| 1. |
- Berrum-Svennung, Ingela, 1963
(författare)
-
Carcinoma of the Urinary Bladder. Aspects of treatment, Costs and Follow-up Routines
- 2007
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: To determine costs and factors related to the total costs of cystectomy. To study the results of the radiological examinations performed 7-14 days after a cystectomy. To investigate if a single instillation of epirubicin after transurethral resection (TUR) may influence the time to the first recurrence and its size. To elucidate if a routine with reduced numbers of follow-up cystoscopies in patients with stage Ta tumour is safe. Patients and methods: The clinical records of 70 consecutive patients subjected to cystectomy were studied. Costs were determined for cystectomies and 22 different factors possibly related to total costs were analysed. The clinical records for a total number of 200 consecutive cystectomy patients were analysed for the results of the postoperative urography. A total number of 404 patients in 13 hospitals were randomised to either one instillation of 50mg epirubicin or placebo within 6 hours after TUR. We included 138 patients with low-grade tumours who had a negative 4?month cystoscopy in a prospective observational study. The size and number of subsequent recurrences were determined. Results and conclusions: The total costs (median) for cystectomy was 189,479 SEK. Room and Board was the most expensive single item of total costs. In the multivariate analysis high peroperative blood loss was the most important factor associated with high total hospital costs. Not a single patient out of 170 had urinary leak or a significant stricture visualised at the postoperative urography. It can be concluded that a postoperative urography is unnecessary in patients with a normal postoperative course. Seventy-nine (51.0%) out of 155 evaluable patients in the epirubicin group had a recurrence as compared to 95 (62.5%) out of 152 patients in the placebo group. Half of the recurrences were small-sized and could be fulgurated at the time of the follow-up cystoscopy. The clinical benefit of single instillations thus seems questionable. Patients with low-grade stage Ta tumours who are tumour-free at 4 months can safely follow a routine with cystoscopy at month 12 and 24 and almost all recurrences can be fulgurated at follow-up.
|
|
| 2. |
- Berrum-Svennung, Ingela, 1963, et al.
(författare)
-
Costs of radical cystectomy.
- 2005
-
Ingår i: Scand J Urol Nephrol. - : Informa UK Limited. ; 39:1, s. 36-41
-
Tidskriftsartikel (refereegranskat)abstract
- Objective . The total costs of radical cystectomy comprise a significant part of the total costs of bladder cancer treatment. The aims of this study were to determine the costs of cystectomy, with and without complications, and to investigate related prognostic factors. Material and methods . The clinical records and relevant economic files of 70 consecutive patients operated on between 1994 and 1998 were studied. Uni- and multivariate analyses were performed on 22 variables of possible prognostic significance to high total costs. Results . The total (median) costs for 53 uncomplicated and 17 complicated cystectomies were 181 096 and 290 625 SEK, respectively. The preoperative variables (patient characteristics) had no or minimal prognostic significance for high total costs. High peri-operative blood loss was the most important factor associated with high total hospital costs for radical cystectomy. Conclusions . Total costs may be very high for a cystectomy with complications. Peri-operative blood loss was the most important factor associated with high total hospital costs for radical cystectomy due to bladder cancer. If the amount of bleeding can be influenced then substantial reductions in the total costs of cystectomy would seem possible.
|
|
| 3. |
- Berrum-Svennung, Ingela, 1963, et al.
(författare)
-
Routine postoperative urography after cystectomy and urinary diversion is not necessary.
- 2005
-
Ingår i: Scand J Urol Nephrol. - : Informa UK Limited. ; 39:3, s. 211-213
-
Tidskriftsartikel (refereegranskat)abstract
- Objective It is routine procedure to obtain a urogram or retrograde stentogram 1-2 weeks after urinary diversion. The purpose of this is to diagnose silent urinary leakage and obstruction of the anastomosis. We registered the frequency of significant findings at routine postoperative urography in patients with bladder cancer treated with radical cystectomy and urinary diversion. Material and methods We identified a total of 200 consecutive patients who were treated with radical cystectomy and urinary diversion between 1994 and 2002. Eight patients were never evaluated radiologically and another 14 were examined earlier than planned due to symptoms or signs from the urinary tract and abdomen. The remaining 178 patients underwent a routine radiological examination. The methods of deviation in these patients were Bricker conduit (n=119), continent abdominal reservoir (n=24) and orthotopic bladder reconstruction (n=35). A total of 170 patients underwent urography, seven underwent bilateral retrograde pyelographies and one was examined by means of antegrade pyelography. Results Not a single significant finding was identified with urography in 170 patients. Minimal leakage was identified at retrograde pyelography in one patient with a Bricker conduit, which resulted in treatment for 2 weeks with a pyelostomy catheter. Conclusion Routine postoperative urography is not necessary in patients who have a normal postoperative course after cystectomy and urinary diversion.
|
|
| 4. |
- Eriksson, Henrik, 1973, et al.
(författare)
-
Reducing queues: demand and capacity variations
- 2011
-
Ingår i: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862. ; 24:8, s. 592-600
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose – The aim of this paper is to investigate how waiting lists or queues could be reduced without adding more resources; and to describe what factors sustain reduced waiting-times. Design/methodology/approach – Cases were selected according to successful and sustained queue reduction. The approach in this study is action research. Findings – Accessibility improved as out-patient waiting lists for two clinics were reduced. The main success was working towards matching demand and capacity. It has been possible to sustain the improvements. Research limitations/implications – Results should be viewed cautiously. Transferring and generalizing outcomes from this study is for readers to consider. However, accessible healthcare may be possible by paying more attention to existing solutions. Practical implications – The study indicates that queue reduction activities should include acquiring knowledge about theories and methods to improve accessibility, finding ways to monitor varying demand and capacity, and to improve patient processing by reducing variations. Originality/value – Accessibility is considered an important dimension when measuring service quality. However, there are few articles on how clinic staff sustain reduces waiting lists. This paper contributes accessible knowledge to the field.
|
|
| 5. |
- Pettersson-Hammerstad, Karin, et al.
(författare)
-
Impaired renal function in newly spinal cord injured patients improves in the chronic state--effect of clean intermittent catheterization?
- 2008
-
Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 180:1
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We investigated renal function in spinal cord injured subjects in relation to the level and completeness of injury and bladder emptying regimen in the acute and chronic stages. MATERIALS AND METHODS: A retrospective chart review was performed of 169 spinal cord injured subjects treated at the Spinal Cord Injury Unit, Sahlgrenska Hospital between 1985 and 2002. Renal function based on glomerular filtration rate was evaluated by chromium ethylenediaminetetraacetic acid clearance 3 to 4 months after injury and at followup 3 to 5 years after injury. RESULTS: The glomerular filtration rate was lower than expected in the first investigation in the whole group (82% of the expected value). When divided according to level of lesion the figure was lower in the cervical (81%) and thoracic (88%) levels of the lesion and in the American Spinal Injury Association A group compared to the American Spinal Injury Association B-E group. In the second investigation we found a significant improvement in the whole group of 6%. When dividing the group according to bladder emptying regimen we found that in the group that emptied the bladder by clean intermittent catheterization glomerular filtration rate improved significantly (+7%). CONCLUSIONS: Spinal cord injury affects renal function and has a deteriorating effect on glomerular filtration rate. The reduction is seen on the cervical and thoracic levels of injury and in complete injuries. Renal function improves with time after injury and improvement is seen most clearly in the group that uses clean intermittent catheterization as a bladder emptying method.
|
|
