Angenete E.,Sahlgrenska University Hospital |
Thornell A.,Sahlgrenska University Hospital |
Burcharth J.,Copenhagen University |
Pommergaard H.-C.,Copenhagen University |
And 8 more authors.
Annals of Surgery | Year: 2016
Objective: To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial. Background: Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment. Methods: Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287). Initial diagnostic laparoscopy showing Hinchey III was followed by randomization. Clinical data was collected up to 12 weeks postoperatively. Results: Eighty-three patients were randomized, out of whom 39 patients in laparoscopic lavage and 36 patients in the Hartmann procedure groups were available for analysis. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay. Conclusions: In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III was feasible and safe in the short-term. © Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.
Lagerqvist B.,Uppsala University |
Frobert O.,Örebro University |
Olivecrona G.K.,Skåne University Hospital |
Gudnason T.,Reykjavik University |
And 19 more authors.
New England Journal of Medicine | Year: 2014
Methods We randomly assigned 7244 patients with STEMI to undergo manual thrombus aspiration followed by PCI or to undergo PCI alone, in a registry-based, randomized clinical trial. The primary end point of all-cause mortality at 30 days has been reported previously. Death from any cause at 1 year was a prespecified secondary end point of the trial.Results No patients were lost to follow-up. Death from any cause occurred in 5.3% of the patients (191 of 3621 patients) in the thrombus-aspiration group, as compared with 5.6% (202 of 3623) in the PCI-only group (hazard ratio, 0.94; 95% confidence interval [CI], 0.78 to 1.15; P = 0.57). Rehospitalization for myocardial infarction at 1 year occurred in 2.7% and 2.7% of the patients, respectively (hazard ratio, 0.97; 95% CI, 0.73 to 1.28; P = 0.81), and stent thrombosis in 0.7% and 0.9%, respectively (hazard ratio, 0.84; 95% CI, 0.50 to 1.40; P = 0.51). The composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis occurred in 8.0% and 8.5% of the patients, respectively (hazard ratio, 0.94; 95% CI, 0.80 to 1.11; P = 0.48). The results were consistent across all the major subgroups, including grade of thrombus burden and coronary flow before PCI.Conclusions Routine thrombus aspiration before PCI in patients with STEMI did not reduce the rate of death from any cause or the composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis at 1 year.BACKGROUND Routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) has not been proved to reduce short-term mortality. We evaluated clinical outcomes at 1 year after thrombus aspiration. Copyright © 2014 Massachusetts Medical Society.
Bajor A.,Sahlgrenska Academy |
Tornblom H.,Sahlgrenska Academy |
Tornblom H.,Gothenburg University |
Rudling M.,Metabolism Unit |
And 4 more authors.
Gut | Year: 2014
Objective: Bile acids may play a role in the pathogenesis of IBS. We investigated the potential effects of bile acids entering the colon and its role in the symptom pattern in IBS.Design: We measured75Se-labelled homocholic acidtaurine (75SeHCAT) retention, and serum levels of 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor (FGF) 19 in patients with IBS (n=141) and control subjects (75SeHCAT n=29; C4 and FGF19 n=435). In patients with IBS stool frequency and form, as well as GI symptom severity were registered, and in a proportion of patients colonic transit time and rectal sensitivity were measured (n=66). An 8-week open-label treatment with colestipol was offered to patients with75SeHCAT <20%, and the effect of treatment was evaluated with IBS severity scoring system and adequate relief of IBS symptoms.Results: Compared with controls, patients with IBS had lower75SeHCAT values (p=0.005), higher C4c levels (C4 corrected for cholesterol) (p<0.001), but similar FGF19 levels. Abnormal75SeHCAT retention (<10%) was seen in 18% of patients, whereas 23% had elevated C4c levels. Patients with IBS with75SeHCAT retention <10% had more frequent stools, accelerated colonic transit time, rectal hyposensitivity, a higher body mass index, higher C4c and lower FGF19 levels. Colestipol treatment improved IBS symptoms (IBS severity scoring system 220 ±109 vs 277±106; p<0.01), and 15/27 patients fulfilled criteria for treatment response (adequate relief ≥50% of weeks 5-8).Conclusions: Increased colonic bile acid exposure influences bowel habit and colonic transit time in patients with IBS. A high response rate to open label treatment with colestipol supports this, but placebo-controlled studies are warranted.
Kajermo U.,Skaraborgs Hospital |
Ulvenstam A.,Ostersunds Hospital |
Modica A.,Ostersunds Hospital |
Jernberg T.,Karolinska Institutet |
Mooe T.,Umeå University
Stroke | Year: 2014
BACKGROUND AND PURPOSE-: Ischemic stroke is a known complication of acute myocardial infarction (AMI). Treatment of AMI has undergone great changes in recent years. We aimed to investigate whether changes in treatment corresponded to a lower incidence of ischemic stroke and which factors predicted ischemic stroke after AMI. METHODS-: Data were taken from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions. Patients with their first registered AMI between 1998 and 2008 were included. To identify ischemic strokes, we used the Swedish national patient register. To study a potential trend in the incidence of ischemic stroke after AMI over time, we divided the patient population into 5 time periods. Event-free survival was studied by Kaplan-Meier analysis. Cox proportional hazards regression model was used to identify stroke predictors. RESULTS-: Of 173 233 patients with AMI, 3571 (2.1%) developed ischemic stroke within 30 days. The incidence of ischemic stroke was significantly lower during the years 2007 to 2008 compared with 1998 to 2000, with respective rates of 2.0% and 2.2% (P=0.02). Independent predictors of an increased risk of stroke were age, female sex, prior stroke, diabetes mellitus, atrial fibrillation, clinical signs of heart failure in hospital, ST-segment-elevation myocardial infarction, coronary artery bypass grafting, and angiotensin-converting enzyme inhibitor treatment at discharge. Percutaneous coronary intervention, fibrinolysis, acetylsalicylic acid, statins, and P2Y12 inhibitors were predictors of reduced risk of stroke. CONCLUSIONS-: The incidence of ischemic stroke within 30 days of an AMI has decreased during the period 1998 to 2008. This decrease is associated with increased use of acetylsalicylic acid, P2Y12 inhibitors, statins, and percutaneous coronary intervention. © 2014 American Heart Association, Inc.
Hermanson M.,Skåne University Hospital |
Hagglund G.,Skåne University Hospital |
Riad J.,Skaraborgs Hospital |
Wagner P.,Skåne University Hospital
Acta Orthopaedica | Year: 2015
Background and purpose - Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The Swedish follow-up program for CP (CPUP) includes standardized monitoring of the hips. Migration percentage (MP) is a widely accepted measure of hip displacement. Coxa valga and valgus of the femoral head in relation to the femoral neck can be measured as the head-shaft angle (HSA). We assessed HSA as a risk factor for hip displacement in CP. Patients and methods - We analyzed radiographs of children within CPUP from selected regions of Sweden. Inclusion criteria were children with Gross Motor Function Classification System (GMFCS) levels III-V, MP of < 40% in both hips at the first radiograph, and a follow-up period of 5 years or until development of MP > 40% of either hip within 5 years. Risk ratio between children who differed in HSA by 1 degree was calculated and corrected for age, MP, and GMFCS level using multiple Poisson regression. Results - 145 children (73 boys) with a mean age of 3.5 (0.6-9.7) years at the initial radiograph were included. 51 children developed hip displacement whereas 94 children maintained a MP of < 40%. The risk ratio for hip displacement was 1.05 (p < 0.001; 95% CI 1.02-1.08). When comparing 2 children of the same age, GMFCS level, and MP, a 10-degree difference in HSA results in a 1.6-times higher risk of hip displacement in the child with the higher HSA. Interpretation - A high HSA appears to be a risk factor for hip displacement in children with CP. Copyright © 2014 Nordic Orthopaedic Federation.
Fernell E.,Skaraborgs Hospital |
Fernell E.,Gothenburg University |
Ek U.,University of Stockholm
Acta Paediatrica, International Journal of Paediatrics | Year: 2010
Aim: To draw attention to groups of children and adolescents with borderline intellectual functioning, especially with respect to their school-situation. Methods: In one study, population-based, children with borderline intellectual functioning at age 10 years were followed until they finished compulsory school when their final certificates could be analysed. In a second study parents of 20 individuals in the upper secondary school for pupils with mild mental retardation were interviewed according to the Vineland adaptive scales and school health records were reviewed. In a third study pupils attending an individual programme in upper secondary school were assessed and we report one representative case. Results: (1) Pupils with borderline intellectual functioning, assessed in grade 4, received significantly lower grades when finishing the compulsory school. (2) In the group of pupils in the upper secondary school for the mildly mentally retarded, compiled data indicated that a considerable number did not fulfil the combined IQ and adaptive criteria for mild mental retardation. (3) The subtle nature of borderline intellectual functioning may delay appropriate measures at school, which our case illustrates. Conclusion: Borderline intellectual functioning seldom attracts attention. Our studies indicate that school and also society at large must be prepared to adapt educational and working conditions for the large minority of individuals with borderline intellectual functioning. © 2010 Foundation Acta Pædiatrica.
Ek U.,University of Stockholm |
Westerlund J.,University of Stockholm |
Holmberg K.,Karolinska University Hospital |
Fernell E.,Skaraborgs Hospital
Acta Paediatrica, International Journal of Paediatrics | Year: 2011
Aim: To study academic performance (final grades at the age of 16 years) in individuals with i) attention-deficit/hyperactivity disorder (ADHD) and ii) other learning and/or behavioural problems. Methods: Of a total population of 591 children, originally assessed at the age of 10-11 years, it was possible to obtain final grades for 536 16-year-olds (in grade 9). Those fulfilling the criteria for ADHD/sub-threshold ADHD (n = 39) and those with 'Behaviour and Learning Problems' (BLP group), (n = 80) and a comparison group (n = 417) were contrasted. Results: The ADHD and BLP groups had a significantly lower total mean grade at the age of 16 years than the comparison group. In addition, the ADHD and BLP groups also qualified for further studies in the upper secondary school to a significantly lesser extent than the controls (72%, 68% and 92%, respectively). All IQ measures (at the age of 10-11 years) were positively correlated with the overall grade after grade 9, with especially strong correlations for verbal capacity. Conclusion: ADHD and similar problems entail a risk of underachievement at school. The results indicate that pupils with ADHD underachieve in the school situation in relation to their optimal cognitive capacity. The contextual situation and the particular requirements should be considered in order for adequate educational measures to be undertaken. © 2010 The Author(s)/Acta Paediatrica.
Gillberg C.,Gothenburg University |
Fernell E.,Gothenburg University |
Fernell E.,Skaraborgs Hospital
Journal of Autism and Developmental Disorders | Year: 2014
The reported prevalence of autism is going up and up. We propose that some—even much—of the increase in the rate of autism spectrum disorder (ASD) is driven by “Autism Plus”. Autism Plus refers to autism with comorbidities (including intellectual developmental disorder, language disorder, and attention-deficit/hyperactivity disorder), and this is what is now being diagnosed by clinicians as ASD. In clinical practice, a diagnosis of ASD much more often entails that the child will receive support at school and in the community, which is not the case for other diagnoses. In the past the comorbidities were given diagnostic priority and the “autistic features” might, or might not be mentioned as the “plus bit” in the diagnostic summary. It is high time that the comorbidities, sometimes even more important than the autism, came back on the diagnostic agenda. Autism is but one of the Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examination (ESSENCE), not the one and only. © 2014, Springer Science+Business Media New York.
Hellstrom A.,Chalmers University of Technology |
Lifvergren S.,Chalmers University of Technology |
Lifvergren S.,Skaraborgs Hospital |
Quist J.,Karlstad University
Journal of Manufacturing Technology Management | Year: 2010
Purpose - The purpose of this paper is to investigate what happens when a new management idea with manufacturing origin is implemented in a healthcare organization. In this paper, it is focussed on process management: what happens when the processes are highlighted, process owners are appointed and more power is allocated to the process dimension of the organization. Design/methodology/ approach - The paper uses the case of a hospital group in Sweden to investigate difficulties in implementing process management. The studied hospital group has been involved in systematic fundamental change to the system for nearly a decade. The research project was conducted using a collaborative management research approach in which academic researchers worked together with the development director. Findings - The paper shows that the organization itself in many ways becomes an obstacle to the achievement of a process-oriented management style. In the empirical story, voices from the healthcare staff reveal conflicts over organizing principles and structures such as budgeting and reimbursement systems - systems obviously built on a more functional view from an organizational perspective. It is not completely evident that the two alternative perspectives are able to co-exist easily - managing them seems to be an advanced balancing act. Originality/value - The paper provides an illustration of knowledge transfer from manufacturing to service industries. It focuses on the meeting between a Swedish healthcare organization and the idea of process management. © Emerald Group Publishing Limited.
Riad J.,Skaraborgs Hospital |
Riad J.,Karolinska Institutet |
Coleman S.,Baylor University |
Lundh D.,Hogskolan Skovde |
Brostrom E.,Karolinska Institutet
Gait and Posture | Year: 2011
Patients with hemiplegic cerebral palsy often have noticeably deviant arm posture and decreased arm movement. Here we develop a comprehensive assessment method for the upper extremity during walking. Arm posture score (APS), deviation of shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension and wrist flexion/extension were calculated from three-dimensional gait analysis. The APS is the root mean square deviation from normal, similar to Baker's Gait Profile Score (GPS) . The total range of motion (ROM) was defined as the difference between the maximum and minimum position in the gait cycle for each variable. The arm symmetry, arm posture index (API) was calculated by dividing the APS on the hemiplegic side by that on the non-involved side, and the range of motion index (ROMI) by dividing the ROM on the hemiplegic side by that on the non-involved side. Using the APS, two groups were defined. Group 1 had minor deviations, with an APS under 9.0 and a mean of 6.0 (95% CI 5.0-7.0). Group 2 had more pronounced deviations, with an APS over 9.0 and a mean of 13.1 (CI 10.8-15.5) (. p= 0.000). Total ROM was 60.6 in group 1 and 46.2 in group 2 (. p= 0.031). API was 0.89 in group 1 and 1.70 in group 2 (. p< 0.001). ROMI was 1.15 in group 1 and 0.69 in group 2 (. p= 0.003).APS describes the amount of deviation, ROM provides additional information on movement pattern and the indices the symmetry. These comprehensive objective and dynamic measurements of upper extremity abnormality can be useful in following natural progression, evaluating treatment and making prognoses in several categories of patients. © 2010 Elsevier B.V.