Swedish Departments Research Articles

A data-driven approach to solve the RT scheduling problem

IntroductionThere is an increase in demand for Radiotherapy (RT) and it is a time critical treatment with a complex scheduling process. RT workflow is inter-dependent and involves various steps including pre-treatment and treatment-related tasks which adds to these challenges. Globally, scheduling delays are reported as one of the most common issues in RT. We aim to create and evaluate an automated strategy which generates a patient allocation list to assist the scheduling staff to create an efficient scheduling process. Methods and MaterialsWe used historical data from a large RT department in Sweden from January to December 2022 with 11–13 operational linear accelerators. The algorithm was developed in C# language. It utilizes patient and treatment-related characteristics including the patient timeline (referral date, preferred treatment start dates), booking category, diagnosis group and intent. Based on this, the algorithm assigns patient priority individually. ResultsThe algorithm’s output resulted in a scheduling list sorted by high to low patient priority per week. We evaluated the algorithm with historical manual allocations from the same year. The comparison between manual and algorithm allocations showed that the number of delayed patients reduced by 10 % in the algorithm suggestion with an average delay reduction of 2 weeks. Furthermore, the focus on patient-related characteristics resulted in diagnosis groups being better balanced. ConclusionThe algorithm’s ability to produce quick results may save significant time that the scheduling staff otherwise need to assess individual patient profiles. RT departments can incorporate such algorithms to accelerate their scheduling decisions and enhance their overall scheduling performance before going through major organizational changes.

Low adherence to a new guideline for managing febrile infants ≤59 days.

Management of young febrile infants is challenging. Therefore, several guidelines have been developed over the last decades. However, knowledge regarding the impact of introducing guidelines for febrile infants is limited. We assessed the impact of and adherence to a novel guideline for managing febrile infants aged ≤59 days. This retrospective cross-sectional study was conducted in 2 pediatric emergency departments in Sweden between 2014 and 2021. We compared the management of infants aged ≤59 days with fever without a source (FWS) and the diagnosis of serious bacterial infections (SBIs) before and after implementing the new guideline. We included 1,326 infants aged ≤59 days with FWS. Among infants aged ≤21 days, urine cultures increased from 49% to 67% (p = 0.001), blood cultures from 43% to 63% (p < 0.001), lumbar punctures from 16% to 33% (p = 0.003), and antibiotics from 38% to 57% (p = 0.002). Only 39 of 142 (28%) infants aged ≤21 days received recommended management. The SBI prevalence was 16.7% (95% CI, 11.0-23.8) and 17.6% (95% CI, 11.7-24.9) before and after the implementation, respectively. Among infants aged ≤59 days, there were 3 infants (0.6%; 95% CI, 0.1-1.7) in the pre-implementation period and 3 infants (0.6%; 95% CI, 0.1-1.7) in the post-implementation period with delayed treated urinary tract infections. Investigations and antibiotics increased significantly after implementation of the new guideline. However, doing more did not improve the diagnosis of SBIs. Thus, the low adherence to the new guideline may be considered justified. Future research should consider strategies to safely minimize interventions when managing infants with FWS.

Experiences of implementing and working with obstetric emergency triage: A qualitative study among Swedish midwifes, auxiliary nurses, and obstetricians

IntroductionObstetric emergency triage is a relatively new form of emergency triage and is not yet implemented in Sweden. Adaptations enables safe assessment of the childbearing woman, fetus and labor status. Failure to identify severely ill childbearing women and women post childbirth has repeatedly led to adverse outcomes. Introducing obstetric emergency triage constitutes a profound alteration in management that may challenge preconceived notions on how to provide best care. This study aimed at exploring and describing obstetric staff’s experiences of working with obstetric emergency triage. Materials and MethodsThirteen obstetricians, midwives and auxiliary nurses at an obstetric emergency department in eastern Sweden were recruited by purposeful sampling. Individual qualitative interviews underwent inductive qualitative content analysis according to Graneheim and Lundman. ResultsAn overarching theme − A new mindset − emerged from the analysis, comprising the four categories: Implications for the individual caregiver’s own work, An improved organization, Improved patient care. Initial skepticism to triage changed towards a positive attitude during implementation, identifying barriers and facilitators for successful implementation. ConclusionsThis first study exploring Swedish obstetric staff’s perception of obstetric emergency triage as a working method suggests that, given time for implementation, a new mindset in obstetric emergency care might develop. Triage provides structure and a sense of control through a clear and quick overview of childbearing women seeking emergency care and enhances teamwork by improving communication. Triage directs attention toward aberrations and promotes reflection and action, improving patient safety.

Towards more realistic measures of accessibility to emergency departments in Sweden

BackgroundAssuring that emergency health care (EHC) is accessible is a key objective for health care planners. Conventional accessibility analysis commonly relies on resident population data. However, the allocation of resources based on stationary population data may lead to erroneous assumptions of population accessibility to EHC.MethodTherefore, in this paper, we calculate population accessibility to emergency departments in Sweden with a geographical information system based network analysis. Utilizing static population data and dynamic population data, we investigate spatiotemporal patterns of how static population data over- or underestimates population sizes derived from temporally dynamic population data.ResultsOur findings show that conventional measures of population accessibility tend to underestimate population sizes particularly in rural areas and in smaller ED’s catchment areas compared to urban, larger ED’s—especially during vacation time in the summer.ConclusionsPlanning based on static population data may thus lead to inequitable distributions of resources. This study is motivated in light of the ongoing centralization of ED’s in Sweden, which largely depends on population sizes in ED’s catchment areas.

Factors predictive of hospital admission for children via emergency departments in Australia and Sweden: an observational cross-sectional study

BackgroundIdentifying factors predictive of hospital admission can be useful to prospectively inform bed management and patient flow strategies and decrease emergency department (ED) crowding. It is largely unknown if admission rate or factors predictive of admission vary based on the population to which the ED served (i.e., children only, or both adults and children). This study aimed to describe the profile and identify factors predictive of hospital admission for children who presented to four EDs in Australia and one ED in Sweden.MethodsA multi-site observational cross-sectional study using routinely collected data pertaining to ED presentations made by children < 18 years of age between July 1, 2011 and October 31, 2012. Univariate and multivariate analysis were undertaken to determine factors predictive of hospital admission.ResultsOf the 151,647 ED presentations made during the study period, 22% resulted in hospital admission. Admission rate varied by site; the children’s EDs in Australia had higher admission rates (South Australia: 26%, Queensland: 23%) than the mixed (adult and children’s) EDs (South Australia: 13%, Queensland: 17%, Sweden: 18%). Factors most predictive of hospital admission for children, after controlling for triage category, included hospital type (children’s only) adjusted odds ratio (aOR):2.3 (95%CI: 2.2–2.4), arrival by ambulance aOR:2.8 (95%CI: 2.7–2.9), referral from primary health aOR:1.5 (95%CI: 1.4–1.6) and presentation with a respiratory or gastrointestinal condition (aOR:2.6, 95%CI: 2.5–2.8 and aOR:1.5, 95%CI: 1.4–1.6, respectively). Predictors were similar when each site was considered separately.ConclusionsAlthough the characteristics of children varied by site, factors predictive of hospital admission were mostly similar. The awareness of these factors predicting the need for hospital admission can support the development of clinical pathways.

Advising parents when their child has a fever: a phenomenographic analysis of nurses’ perceptions when working at a telephone helpline, at primary care or at a paediatric emergency department in Sweden

ObjectivesTo describe nurses’ perceptions of advising parents when their child has a fever.Design/methodInductive, descriptive study with a qualitative, phenomenographic approach.Participants and settingA purposive sampling was used. To be included, the...

Agreement of pCO2 in venous to arterial blood gas conversion models in undifferentiated emergency patients

BackgroundVenous blood gas sampling has replaced arterial sampling in many critically ill patients, though interpretation of venous pCO2 still remains a challenge. Lemoël et al., Farkas and Zeserson et al. have proposed models to estimate arterial pCO2 based on venous pCO2. Our objective was to externally validate these models with a new dataset. This was a prospective cross-sectional study of consecutive adult patients with a clinical indication for blood gas analysis in an academic emergency department in Sweden. Agreement of pairs was reported as mean difference with limits of agreement (LoA). Vital signs and lead times were recorded.ResultsTwo hundred and fifty blood gas pairs were collected consecutively between October 2021 and April 2022, 243 valid pairs were used in the final analysis [mean age 72.8 years (SD 17.8), 47% females]. Respiratory distress was the most common clinical indication (84% of all cases). The model of Farkas showed the best metrics with a mean difference between estimated and arterial pCO2 of − 0.11 mmHg (95% LoA − 6.86, + 6.63). For Lemoël the difference was 2.57 mmHg (95% LoA − 5.65, + 10.8), Zeserson 2.55 mmHg (95% LoA − 7.43, + 12.53). All three models showed a decrease in precision in patients with ongoing supplemental oxygen therapy.ConclusionArterial pCO2 may be accurately estimated in most patients based on venous blood gas samples. Additional consideration is required in patients with hypo- or hypercapnia or oxygen therapy. Thus, conversion of venous pCO2 may be considered as an alternative to arterial blood gas sampling with the model of Farkas being the most accurate.

Design of a national patient-centred clinical pathway for sepsis in Sweden

Background The World Health Organization has adopted a resolution on sepsis and urged member states to develop national processes to improve sepsis care. In Sweden, sepsis was selected as one of the ten first diagnoses to be addressed, when the Swedish government in 2019 allocated funds for patient-centred clinical pathways in healthcare. A national multidisciplinary working group, including a patient representative, was appointed to develop the patient-centred clinical pathway for sepsis. Methods The working group mapped challenges and needs surrounding sepsis care and included a survey sent to all emergency departments (ED) in Sweden, and then designed a patient-centred clinical pathway for sepsis. Results The working group decided to focus on the following four areas: (1) sepsis alert for early detection and management optimisation for the most severely ill sepsis patients in the ED; (2) accurate sepsis diagnosis coding; (3) structured information to patients at discharge after sepsis care and (4) structured telephone follow-up after sepsis care. A health-economic analysis indicated that the implementation of the clinical pathway for sepsis will most likely not drive costs. An important aspect of the clinical pathway is implementing continuous monitoring of performance and process indicators. A national working group is currently building up such a system for monitoring, focusing on extraction of this information from the electronic health records systems. Conclusion A national patient-centred clinical pathway for sepsis has been developed and is currently being implemented in Swedish healthcare. We believe that the clinical pathway and the accompanying monitoring will provide a more efficient and equal sepsis care and improved possibilities to monitor and further develop sepsis care in Sweden.

Evaluation of pre-diagnostic blood protein measurements for predicting survival after lung cancer diagnosis.

To evaluate whether circulating proteins are associated with survival after lung cancer diagnosis, and whether they can improve prediction of prognosis. We measured up to 1159 proteins in blood samples from 708 participants in 6 cohorts. Samples were collected within 3 years prior to lung cancer diagnosis. We used Cox proportional hazards models to identify proteins associated with overall mortality after lung cancer diagnosis. To evaluate model performance, we used a round-robin approach in which models were fit in 5 cohorts and evaluated in the 6th cohort. Specifically, we fit a model including 5 proteins and clinical parameters and compared its performance with clinical parameters only. There were 86 proteins nominally associated with mortality (p<0.05), but only CDCP1 remained statistically significant after accounting for multiple testing (hazard ratio per standard deviation: 1.19, 95% CI: 1.10-1.30, unadjusted p=0.00004). The external C-index for the protein-based model was 0.63 (95% CI: 0.61-0.66), compared with 0.62 (95% CI: 0.59-0.64) for the model with clinical parameters only. Inclusion of proteins did not provide a statistically significant improvement in discrimination (C-index difference: 0.015, 95% CI:-0.003 to 0.035). Blood proteins measured within 3 years prior to lung cancer diagnosis were not strongly associated with lung cancer survival, nor did they importantly improve prediction of prognosis beyond clinical information. No explicit funding for this study. Authors and data collection supported by the US National Cancer Institute (U19CA203654), INCA (France, 2019-1-TABAC-01), Cancer Research Foundation of Northern Sweden (AMP19-962), and Swedish Department of Health Ministry.

Patients With Microscopic Colitis Are at Higher Risk of Major Adverse Cardiovascular Events: A Matched Cohort Study

Inflammatory diseases are associated with an increased risk of incident major adverse cardiovascular events (MACE). However, data on MACE are lacking in large population-based histopathology cohorts of microscopic colitis (MC). This study included all Swedish adults with MC without previous cardiovascular disease (1990-2017; N = 11,018). MC and subtypes (collagenous colitis and lymphocytic colitis) were defined from prospectively recorded intestinal histopathology reports from all pathology departments (n= 28) in Sweden. MC patients were matched for age, sex, calendar year, and county with up to 5 reference individuals (N= 48,371) without MC or cardiovascular disease. Sensitivity analyses included full sibling comparisons, and adjustment for cardiovascular medication and healthcare utilization. Multivariable-adjusted hazard ratios for MACE (any of ischemic heart disease, congestive heart failure, stroke, and cardiovascular mortality) were calculated using Cox proportional hazards modelling. Over a median of 6.6 years of follow-up, 2181 (19.8%) incident cases of MACE were confirmed in MC patients and 6661 (13.8%) in reference individuals. MC patients had a higher overall risk of MACE outcomes compared with reference individuals (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.21-1.33) and higher risk of its components: ischemic heart disease (aHR, 1.38; 95% CI, 1.28-1.48), congestive heart failure (aHR, 1.32; 95% CI, 1.22-1.43), and stroke (aHR, 1.12; 95% CI, 1.02-1.23) but not cardiovascular mortality (aHR, 1.07; 95% CI, 0.98-1.18). The results remained robust in the sensitivity analyses. Compared with reference individuals, MC patients had a 27% higher risk of incident MACE, equal to 1 extra case of MACE for every 13 MC patients followed for 10 years.

Abstract OT3-30-01: A randomized double-blind placebo controlled phase 3 trial on the effect of Salovum™ and SPC-Flakes™ on abemaciclib-induced gastrointestinal toxicity in early breast cancer – the ASF-BC study

Abstract Background: In patients with high-risk luminal breast cancer, the addition of CDK 4/6-inhibitor abemaciclib to adjuvant endocrine therapy for two years has been associated with improved disease-free survival and is now recommended as the preferred treatment strategy for this patient group. However, patients treated with abemaciclib frequently (82%) experience diarrhea which primarily occurs during the first three months from treatment initiation and seems to impact patients’ quality of life. No proactive strategy to reduce the occurrence of abemaciclib-induced diarrhea is proposed but patients are recommended to start with loperamide upon the occurrence of diarrhea to be combined with treatment interruption and dose adjustment as needed. Cholera induced diarrhea, as well as other forms of diarrhea-inducing agents, has been shown to elicit a stimulated, endogenous production of a protein, named ”antisecretory factor”, ASF, which acts by modulating secretion of water and ions but also counteracts inflammatory processes. ASF is commercialized as Salovum® and registered by the EU authorities as ”Food for specific medical purposes”. Another way to increase ASF and, thus, to achieve benefit, is to induce its production/conversion by ingestion of malted oat flakes (SPC-flakes®) which has been recommended or considered for several secretory pathological conditions. Salovum has been shown to rapidly, ie within hours to a few days, antagonize diarrheal diseases of various etiologies. It has also been used against high fluid passages and inflammation in Crohn disease, Colitis ulcerosa and carcinoids in adults. SPC-flakes have similar effects but need weeks of administration to emerge. Importantly, to raise body ASF, by Salovum or SPC-flakes, for the above indications has not been associated with adverse effects. Methods: This is a randomized double-blind multicenter phase III study aiming to investigate a proactive strategy including Salovum and SPC-flakes to prevent the occurrence of abemaciclib-induced diarrhea in patients with early breast cancer treated with abemaciclib. A total of 100 patients will be randomized, in a 1:1 manner, between 13 weeks with Salovum/SPC flakes (A) or placebo (B). The study will be conducted in up to ten different oncology departments in Sweden starting in Q3 2022. Primary objective: Occurrence of any-grade (mild, moderate, severe) diarrhea according to the Systemic Treatment-Induced Diarrhea Assessment Tool (STIDAT; patient-reported outcome). Secondary objectives: Occurrence of any-grade diarrhea according to CTCAE v. 5.0, health-related quality of life (QoL), other adverse events related to abemaciclib, adherence to planned abemaciclib treatment, adherence to and pharmacodynamic effect from study products, safety of investigational products, sick leave duration, breast cancer recurrence. Investigational product, dosage and mode of administration: Salovum/placebo egg powder high in antisecretory factor, 4 g. Four sachets, ie 16 g q 8 h for 5 - 7 days before start of abemaciclib. The appropriate amount of Salovum is mixed with 100 – 200 ml of suitable liquid, e.g., fruit juice, and ingested orally. SPC-flakes/placebo flat dose of 75 g/d divided in 2 – 4 doses started in parallel with Salovum/placebo to be continued during the first 12 weeks of treatment with abemaciclib. End of study: All included patients will be followed using questionnaires up to 12 weeks from initiation of abemaciclib. After 12 weeks, all the patients will be followed through electronic medical records until the end of abemaciclib treatment (up to two years) for collecting potential adverse events and information on sick leave. Data from electronical medical records regarding recurrence and subsequent therapy will be collected until breast cancer recurrence or up to 5 years from initiation of abemaciclib. Citation Format: Henrik Lindman, Peter Nygren, Antonis Valachis. A randomized double-blind placebo controlled phase 3 trial on the effect of Salovum™ and SPC-Flakes™ on abemaciclib-induced gastrointestinal toxicity in early breast cancer – the ASF-BC study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-30-01.

Celiac disease and risk of microscopic colitis: A nationwide population-based matched cohort study.

An association has been reported between celiac disease (CD) and microscopic colitis (MC). However, large, population-based cohort studies are rare. To systematically examine the association between CD and MC in a large, nationwide cohort. We conducted a nationwide population-based matched cohort study in Sweden of 45,138 patients with biopsy-verified CD (diagnosed in 1990-2016), 223,149 reference individuals, and 51,449 siblings of CD patients. Data on CD and MC were obtained from all (n=28) pathology departments in Sweden. Adjusted hazard ratios (aHRs) were calculated using Cox regression. During follow-up, 452 CD patients and 197 reference individuals received an MC diagnosis (86.1 vs. 7.5 per 100,000person-years). This difference corresponded to an aHR of 11.6 (95% confidence interval [CI]=9.8-13.8) or eight extra MC cases in 1000 CD patients followed up for 10years. Although the risk of MC was highest during the first year of follow-up (aHR 35.2; 95% CI=20.1-61.6), it remained elevated even after 10years (aHR 8.1; 95% CI=6.0-10.9). Examining MC subtypes lymphocytic colitis (LC) and collagenous colitis (CC) separately, the aHR was 12.4 (95% CI=10.0-15.3) for LC and 10.2 (95% CI=7.7-13.6) for CC. MC was also more common before CD (adjusted odds ratio [aOR]=52.7; 95% CI=31.4-88.4). Compared to siblings, risk estimates decreased but remained elevated (CD and later MC: HR=6.2; CD and earlier MC: aOR=7.9). Our study demonstrated a very strong association of MC with CD with an increased risk of future and previous MC in CD patients. The magnitude of the associations underscores the need to consider the concomitance of these diagnoses in cases in which gastrointestinal symptoms persist or recur despite a gluten-free diet or conventional MC treatment. The comparatively lower risk estimates in sibling comparisons suggest that shared genetic and early environmental factors may contribute to the association between CD and MC.

Automated data extraction tool (DET) for external applications in radiotherapy.

We used OIS data from a nine-linac RT department in Sweden (70weeks, 2015-16). Extracted data included patients' referrals and appointments with details for RT sub-tasks. The data extraction tool to prepare the data for external use was built in C# programming language. It used excel-automation queries to remove unassigned/duplicated values, substitute missing data and perform application-specific calculations. Descriptive statistics were used to verify the output with the manually prepared dataset from the corresponding time period. From the initial raw data, 2030 (51%)/907 (23%) patients had known curative and palliative treatment intent for 84 different cancer diagnoses. After removal of incomplete entries, 373 (10%) patients had unknown treatment intents which were substituted based on the known curative/palliative ratio. Automatically- and manuallyprepared datasets differed<1% for Mould, Treatment planning, Quality assurance and±5% for Fractions and Magnetic resonance imaging with overestimations in 80/140 (57%) entries by the tool. We successfully implemented a software tool to prepare ready-to-use OIS datasets for external applications. Our evaluations showed overall results close to the manually-prepared dataset. The time taken to prepare the dataset using our automated strategy can reduce the time for manual preparation from weeks to seconds.

Perioperative Comfort and Discomfort: Transitioning From Epidural to Oral Pain Treatment After Pancreas Surgery: A Qualitative Study

To explore patients' experiences of pain treatment in the perioperative period after surgery for pancreatic cancer. A qualitative descriptive design using semi-structured interviews. This study was a qualitative study based on 12 interviews. Participants were patients that had undergone surgery for pancreatic cancer. The interviews were conducted 1 to 2 days after the epidural was turned off, in a surgical department in Sweden. The interviews were analysed with qualitative content analysis. The Standard for Reporting Qualitative Research checklist was used for reporting the qualitative research study. The analysis of the transcribed interviews, generated one theme: Maintaining a sense of control in the perioperative phase, and two subthemes: (i) Sense of vulnerability and safety, and (ii) Sense of comfort and discomfort, were found. The participants experienced comfort after pancreas surgery if they maintained a sense of control in the perioperative phase and when the epidural pain treatment provided pain relief without any side effects. The transition from epidural pain treatment to oral pain treatment with opioid tablets was experienced individually, from an almost unnoticed transition to the experience of severe pain, nausea, and fatigue. The sense of vulnerability and safety among the participants were affected by nursing care relationship and the environment on the ward.

Work Interventions Within Interdisciplinary Pain Rehabilitation Programs (IPRP) - Frequency, Patient Characteristics, and Association with Self-Rated Work Ability.

Interdisciplinary pain rehabilitation programs (IPRPs) help people with chronic pain improve their health and manage their work; however, the way IPRPs address sick leave could be improved. Although work interventions can be a part of IPRP, it is not well known how and to what extent. This study explores the frequency of work interventions and the characteristics of patients who participate in work interventions as part of IPRP at specialist pain rehabilitation departments in Sweden. In addition, this study explores the association between participation in work interventions and change in patients' self-rated work ability after IPRP. Data from the Swedish quality registry for pain rehabilitation (SQRP), which includes 3809 patients between 2016 and 2018, were analysed with descriptive statistics and regression analyses. The results indicate a high participation rate in work interventions (90%). Some differences were evident concerning characteristics of patients who participated in different work interventions. The return-to-work (RTW) plan, the most frequently used work intervention, had the strongest association with change in self-rated work ability after IPRP. However, the effect sizes were small, and the initial score best explained the change. Furthermore, there were differences between employed and unemployed patients and employment had a positive association with change in self-rated work ability. More research is needed to understand IPRP's mechanisms and work interventions to support patients with chronic pain, reduce sick leave, and manage work. Employment status needs to be considered and interventions should be tailored to match the individual needs.

Androgen deprivation therapy in men with prostate cancer is not associated with COVID-2019 infection.

Androgens may play a role in severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) infection and host responses as the virus is dependent on the androgen-regulated protein transmembrane serine protease 2 for cell entry. Studies have indicated that prostate cancer patients receiving androgen deprivation therapy (ADT) are at reduced risk of SARS-CoV-2 infection and serious complications compared with patients without ADT, but data are inconsistent. A total of 655 prostate cancer patients who were under surveillance at two urology departments in Sweden on April 1, 2020 were included in the study as well as 240 patients with benign prostatic hyperplasia (BPH). At follow-up early in 2021, the participants completed a questionnaire containing information about symptoms compatible with coronavirus disease 2019 (COVID-19). Blood samples were also collected for the assessment of SARS-CoV-2 IgG antibodies (SARS-CoV-2 Total; Siemens). We used multivariable logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between ADT and the risk of SARS-CoV-2 infection. The cumulative incidence of SARS-CoV-2 seropositivity was 13.4% among patients receiving ADT and 10.4% among patients without ADT. After adjusting for potential confounders, we observed no differences in symptoms or risk of SARS-CoV-2 infection between patients with and without ADT (OR: 0.98; 95% CI: 0.52-1.85). Higher body mass index, Type 1 diabetes, and prostate cancer severity, defined by high Gleason score (8-10; OR: 2.06; 95% CI: 1.04-4.09) or elevated levels of prostate-specific antigen(>20 µg/l;OR: 2.15; 95% CI: 1.13-4.07) were associated with increased risk of SARS-CoV-2 infection. Overall, the risk of SARS-CoV-2 infection was not higher among men with prostate cancer than among men with BPH. Our results do not support the hypothesis that ADT use in prostate cancer patients reduces the risk or symptom severity of SARS-CoV-2 infection or that prostate cancer patients are at increased risk of COVID-19 compared with men without prostate cancer.

Undén — Hammarsjöld Political Duet: the New Doctrine of Swedish Neutrality in Action

The aim of the article is to analyze the relationship between two Swedish politicians — Ö. Undén and D. Hammarsjöld: one of them was a creator of the Swedish foreign policy doctrine after the World War II and another was the UN secretary general. They stayed allied working together in the same department in Sweden and even after Hammarsjöld became the UN secretary general. The article shows how mutual interest to keep the peace at all levels helped to relieve world tension between conflicts’ participants. Thus, it interesting how these politicians are cross-influencing to each other and how the base principles of “home” policy was implemented in operation of international organization. Studying the political duet Undén — Hammarsjöld it supports to come to conclusion that both politicians have used similar procedures and management methods.

Admission glucose as a prognostic marker for all-cause mortality and cardiovascular disease

BackgroundDiabetes and prediabetes are known risk factors for cardiovascular disease and associated with increased mortality risk. Whether patients with a random elevated blood glucose level but no history of diabetes are at a higher mortality and cardiovascular risk is not entirely known.MethodsA retrospective cohort study where patients (18–80 years) with no history of diabetes between 2006 and 2016 attending the emergency department (ED) in Sweden were included. Based on the first (index) blood glucose level patients were categorized into four groups: hypoglycemia (< 3.9 mmol/L), normal glucose tolerance (NGT) (3.9–7.8 mmol/L), dysglycemia (7.8–11.1 mmol/L), and hyperglycemia (> 11.1 mmol/L). Data was collected from four nationwide registers (National Patient Register, National Cause of Death Register, Prescribed Drug Register and Statistics Sweden). Cox regression was used to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI) for all-cause mortality and cardiovascular outcomes using NGT as reference.Results618,694 patients were included during a mean follow-up time of 3.9 years. According to the index blood glucose level: 1871 (0.3%) had hypoglycemia, 525,636 (85%) had NGT, 77,442 (13%) had dysglycemia, and 13,745 (2%) patients had hyperglycemia, respectively. During follow-up 44,532 (7.2%) deaths occurred. After multiple adjustments, mortality risk was highest in patients with hypoglycemia HR 2.58 (2.26–2.96) followed by patients with hyperglycemia HR 1.69 (1.63–1.76) and dysglycemia HR 1.16 (1.13–1.19). Risk for cardiovascular events: i.e., myocardial infarction, stroke and heart failure, were highest among patients with hyperglycemia HR 2.28 (2.13–2.44), HR 1.62 (1.51–1.74) and HR 1.60 (1.46–1.75), respectively.ConclusionPatients with disturbed blood glucose level at ED admission have a higher mortality risk than patients with NGT. Patients with hyperglycemia have almost a two folded increased long-term mortality risk and more than a doubled risk for cardiovascular events compared to patients with NGT.

Effect of Irrigation Fluid Temperature on Recurrence in the Evacuation of Chronic Subdural Hematoma

The effect of a physical property of irrigation fluid (at body vs room temperature) on recurrence rate in the evacuation of chronic subdural hematoma (cSDH) needs further study. To explore whether irrigation fluid temperature has an influence on cSDH recurrence. This was a multicenter randomized clinical trial performed between March 16, 2016, and May 30, 2020. The follow-up period was 6 months. The study was conducted at 3 neurosurgical departments in Sweden. All patients older than 18 years undergoing cSDH evacuation during the study period were screened for eligibility in the study. The study participants were randomly assigned by 1:1 block randomization to the cSDH evacuation procedure with irrigation fluid at room temperature (RT group) or at body temperature (BT group). The primary end point was recurrence requiring reoperation within 6 months. Secondary end points were mortality, health-related quality of life, and complication frequency. At 6 months after surgery, 541 patients (mean [SD] age, 75.8 [9.8] years; 395 men [73%]) had a complete follow-up according to protocol. There were 39 of 277 recurrences (14%) requiring reoperation in the RT group, compared with 16 of 264 recurrences (6%) in the BT group (odds ratio, 2.56; 95% CI, 1.38-4.66; P < .001). There were no significant differences in mortality, health-related quality of life, or complication frequency. In this study, irrigation at body temperature was superior to irrigation at room temperature in terms of fewer recurrences. This is a simple, safe, and readily available technique to optimize outcome in patients with cSDH. When irrigation is used in cSDH surgery, irrigation fluid at body temperature should be considered standard of care. ClincalTrials.gov Identifier: NCT02757235.

Interventional and EBUS cytology in Sweden.

Interventional cytology was first introduced in Sweden in the late 1940ies by Sixten Franzén at the Karolinska University Hospital in Solna, Stockholm. In the early 1950ies, Nils Söderström started using the technique at the University Hospital in Lund. Cytology was successively established as common practice at the pathology departments in Sweden, and e.g. Solna and Lund today have a high rate of cytological samples. Over the years new techniques, such as endobronchial ultrasound (EBUS)-guided fine-needle aspirations, and analyses have been introduced, contributing to the maintained value of cytology as a diagnostic method. In this article, we present a brief history and the current situation of cytology in Sweden with focus on interventional and EBUS cytology.