Capio Lundby Sjukhus

ABSTRACTObjectivesAlthough septoplasty is frequently performed in patients with nasal obstruction, studies on clinical practice and real‐life outcomes are sparse. This study aimed to describe the clinical practice, characteristics of septoplasty patients, patient‐reported outcomes and complications, as well as predictors for a successful outcome in a comprehensive national longitudinal database.MethodsAll patients, > 18 years of age, registered in the Swedish Quality Register for Septoplasty (SQRS) between 2014 and 2023 were included in the study (n = 11,714). A multivariate logistic regression analysis was used to search for predictors of a successful outcome (i.e., no or mild self‐reported nasal obstruction).ResultsClinical practice was influenced by the surgical unit. A successful outcome was reported in 59.9% of the patients. Predictors for a successful outcome were higher age, more recent surgery, unilateral subjective nasal obstruction, no nighttime nasal obstruction, and no smoking. Almost one in four patients reported a chronic complication from surgery after 12 months.ConclusionThere is an unwarranted diversity in Swedish septoplasty practice, which illustrates a lack of knowledge of best practices. The patient‐reported outcome, where only six of 10 patients had no or mild nasal obstruction at follow‐up, indicates room for improvement.Level of Evidence4

Catheter-associated urinary tract infections (CAUTIs) are prevalent healthcare-associated infections, arising from biofilm-forming bacteria. This may be prevented by coating the catheter with an antifouling substance. The novel LubriShield™ Foley catheter is coated with a superhydrophilic surface and a covalently bonded antifouling ligand. Preclinical studies revealed that the coating established a persistent local antifouling environment, inhibiting uropathogenic bacteria from forming biofilms. No substance release has been detected from the coating. The coating achieved a 28-fold reduction in surface friction compared to an uncoated catheter. The aim of this study is to assess the clinical safety of the catheter in patients. In a prospective single-centre randomised study, 30 patients undergoing transurethral resection of bladder tumour were enrolled and randomly assigned to receive either a standard control catheter or the novel LubriShield™ catheter. Urinary cultures were obtained twice. The duration of catheterisation for the patients ranged from 3 to 24 h. The primary outcome was the assessment of device-specific adverse events (AEs). Secondary outcomes included evaluations of pain, irritation and discomfort, measured using the Numeric Rating Scale (NRS) (0-10) via a patient questionnaire. There were no serious adverse events (SAEs) or AEs reported for the coated catheters. Urinary cultures showed no significant differences between the coated and uncoated catheters. Both patients and healthcare professionals rated the NRS equally for the two types of catheters. The novel-coated LubriShield™ catheter was found to be safe for short-term clinical use.

BackgroundThe use of chat-based digital visits (eVisits) to assess infectious symptoms in primary care is rapidly increasing. The “digi-physical” model of care uses eVisits as the first line of assessment while assuming a certain proportion of patients will inevitably need to be further assessed through urgent physical examination within 48 h. It is unclear to what extent this approach can mitigate physical visits compared to assessing patients directly using office visits.MethodsThis pre-COVID-19-pandemic observational study followed up “digi-physical” eVisit patients (n = 1188) compared to office visit patients (n = 599) with respiratory or urinary symptoms. Index visits occurred between March 30th 2016 and March 29th 2019. The primary outcome was subsequent physical visits to physicians within two weeks using registry data from Skåne county, Sweden (Region Skånes Vårddatabas, RSVD).ResultsNo significant differences in subsequent physical visits within two weeks (excluding the first 48 h) were noted following “digi-physical” care compared to office visits (179 (18.0%) vs. 102 (17.6%), P = .854). As part of the “digital-physical” concept, a significantly larger proportion of eVisit patients had a physical visit within 48 h compared to corresponding office visit patients (191 (16.1%) vs. 19 (3.2%), P < .001), with 150 (78.5%) of these eVisit patients recommended some form of follow-up by the eVisit physician.ConclusionsMost eVisit patients (68.9%) with respiratory and urinary symptoms have no subsequent physical visits. Beyond an unavoidable portion of patients requiring urgent physical examination within 48 h, “digi-physical” management of respiratory and urinary symptoms results in comparable subsequent health care utilization compared to office visits. eVisit providers may need to optimize use of resources to minimize the proportion of patients being assessed both digitally and physically within 48 h as part of the “digi-physical” concept.Trial registrationClinicaltrials.gov identifier: NCT03474887.

Acute otitis media (AOM), or acute middle ear infection, is one of the most frequently occurring childhood diseases, and the most common reason given for prescribing antibiotics in this age group. Guidelines often recommend antibiotics as first-line treatment for severe AOM. However, antibiotics also lead to antibiotic resistance, so preventing episodes of AOM is an urgent priority. To assess the effects of probiotics to prevent the occurrence and reduce the severity of acute otitis media in children. We searched CENTRAL, PubMed, Embase, and three other databases (October 2018), two trial registers (October 2018), and conducted a backwards and forwards citation analysis (August 2018). We did not apply any language, publication date, or publication status restrictions. Randomised controlled trials (RCTs) of children (aged up to 18 years), comparing probiotics with placebo, usual care, or no probiotic. Two review authors independently assessed the eligibility of trials for inclusion and risk of bias of the included trials, and extracted data using pre-piloted data extraction forms. We analysed dichotomous data as either risk ratio (RR) or odds ratios (OR) and continuous data as mean differences (MD). We included 17 RCTs involving 3488 children, of which 16 RCTs were included in the meta-analyses. Of the 16 RCTs that reported the mean age of children, mean age overall was 2.4 years; in 4 RCTs the mean age of children participating in the trial was less than 1 year old; in 2 RCTs the mean age was between 1 and 2 years old; and in 10 RCTs the mean age was older than 2 years. Probiotic strains evaluated by the trials varied, with 11 of the included RCTs evaluating Lactobacillus-containing probiotics, and six RCTs evaluating Streptococcus-containing probiotics.The proportion of children (i.e. the number of children in each group) experiencing one or more episodes of AOM during the treatment was lower for those taking probiotics (RR 0.77, 95% confidence interval (CI) 0.63 to 0.93; 16 trials; 2961 participants; number needed to treat for an additional beneficial outcome (NNTB) = 10; moderate-certainty evidence).Post hoc subgroup analysis found that among children not prone to otitis media, a lower proportion of children receiving probiotics experienced AOM (RR 0.64, 95% CI 0.49 to 0.84; 11 trials; 2227 participants; NNTB = 9; moderate-certainty evidence). However, among children who were otitis prone, there was no difference between probiotic and comparator groups (RR 0.97, 95% CI 0.85 to 1.11; 5 trials; 734 participants; high-certainty evidence). The test for subgroup differences was significant (P = 0.007).None of the included trials reported on the severity of AOM.The proportion of children experiencing adverse events did not differ between the probiotic and comparator groups (OR 1.54, 95% CI 0.60 to 3.94; 4 trials; 395 participants; low-certainty evidence).Probiotics decreased the proportion of children taking antibiotics for any infection (RR 0.66, 95% CI 0.51 to 0.86; 8 trials; 1768 participants; NNTB = 8; moderate-certainty evidence). Test for subgroup differences (use of antibiotic specifically for AOM, use of antibiotic for infections other than AOM) was not significant.There was no difference in the mean number of school days lost (MD -0.95, 95% CI -2.47 to 0.57; 5 trials; 1280 participants; moderate-certainty evidence). There was no difference between groups in the level of compliance in taking the intervention (RR 1.02, 95% CI 0.99 to 1.05; 5 trials; 990 participants).Probiotics decreased the proportion of children having other infections (RR 0.75, 95% CI 0.65 to 0.87; 11 trials; 3610 participants; NNTB = 12; moderate-certainty evidence). Test for subgroup differences (acute respiratory infections, gastrointestinal infections) was not significant.Probiotic strains trialled and their dose, frequency, and duration of administration varied considerably across studies, which likely contributed to the substantial levels of heterogeneity. Sensitivity testing of funnel plots did not reveal publication bias. Probiotics may prevent AOM in children not prone to AOM, but the inconsistency of the subgroup analyses suggests caution in interpreting these results. Probiotics decreased the proportion of children taking antibiotics for any infection. The proportion of children experiencing adverse events did not differ between the probiotic and comparator groups. The optimal strain, duration, frequency, and timing of probiotic administration still needs to be established.

Objective: There is a strong genetic predisposition towards abdominal aortic aneurysm (AAA), but it is unknown whether persons without AAA but with first-degree relatives who are AAA patients have a generalized dilating diathesis, defect arterial wall mechanics, or increased cardiovascular risk. The aim of the study was to investigate arterial diameters and wall mechanics at multiple arterial sites in these subjects and compare them with controls without a family history of AAA. Design and method: This study included 118 first-degree relatives of patients with AAA and 66 controls (age 40–80 years). The abdominal aorta, common carotid artery, common femoral artery, and popliteal artery were investigated by echo-tracking ultrasound. Results: The relatives had no arterial dilatation, but they did tend to have smaller diameters than controls. Relatives had a higher heart rate, diastolic blood pressure, and mean arterial pressure than controls. The distensibility coefficient and the compliance coefficient were decreased in all arteries in male relatives, adjusted for age and smoking; these coefficients were normalized after adjustment for mean arterial pressure and heart rate. Female relatives had a lower compliance coefficient in the abdominal aorta, adjusted for age and smoking. After adjustment for mean arterial pressure and heart rate, the difference disappeared. Conclusions: No general arterial dilatation in relatives without AAA was found, supporting the hypothesis that the dilating diathesis is linked to the aneurysmal manifestation in the abdominal aorta. Although the threat of aneurysmal dilatation and rupture seems to be lacking in these subjects, heart rate, blood pressure, and arterial wall stiffness were all increased, which may indicate a higher risk of developing cardiovascular morbidity and mortality.

To analyze the incidence of primary bleeding following tonsil surgery and to evaluate risk factors. Register study of the results from the National Tonsil Surgery Register in Sweden covering the period 1997 to 2008 and 54,696 operations. Data were collected by means of three questionnaires, two filled in by professionals and one 6 months postoperatively by the patient/parent. A total of 719 patients experienced primary postoperative bleeding during the hospital stay (1.3%). A number of independent factors were correlated with decreased risk of post-tonsillectomy hemorrhage: younger age (P < .0001), female sex (P < .0001), type of surgery (tonsillotomy) (P = .0006), and surgery performed on a day-surgery basis (P < .0001). Indication for surgery and number of operations performed at the department did not correlate with postoperative bleeding risk. A significant decrease in primary postoperative hemorrhage rate from 2% to 0.96% was found during the study period. Primary hemorrhage following tonsil surgery is rare. During the study period, a significant decrease in primary bleeding rates occurred. The changes in practice with an increasing proportion of day-surgery cases and tonsillotomy have contributed to the reduced risk, but cannot completely explain the reduction.

The effects of fair treatment on saliva cortisol release of low and high Type-A behavior participants in high or low stress conditions are studied. Based on the Injustice Stress Theory (Vermunt & Steensma, 2001), predictions were made about fair treatment as a stress reducing factor. The results support the expected effect of fair treatment in that high type-A behavior participants in the low stress conditions had lower saliva cortisol levels after fair treatment while this effect was absent in the neutral condition, while low type-A behavior participants showed lower saliva cortisol release in the high stress conditions after fair treatment while this effect was absent in the neutral condition. Moreover, saliva cortisol scores are correlated positively with negative affect scores and negatively with positive affect scores. The discussion focuses on theoretical implications and suggestions for future research.