| 1. |
- Almquist, Martin, et al.
(author)
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Kloka kliniska val – att avstå det som inte gör nytta för patienten : [Choosing Wisely in Sweden]
- 2023
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In: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 120
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Research review (peer-reviewed)abstract
- Overdiagnosis and overtreatment receive increasing attention. More than 20 percent of health expenditure is without patient benefit, so-called low-value care. Several national and international initiatives have been launched to minimize low-value care. Arguably, the most widely spread initiative is Choosing Wisely. First launched by the American Board of Internal Medicine in 2012, this campaign has spread to more than 20 countries. The Swedish Society of Medicine has identified low-value care as a significant problem in Swedish health care and has established a working group to investigate if and how a campaign based on Choosing Wisely would be feasible in Sweden. Here, the working group reports on the history of Choosing Wisely, identifies potential challenges for deimplementation generally and in the Swedish context specifically.
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| 2. |
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| 3. |
- Nilsson, Martin, et al.
(author)
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Reduced fracture incidence in patients having surgery for primary hyperparathyroidism
- 2022
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In: Clinical Endocrinology. - : Wiley. - 0300-0664 .- 1365-2265. ; 97:3, s. 276-283
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Journal article (peer-reviewed)abstract
- Objective: The indication of surgery in primary hyperparathyroidism has been controversial, as many patients experience mild disease. The primary aim was to evaluate fracture incidence in a contemporary population-based cohort of patients having surgery for primary hyperparathyroidism. The secondary aim was to investigate whether preoperative serum calcium, adenoma weight or multiglandular disease influence fracture incidence. Design: A retrospective cohort study with population controls. Primary outcomes, defined by discharge diagnoses and prescriptions, were any fracture and fragility fracture, secondary outcomes were multiple fractures anytime and osteoporosis. Subjects were followed 10 years pre- and up to 10 years postoperatively (or 31 December 2015). Multiple events per subject were allowed. Fracture incidence rate ratios (IRRs) for patients pre- and postoperatively were tabulated and evaluated with mixed-effects Poisson regression. Secondary outcomes were evaluated using conditional logistic regression. Patients: A Swedish nationwide cohort of patients having surgery for primary hyperparathyroidism (n = 5009) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery between 2003 and 2013 was matched with population controls (n = 14,983). Data were cross-linked with Statistics Sweden and the National Board of Health and Welfare. Measurements: Preoperative serum calcium and adenoma weight at pathological examination. Results: Patients had an increased incidence rate of any fracture preoperatively, IRR 1.27 (95% confidence interval: 1.11–1.46), highest in the last year before surgery. Fracture incidence was not increased postoperatively. Serum calcium, adenoma weight and multiglandular disease were not associated with fracture incidence. Conclusions: Fracture incidence is higher in patients with primary hyperparathyroidism but is normalized after surgery.
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| 4. |
- Agcaoglu, Orhan, et al.
(author)
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Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options
- 2022
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In: Updates in Surgery. - : Springer Science and Business Media LLC. - 2038-131X .- 2038-3312. ; 74:1, s. 325-335
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Journal article (peer-reviewed)abstract
- Purpose: The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods: We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results: Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole ± β-blocker combination for Graves’ disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3–4 cytological results and papillary microcarcinoma. Conclusion: This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible. © 2021, Italian Society of Surgery (SIC).
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| 5. |
- Albers, Max B., et al.
(author)
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Complications of surgery for gastro-entero-pancreatic neuroendocrine neoplasias
- 2020
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In: Langenbeck's Archives of Surgery. - : Springer Science and Business Media LLC. - 1435-2443 .- 1435-2451. ; 405:2, s. 137-143
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Journal article (peer-reviewed)abstract
- Purpose: Surgery is recommended for most patients with gastro-entero-pancreatic neuroendocrine neoplasias (GEP-NENs). Rates of complications and perioperative mortality have been reported in few mostly retrospective single-center series, but there has been no detailed analysis on risk factors for perioperative complications and mortality to date. Methods: Data of patients with GEP-NENs operated between January 2015 and September 2018 were retrieved from EUROCRINE©, a European online endocrine surgical quality registry, and analyzed regarding rate and risk factors of surgical complications. Risk factors were assessed by logistic regression. Results: Some 376 patients (211 female, 167 male; age median 63, range 15–89 years) were included. Most NENs were located in the small intestine (SI) (n = 132) or pancreas (n = 111), the rest in the stomach (n = 34), duodenum (n = 30), appendix (n = 30), colon, and rectum (n = 22), or with unknown primary (n = 15). Of the tumors, 320 (85.1%) were well or moderately differentiated, and 147 (39.1%) of the patients had distant metastases at the time of operation. Severe complications (Dindo-Clavien ≥ 3) occurred in 56 (14.9%) patients, and 4 (1.1%) patients died perioperatively. Severe complications were more frequent in surgery for duodenopancreatic NENs (n = 31; 22.0%) compared with SI-NENs (n = 15; 11.4%) (p = 0.014), in patients with lymph node metastases operated with curative aim of surgery (n = 24; 21.4%) versus non-metastasized tumors or palliative surgery (n = 32; 12.1%) (p = 0.020), and in functioning tumors (n = 20; 23.0%) versus non-functioning tumors (n = 30; 13.5%) (p = 0.042). Complication rates were not significantly associated with tumor stage or grade. Conclusions: Severe complications are frequent in GEP-NEN surgery. Besides duodenopancreatic tumor location, curative resection of nodal metastases and functioning tumors are risk factors for complications.
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| 6. |
- Albers, Max B., et al.
(author)
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Sentinel Lymph Node Biopsy in Thyroid Cancer
- 2020
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 44, s. 142-147
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Journal article (peer-reviewed)abstract
- Background: Prophylactic central neck dissection in patients with papillary thyroid carcinoma is controversial. Sentinel node biopsy might be an adjunct to optimize surgical treatment for these patients. Earlier studies reported inconsistent detection rates and diagnostic value of this technique, and the role of sentinel lymph node biopsy in thyroid cancer needs to be established. Patients and methods: During a single-center prospective interventional study between 2010 and 2017, sentinel lymph node biopsy using 99mTc-nanocolloidal albumin tracer was performed on patients undergoing thyroid surgery for suspected thyroid cancer by fine needle aspiration cytology. All eligible patients without clinical lymph node involvement were invited to participate. Central neck dissection was performed on all patients after the detection of sentinel lymph nodes. Results: Ninety-six patients participated in the study. The detection rates of the sentinel node were 67% and 45% by scintigraphy and intraoperative gamma probe, respectively. The detection rate was not associated with Bethesda score, malignancy, or presence of lymph node metastases. Sensitivity, negative predictive value, and accuracy were 80%, 97%, and 98%, respectively, for the sentinel node to represent the status of lymph node metastasis in the central neck compartment. The false negative rate was 20%. Conclusion: Sentinel lymph node biopsy had a low detection rate and only moderate sensitivity in patients with suspected thyroid carcinoma and is not a useful adjunct to surgery in the context of current treatment concepts.
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| 8. |
- Almquist, Martin, et al.
(author)
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Elastic wave propagation in anisotropic solids using energy-stable finite differences with weakly enforced boundary and interface conditions
- 2021
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In: Journal of Computational Physics. - : Elsevier. - 0021-9991 .- 1090-2716. ; 424
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Journal article (peer-reviewed)abstract
- Summation-by-parts (SBP) finite difference methods have several desirable properties for second-order wave equations. They combine the computational efficiency of narrow-stencil finite difference operators with provable stability on curvilinear multiblock grids. While several techniques for boundary and interface conditions exist, weak imposition via simultaneous approximation terms (SATs) is perhaps the most flexible one. Although SBP methods have been applied to elastic wave equations many times, an SBP-SAT method for general anisotropic elastic wave equations has not yet been presented in the literature. We fill this gap by deriving energy-stable self-adjoint SBP-SAT methods for general anisotropic materials on curvilinear multiblock grids. The methods are based on fully compatible SBP operators. Although this paper focuses on classical SBP finite difference operators, the presented boundary and interface treatments are general and apply to a range of methods that satisfy an SBP property. We demonstrate the stability and accuracy properties of a particular set of fully compatible SBP-SAT schemes using the method of manufactured solutions. We also demonstrate the utility of the new method in elastodynamic cloaking and seismic imaging in mountainous regions.
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| 9. |
- Almquist, Martin
(author)
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Localization studies for parathyroid surgery
- 2021
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In: JAMA Otolaryngology - Head and Neck Surgery. - : American Medical Association (AMA). - 2168-6181. ; 147:8, s. 706-707
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Journal article (peer-reviewed)
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