Skane University Hospital Research Articles

Antisecretory factor in severe traumatic brain injury (AFISTBI): protocol for an exploratory randomized placebo-controlled trial

BackgroundDespite recent advances in neuroimaging and neurocritical care, severe traumatic brain injury (TBI) is still a major cause of severe disability and mortality, with increasing incidence worldwide. Antisecretory factor (AF), commercially available as Salovum®, has been shown to lower intracranial pressure (ICP) in experimental models of, e.g., TBI and herpes encephalitis. The aim of this study is to assess the effect of antisecretory factors in adult patients with severe TBI on ICP and inflammatory mediators in extracellular fluid and plasma.Methods/designThis is a single-center, randomized, placebo-controlled clinical phase 2 trial, investigating the clinical superiority of Salovum® given as a food supplement during 5 days to adults with severe TBI (Glasgow Coma Scale (GCS) < 9), admitted to the neurocritical intensive care unit (NICU) at Skane university hospital, Lund, Sweden. All patients with GCS < 9 and clinical indication for insertion of ICP-monitor and microdialysis catheter will be screened for inclusion and assigned to either the treatment group (n = 10) or placebo group (n = 10). In both groups, the primary outcome will be ICP (mean values and change from baseline during intervention), registered from high-frequency data monitoring for 5 days. Secondary outcomes will be inflammatory mediators in plasma and intracerebral microdialysis perfusate days 1, 3, and 5 during trial treatment.Trial registrationClinicalTrials.gov NCT04117672. Registered on September 17, 2017. Protocol version 6 from October 24, 2023.

Safe to save blood in ovarian cancer surgery - time to change transfusion habits.

Patients with advanced ovarian cancer (AOC) undergoing surgery are often subjected to red blood cell (RBC) transfusions. Both anemia and RBC transfusion are associated with increased morbidity. The aim was to evaluate patient recovery after the implementation of patient blood management (PBM) strategies. This retrospective cohort study included 354 patients with AOC undergoing surgery at Skane University Hospital Lund, Sweden, between January 2016 and December 2021. The gradual implementation of PBM strategies included restrictive RBC transfusion, tranexamic acid as standard medication before laparotomies and intravenous iron administered to patients with iron deficiency. Severe complications were defined as Clavien-Dindo (CD) grade ≥ 3a. Logistic and linear regression analyses were used to evaluate the differences between three consecutive periods. After the implementation of new strategies, 52% of the patients had at least one transfusion compared to 83% at baseline (p < 0.001). There was no difference in the rate of severe complications (CD ≥ 3a) between the groups, adjusted odds ratio 0.55 (95% CI 0.26-1.17). The mean difference in hemoglobin before chemotherapy was -1.32 g/L (95% CI -3.04 to -0.22) when adjusted for blood loss and days from surgery to chemotherapy. The length of stay (LOS) decreased from 8.5 days to 7.5 days (p 0.002). The number of patients transfused were reduced by 31%. Despite a slight increase in anemia rate, severe complications (CD ≥ 3a) remained stable. The LOS was reduced, and chemotherapy was given without delay, indicating that PBM is feasible and without causing major severe effects on short-term recovery.

18F-FDG-PET/CT in breast cancer imaging: Restaging and Implications for treatment decisions in a clinical practice setting.

Although the diagnostic accuracy of 18F-fluorodeoxyglucose - positron emission tomography/computed tomography (18F-FDG-PET/CT) for breast cancer (BC) has been well studied, few studies have evaluated the impact of 18F-FDG-PET/CT on BC patient care. This study aimed to investigate restaging and 18F-FDG-PET/CT-induced changes in clinical decision-making in patients with BC. We retrospectively evaluated 18F-FDG-PET/CT-scans performed for BC-related indications in a prospectively collected consecutive cohort of adult patients at Skane University Hospital, Sweden. Patients with all BC stages were included and divided into three groups based on the indication for 18F-FDG-PET/CT: Group A (primary staging), Group B (response evaluation), and Group C (recurrence). The impact of 18F-FDG-PET/CT-scans on clinical management was categorized as no change, minor change (e.g. modification of treatment plans), or major change (e.g. shift from curative to palliative treatment intention). A total of 376 scans (151 patients) were included: Group A 9.3% (35 of 376 scans), Group B 77.4% (291 of 376 scans), and Group C 13.3% (50 of 376 scans). Significant stage migration, predominantly upstaging, occurred in Group A (45.7%) and Group C (28.0%). Changes in clinical management were observed in 120 scans (31.9%), of which 66 were major and 54 were minor. The largest proportion of 18F-FDG-PET/CT-induced management changes were observed in Group A (57.1%), most commonly a shift from curative to palliative treatment intention due to upstaging. Our study indicates the clinical utility of 18F-FDG-PET/CT in BC restaging and changes in clinical management; the latter observed in approximately one-third of all cases.

Cognitive functioning in adolescents with severe obesity undergoing bariatric surgery or intensive non-surgical treatment in Sweden (AMOS2): a multicentre, open-label, randomised controlled trial

Cognitive functioning in adolescents with severe obesity undergoing bariatric surgery or intensive non-surgical treatment in Sweden (AMOS2): a multicentre, open-label, randomised controlled trial

Outcomes of external and endonasal dacryocystorhinostomy according to a modified Lacrimal Symptom Questionnaire (Lac-Q).

Nasolacrimal duct obstruction is usually treated using endoscopic or external dacryocystorhinostomy (DCR). The anatomic outcomes of both the endoscopic and external approaches are considered excellent. However, anatomic success does not translate into patient satisfaction. The current study assessed pre- and postoperative lacrimal problems using the symptom-based Lacrimal Symptom Questionnaire (Lac-Q) and investigated patient satisfaction depending on the choice of surgical technique. A total of 112 eligible patients with lacrimal problems treated using external or endonasal DCR at the ophthalmology and ear, nose, and throat clinics at Skane University Hospital, Scania, Sweden, over a four-year period, were enrolled in this retrospective study. Patients were considered eligible if they experienced preoperative epiphora and had lacrimal duct stenosis. They were offered treatment using either external or endonasal DCR and were allowed to freely choose the technique. Exclusion criteria consisted of previous ipsilateral DCR, congenital NLDO, age < 18 years, presence of cancer, previous orbital trauma, or noncompliance with postoperative follow-up. After surgery, the patients were sent the Lac-Q to evaluate their lacrimal symptoms pre- and postoperatively. Complementary questions were added pertaining to the operative scar and the patients' overall satisfaction with the operation. In total, 67 (60%) patients with ages ranging from 18 to 88 years completed the questionnaire, 33 (49%) of whom underwent external DCR and 34 (51%) endonasal DCR. Of the 67 respondents, 51 (76%) were women and 16 (24%) were men. Patients scored preoperative lacrimal problems highly on the Lac-Q, reporting both symptomatic and social problems due to epiphora. Following surgery, the group that underwent external DCR remained home from work for 2 - 14 days (median, 3.5 days). However, 17 (52%) were retired. After the endonasal DCR, the patients remained home for 0 - 7 days (median, 2 days). Most patients were satisfied after DCR surgery, with both techniques significantly improving total, lacrimal symptom, and social impact scores (all P < 0.001). No differences in postoperative satisfaction were observed between the external DCR and endonasal DCR groups (P > 0.05). A small number of patients expressed scar-related concerns after external DCR. The patients perceived lacrimal problems as a significant symptomatic and social burden. Postoperative satisfaction and symptom relief were good regardless of the surgical approach. Further prospective studies assessing patient satisfaction and its correlation with anatomical and functional success rates after external and endonasal DCR could provide robust, practical, real-world implications.

#3319 GOODRENAL: A FEASIBILITY STUDY OF AN INTRADIALYTIC HOLISTIC VIRTUAL-REALITY PLATFORM

Abstract Background and Aims People with advanced stages of chronic kidney disease (CKD) undergoing hemodialysis often suffer from comorbidities that together with malnutrition and frailty contribute to a sedentary lifestyle, and cognitive and emotional impairments. Intradialytic non-immersive virtual reality exercise programs may improve the health-related quality of life and physical function of people undertaking hemodialysis. The aim of the GoodRENal project was to test the feasibility of an intradialytic holistic virtual-reality platform designed to combine exercise with efforts to improve nutrition and psychological well-being as well as cognitive functioning and to assess the impact on physical, nutritional and psychological variables. Method People undergoing hemodialysis for at least 3 months who were medically stable, from Spain (Hospital de Manises), Sweden (Skane University Hospital and Karolinska Institutet), and Greece (Aristotle University of Thessaloniki) were selected and randomized into the GoodRENal intradialysis intervention group and a control group (usual care). The GoodRENal group was exposed to a platform that consisted of several Virtual Scenarios (games) for each one of the targeted treatment areas: Physical Activity, Nutritional Information, Psychological Well-being and Cognitive Functionality. Specifically, these scenarios (“games”) are aimed to make participants move (Physical Activity), learn aspects related to nutrition that they must follow (Nutritional Information), improve their psychological state (Psychological Well-being), and practice their cognitive abilities (Cognitive Functionality). The interaction with the Virtual Scenarios was designed to minimize “invasive” and “annoying” features by using a depth camera (AZURE Kinect), so that the patient, through the movement of their lower extremities (legs) was able to carry out the interaction. The control group carried out the usual care in the unit. The test battery included physical variables (lower-limb muscle strength, Sit-to-stand to sit test 10 repetitions, 4-meters gait speed, and 6-minute walking test), nutritional variables (short-form food question, 7-point subjective global assessment, body weight, and handgrip strength), psychological variables (depression and anxiety), and cognitive variables. Differences between groups (GoodRENal vs usual care) will be analyzed with a mixed ANOVA model for repeated measures. Results The study so far includes 55 participants (mean age 65.4 ± 13 years), 17 females, median time on hemodialysis 48 months). The program, which starts in 2023, will last 12 weeks, until the middle of May 2023. Conclusion The evaluation of the GoodRENal platform will show if this is a feasible holistic treatment for improving the physical, nutritional, psychological and cognitive condition of people undertaking hemodialysis.

Age and Referral Route Impact the Access to Diagnosis for Women with Advanced Ovarian Cancer.

The majority of women with ovarian cancer are diagnosed in late stages. Most women do have symptoms prior to diagnosis, sometimes several months before the diagnosis. The aim of this study was to evaluate the timeline from the first presentation of symptoms to a physician until there is a reasonable suspicion of cancer, among women diagnosed with advanced stage ovarian cancer. We wanted to investigate which symptoms were the most common and whether there are other factors affecting the time interval before the suspicion of cancer was confirmed. This was a retrospective population-based cohort study of women diagnosed with advanced ovarian cancer between January 1, 2017 and December 31, 2019 who were referred to Skane University Hospital Lund, Sweden. Data were collected from electronic medical records at Skane University Hospital. The time interval was recorded as the time from first physician consultation with predefined symptoms to the date when there was a reasonable suspicion of ovarian cancer. Data processing and statistical analysis were performed with the statistical software R. Among the 249 patients included in this study, the median time interval from the first consultation to the reasonable suspicion of cancer was 24 days. The first consultation in specialized care had a 70% decrease in delay compared to primary care. Emergency consultations had a 52.2% decrease in time delay compared to planned consultations. Older age was associated with an increase in the geometric mean by 54.7%, comparing the first to the third quartile. The most common symptom was abdominal pain. The length of time interval from first presentation with symptoms relating to ovarian cancer to reasonable suspicion of cancer was associated with whether the consultation was in primary or specialized care, emergency or planned visit and the patient's age.

Whole-Genome Sequencing Reveals Genetic Variant at the HLA Locus Associated with Graft Failure After Heart Transplantation

Whole-Genome Sequencing Reveals Genetic Variant at the HLA Locus Associated with Graft Failure After Heart Transplantation

Development and validation of an artificial neural network algorithm to predict mortality and admission to hospital for heart failure after myocardial infarction: a nationwide population-based study

Patients have an estimated mortality of 15-20% within the first year following myocardial infarction and one in four patients who survive myocardial infarction will develop heart failure, severely reducing quality of life and increasing the risk of long-term mortality. We aimed to establish the accuracy of an artificial neural network (ANN) algorithm in predicting 1-year mortality and admission to hospital for heart failure after myocardial infarction. In this nationwide population-based study, we used data for all patients admitted to hospital for myocardial infarction and discharged alive from a coronary care unit in Sweden (n=139 288) between Jan 1, 2008, and April 1, 2017, from the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) nationwide registry; these patients were randomly divided into training (80%) and testing (20%) datasets. We developed an ANN using 21 variables (including age, sex, medical history, previous medications, in-hospital characteristics, and discharge medications) associated with the outcomes of interest with a back-propagation algorithm in the training dataset and tested it in the testing dataset. The ANN algorithm was then validated in patients with incident myocardial infarction enrolled in the Western Denmark Heart Registry (external validation cohort) between Jan 1, 2008, and Dec 31, 2016. The predictive ability of the model was evaluated using area under the receiver operating characteristic curve (AUROC) and Youden's index was established as a means of identifying an empirical dichotomous cutoff, allowing further evaluation of model performance. 139 288 patients who were admitted to hospital for myocardial infarction in the SWEDEHEART registry were randomly divided into a training dataset of 111 558 (80%) patients and a testing dataset of 27 730 (20%) patients. 30 971 patients with myocardial infarction who were enrolled in the Western Denmark Heart Registry were included in the external validation cohort. A first event, either all-cause mortality or admission to hospital for heart failure 1 year after myocardial infarction, occurred in 32 308 (23·2%) patients in the testing and training cohorts only. For 1-year all-cause mortality, the ANN had an AUROC of 0·85 (95% CI 0·84-0·85) in the testing dataset and 0·84 (0·83-0·84) in the external validation cohort. The AUROC for admission to hospital for heart failure within 1 year was 0·82 (0·81-0·82) in the testing dataset and 0·78 (0·77-0·79) in the external validation dataset. With an empirical cutoff the ANN algorithm correctly classified 73·6% of patients with regard to all-cause mortality and 61·5% of patients with regard to admission to hospital for heart failure in the external validation cohort, ruling out adverse outcomes with 97·1-98·7% probability in the external validation cohort. Identifying patients at a high risk of developing heart failure or death after myocardial infarction could result in tailored therapies and monitoring by the allocation of resources to those at greatest risk. The Swedish Heart and Lung Foundation, Swedish Scientific Research Council, Swedish Foundation for Strategic Research, Knut and Alice Wallenberg Foundation, ALF Agreement on Medical Education and Research, Skane University Hospital, The Bundy Academy, the Märta Winkler Foundation, the Anna-Lisa and Sven-Eric Lundgren Foundation for Medical Research.

Invited commentary: Outcomes of pericardiectomy for constrictive pericarditis following mediastinal irradiation.

Journal of Cardiac SurgeryVolume 36, Issue 12 p. 4643-4644 COMMENTARY Invited commentary: Outcomes of pericardiectomy for constrictive pericarditis following mediastinal irradiation Shahab Nozohoor MD, Phd, Corresponding Author Shahab Nozohoor MD, Phd shahab.nozohoor@med.lu.se orcid.org/0000-0002-5786-864X Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden Correspondence Shahab Nozohoor, Consultant in Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden. Email: shahab.nozohoor@med.lu.seSearch for more papers by this author Shahab Nozohoor MD, Phd, Corresponding Author Shahab Nozohoor MD, Phd shahab.nozohoor@med.lu.se orcid.org/0000-0002-5786-864X Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden Correspondence Shahab Nozohoor, Consultant in Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden. Email: shahab.nozohoor@med.lu.seSearch for more papers by this author First published: 21 September 2021 https://doi.org/10.1111/jocs.15998Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume36, Issue12December 2021Pages 4643-4644 RelatedInformation

Dexamethasone Eye Drops for the Treatment of Retinopathy of Prematurity

Both studies on animals and humans have demonstrated the role of inflammatory mediators on the retinopathy process.2,3 Dexamethasone is a glucocorticoid with a known reductive effect on several of these mediators and on the expression of VEGF.4Starting in 2016, infants receiving laser ablation for type 1 ROP at Skane University Hospital were administered dexamethasone eye-drops postoperatively, usually three times daily. None of the infants receiving postoperative topical steroids needed retreatment, in comparison to a general retreatment frequency of 26% nationally when postoperative dexamethasone wasn’t administered routinely.5 During 2018 and 2019, two premature infants started the dexamethasone regimen before the planned laser treatment could be performed and in one the laser could be postponed, in the other the laser treatment was cancelled. Successively, several other infants with type 2 ROP that were considered at very high risk of requiring laser ablation were administered dexamethasone drops preoperatively and the regression of ROP changes were observed on multiple occasions. Consequently, for infants with type 2 ROP born in 2020, all were administered dexamethasone drops before the laser treatment, but usually in a lower dosage of one drop daily.We therefore aim to compare the treatment frequency for screened infants in the southern healthcare region of Sweden born during 2016 through 2020 to make a systematic retrospective analysis to compare dexamethasone treated and untreated infants.The retrospective study was carried through in accordance with the declaration of Helsinki and received ethical approval from the Swedish ethical board. The study followed the Strengthening and Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies.

MO619GOODRENAL: HOLISTIC PATIENT CARE INTRADIALYSIS PROGRAM IN HEMODIALYSIS THROUGH A VIRTUAL HEALTH PLATFORM

Abstract Background and Aims There is wide evidence that weak points of the care of end-stage Chronic kidney disease (CKD) patients in hemodialysis include three aspects that are suitable for intervention: exercise, nutrition and psychological support. Evidence shows that exercise for patients on hemodialysis results in increased functional capacity and strength and improved health-related quality of life and survival. Additionally, earlier studies have shown the benefits of psychological interventions and the positive effect of educational programs on nutritional status for patients on hemodialysis. Despite the well-known benefits of exercise, these programs are not being implemented in the routine clinical care of hemodialysis patients. Thus, the GoodRENal project aims to promote a healthy lifestyle among hemodialysis patients using a holistic pedagogical approach that, addressing adult learners, combines exercise, nutrition and psychological well-being as well as cognitive functioning. Method GoodRENal is a project funded by the European Community, Erasmus + program (336.327 euros). The project will last 3 years, from September 2020 to August 2023 and the Partners of the consortium include institutions from five European countries: Spain (Universidad CEU Cardenal Herrera, Hospital de Manises, Univesitat de Valéncia, Universitat Politécnica de Valéncia), Sweden (Skane University Hospital and Karolinska Institutet), Greece (Aristotles University of Thessaloniki) and Belgium (Katholieke Universiteit Leuven). Other supporting institutions are located in the UK, Chile and Brazil. Results The project will develop a virtual platform comprising three aspects of care: physical activity/exercise, nutrition, psychological well-being/cognition. In summary, the project outputs will be: 1. A didactic content on a modular platform with an educational program for integrated treatment in patients on hemodialysis; 2. A guideline to promote a healthy lifestyle among patients on hemodialysis for healthcare providers; 3. A guideline to promote a healthy lifestyle among patients on hemodialysis for patients, and their formal- and non-formal carers. At the present stage exploratory questionnaires regarding physical activity/exercise-nutrition-psychological well-being/cognition have been developed in consensus with all the partners. Data from this first exploratory study regarding needs and barriers of the stakeholders (patients, health professionals, carers) will be presented at the ERA-EDTA congress. Conclusion GoodRENal aims at improving the overall health, and thus the health-related quality of life, of patients on hemodialysis through a holistic and pedagogical approach that will target especially improvements of patient reported outcomes including quality of life.

Global leadership in paediatric and congenital cardiac care: "Humility in Leadership - an interview with Katarina Hanséus, MD, PhD, President of the Association for European Paediatric and Congenital Cardiology (AEPC)".

Dr. Katarina Hanséus is the focus of our fourth in a series of interviews in Cardiology in the Young entitled, "Global Leadership in Paediatric and Congenital Cardiac Care". Dr. Hanséus was born in Malmö, Sweden. She attended undergraduate school in her home town in Malmö, Sweden, graduating in 1974. Dr. Hanséus then went on to complete medical school at University of Lund in Lund, Sweden, graduating in 1980, where additionally she completed a Doctoral Dissertation in the evaluation of cardiac function and chamber size in children using Doppler and cross-sectional echocardiography. Under the Swedish Board of National Welfare, Dr. Hanséus completed her authorisation as a paediatrician in 1986, followed by her authorisation as a paediatric cardiologist in 1988, at University of Lund. She was appointed head of Paediatric Cardiology in 2000 at the Children's Heart Center, Skane University Hospital, Lund, Sweden. The programme at Lund serves as one of the two national referral centres for comprehensive paediatric and congenital cardiac care, including paediatric cardiac surgery, in Sweden. From 2006 to 2013, she served as the clinical and administrative head of the Department of Neonatology, Paediatric Surgery, Paediatric Intensive Care, Paediatric Cardiology, and Paediatric Cardiac Surgery, returning as the head of Paediatric Cardiology in 2013, for which she currently holds the position.Dr. Hanséus is a recognised leader in the field of Paediatric Cardiology and has been involved in leadership within the Swedish Pediatric Society, the Swedish Association for Pediatric Cardiology, and the Association for European Paediatric and Congenital Cardiology throughout her career. Within the Association for European Paediatric and Congenital Cardiology, she served as the Secretary General from 2011 to 2016, the President Elect in 2018, and is the current President serving from 2019 until 2022. This article presents our interview with Dr. Hanséus, an interview that covers her experience as a leader in the field of Paediatric Cardiology, including the history and goals of the Association for European Paediatric and Congenital Cardiology, and her role and vision as their current President.

Exercise Echocardiography following Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy.

To investigate outcome after septal myectomy and to evaluate long-term hemodynamics with exercise echocardiography. This study included 40 consecutive patients operated with septal myectomy for hypertrophic obstructive cardiomyopathy from January 1998 to August 2017 at Skane University Hospital, Lund, Sweden. Perioperative clinical data and echocardiography measurements were reviewed retrospectively. Patients (n = 36) who were alive and living in Sweden were invited for exercise echocardiography to evaluate exercise capacity and hemodynamics, of whom 19 patients performed exercise echocardiography. Overall survival was 100% at 1 year and 96% at 5 years following surgery. Preoperative median resting peak LVOT (left ventricular outflow tract) gradient was 80 mm Hg. Septum thickness was reduced from 22 ± 4 mm preoperatively to 16 ± 3 mm postoperatively (p < 0.001). During exercise echocardiography, the peak LVOT gradient was 8 mm Hg at rest, and increased to 13 mm Hg during exercise echocardiography (p = 0.002). None of the patients had dynamic LVOT obstruction during exercise echocardiography, and there was no clinically significant systolic anterior motion or severe mitral insufficiency during exercise. Long-term survival following septal myectomy is very good. At long-term follow-up, LVOT gradients were low and exercise echocardiography demonstrated good hemodynamics.

Identify New Genetic Variants on Chromosome 6 Associated with Mortality after Heart Transplantation

Identify New Genetic Variants on Chromosome 6 Associated with Mortality after Heart Transplantation

Iron Deficiency in Left Ventricular Assist Device Recipients

Iron Deficiency in Left Ventricular Assist Device Recipients

Clinical Implications of Different Risk Factor Profiles in Patients with Mesenteric Venous Thrombosis and Systemic Venous Thromboembolism – A Population-Based Study

Clinical Implications of Different Risk Factor Profiles in Patients with Mesenteric Venous Thrombosis and Systemic Venous Thromboembolism – A Population-Based Study

The impact of care process development and comorbidity on time to surgery, mortality rate and functional outcome for hip fracture patients: a retrospective analysis over 19\u2009years with data from the Swedish National Registry for hip fracture patients, RIKSH\xd6FT

For a long time the attention given to the hip fracture patient group was minor and without any certain consideration to their frailty. To improve the care for these patients Skane University Hospital in Lund has during the past 19 years worked actively with developing the care. This paper aims to describe what impact the care process development has had on functional outcome and mortality, as well as to analyze the impact of comorbidity and fracture type.MethodsPatients older than 50 years with non-pathological cervical and trochanteric hip fracture admitted between Jan 1st 1999 and Dec 31st 2017 were included and data was retrieved from the National Quality Register for hip fracture patients, RIKSHÖFT. Variables regarding patient characteristics, fracture type, operation method, lead-times and outcome were analyzed. For comparison Fischer’s exact test and Spearman’s rank correlation coefficient was used for the categorical data and Pearson correlation coefficient for the continuous. To further analyze the effect over time a linear regression model was used.ResultsA total of 7827 patients were included. A significant shift in the overall morbidity was seen, with an increase in patients of higher ASA grade. No correlation was seen between outcome and the care process development. The mortality rate for the group as a whole the mortality rate had decreased over time. The total length of stay had decreased significantly over time. There was no statistically significant change in mortality rate over time when relating it to time-to-surgery.ConclusionsAlthough the patients display a higher morbidity over time, the mortality rate has not changed significantly, which might indicate an effect of the care process development.The care process development does not seem to impact on outcome as much as other factors.This study supports the possibility to create a more specific algorithm for hip fracture patients, taking specific subgroups into consideration.

ELEVATE TN: Phase 3 Study of Acalabrutinib Combined with Obinutuzumab (O) or Alone Vs O Plus Chlorambucil (Clb) in Patients (Pts) with Treatment-Naive Chronic Lymphocytic Leukemia (CLL)

ELEVATE TN: Phase 3 Study of Acalabrutinib Combined with Obinutuzumab (O) or Alone Vs O Plus Chlorambucil (Clb) in Patients (Pts) with Treatment-Naive Chronic Lymphocytic Leukemia (CLL)

A quick test of cognitive speed can predict development of dementia in Parkinson\u2019s disease

Parkinson’s disease (PD) patients frequently develop cognitive impairment. There is a need for brief clinical assessments identifying PD patients at high risk of progressing to dementia. In this study, we look into predicting dementia in PD and underlying structural and functional correlates to cognitive decline in PD. We included 175 patients with PD, 30 with PD dementia, 51 neurologically healthy controls and 121 patients with Alzheimer’s disease (AD) from Skane University Hospital, BIOFINDER cohorts. All underwent cognitive tests, including MMSE, 10-word list delayed recall (ADAS-cog), A Quick Test of cognitive speed (AQT), Letter S fluency, Clock Drawing Test (CDT) and pentagon copying. In non-demented patients with PD, abnormal AQT and CDT results predicted an increased risk of subsequent development of dementia (hazard ratio 2.2 for both). When comparing the cognitive profile between PD and AD, decreased performance on AQT, which measures attention and processing speed, was more typical in PD. Lastly, we investigated the underlying structural and functional correlates for the PD-specific test AQT with magnetic resonance imaging. In PD patients, decreased performance on AQT was associated with i) cortical thinning in temporoparietal regions, ii) changes in diffusion MRI, especially in the cingulum tract, and iii) decreased functional connectivity in posterior brain networks.