Sigurdardottir K.,Falun Hospital |
Robertsson J.,Reykjavik University
Acta Orthopaedica | Year: 2011
Background and purpose Recent literature suggests that the incidence and treatment modalities of distal radius fractures have been changing over the past 2 decades in the developed world. We examined the epidemiology of adult distal radius fractures in Iceland in 2004 and compared it with an Icelandic study from 1985 and other studies. Methods A retrospective study of the epidemiology, classification, and treatment of distal radius fractures in Reykjavik residents aged 16 and older in 2004 was conducted by analysis of medical records and re-evaluation of all radiographic examinations. Results The 228 fractures included in our material yielded an overall annual incidence of 17/10 4 in men and 37/104 in women. Age-specific incidence rose steadily with age in both sexes. One third of the fractures were intraarticular, and working-age men accounted for a large proportion of them. 95% of fractures were treated nonoperatively. Interpretation The annual incidence of distal radius fractures was similar in 1985 and 2004. However, age-specific incidence in younger postmenopausal women decreased sharply. This trend has also been observed in recent Scandinavian studies. Most fractures were treated nonoperatively in Iceland in 2004. © 2011 Nordic Orthopaedic Federation.
Frobert O.,Örebro University |
Lagerqvist B.,Uppsala University |
Olivecrona G.K.,Lund University |
Omerovic E.,Sahlgrenska University Hospital |
And 18 more authors.
New England Journal of Medicine | Year: 2013
BACKGROUND: The clinical effect of routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is uncertain. We aimed to evaluate whether thrombus aspiration reduces mortality. METHODS: We conducted a multicenter, prospective, randomized, controlled, open-label clinical trial, with enrollment of patients from the national comprehensive Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and end points evaluated through national registries. A total of 7244 patients with STEMI undergoing PCI were randomly assigned to manual thrombus aspiration followed by PCI or to PCI only. The primary end point was all-cause mortality at 30 days. RESULTS: No patients were lost to follow-up. Death from any cause occurred in 2.8% of the patients in the thrombus-aspiration group (103 of 3621), as compared with 3.0% in the PCI-only group (110 of 3623) (hazard ratio, 0.94; 95% confidence interval [CI], 0.72 to 1.22; P = 0.63). The rates of hospitalization for recurrent myocardial infarction at 30 days were 0.5% and 0.9% in the two groups, respectively (hazard ratio, 0.61; 95% CI, 0.34 to 1.07; P = 0.09), and the rates of stent thrombosis were 0.2% and 0.5%, respectively (hazard ratio, 0.47; 95% CI, 0.20 to 1.02; P = 0.06). There were no significant differences between the groups with respect to the rate of stroke or neurologic complications at the time of discharge (P = 0.87). The results were consistent across all major prespecified subgroups, including subgroups defined according to thrombus burden and coronary flow before PCI. CONCLUSIONS: Routine thrombus aspiration before PCI as compared with PCI alone did not reduce 30-day mortality among patients with STEMI. Copyright © 2013 Massachusetts Medical Society.
Sarno G.,Uppsala University |
Sarno G.,Uppsala University Hospital |
Lagerqvist B.,Uppsala University |
Nilsson J.,Umeå University |
And 7 more authors.
Journal of the American College of Cardiology | Year: 2014
BACKGROUND: Some concerns still have not been resolved about the long-term safety of drug-eluting stents (DES) in patients with acute STEMI. OBJECTIVES: The aim of this study was to evaluate the stent thrombosis (ST) rate up to 3 years in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (n-DES) compared with bare-metal stents (BMS) and old-generation drug-eluting stents (o-DES) enrolled in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). METHODS: From January 2007 to January 2013, 34,147 patients with STEMI were treated by PCI with n-DES (n = 4,811), o-DES (n = 4,271), or BMS (n = 25,065). The risks of early/late (up to 1 year) and very late definite ST (after 1 year) were estimated. RESULTS: Cox regression landmark analysis showed a significantly lower risk of early/late ST in patients treated with n-DES (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.99; p = 0.04) and o-DES (HR: 0.60; 95% CI: 0.41 to 0.89; p = 0.01) compared with the BMS group. The risk of very late ST was similar between the n-DES and BMS groups (HR: 1.52; 95% CI: 0.78 to 2.98; p = 0.21), whereas a higher risk of very late ST was observed with o-DES compared with BMS (HR: 2.88; 95% CI: 1.70 to 4.89; p < 0.01). CONCLUSIONS: Patients treated with n-DES have a lower risk of early/late ST than patients treated with BMS. The risk of very late ST is low and comparable between n-DES and BMS up to 3 years of follow-up, whereas o-DES treatment is associated with an increased risk of very late ST. The current STEMI guidelines might require an update in light of the results of this and other recent studies. © 2014 by the American College of Cardiology Foundation.
Hellberg D.A.N.,Center for Clinical Research |
Hellberg D.A.N.,Uppsala University |
Tibor T.O.T.,Falun Hospital
Anticancer Research | Year: 2014
Background/Aim: Histopathological and clinical scores to predict prognosis in cervical cancer have been of limited value. In the present study a tumor marker expression score was evaluated for prognostication in early-stage cervical cancer. Materials and Methods: The entire study population included 128 women with invasive squamous cell cervical cancer followed-up for at least 10 years. Results: Expression of 12 tumor markers (epidermal growth factor receptor (EGFR), Ki-67, c-MYC, p53, p27, E-cadherin, CD44, vascular endothelial growth factor receptor (VEGF), cyclooxygenase-2 (COX2), CD4, and leucine-rich immunoglobulin-like repeats-1 (LRIG1) and LRIG2, considered relevant for cervical cancer prognostication was evaluated by immunohistochemistry. Expression of five markers, LRIG1, LRIG2, p53, COX2 and c-MYC were useful to make a prognostication score, ranging from 0 to 5. Score 0-1 correlated to less than 5% 10-year mortality, while the mortality rate of those with score 4-5 approached 70%; those with score 2 formed an intermediate group. Using different models, a high sensitivity, specificity, positive predictive value and negative predictive value was attained. Conclusion: Tumor marker scoring could be an adjunct to histopathological and clinical parameters in prognostication of early-stage cervical cancer. © 2014, International Institute of Anticancer Research. All rights reserved.
Cost-effectiveness of balloon Kyphoplasty Versus Standard Medical Treatment in patients with osteoporotic vertebral compression fracture: A Swedish multicenter randomized controlled trial with 2-year follow-up
Fritzell P.,Falun Hospital |
Ohlin A.,Skåne University Hospital |
Borgstrom F.,I3 Innovus Quantify Research AB |
Borgstrom F.,Karolinska Institutet
Spine | Year: 2011
Study Design: A multicenter, randomized, controlled, cost-effectiveness analysis. Objective: To assess the cost-effectiveness of balloon kyphoplasty (BKP) compared with standard medical treatment (control) in patients with acute/subacute (<3 months) vertebral compression fracture (VCF) due to osteoporosis. Summary of Background Data: Patients with a VCF due to osteoporosis are common and will increase in number in an aging population, putting a substantial strain on health care. Selected patients may benefit from stabilizing the fracture with cement through BKP, a minimally invasive procedure. BKP has been reported to give good short-time clinical results, and economic modeling has suggested that the procedure could be cost-effective after 2 years compared with standard treatment. Methods: Hospitalized patients with back pain due to VCF were randomized to BKP or to control using a computer-generated random list. All costs associated with VCF and cost-effectiveness were reported primarily from the perspective of society. We used EQ-5D to assess quality of life (QoL). The accumulated quality-adjusted life years (QALYs) gained and costs/QALY gained were assessed using intention to treat. Results: Between February 2003 and December 2005, a total of 63 out of 67 Swedish patients were analyzed: BKP (n = 32) and control (n = 31). Societal cost per patient for BKP was SEK 160,017 (SD = 151,083) = €16,668 (SD = 15,735), and for control SEK 84,816 (SD = 40,954) = €8835 (SD = 4266), a significant difference of 75,198 (95% confidence intervals [CI] = 16,037-120,104) = €7833 (95% CI = 1671-12,511). The accumulated difference in QALYs was 0.085 (95% CI = -0.132 to 0.306) in favor of BKP. Cost/QALY gained using BKP was SEK 884,682 = €92,154 and US $134,043. Conclusion: In this randomized controlled trial, it was not possible to demonstrate that BKP was cost-effective compared with standard medical treatment in patients treated for an acute/subacute vertebral fracture due to osteoporosis. However, sensitivity analysis indicated a certain degree of uncertainty, which needs to be considered. © 2011 Lippincott Williams & Wilkins.
Baron T.,Uppsala University |
Hambraeus K.,Falun Hospital |
Sundstrom J.,Uppsala University |
Erlinge D.,Skåne University Hospital |
And 2 more authors.
Heart | Year: 2015
Objective: We aimed to assess differences in incidence, clinical features, current treatment strategies and outcome in patients with type 2 vs. type 1 acute myocardial infarction (AMI). Methods and results: All 20 138 hospitalisations in Sweden with a diagnosis of AMI registered during 2011 in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies were classified into types 1-5 in accordance with the universal definition of myocardial infarction (MI) from 2007. Type 1 AMI was present in 88.5% of the cases while 7.1% were classified as type 2 AMI. Higher age, female sex, comorbidities, impaired renal function, anaemia and smaller extent of myocardial necrosis characterised patients with type 2 AMI. While normal coronary arteries were more frequently seen (42.4% vs. 7.4%), an invasive treatment was less common, and antiplatelet medications were less prescribed in patients with type 2 AMI compared with type 1 AMI. The group with type 2 AMI had significantly higher crude 1-year mortality compared with the group with type 1 AMI (24.7% vs. 13.5%, p<0.001). However, after adjustment, the HR for 1-year mortality in patients with type 2 AMI was 1.03 (95% CI 0.86 to 1.23). Conclusions: In this real-life study, 7.1% of myocardial infarctions were classified as type 2 AMI. These patients were older, predominantly women and had more comorbidities. Invasive treatment strategies and cardioprotective medications were less used. Patients with type 2 AMI had higher crude mortality compared with type 1 patients with MI. However, after adjustment, the 1-year mortality was similar. © 2015, BMJ Publishing Group. All rights reserved.
Hedin G.,Falun Hospital |
Rynback J.,Falun Hospital |
Lore B.,Falun Hospital
Journal of Hospital Infection | Year: 2010
The benefit of routine surface disinfection in hospitals has been discussed. In this study we have investigated a new product, Appeartex®. After application on surfaces a remnant effect is achieved due to the positive charge of the active molecule. We studied the persistent effect of Appeartex one day after application in both an experimental study in the laboratory and a field study in a hospital ward. Surfaces of bedside tables were investigated. In the experimental study, large inocula of ≥106cfu of S. aureus or enterococci were inoculated on to well-defined areas which had been treated/not treated with Appeartex. One hour later, samples were taken with a swab rinse technique. A reduction in the number of viable bacteria in the magnitude 10-103 cfu was seen due to the effect of Appeartex. In the field study the effect on naturally occurring low level contamination was studied. Defined surfaces on bedside tables used by patients were treated/not treated with Appeartex. One day later, samples were taken with contact agar plates and with a new swab method using two sequential nylon flocked swabs. Significantly fewer bacteria were found on Appeartex-treated surfaces compared with untreated surfaces. The median counts on Appeartex-treated surfaces were 10 cfu/50cm2, and on untreated surfaces 20 cfu/50 cm2. There was no significant difference in the number of bacteria found by culture of samples taken with the contact agar method compared with samples taken using the nylon flocked swab method. © 2010 The Hospital Infection Society.
Hedin G.,Falun Hospital |
Rynback J.,Falun Hospital |
Lore B.,Falun Hospital
Journal of Hospital Infection | Year: 2010
Environmental surfaces near infected and/or colonised patients in hospitals are commonly contaminated with potentially pathogenic micro-organisms. At present, however, there is no standardised method for taking samples from surfaces in order to perform quantitative cultures. Usually contact plates or swabs are used, but these methods may give different results. The recovery rate of traditional swabbing, e.g. cotton or rayon, is poor. With a new type of swab utilising flocked nylon, the recovery may be enhanced up to three times compared with a rayon swab. In this study, we inoculated reference strains of Staphylococcus aureus and Enterococcus hirae onto a bedside table and took samples 1. h later when inocula were dry. Sequential samples were taken from the same surface. A new sampling technique using two sequential nylon swabs for each sample was validated. The efficiency of the sampling, percentage recovery of the inoculum and the variation of culture results obtained from repeated experiments are described. Enhanced efficiency and higher recovery of inoculum were demonstrated using two sequential flocked nylon swabs for sampling. © 2010 The Hospital Infection Society.
Norlander T.,Falun Hospital |
Linden M.,Falun Hospital
Acta Oto-Laryngologica | Year: 2011
Conclusion: Power-assisted turbinectomy is a safe and reliable alternative for patients with nasal blockage if nasal corticosteroid spray therapy is not suitable. Objective: Powered-assisted partial turbinectomy was compared to the use of a corticosteroid nasal spray for relief of nasal obstruction in chronic or idiopathic rhinosinusitis. Methods: Patients were randomized to either power-assisted partial turbinectomy or daily use of mometasone furoate nasal spray for 6 months. Evaluation by peak nasal inspiratory flow (PNIF) and grading of symptoms by use of visual analog scale was done after 3 and 6 months. Grading of symptoms was also done by use of a questionnaire approximately 30 months after the last visit. Results: PNIF scores improved for all patients, although significantly only for patients on mometasone spray. Patients' self-reported symptoms decreased more for operated patients. Side effects were few and mild in both groups. © 2011 Informa Healthcare.
Norman M.,Falun Hospital |
Jones I.,Falun Hospital
Clinical Biochemistry | Year: 2014
Objectives: To ascertain whether or not the change in blood collection tubes for plasma glucose from fluoride/oxalate to citrate/fluoride/EDTA has had an effect upon the glucose results. Methods: Plasma glucose results from fasting patients from 2007 to 2012 were extracted from the laboratory information system. The data was evaluated in order to see the potential impact on patient results due to the change in glucose stabilizer implemented in September 2010. Results: The mean glucose result was increased by approximately 14% (difference: +. 0.80. mmol/L) after the implementation of the citrate-buffered tubes (mean value = 6.45. mmol/L; n = 15. 125) as compared to fluoride/oxalate tubes (mean value = 5.65. mmol/L; n = 15. 867). Conclusions: An increase in glucose results is seen after changing to citrate-buffered tubes due to the improved stabilizing effect as compared to fluoride. Properly collected blood samples will lead to the patient being correctly diagnosed. However, decision limits and reference intervals for glucose may need to be revised using citrate-tubes. © 2014 The Canadian Society of Clinical Chemists.