Region Blekinge

ObjectiveTo provide an overview on the effect of hyaluronic acid (HyA) on hard tissue healing in alveolar bone augmentation procedures in humans (PROSPERO registration: CRD42023464863).MethodsThree databases were searched until April 2025. Studies using HyA in any form and in any alveolar bone augmentation procedure were included, if a control group allowing to assess the effect of HyA was available; studies addressing periodontal regeneration or using HyA coated implants were not included. Primary outcome parameters, summarized descriptively, were histologic/radiographic new bone formation (NBF), alveolar ridge width (ARW) and height (ARH). The Cochrane Collaborations RoB 2.0 and ROBINS-I tool were used to assess the risk of bias.ResultsFourteen studies with a follow-up of 3–12 months were included, which contributed with 229 patients and 317 sites allowing to assess the effect of HyA. HyA was assessed as adjunct to maxillary sinus floor augmentation (MSFA), guided bone regeneration (GBR), and alveolar ridge preservation (ARP). The addition of HyA significantly improved NBF in 50 and 66% of the MSFA and ARP studies, respectively; however, a significant clinical improvement was not consistently observed. Advantages for NBF as well as ARW or ARH gain have been reported in GBR procedures, but the available data are limited and mostly descriptive. No differences were observed regarding reported post-operative complication rates. Due to the heterogeneity in treatments and outcome measures, as well as the limited number of studies, a meta-analysis was not feasible for any of the outcomes.ConclusionsIn the original studies, positive and occasionally significant results have been reported for the adjunct use of HyA in alveolar bone augmentation; however, the effect size and clinical relevance is unclear, and further clinical research is needed.Clinical relevanceHyA in alveolar bone augmentation is safe, but it remains unclear in which indication and in which application form it may enhance quality and/or quantity of NBF and at what extent.

BackgroundPatients benefit from antiplatelet therapy after coronary-artery bypass grafting (CABG) for an acute coronary syndrome. Whether the addition of ticagrelor to aspirin, as compared with aspirin alone, further reduces the risk of adverse cardiovascular outcomes is unclear.MethodsIn this open-label, registry-based, clinical trial conducted at 22 Nordic cardiothoracic surgery centers, we randomly assigned patients in a 1:1 ratio to receive either ticagrelor plus aspirin or aspirin alone for 1 year after CABG for an acute coronary syndrome. The primary outcome was a composite of death, myocardial infarction, stroke, or repeat revascularization, evaluated at 1 year. A key secondary outcome was net adverse clinical events, defined as a primary-outcome event or major bleeding.ResultsA total of 2201 patients were randomly assigned to receive ticagrelor plus aspirin (1104 patients) or aspirin alone (1097 patients). The mean age of the patients was 66 years, and 14.4% were women. A primary-outcome event occurred in 53 patients (4.8%) in the ticagrelor-plus-aspirin group and 50 (4.6%) in the aspirin-alone group (hazard ratio, 1.06; 95% confidence interval [CI], 0.72 to 1.56; P=0.77). Net adverse clinical events occurred in 9.1% of patients in the ticagrelor-plus-aspirin group and 6.4% in the aspirin-alone group (hazard ratio, 1.45; 95% CI, 1.07 to 1.97). Major bleeding occurred in 4.9% of patients in the ticagrelor-plus-aspirin group and 2.0% in the aspirin-alone group (hazard ratio, 2.50; 95% CI, 1.52 to 4.11).ConclusionsAmong patients who underwent CABG for an acute coronary syndrome, ticagrelor plus aspirin did not result in a lower incidence of death, myocardial infarction, stroke, or repeat coronary revascularization than aspirin alone at 1 year. (Funded by the Swedish Research Council and others; TACSI ClinicalTrials.gov number, NCT03560310; EudraCT number, 2017-001499-43; EU Clinical Trials number, 2023-508551-40-00.)

Rapidly evolving evidence, from preclinical and clinical studies, indicates a possible connection between inflammatory bowel disease and periodontitis. This study aimed to summarize the evidence from preclinical in vivo studies regarding the possible link between periodontitis and colitis. A systematic literature search was performed and resulting studies were screened against predefined eligibility criteria; data from included studies were extracted, and meta-analyses were performed whenever possible. Thirty-four publications using mice or rats were included; 26 experiments evaluated the effect of inoculation with oral bacteria on experimental colitis, 3 the effect of experimental periodontitis on experimental colitis, and 7 the effect of experimental colitis on periodontal status; 45% (9), 78% (14), 57% (12), and 89% (16) of the studies found a significantly higher body weight loss, shorter colon length, higher disease activity index (DAI), and higher intestinal histopathological assessment scores (IHA), respectively, in animals exposed to inoculation with oral bacteria and experimental colitis compared with animals with only colitis. Meta-analyses confirmed that inoculation with oral bacteria significantly aggravated colitis, that is, significant negative overall effect on body weight, colon length, DAI, and IHA. Among the tested bacteria, Fusobacterium nucleatum had the strongest effect followed by Porphyromonas gingivalis. The results of the remaining interactions and comparisons are inconclusive due to a limited number of studies and differences in study design. Inoculation with the periodontitis-associated bacteria F. nucleatum and probably also P. gingivalis exacerbates experimental colitis in mice. It is yet unclear whether colitis can affect periodontal health and/or disease.

BackgroundAs primary health care forms the basis of the health care system, it is regarded as an efficient way to address main causes of, and risk factors for, poor health. In the Swedish health care system, general practitioners play a role in facilitating access to specialized health care and in coordinating care from other parts of the health care system. In Sweden, recent marketization efforts in primary health care, particularly the Patient Choice Reform, have adversely impacted geographical equity in access health care. This study aimed to examine long-term trends in specialized outpatient health care utilization in the context of the Patient Choice Reform, and to do so in regard to demographical, socioeconomic and geographical determinants of health care utilization.MethodRegister data from Region Skåne, the third most populous region in Sweden, was retrieved and a cohort was constructed, describing individuals’ health care utilization between 2007 and 2017. Utilization was measured as the number of outpatient visits to physicians in specialized health care, and based on trajectory analyses trends in utilization were identified. Differences in demographic, geographic and socioeconomic determinants between subgroups with distinct utilization trends were analyzed using logistic regression models.ResultsA closed cohort of 659,298 individuals was constructed. Utilization increased in all sex and age groups except for younger women where utilization decreased. Increased utilization was, in younger individuals, associated with lower socioeconomic status and, in older individuals, with higher socioeconomic status. In all female groups, increased utilization was associated with residence in urban areas and decreased utilization to residence in non-urban areas.ConclusionThis study provides key insights into long-term trends in outpatient SHC utilization during a time period that overlaps with the Patient Choice Reform. The impact of socioeconomic and geographic determinants on utilization varies in magnitude and direction between different age groups of the population in a similar pattern as previously described for primary health care. However, unlike previously reported trends of primary health care utilization, specialized health care utilization in younger women is decreasing.

ABSTRACTObjectiveTo evaluate the impact of implant surface and instrumentation time on the efficacy of two air powder water‐jet (APWJ) devices in cleaning the implant surface in a simulation of non‐surgical peri‐implantitis treatment.Materials and MethodsTurned and modified surface implants (28 each) were coated with a biofilm imitation and mounted on resin models replicating peri‐implant intra‐osseous defects, including a soft tissue replica. The entire implant periphery was instrumented for 5 or 15s per implant sextant (i.e., in total 30 or 90s per implant), with one of two different APWJ devices using either a glycine or an erythritol powder. Residual biofilm imitation was automatically assessed on standardized photographs and expressed as percentage of the exposed implant surface.ResultsImplant surface (ε2:0.253, p < 0.001) and instrumentation time (ε2:0.044, p = 0.036) had a moderate and small effect, respectively, on the outcome, that is, instrumenting turned compared to modified surface implants as well as using a longer compared to a shorter instrumentation time resulted in less residual biofilm imitation. Complete biofilm imitation removal was achieved only in four turned implants, treated for 15s per sextant. Every second turned implant presented with a maximum of 5% residual biofilm imitation, while only two modified implants achieved this level of cleanliness.ConclusionIn a non‐surgical peri‐implantitis treatment simulation with APWJ devices, superior biofilm imitation removal was achieved at turned implants, and a longer instrumentation time resulted in less residual biofilm imitation. Modified implants had high chances of incomplete biofilm imitation removal, especially at the apical part of the defect. Complete biofilm imitation removal was in general largely unpredictable.

Background: Ambulance staff face ethical demands to safeguard patient dignity and autonomy in situations where these values may be threatened. However, influences on how patients are understood can undermine this safeguarding, potentially impacting health outcomes. To address this, increased knowledge of these influences is needed as well as how they may form the ability to protect ethical values.Aim: The aim was to explore ambulance staff's view of what influences their understandings of encounters with persons living in stigmatized neighborhoods.Research Design: Transcripts from semi-structured interviews with ambulance staff were analyzed with content analysis.Participant and Research Context: Twenty-seven ambulance staff members were included from two different Swedish ambulance districts.Ethical Considerations: The study was conducted based on the Declaration of Helsinki and approved by the Swedish Ethical Review Authority.Findings: Six categories emerged; Individual values; Colleagues; Associated organizations; Societal information; Professional experiences; and Management.Conclusion: Ambulance staff's understandings are influenced in a multifaceted way that can produce processes of othering toward persons tied to specific neighborhoods, ethnicities, or cultures. This process endangers the safeguarding of dignity and autonomy due to understandings of the patient as of less value. However, critical reflection and exposure to diverse perspectives can counteract this and protect these ethical values.

This project aimed to develop a Person-Centred Co-ordinated Care (P3C) pathway for low back pain (LBP). A national working group was formed consisting of representatives from all regional healthcare organisations in Sweden and included all relevant healthcare professions, academia, and patient organisations. A mixed method iterative design and consensus approach was applied in the development of the P3C pathway. As a foundation, patient interviews along with a review of literature were conducted investigating the evidence base for healthcare interventions, earlier regional care programs/pathways and guidelines in Sweden as well as patient experiences and challenges with healthcare for LBP. Updated evidence-based clinical recommendations, tools supporting the practical use of the national P3C pathway and national healthcare data registry-based quality outcome indicators were then developed. Thereafter, an open consultation period provided review and feedback for final revisions and consensus. Essential factors for integrating best praxis according to scientific evidence and patient and healthcare professional perspectives were identified to establish a Swedish national P3C pathway for LBP. This provides a novel and innovative example of feasible methodology applicable in the international context. Future research will evaluate potential improvements in healthcare quality outcomes and effectiveness of dissemination and implementation strategies.

BackgroundMultimorbidity is increasingly acknowledged as a significant health concern, particularly among older individuals. It is associated with a decline in quality of life and psychosocial well-being as well as an increased risk of being referred to multiple healthcare providers, including more frequent admissions to emergency departments. Person-centered care interventions tailored to individuals with multimorbidity have shown promising results in improving patient outcomes. Research is needed to explore how work practices within integrated care models are experienced from Registered Nurse Case Managers’ (RNCMs) perspective to identify areas of improvement. Therefore, the aim of this study was to describe RNCMs’ work experience with a person-centered collaborative healthcare model (PCCHCM).MethodsThis study used an inductive design. The data were collected through individual interviews with 11 RNCMs and analyzed using qualitative content analysis.ResultsData analysis resulted in four generic categories: ‘Being a detective, ‘Being a mediator’, ‘Being a partner’, and ‘Being a facilitator of development’ which formed the basis of the main category ‘Tailoring healthcare, and social services to safeguard the patient’s best.’ The findings showed that RNCMs strive to investigate, identify, and assess older persons’ needs for coordinated care. They worked closely with patients and their relatives to engage them in informed decision-making and to implement those decisions in a personalized agreement that served as the foundation for the care and social services provided. Additionally, the RNCMs acted as facilitators of the development of the PCCHCM, improving collaboration with other healthcare professionals and enhancing the possibility of securing the best care for the patient.ConclusionsThe results of this study demonstrated that RNCMs tailor healthcare and social services to provide care in various situations, adhering to person-centered care principles and continuity of care. The findings underline the importance of implementing integrated care models that consider the unique characteristics of each care context and adapt different case managers’ roles based on the patient’s individual needs as well as on the specific needs of the local setting. More research is needed from the patients’ and their relatives’ perspectives to deepen the understanding of the PCCHCM concerning its ability to provide involvement, security, and coordination of care.