE was 18 months. Following therapeutic intervention, TBE parameters did not differ significantly between treatment groups. However, significant correlations were found between the height of the barium column at 1 min and the symptom scores at the end of follow up for 'dysphagia for liquids' (P < 0.05, rho = 0.47), 'chest pain' (P < 0.05, rho = 0.42), and the 'Watson dysphagia score' (P < 0.05, rho = 0.46). Patients with less than 50% improvement in this TBE-parameter (height at 1 min) post-treatment had a 40% risk of treatment failure during follow-up. In summary, pneumatic balloon dilatation and laparoscopic myotomy similarly affected esophageal function as assessed by TBE-emptying. Lack of improvement in barium-column height post-treatment was associated with an increased risk of treatment failure which should motivate close surveillance in order to detect symptomatic recurrence at an early stage.
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| 14. |
- Andersson, M, et al.
(author)
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Macroscopic alignment of silver nanoparticles in reverse hexagonal liquid crystalline templates
- 2002
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In: Nano Letters. - : American Chemical Society (ACS). - 1530-6992 .- 1530-6984. ; 2:12, s. 1403-1407
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Journal article (peer-reviewed)abstract
- A flexible method of preparing and macroscopically aligning nanoparticles of crystalline silver into millimeter long fibers is presented. The approach utilizes the dual functionality of a reverse hexagonal liquid crystalline template containing a built-in reducing agent facing the aqueous domain. The method is advantageous in that its slow kinetics allows for a thorough introduction of a silver salt into the liquid crystal before the reduction takes place, allowing for an efficient loading of he template and a retained mesoscopic ordering as evidenced by SAXS. It was confirmed by H-1 NMR that the oxyethylene groups of the amphiphilic polymer reduce the silver ions while being oxidized to aldehydes. The silver nanoparticles are uniform in size and in the same size range as the diameter of the aqueous domain of the liquid crystal (3 nm), further supporting that the silver particles form inside the liquid crystal. TEM images confirm the macroscopic alignment of silver nanoparticles into fibrils and the packing of fibrils into millimeter long fibers. The diameter of the fibrils and fibers ranges from 30 nm to several hundreds of micrometers. Electron diffraction analysis of a collection of silver nanoparticles confirms their crystallinity as three diffraction rings could be indexed to the face centered cubic structure of silver. A key to the successful macroscopic alignment of the nanoparticles is that the particles are formed inside the liquid crystal, thus minimizing the need for their diffusion i to and inside the liquid crystal.
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| 15. |
- Bluhme, E, et al.
(author)
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Procurement and Evaluation of Hepatocytes for Transplantation From Neonatal Donors After Circulatory Death
- 2022
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In: Cell transplantation. - : SAGE Publications. - 1555-3892 .- 0963-6897. ; 31, s. 9636897211069900-
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Journal article (peer-reviewed)abstract
- Hepatocyte transplantation is a promising treatment for liver failure and inborn metabolic liver diseases, but progress has been hampered by a scarcity of available organs. Here, hepatocytes isolated from livers procured for a neonatal hepatocyte donation program within a research setting were assessed for metabolic function and suitability for transplantation. Organ donation was considered for infants who died in neonatal intensive care in the Stockholm region during 2015–2021. Inclusion was assessed when a decision to discontinue life-sustaining treatment had been made and hepatectomy performed after declaration of death. Hepatocyte isolation was performed by three-step collagenase perfusion. Hepatocyte viability, yield, and function were assessed using fresh and cryopreserved cells. Engraftment and maturation of cryopreserved neonatal hepatocytes were assessed by transplantation into an immunodeficient mouse model and analysis of the gene expression of phase I, phase II, and liver-specific enzymes and proteins. Twelve livers were procured. Median warm ischemia time (WIT) was 190 [interquartile range (IQR): 80–210] minutes. Median viability was 86% (IQR: 71%–91%). Median yield was 6.9 (IQR: 3.4–12.8) x106 viable hepatocytes/g. Transplantation into immunodeficient mice resulted in good engraftment and maturation of hepatocyte-specific proteins and enzymes. A neonatal organ donation program including preterm born infants was found to be feasible. Hepatocytes isolated from neonatal donors had good viability, function, and engraftment despite prolonged WIT. Therefore, neonatal livers should be considered as a donor source for clinical hepatocyte transplantation, even in cases with extended WIT.
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| 16. |
- Claesson, PM, et al.
(author)
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Polyelectrolyte-surfactant interactions at interfaces
- 1997
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In: Progress in Colloid and Polymer Science. - 0340-255X .- 1437-8027. ; 106, s. 24-33
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Journal article (peer-reviewed)abstract
- Interactions between negatively charged surfaces coated with cationic polyelectrolytes across solutions containing an anionic surfactant, sodium dodecyl sulphate (SDS) have been studied. Polyelectrolytes with charge densities between 100% and 10%, counted per monomer unit, were used. At low ionic strength the polyelectrolytes adsorb in a flat conformation to neutralize the negative mica surface charge. The higher the linear charge density of the polyelectrolyte, the thinner adsorbed layers are obtained. In no case could any desorption be detected when the polyelectrolyte containing solution was replaced with an aqueous polyelectrolyte-free solution. The presence of SDS at concentrations considerably below the critical micellar concentration, cmc, does in all cases result in a recharging and a considerable swelling of the adsorbed layer. This is due to a cooperative association of surfactants in the preadsorbed polyelectrolyte layer. In case of the 100% charged PCMA, the force versus distance profile displays clear oscillations. We interpret these oscillations as being caused by the spatial arrangement of SDS micelles stabilised by the polyelectrolyte. The oscillations in the force curve remain as the SDS concentration is increased to twice the cmc. No similar oscillations in the force distance curve are observed when the surfaces are precoated with less charged polyelectrolytes. In these cases a strong swelling of the polyelectrolyte layer is observed once the surfactant concentration reaches a critical value (well below the cmc).
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| 17. |
- Courteille, O., et al.
(author)
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Mixed Virtual Reality Simulation -Taking Endoscopic Simulation One Step Further
- 2011
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In: Medicine Meets Virtual Reality 18. - : IOS Press. - 9781607507062 - 9781607507055 ; 163, s. 144-6
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Conference paper (peer-reviewed)abstract
- This pilot study aimed to assess medical students' appraisals of a "mixed" virtual reality simulation for endoscopic surgery (with a virtual patient case in addition to a virtual colonoscopy) as well as the impact of this simulation set-up on students' performance. Findings indicate that virtual patients can enhance contextualization of simulated endoscopy and thus facilitate an authentic learning environment, which is important in order to increase motivation.
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| 18. |
- Edelbroek, Bart, et al.
(author)
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Evolution of microRNAs in Amoebozoa and implications for the origin of multicellularity
- 2024
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In: Nucleic Acids Research. - : Oxford University Press. - 0305-1048 .- 1362-4962. ; 52:6, s. 3121-3136
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Journal article (peer-reviewed)abstract
- MicroRNAs (miRNAs) are important and ubiquitous regulators of gene expression in both plants and animals. They are thought to have evolved convergently in these lineages and hypothesized to have played a role in the evolution of multicellularity. In line with this hypothesis, miRNAs have so far only been described in few unicellular eukaryotes. Here, we investigate the presence and evolution of miRNAs in Amoebozoa, focusing on species belonging to Acanthamoeba, Physarum and dictyostelid taxonomic groups, representing a range of unicellular and multicellular lifestyles. miRNAs that adhere to both the stringent plant and animal miRNA criteria were identified in all examined amoebae, expanding the total number of protists harbouring miRNAs from 7 to 15. We found conserved miRNAs between closely related species, but the majority of species feature only unique miRNAs. This shows rapid gain and/or loss of miRNAs in Amoebozoa, further illustrated by a detailed comparison between two evolutionary closely related dictyostelids. Additionally, loss of miRNAs in the Dictyostelium discoideum drnB mutant did not seem to affect multicellular development and, hence, demonstrates that the presence of miRNAs does not appear to be a strict requirement for the transition from uni- to multicellular life.
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| 19. |
- Edelbroek, Bart, et al.
(author)
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Evolution of microRNAs in Amoebozoa and implications for the origin of multicellularity
- 2024
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In: Nucleic Acids Research. - 0305-1048 .- 1362-4962.
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Journal article (peer-reviewed)abstract
- MicroRNAs (miRNAs) are important and ubiquitous regulators of gene expression in both plants and animals. They are thought to have evolved convergently in these lineages and hypothesized to have played a role in the evolution of multicellularity. In line with this hypothesis, miRNAs have so far only been described in few unicellular eukaryotes. Here, we investigate the presence and evolution of miRNAs in Amoebozoa, focusing on species belonging to Acanthamoeba, Physarum and dictyostelid taxonomic groups, representing a range of unicellular and multicellular lifestyles. miRNAs that adhere to both the stringent plant and animal miRNA criteria were identified in all examined amoebae, expanding the total number of protists harbouring miRNAs from 7 to 15. We found conserved miRNAs between closely related species, but the majority of species feature only unique miRNAs. This shows rapid gain and/or loss of miRNAs in Amoebozoa, further illustrated by a detailed comparison between two evolutionary closely related dictyostelids. Additionally, loss of miRNAs in the Dictyostelium discoideum drnB mutant did not seem to affect multicellular development and, hence, demonstrates that the presence of miRNAs does not appear to be a strict requirement for the transition from uni- to multicellular life.
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| 37. |
- Kalisova, Lucie, et al.
(author)
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Do patient and ward-related characteristics influence the use of coercive measures? : Results from the EUNOMIA international study
- 2014
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In: Social Psychiatry and Psychiatric Epidemiology. - : Springer. - 0933-7954 .- 1433-9285. ; 49:10, s. 1619-1629
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Journal article (peer-reviewed)abstract
- This study aims to identify whether selected patient and ward-related factors are associated with the use of coercive measures. Data were collected as part of the EUNOMIA international collaborative study on the use of coercive measures in ten European countries.Involuntarily admitted patients (N = 2,027) were divided into two groups. The first group (N = 770) included patients that had been subject to at least one of these coercive measures during hospitalization: restraint, and/or seclusion, and/or forced medication; the other group (N = 1,257) included patients who had not received any coercive measure during hospitalization. To identify predictors of use of coercive measures, both patients' sociodemographic and clinical characteristics and centre-related characteristics were tested in a multivariate logistic regression model, controlled for countries' effect.The frequency of the use of coercive measures varied significantly across countries, being higher in Poland, Italy and Greece. Patients who received coercive measures were more frequently male and with a diagnosis of psychotic disorder (F20-F29). According to the regression model, patients with higher levels of psychotic and hostility symptoms, and of perceived coercion had a higher risk to be coerced at admission. Controlling for countries' effect, the risk of being coerced was higher in Poland. Patients' sociodemographic characteristics and ward-related factors were not identifying as possible predictors because they did not enter the model.The use of coercive measures varied significantly in the participating countries. Clinical factors, such as high levels of psychotic symptoms and high levels of perceived coercion at admission were associated with the use of coercive measures, when controlling for countries' effect. These factors should be taken into consideration by programs aimed at reducing the use of coercive measures in psychiatric wards.
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| 38. |
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| 39. |
- Kjellin, A., et al.
(author)
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Hybrid simulation : bringing motivation to the art of teamwork training in the operating room
- 2014
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In: Scandinavian Journal of Surgery. - : SAGE Publications. - 1457-4969 .- 1799-7267. ; 103:4, s. 232-236
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Journal article (peer-reviewed)abstract
- Background and Aims: Crew resource management-based operating room team training will be an evident part of future surgical training. Hybrid simulation in the operating room enables the opportunity for trainees to perform higher fidelity training of technical and non-technical skills in a realistic context. We focus on situational motivation and self-efficacy, two important factors for optimal learning in light of a prototype course for teams of residents in surgery and anesthesiology and nurses. Material and Methods: Authentic operating room teams consisting of residents in anesthesia (n = 2), anesthesia nurses (n = 3), residents in surgery (n = 2), and scrub nurses (n = 6) were, during a one-day course, exposed to four different scenarios. Their situational motivation was self-assessed (ranging from 1 = does not correspond at all to 7 = corresponds exactly) immediately after training, and their self-efficacy (graded from 1 to 7) before and after training. Training was performed in a mock-up operating theater equipped with a hybrid patient simulator (SimMan 3G; Laerdal) and a laparoscopic simulator (Lap Mentor Express; Simbionix). The functionality of the systematic hybrid procedure simulation scenario was evaluated by an exit questionnaire (graded from 1 = disagree entirely to 5 = agree completely). Results and Conclusions: The trainees were mostly intrinsically motivated, engaged for their own sake, and had a rather great degree of self-determination toward the training situation. Self-efficacy among the team members improved significantly from 4 to 6 (median). Overall evaluation showed very good result with a median grading of 5. We conclude that hybrid simulation is feasible and has the possibility to train an authentic operating team in order to improve individual motivation and confidence.
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| 40. |
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| 41. |
- Kjellin, A, et al.
(author)
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Utvärdering av utökat föräldradeltagande inom barnkirurgisk vård
- 2002
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In: Vård i Norden. - 0107-4083. ; 22:2, s. 38-42
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Journal article (peer-reviewed)abstract
- The benefits of increased parental participation in the care of the hospitalised child is well documented, and care given by parents is found to be effective. To facilitate the child’s recovery by providing the parents with information and education about care, and to minimise disruption to the child’s and the family’s normal life the care after hypospadiasis repair was changed. Outcomes were evaluated in two different ways: a cost-effectiveness analysis for calculating the relative value of the alternative medical interventions, and qualitative interviews with parents to gain an understanding of parents’ experiences. The sample consisted of consecutive series of children (n= 17) and accompanying parents (n=19). This article describes the parents’ views. The results showed that feelings of participation, support and uncertainty were predominant for parents during their child’s care and treatment. The results highlighted the importance of evaluating new processes and routines.
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| 45. |
- Kostic, Srdjan, 1958, et al.
(author)
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Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia: results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy
- 2007
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In: Surgical endoscopy. - 1432-2218 .- 0930-2794. ; 21:7, s. 1184-9
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Journal article (peer-reviewed)abstract
- BACKGROUND: We have prospectively collected information concerning the costs incurred during the management of patients allocated to either forceful dilatation or to an immediate laparoscopic operation because of newly diagnosed achalasia. METHODS: Fifty-one patients with newly diagnosed achalasia were randomized to either pneumatic dilatation to a diameter of 30-40 mm or to a laparoscopic myotomy to which was added a posterior partial fundoplication. Follow-ups were scheduled at 1, 3, 6, and 12 months after inclusion. At each follow-up visit a study nurse interviewed the patients regarding symptoms and their quality of life (QoL) and a health economic questionnaire was completed. In the latter questionnaire, patients were asked to report the presence and character of contacts with the healthcare system since the last visit. RESULTS: In the dilatation group six patients (23%), including the patient who was operated on because of perforation, were classified as failures during the first 12 months of follow-up compared to one (4%) in the myotomy group (p = 0.047). Five of those classified as failures in the dilatation group subsequently had a surgical myotomy and the sixth patient was treated with repeated dilatations. The patient classified as failure in the myotomy group was treated with endoscopic dilatation. The initial treatment cost and the total costs were significantly higher for laparoscopic myotomy compared to a pneumatic dilatation-based strategy (p = 0.0002 and p = 0.0019, respectively). When the total costs were subdivided into the different resources used, we found that the single largest cost item for pneumatic dilatation was that for hospital stay and that for laparoscopic myotomy was the actual operative treatment (operating room time). The cost-effectiveness analysis, relating to the actual treatment failures, revealed that the cost to avoid one treatment failure (incremental cost-effectiveness ratio) amounted to 9239 euros. CONCLUSION: The current prospective, controlled clinical trial shows that despite a higher level of clinical efficacy of laparoscopic myotomy to prevent treatment failure in newly diagnosed achalasia, the cost effectiveness of pneumatic dilatation is superior, at least when a reasonable time horizon is applied.
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| 46. |
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| 47. |
- Kostic, Srdjan, 1958, et al.
(author)
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Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial
- 2007
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In: World journal of surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 31:3, s. 470-8
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Journal article (peer-reviewed)abstract
- BACKGROUND: The most effective therapeutic strategy in newly diagnosed achalasia is yet to be established. Therefore we designed a study in which pneumatic dilatation was compared to laparoscopic cardiomyotomy to which was added a partial posterior fundoplication. PATIENTS AND RESULTS: A series of 51 patients (24 males, mean age 44 years) were randomly allocated to the therapeutic modalities (dilatation = 26, surgery = 25). All patients were followed for at least 12 months, and during that period the pneumatic dilatations strategy had significantly more treatment failures (P = 0.04). Only minor differences emerged between the study groups when symptoms, dysphagia scorings, and quality-of-life assessments were evaluated 12 months after initiation of therapy. CONCLUSIONS: Laparoscopic myotomy was found to be superior to an endoscopic balloon dilatation strategy in the treatment of achalasia when studied during the first 12 months after treatment.
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