Swedish Centres Research Articles

Staff experiences of a new tool for comprehensive geriatric assessment in primary care (PASTEL): a focus group study

Objective: Comprehensive geriatric assessment (CGA) is recommended for the management of frailty. Little is known about professionals’ experiences of CGA; therefore we wanted to investigate the experiences of staff in primary care using a new CGA tool: the Primary care Assessment Tool for Elderly (PASTEL).Design: Focus group interviews. Manifest qualitative content analysis.Setting: Nine primary health care centres in Sweden that participated in a CGA intervention. These centres represent urban as well as rural areas.Subjects: Nine nurses, five GPs and one pharmacist were divided into three focus groups.Main outcome measures: Participants’ experiences of conducting CGA with PASTEL.Results: The analysis resulted in four main categories. A valuable tool for selected patients: The participants considered the assessment tool to be feasible and valuable. They stated that having enough time for the assessment interview was essential but views about the ideal patient for assessment were divided. Creating conditions for dialogue: The process of adapting the assessment to the individual and create conditions for dialogue was recognised as important. Managing in-depth conversations: In-depth conversations turned out to be an important component of the assessment. Patients were eager to share their stories, but talking about the future or the end of life was demanding. The winding road of actions and teamwork: PASTEL was regarded as a good preparation tool for care planning and a means of support for identifying appropriate actions to manage frailty but there were challenges to implement these actions and to obtain good teamwork.Conclusion: The participants reported that PASTEL, a tool for CGA, gave a holistic picture of the older person and was helpful in care planning.Key pointsTo manage frailty using comprehensive geriatric assessment (CGA) in primary care, there is a need for tools that are efficient, user-friendly and which support patient involvement and teamwork•This study found that the Primary care Assessment tool for Elderly (PASTEL) is regarded as both valuable and feasible by primary care professionals•Use of carefully selected items in the tool and allowing enough time for dialogue may enhance patient-centeredness•The PASTEL tool supports the process of identifying actions to manage frailty in older adults. Teamwork related to the tool and CGA in primary care needs to be further investigated and developed

Long-term (up to 16\xa0months) health-related quality of life after adjuvant tailored dose-dense chemotherapy vs. standard three-weekly chemotherapy in women with high-risk early breast cancer

PurposeTo prospectively compare HRQoL effects of two modern adjuvant chemotherapy breast cancer treatment regimens at six time-points up to 16 months after random assignment.MethodsThe open-label, randomized, Phase 3 “Panther trial” was conducted between February 2007 and September 2011. 760 women, aged 65 years and younger, after surgery for non-metastatic node-positive or high-risk node-negative breast cancer were randomized 1:1 to the experimental group (four cycles of tailored and dose-dense adjuvant epirubicin and cyclophosphamide/2 weeks followed by four cycles of tailored dose-dense docetaxel/2 weeks) or standard group (three cycles of fluorouracil and epirubicin-cyclophosphamide/3 weeks followed by three cycles of docetaxel/3 weeks). HRQoL was assessed at all Swedish centres using EORTC QLQ-C30 and EORTC QLQ-BR23 at six points during 16 months before randomization.ResultsResponse rates to questionnaires were highest at baseline 728/780 (93%) and lowest 16 months after randomization, 557/750 (74%). HRQoL declined during treatment in both groups. At the end of treatment, the experimental group reported statistically significantly lower HRQoL (P < 0.001) than the standard group on global health status, physical functioning, role functioning, social functioning, fatigue, sexual functioning, and systemic therapy effects. No differences were found for emotional functioning, body image, and arm and breast symptoms. There were no statistically significant differences between the groups at the first follow-up and at subsequent assessments. HRQoL levels at the 16-month follow-up were similar to baseline values.ConclusionsNegative HRQoL impact of the dose-dense and tailored strategy appears to be prominent during treatment, but HRQoL recover once treatment ends.Trial Registration clinicaltrials.gov Identifier: NCT00798070; isrctn.org Identifier:ISRCTN39017665.

A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomized Controlled Trial.

BackgroundHigh positive mental health, including the ability to cope with the normal stresses of life, work productively, and be able to contribute to one’s community, has been associated with various health outcomes. The role of positive mental health is therefore increasingly recognized in national mental health promotion programs and policies. Mobile health (mHealth) interventions could be a cost-effective way to disseminate positive psychological interventions to the general population.ObjectiveThe aim of this study was to estimate the effect of a fully automated mHealth intervention on positive mental health, and anxiety and depression symptomology among Swedish university students using a randomized controlled trial design.MethodsA 2-arm, single-blind (researchers), parallel-groups randomized controlled trial with an mHealth positive psychology program intervention group and a relevant online mental health information control group was employed to estimate the effect of the novel intervention. Participants were recruited using digital advertising through student health care centers in Sweden. Inclusion criteria were (1) university students, (2) able to read and understand Swedish, (3) and have access to a mobile phone. Exclusion criteria were high positive mental health, as assessed by the Mental Health Continuum Short Form (MHC-SF), or high depression and anxiety symptomology, as assessed by the Hospital Anxiety Depression Scale (HADS). The primary outcome was positive mental health (MHC-SF), and the secondary outcomes were depression and anxiety symptomatology (HADS). The subscales of MHC-SF were also analyzed as exploratory outcomes. Outcomes were measured 3 months after randomization through questionnaires completed on the participants’ mobile phones.ResultsA total of 654 participants (median age 25 years), including 510 (78.0%) identifying as female, were randomized to either the intervention (n=348) or control group (n=306). At follow-up, positive mental health was significantly higher in the intervention group compared with the control group (incidence rate ratio [IRR]=1.067, 95% CI 1.024-1.112, P=.002). For both depression and anxiety symptomatology, the intervention group showed significantly lower scores at follow-up compared with the control group (depression: IRR=0.820, 95% CI 0.714-0.942, P=.005; anxiety: IRR=0.899, 95% CI 0.840-0.962, P=.002). Follow-up rates were lower than expected (58.3% for primary outcomes and 52.3% for secondary outcomes); however, attrition analyses did not identify any systematic attrition with respect to baseline variables.ConclusionsThe mHealth intervention was estimated to be superior to usual care in increasing positive mental health among university students. A protective effect of the intervention was also found on depressive and anxiety symptoms. These findings demonstrate the feasibility of using an automated mobile phone format to enhance positive mental health, which offers promise for the use of mHealth solutions in public mental health promotion.Trial RegistrationInternational Standard Randomized Controlled Trial Registry ISRCTN54748632; http://www.isrctn.com/ISRCTN54748632

Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry.

Guidelines recommend considering workload in interpretation of the systolic blood pressure (SBP) response to exercise, but reference values are lacking. This was a retrospective, consecutive cohort study. From 12,976 subjects aged 18-85 years who performed a bicycle ergometer exercise test at one centre in Sweden during the years 2005-2016, we excluded those with prevalent cardiovascular disease, comorbidities, cardiac risk factors or medications. We extracted SBP, heart rate and workload (watt) from ≥ 3 time points from each test. The SBP/watt-slope and the SBP/watt-ratio at peak exercise were calculated. Age- and sex-specific mean values, standard deviations and 90th and 95th percentiles were determined. Reference equations for workload-indexed and peak SBP were derived using multiple linear regression analysis, including sex, age, workload, SBP at rest and anthropometric variables as predictors. A final sample of 3839 healthy subjects (n = 1620 female) were included. While females had lower mean peak SBP than males (188 ± 24 vs 202 ± 22 mmHg, p < 0.001), workload-indexed SBP measures were markedly higher in females; SBP/watt-slope: 0.52 ± 0.21 versus 0.41 ± 0.15 mmHg/watt (p < 0.001); peak SBP/watt-ratio: 1.35 ± 0.34 versus 0.90 ± 0.21 mmHg/watt (p < 0.001). Age, sex, exercise capacity, resting SBP and height were significant predictors of the workload-indexed SBP parameters and were included in the reference equations. These novel reference values can aid clinicians and exercise physiologists in interpreting the SBP response to exercise and may provide a basis for future research on the prognostic impact of exercise SBP. In females, a markedly higher SBP in relation to workload could imply a greater peripheral vascular resistance during exercise than in males.

Ascending the Waste Hierarchy: Re-use potential in Swedish recycling centres

According to the waste hierarchy principle, which constitutes the basis of European waste legislation, waste prevention and re-use are considered – most of the times – better waste management options than recycling. However, prevention and re-use activities are difficult to operationalise and measure, without a monitoring framework in place. This contribution investigates the potential of re-using end-of-life products that have been disposed at recycling centres in Sweden. Recycling centres receive a wide variety of materials for recycling, of which a portion could be re-used instead. The aim is to identify what product groups can be re-used, the share of these potentially re-usable products in the recycling centres, and under what conditions their re-use is feasible. A literature review of similar studies, site visits at recycling centres in Sweden, and semi-structured interviews with relevant stakeholders were used to analyse the potential for re-use in private recycling centres in Sweden. The most suitable product groups for re-use identified are building materials, furniture and electrical equipment (mainly white goods), as other material types are mostly handled by charity organisations (e.g. textiles). There is significant potential for increasing re-use operations in recycling centres, but in order to be economically profitable it is important to identify the most suitable material fractions (or product groups) and engage in strategic partnerships that will allow more effective organisation of re-use processes.

Update on the EFFECTS study of fluoxetine for stroke recovery: a randomised controlled trial in Sweden

Studies have suggested that fluoxetine might improve neurological recovery after stroke, but the results remain inconclusive. The EFFECTS (Efficacy oF Fluoxetine – a randomisEd Controlled Trial in Stroke) reached its recruitment target of 1500 patients in June 2019. The purpose of this article is to present all amendments to the protocol and describe how we formed the EFFECTS trial collaboration in Sweden.MethodsIn this investigator-led, multicentre, parallel-group, randomised, placebo-controlled trial, we enrolled non-depressed stroke patients aged 18 years or older between 2 and 15 days after stroke onset. The patients had a clinical diagnosis of stroke (ischaemic or intracerebral haemorrhage) with persisting focal neurological deficits. Patients were randomised to fluoxetine 20 mg or matching placebo capsules once daily for 6 months.ResultsSeven amendments were made and included clarification of drug interaction between fluoxetine and metoprolol and the use of metoprolol for severe heart failure as an exclusion criterion, inclusion of data from central Swedish registries and the Swedish Stroke Register, changes in informed consent from patients, and clarification of design of some sub-studies.EFFECTS recruited 1500 patients at 35 centres in Sweden between 20 October 2014 and 28 June 2019. We plan to unblind the data in January 2020 and report the primary outcome in May 2020.ConclusionEFFECTS will provide data on the safety and efficacy of 6 months of treatment with fluoxetine after stroke in a Swedish health system setting. The data from EFFECTS will also contribute to an individual patient data meta-analysis.Trial registrationEudraCT 2011-006130-16. Registered on 8 August 2014.ISRCTN, ISRCTN13020412. Registered on 19 December 2014.ClinicalTrials.gov: NCT02683213. Retrospectively registered on 2 February 2016.

Dealing With Questions of Responsiveness in a Low-Discretion Context: Offers of Assistance in Standardized Public Service Encounters

A key theme in the research on bureaucratic encounters pertains to street-level bureaucrats’ opportunities for responsiveness when discretion is constrained by the introduction of standardized service delivery regulations, such as information communication technology (ICT). This article contributes to existing scholarship by exploring how low-discretion officials at the Swedish Social Insurance Agency Customer Center manage competing demands of making decisions that are built on regulations and simultaneously responding to the situation at hand and individuals’ needs. Analyzing real-time interactions using the conversation analytical concept of “offers of assistance” enables us to discover new aspects of interactional practices of responsiveness in standardized service encounters.

Associations between materials used and work-related musculoskeletal hand complaints among haemodialysis nurses.

One in every two haemodialysis nurses has reported musculoskeletal complaints concerning their hands, which is twice that reported for hospital nurses in general. It is possible that there is an association between the materials used by haemodialysis nurses and the occurrence of hand complaints. To examine the association between the type of dialysis machine and disposables used with the occurrence of hand complaints among haemodialysis nurses. To compare occupational risks of developing work-related musculoskeletal disorders based on the materials used for haemodialysis. Cross-sectional. Two hundred and eighty-two nurses working in 27 haemodialysis centres in Sweden participated in a survey, and 19 nurses at five centres were observed during priming procedures. Nurses supplied demographic data and answered the Nordic Musculoskeletal Questionnaire. Centre level data regarding machines and disposables used for haemodialysis during the past year were also collected. There were no differences in the prevalence of hand complaints based on the type of haemodialysis machines, dialysers or tubing used. There were no differences found in physical exposure to the hands during priming, based on machine type used. The results of this study could not reveal any association between disposable materials used and the occurrence of hand complaints among haemodialysis nurses. Additionally, there were no occupational risks detected based on the types of machines used. Hence, the results of the present study strongly indicate that a deeper ergonomic analysis of the work environment is needed to understand the prevalence of hand complaints among nurses working in haemodialysis settings.

Beyond connected cars: A systems of systems perspective

The automotive domain is rapidly changing in the last years. Among the different challenges OEMs (i.e. the vehicle manufacturers) are facing, vehicles are evolving into systems of systems. In fact, over the last years vehicles have evolved from disconnected and “blind” systems to systems that are (i) able to sense the surrounding environment and (ii) connected with other vehicles, the city, pedestrians, cyclists, etc. Future transportation systems can be seen as a System of Systems (SoS). In an SoS, constituent systems, i.e. the units that compose an SoS, can act as standalone systems, but their cooperation enables new emerging and promising scenarios. While this trend creates new opportunities, it also poses a risk to compromise key qualities such as safety, security, and privacy. In this paper we focus on the automotive domain and we investigate how to engineer and architect cars in order to build them as constituents of future transportation systems. Our contribution is an architectural viewpoint for System of Systems, which we demonstrate based on an automotive example. Moreover, we contribute a functional reference architecture for cars as constituents of an SoS. This reference architecture can be considered as an imprinting for the implementations that would be devised in specific projects and contexts. We also point out the necessity for a collaboration among different OEMs and with other relevant stakeholders, such as road authorities and smart cities, to properly engineer systems of systems composed of cars, trucks, roads, pedestrians, etc. This work is realized in the context of two Swedish projects coordinated by Volvo Cars and involving some universities and research centers in Sweden and many suppliers of the OEM, including Autoliv, Arccore, Combitech, Cybercom, Knowit, Prevas, ÅF-Technology, Semcom, and Qamcom.

NCF1-339 polymorphism is associated with altered formation of neutrophil extracellular traps, high serum interferon activity and antiphospholipid syndrome in systemic lupus erythematosus

​ObjectivesA single nucleotide polymorphism in the NCF1 gene (NCF1-339, rs201802880), encoding NADPH oxidase type II subunit NCF1/p47phox, reducing production of reactive oxygen species (ROS) is strongly associated with the development...

A retrospective register study comparing fibrinogen treated trauma patients with an injury severity score matched control group

BackgroundFibrinogen concentrate (FC) is frequently used to treat bleeding trauma patients, although the clinical effects are not well known. In this study we describe demographic and clinical outcome data in a cohort of trauma patients receiving FC, compared to a matched control group, who did not receive FC.MethodsThis retrospective, single-center, observational study included adult trauma patients admitted to a level 1-trauma center in Sweden between January 2013 and June 2015. The study population consisted of patients to whom FC was administrated within 24 h (n = 138, “Fib+”). Patients with Injury Severity Score (ISS) > 49 and/or deceased within 1 h from arrival were excluded (n = 30). Controls (n = 108) were matched for age, gender and ISS (“Fib-“). Primary outcome was mortality (24 h−/30 days−/1 year-), and secondary outcomes were blood transfusions, thromboembolic events and organ failure.ResultsThe Fib+ group, despite having similar ISS as Fib-, had higher prevalence of penetrating trauma and lower Glasgow Coma Scale (GCS), indicating more severe injuries. Patients receiving FC had a higher mortality after 24 h/ 30 days/ 1 year compared to controls (Fib-). However, in a propensity score matched model, the differences in mortality between Fib+ and Fib- were no longer significant. Blood transfusions were more common in the Fib+ group, but no difference was observed in thromboembolic events or organ failure. In both groups, low as well as high P-fibrinogen levels at arrival were associated with increased mortality, with the lowest mortality observed at P-fibrinogen values of 2–3 g/l.ConclusionsDespite equal ISS, patients receiving FC had a higher mortality compared to the control group, presumably associated to the fact that these patients were bleeding and physiologically deranged on arrival. When applying a propensity score matching approach, the difference in mortality between the groups was no longer significant. No differences were observed between the groups regarding thromboembolic events or organ failure, despite higher transfusion volumes in patients receiving FC.

Short and long-term efficacy of adalimumab in ulcerative colitis: a real-life study

Objective: Randomized controlled trials have shown the effectiveness of Adalimumab in ulcerative colitis. However, real-life data is scarce. We aimed to assess the effectiveness and predictive factors of effectiveness in a large Swedish cohort.Methods: Retrospective capture of data from local registries at five Swedish IBD centers. Clinical response and remission rates were assessed at three months after starting adalimumab treatment and patients were followed until colectomy or need for another biological. Bio-naive patients were compared to bio experienced patients. Factors associated with short term responses were assessed using logistic regression model. Failure on drug was assessed using a Cox proportional hazards regression model.Results: 118 patients (59 males, 59 females) with median age 34.4 years (IQR 27.0–51.4) were included. Median disease duration was 4.3 years (IQR 2.0–9.0) and follow-up 1.27 years (IQR 0.33–4.1). A clinical corticosteroid-free remission was achieved by 38/118 (32.2%) and response by 91/118 (77%) after three months. CRP >3 mg/l at baseline was predictive of short-term failure to reach corticosteroid-free remission. Factors associated with survival on the drug were male gender, CRP <3 mg/l and absence of primary sclerosing cholangitis. Patients >42 years of age at diagnosis were more likely to respond to adalimumab and remain on treatment compared to patients <20 years.Conclusions: An elevated CRP-level, primary sclerosing cholangitis and female gender were predictors of treatment failure. In contrast older age at diagnosis was a predictor of short-term clinical response and drug survival. Prior infliximab failure, regardless of cause, did not influence the outcome of adalimumab treatment.

Retraining for prevention of peritonitis in peritoneal dialysis patients: A randomized controlled trial.

Peritonitis is more common in peritoneal dialysis (PD) patients nonadherent to the PD exchange protocol procedures than in compliant patients. We therefore investigated whether regular testing of PD knowledge with focus on infection prophylaxis could increase the time to first peritonitis (primary outcome) and reduce the peritonitis rate in new PD patients. This physician-initiated, open-label, parallel group trial took place at 57 centers in Sweden, Denmark, Norway, Finland, Estonia, Latvia, the Netherlands, and the United Kingdom from 2010 to 2015. New peritonitis-free PD patients were randomized using computer-generated numbers 1 month after the start of PD either to a control group (n = 331) treated according to center routines or to a retraining group (n = 340), which underwent testing of PD knowledge and skills at 1, 3, 6, 12, 18, 24, 30, and 36 months after PD start, followed by retraining if the goals were not achieved. In all, 74% of the controls and 80% of the retraining patients discontinued the study. The groups did not differ significantly regarding cumulative incidence of first peritonitis adjusted for competing risks (kidney transplantation, transfer to hemodialysis and death; hazard ratio 0.84; 95% confidence interval (CI) 0.65-1.09) nor regarding peritonitis rate per patient year (relative risk 0.93; 95% CI 0.75-1.16). In this randomized controlled trial, we were unable to demonstrate that regular, targeted testing and retraining of new PD patients increased the time to first peritonitis or reduced the rate of peritonitis, as the study comprised patients with a low risk of peritonitis, was underpowered, open to type 1 statistical error, and contamination between groups.

N08 IBD Home at GHP Stockholm Gastro Center in Sweden

Abstract Background Patients with IBD and with biological treatment often need close monitoring. In this study, a digital tool was used to meet the patients′ need and increase their participation. IBD Home is a cell phone application that is connected to the national quality registry, SWIBREG. It offers the patients to register their symptoms and to perform a home-test of faecal kalprotectin, the result transmitted directly to the registry. At the Stockholm Gastro Center we decided to offer inclusion in IBD Home to all patients on biological treatment. The aim of this study was to investigate the functionality of IBD Home from the patients and the health care professionals point of view, and to investigate if the patients experienced an increased participation by monitoring with IBD Home. Methods In March 2018, a letter with information about IBD Home and an offer to use the tool was sent to all patients with biological treatment. A letter of reminder was sent after two months. Those who accepted were included and got information about how to download the application. In December, both patients and health care professionals got a questionnaire concerning IBD Home. Results A total of 166 patients on biological treatment were offered monitoring by IBD Home and 89 (53%) accepted. When answering the evaluation, 79 patients were active in using IBD Home. Causes for inactivity were stated as: too old phone model (n = 1), technical differences (n = 2), worries concerning the security of the system (n = 1), and others e.g. ‘forgotten about it’ and ‘did not find the time to do it’. Only 27 patients (34%) left home-test faecal kalprotectin on a regular basis. The questionnaire was answered by 27 patients (34%). The majority (n = 24) stated that it was easy to install IBD Home. A total of nine patients noted that their participation in their own health care had increased, while the majority (n = 16) stated that there was no difference. A total of five nurses and three gastroenterologists answered the questionnaire. Those using the manual for including patients in IBD Home and the manual to interpret values expressed them to be very clear or fairly clear (n = 4). Four health care professionals had never used the manuals. The majority (n = 6), had used IBD Home in the clinical work and regarded it as useful. Conclusion Patients using IBD Home experiences the tool to be very easy to use but most of them did not experience any improvements concerning participation in their own care. The response rate was however low. It may be some difficulties to get started with the home-test faecal kalprotectin since only 34% are using it on a regular basis. The health care professionals using IBD Home in their clinical work found it useful.

Important situations that capture moral distress in paediatric oncology

BackgroundThe paediatric Moral Distress Scale-Revised (MDS-R) was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents’ unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish paediatric MDS-R, among healthcare professionals (HCPs) in paediatric oncology.MethodsIn this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach’s alpha and inter-item correlation test. HCPs (n = 278) at all six Swedish paediatric oncology centres participated (> 89%). The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned.ResultsNursing assistants (NAs) reported higher intensity and lower frequency on all added items; registered nurses (RNs) reported a higher frequency on item 22–25; medical doctors (MDs) reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21.ConclusionIn accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology.

Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age.

An asymptomatic Atrial Septal Defect (ASD) is often closed at the age of 3–5 years using a transcatheter or surgical technique. Symptomatic ASD or ASD associated with pulmonary hypertension (PHT) may require earlier closure, particularly in combination with other non-cardiac risk factors for PHT, but the indications for early closure and the potential risk for complications are largely unknown. The aim of this study was to assess risk factors for needing ASD closure during the first and second years of life. This case-control study included all children treated with surgical or percutaneous ASD closure between 2000 and 2014 at two out of three pediatric heart centers in Sweden. “Cases” were children with ASD closure at ≤1 or ≤2 years of age. Clinical data were retrieved from medical journals and national registries. Overall, 413 children were included. Of these, 131 (32%) were ≤2 years, and 50 (12%) were ≤1 year. Risk factors associated with a ≤2 years ASD closure were preterm birth, OR = 2.4 (95% CI: 1.5–3.9); additional chromosomal abnormalities, OR = 3.4 (95% CI: 1.8–6.5); pulmonary hypertension, OR = 5.8 (95% CI: 2.6–12.6); and additional congenital heart defects, OR = 2.6 (95% CI: 1.7–4.1). These risk associations remained after adjustments for confounding factors, such as need for neonatal respiratory support, neonatal pulmonary diseases, neonatal sepsis, additional congenital heart defects (CHD) and chromosomal abnormalities. ASD size:body weight ratio of 2.0, as well as a ratio of 0.8 (upper and lower limit of the ASD size:body weight ratios), was associated with increased risk of an early ASD closure. Risk factors such as very premature birth, very low birth weight, congenital, and chromosomal abnormalities, neonatal pulmonary disease and need for ventilation support, as well as pulmonary hypertension, were associated with very early (<1 year of age) ASD closure. Several independent neonatal risk factors were associated with an increased risk of early ASD closure at 2 and at 1 year of age. An ASD size:body weight ratio is a poor predictor for indications for ASD closure.

Treatment patterns and survival outcomes for small-cell lung cancer patients – a Swedish single center cohort study

Objectives: This real-world study on small-cell lung cancer (SCLC) patients aimed to investigate treatment patterns, outcome of re-challenge with platinum doublet chemotherapy (PDCT), and associations between clinical characteristics and survival outcomes.Material and methods: This retrospective single center cohort study was based on patients diagnosed with SCLC between 2008 and 2016 at the Karolinska University Hospital, Stockholm, Sweden. Patients were divided into two subgroups; limited disease (LD), receiving concomitant chemo- and radiotherapy and extensive disease (ED), receiving palliative PDCT. The progression-free survival (PFS) was defined as the interval between the start of CT and the earliest date of documented progression. ‘Refractory relapse’ (Rr) and ‘Sensitive relapse’ (Sr) were defined as relapse occurring < or ≥180 days after start of PDCT, respectively. The results for treatment patterns were reported as numbers and percentages of patients, and descriptive analyses including medians and 95% confidence intervals (CIs). The Cox proportional hazards regression model was applied to assess the relationship between clinical characteristics and overall survival (OS).Results: The study included 544 patients; 408 with ED and 136 patients had LD. The median PFS and OS for ED patients were 5.1 and 7.0, respectively. In the ED subgroup, Sr occurred in 169 patients (41%), with a longer median OS when compared to Rr patients (10.8 vs. 3.6 months). Patients with LD had a median PFS and OS of 12 and 24 months, respectively. Some LD patients did not show a sign of relapse (22%). The majority of LD patients who relapsed had Sr (66%), with a longer median OS when compared to patients with Rr (20.9 vs. 7.8 mo).Conclusions: The survival outcomes for ED and LD SCLC patients correspond to historical data. Patients with Sr after 1st line therapy might benefit from re-challenge with PDCT in the 2nd line setting.

Long-term effects on function, health-related quality of life and work ability after structured physiotherapy including a workplace intervention. A secondary analysis of a randomised controlled trial (WorkUp) in primary care for patients with neck and/or back pain

Objective: To study the long-term effects of a workplace intervention in addition to structured physiotherapy regarding self-reported measures in patients with acute/subacute neck and/or back pain.Design: WorkUp – a cluster-randomised controlled trial in 32 primary care centers in Sweden, from January 2013 through December 2014 (ClinicalTrials.gov ID: NCT02609750).Intervention: Structured physiotherapy with the workplace dialogue ‘Convergence Dialogue Meeting’ (CDM), conducted by the treating physiotherapist as an add-on. Reference group received structured physiotherapy.Subjects: Adults, 18–67 years (mean 43.7, standard deviation (SD) 12.2), 65.3% women with acute/subacute neck and/or back pain who had worked ≥4 weeks past year, considered at risk of sick leave or were on short-term sick leave (≤60 days) were included (n = 352).Outcome measures: Self-reported function, functional rating index (FRI), health-related quality of life (EQ-5D-3L) and work ability (Work Ability Score, WAS) at 12 months follow-up.Results: The mean differences in outcomes between intervention and reference group were; −0.76 (95% confidence interval (CI): −2.39, 0.88; FRI), 0.02 (95% CI: −0.04, 0.08; EQ-5D-3L) and −0.05 (95% CI: −0.63, 0.53; WAS). From baseline to 12 months, the intervention group improved function from 46.5 (SD 19.7) to 10.5 (SD 7.3) on FRI; health-related quality of life from 0.53 (SD 0.29) to 0.74 (SD 0.20) on EQ-5D and work ability from 5.7 (SD 2.6) to 7.6 (SD 2.1) on WAS.Conclusion: Despite a clinically relevant improvement over time, there were no significant differences in improvement between groups, thus we conclude that CDM had no effect on self-reported measures in this study.Key pointsIn earlier analysis of the primary outcome (work ability measured by absenteeism) in this trial, a positive effect was found when the workplace intervention ‘Convergence Dialogue Meeting’ (CDM) was added to structured physiotherapy for patients with neck or back pain.By contrast, in this new analysis of secondary outcomes (self-reported function, health and perceived work ability), there was no added effect of CDM above structured physiotherapy alone, although patients in both the intervention and reference group improved over time.The addition of CDM to physiotherapy is therefore justified by its specific effect on behavior (work absence) rather than any effect on clinical outcomes.

Blood transfusions during neoadjuvant chemotherapy for muscle-invasive urinary bladder cancer may have a negative impact on overall survival

Objective: To evaluate the extent and plausible effects of blood transfusions given during cisplatin-based neoadjuvant chemotherapy (NAC) on overall survival in patients with muscle-invasive urothelial bladder cancer (MIBC) undergoing NAC and radical cystectomy (RC).Background: Several studies have demonstrated a decreased survival for MIBC patients receiving allogenic peri- and postoperative blood transfusions in conjunction with RC. No studies have previously investigated the effects of blood transfusions during NAC.Materials and methods: 120 patients with MIBC (cT2-T4aN0M0) undergoing NAC and RC between 2008 and 2014 at four Swedish cystectomy centers were retrospectively evaluated. Clinicopathological data were obtained, including data of allogenic blood administration. Survival data was analyzed by Kaplan–Meier plotting and Cox regression.Results: One third of the cohort received blood transfusions during the period of NAC. In univariate analysis, blood transfusions during NAC, nodal stage and advanced tumor stage (pT >2) were negative prognostic factors for survival. In multivariate analysis, only pNx and pT >2 remained significant negative prognostic factors. In a subgroup analysis consisting of patients with localized tumors without dissemination (n = 96), patients that received transfusions during NAC showed an 18.5% absolute risk increase of death at five years of observation, although without statistical significance (p = .197).Conclusions: This is the first time that the extent and plausible effects of allogenic blood transfusions during NAC is examined in MIBC. Data suggest that there may be an association between blood transfusion and poor pathological and oncological outcome. Firm conclusions are difficult to draw due to few study participants and the retrospective nature of the study.

Outcome of Surgery for Adolescent Idiopathic Scoliosis

Research Article| December 01 2019 Outcome of Surgery for Adolescent Idiopathic Scoliosis AAP Grand Rounds (2019) 42 (6): 64. https://doi.org/10.1542/gr.42-6-64 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Outcome of Surgery for Adolescent Idiopathic Scoliosis. AAP Grand Rounds December 2019; 42 (6): 64. https://doi.org/10.1542/gr.42-6-64 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: adolescent idiopathic scoliosis, surgical outcome, pain Source: Helenius L, Diarbakerli E, Grauers A, et al. Back pain and quality of life after surgical treatment for adolescent idiopathic scoliosis at 5-year follow-up: comparison with healthy controls and patients with untreated idiopathic scoliosis. J Bone Joint Surg Am. 2019; 101(16): 1460– 1466; doi: https://doi.org/10.2106/JBJS.18.01370Google Scholar Investigators from multiple institutions in Finland and Sweden conducted a case control study to compare long-term pain and quality of life in patients with adolescent idiopathic scoliosis (AIS) who underwent surgical treatment, consisting of posterior spinal fusion with pedicle screws, to that of untreated AIS patients and individuals without AIS. Cases were patients with AIS who underwent surgical treatment when they were between 12 and 19 years old at a single center by a single orthopaedic surgeon. These patients completed the Scoliosis Research Society-24 (SRS-24) questionnaire at minimum of 5 years after surgical treatment for AIS. The SRS-24 is designed to measure disease-specific quality of life across multiple domains. The 2 sets of controls were selected from the populations of other studies conducted by the authors1,2 ; one control from each set was age- and gender-matched to a case. The untreated AIS control group was patients from 1 of 6 centers in Sweden who were diagnosed with AIS when they were 10–17 years old and had a Cobb angle of ≥10°. Healthy controls were selected from the general population in Sweden. Participants in both control groups completed the SRS-22r, which is a revised version of the SRS-24. For the study, SRS-24 scores from 4 domains in cases, including pain, self-image, function, and activity, were compared to SRS-22r scores in controls for the same domains. Wording of the specific questions in these domains in the SRS-24 or SRS-22r are either the same or close. Scores between the cases and 2 control groups were compared using ANOVA. There were 49 cases with AIS who underwent surgical treatment. Mean Cobb angle in these individuals was 53.2° + 7.3° preoperatively, and 11.7° + 6.0° at 2 years postoperatively. The mean age of cases was 22 years, and they had a mean follow-up period of 6.2 years. Among those in the untreated AIS group, the mean Cobb angle at the time of diagnosis was 27.7° + 10.1°. Scores for the domains of pain, self-image, and activity were significantly better in cases than in untreated AIS controls (P values <.001, .014, and <.001, respectively); there was no significant difference between these groups in the domain of function (P=.26). There were also no significant differences for the domains of pain, self-image, and activity between cases and healthy controls, but scores in the domain of function were significantly better in healthy controls than in cases (P<.001). The authors conclude that patients with surgical treatment of AIS had improved pain and health-related quality of life compared to those with untreated AIS. Dr Hennrikus has disclosed no financial relationship relevant to this commentary.... You do not currently have access to this content.