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Karlsson, M., Steinvall, I., Sjöberg, F., Olofsson, P. & Elmasry, M. (2020). Burn scar outcome at six and 12 months after injury in children with partial thickness scalds: Effects of dressing treatment.. Burns, 46(3), 546-551, Article ID S0305-4179(19)30714-4.
Open this publication in new window or tab >>Burn scar outcome at six and 12 months after injury in children with partial thickness scalds: Effects of dressing treatment.
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2020 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 46, no 3, p. 546-551, article id S0305-4179(19)30714-4Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: In line with other researchers in the field of burns' care, we think that research investigating the long-term outcome of scars is largely lacking. As scarring is of the utmost importance to the patient, clinicians who treat burns must aim to find treatments that lead to a good end result. The aim of this study was to study scar outcomes at six and 12 months after injury. It is an extension of a previous randomised controlled trial (RCT) in which two dressings (porcine xenograft and silver foam dressing) were examined with respect to their ability to help heal partial thickness scalds.

METHOD: Children aged six months - six years with acute partial thickness scalds, on the trunk, or extremities, or both, were included. In the previous study, the silver foam was found to have significantly shorter healing times than the xenograft. Children were assessed at six and 12 months after injury for this study, and photographs were taken of the burn site, and both the patient and observer scar assessment scale (POSAS) and the Vancouver scar scale (VSS) were completed and evaluated by blinded observers.

RESULTS: Of the 58 children from the original RCT, 39 returned to the clinic for evaluation of their scars at six months, and 34 at 12 months after injury. There were no differences in POSAS, VSS total scores, or incidence of hypertrophic scarring between the different dressings. Fifteen children were assessed as having hypertrophic scarring, all of whom had healing times that had extended beyond 14 days.

CONCLUSIONS: This study compared burn scarring after two different treatments for burns in children with partial-thickness scalds and the data suggested that neither dressing had a more favourable impact on scar outcome. The conclusion is, however, tempered by the non-return of all the patients to the follow up. However, as anticipated, regardless of the dressing used, longer healing times were associated with higher scar scores (more scarring) and hypertrophic scarring.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
HTS, POSAS, Partial thickness burns, Porcine xenograft, Scar outcome, Silver foam
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-165727 (URN)10.1016/j.burns.2020.02.007 (DOI)32165027 (PubMedID)
Available from: 2020-05-15 Created: 2020-05-15 Last updated: 2020-05-15
Abdelrahman, I., Vieweg, R., Irschik, S., Steinvall, I., Sjöberg, F. & Elmasry, M. (2020). Development of delirium: Association with old age, severe burns, and intensive care. Burns
Open this publication in new window or tab >>Development of delirium: Association with old age, severe burns, and intensive care
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2020 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409Article in journal (Refereed) In press
Abstract [en]

Background Delirium is defined as a disturbance of attention and awareness that develops over a short period of time, is a change from the baseline, and typically fluctuates over time. Burn care involves a high prevalence of known risk factors for delirium such as sedation, inflammation, and prolonged stay in hospital. Our aim was to explore the extent of delirium and the impact of factors associated with it for adult patients who have been admitted to hospital with burns. Methods In this retrospective study, all adult patients who had been admitted with burns during a four-year period were studied, including both those who were treated with intensive care and intermediate care only (no intensive care). Daily records of the assessment of delirium using the Nursing Delirium Screening Scale (Nu-DESC) were analysed together with age, sex, the percentage of total body surface area burned, operations, and numbers of wound care procedures under anaesthesia, concentrations of plasma C-reactive protein, and other clinical variables. Logistic regression was used to analyse factors that were associated with delirium and its effect on mortality, and linear regression was used to analyse its effect on the duration of hospital stay. Results Fifty-one patients (19%) of the total 262 showed signs of delirium (Nu-DESC score of 2 or more) at least once during their stay in hospital. Signs of delirium were recorded in 42/89 patients (47%) who received intensive care, and in 9/173 (5%) who had intermediate care. Independent factors for delirium in the multivariable regression were: age over 74 years; number of operations and wound care procedures under anaesthesia; and the provision of intensive care (area under the curve 0.940, 95% CI 0.899–0.981). Duration of hospital stay, adjusted for age and burn size, was 13.2 (95% CI 7.4–18.9, p < 0.001) days longer in the group who had delirium. We found no independent effects of delirium on mortality. Conclusion We found a strong association between delirium and older age, provision ofr intensive care, and number of interventions under anaesthesia. A further 5% of patients who did not receive intensive care also showed signs of delirium, which is a finding that deserves to be thoroughly investigated in the future.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Burns, Delirium, Inflammation, Intensive care, Wound care procedures, Old age
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-164415 (URN)10.1016/j.burns.2020.02.013 (DOI)
Available from: 2020-03-19 Created: 2020-03-19 Last updated: 2020-03-19
Abdelrahman, I., Steinvall, I., Elmasry, M. & Sjöberg, F. (2020). Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial. Burns, 46(2), 465-471
Open this publication in new window or tab >>Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial
2020 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 46, no 2, p. 465-471Article in journal (Refereed) Published
Abstract [en]

Background

The pain of a burn mainly results from the inflammatory cascade that is induced by the injured tissue, and is classified as background, breakthrough, procedural and postoperative pain. High doses of opioids are usually needed to treat background pain, so its management includes a combination of types of analgesia to reduce the side effects. Lidocaine given intravenously has been shown in two small, uncontrolled studies to have an appreciable effect on pain after burns.

Objectives

In this prospective double-blind controlled trial we aimed to examine and quantify the opioid-sparing effect of a continuous infusion of lidocaine for the treatment of background pain during the early period after a burn.

Methods

Adult patients injured with burns of >10 total body surface area burned (TBSA%) and treated with a morphine based patient-controlled analgesia device (PCA) were randomised to have either lidocaine infusion starting with a bolus dose (1 mg lidocaine/kg) followed by continuous infusion (180 mg lidocaine/hour) or a placebo infusion, for seven consecutive days. Total daily consumption of opioids (mg) and amount of pain (visual analogue score, VAS) were recorded.

Results

We included 19 patients, 10 of whom were given a lidocaine infusion. There were no differences between groups in VAS, TBSA%, time of enrolment to the study since the initial burn, or duration of hospital stay. The opioid consumption in the lidocaine group declined by roughly 25% during the period of the study.

Conclusion

An intravenous infusion of lidocaine was safe and had an opioid-sparing effect when treating background pain in burns.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Lidocaine infusion, Background pain, Burns, Opioid sparing effect, Randomized controlled trial
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-160128 (URN)10.1016/j.burns.2019.08.010 (DOI)000520838400028 ()31493952 (PubMedID)
Note

Funding agencies: Department of Hand Surgery, Plastic Surgery, and Burns; Linkoping University, Linkoping, Sweden

Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2020-04-08Bibliographically approved
Abdelrahman, I., Elmasry, M., Steinvall, I., Turesson, C., Sjöberg, F. & Hansson, T. (2020). Needle Fasciotomy or Collagenase Injection in the Treatment of Dupuytren’s Contracture: A Retrospective Study. Plastic and Reconstructive Surgery – Global Open, 8(1)
Open this publication in new window or tab >>Needle Fasciotomy or Collagenase Injection in the Treatment of Dupuytren’s Contracture: A Retrospective Study
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2020 (English)In: Plastic and Reconstructive Surgery – Global Open, E-ISSN 2169-7574, Vol. 8, no 1Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

Background: Dupuytren’s contracture is common among older people in Sweden. Previous studies comparing the treatment with an injection of collagenase with percutaneous needle fasciotomy found no differences. Methods: We retrospectively compared the degree of improvement in the deficit in extension of the joints in 2 groups of patients who had been treated with collagenase (71 fingers) or needle fasciotomy (109 fingers) before and 1 year after treatment. We compared the improvement of the extension deficit among the metacarpophalangeal (MCP) and proximal interphalangeal joints before and after the intervention; additionally, the level of improvement was classified into 3 levels (mild = 0° to 29°; moderate = 30° to 60°; considerable = 61° and more). Results: The degree of improvement of extension in the MCP joints was 11° greater in the collagenase group (P = 0.001). The number of patients who had an improvement of >60° (considerable) in extension was greater in the collagenase group (P = 0.02). Conclusion: Collagenase was more effective than needle fasciotomy in treating extension deficits of the MCP joints in Dupuytren’s contracture in this retrospective analysis. Further prospective studies are required to confirm the finding.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2020
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-163787 (URN)10.1097/GOX.0000000000002606 (DOI)
Available from: 2020-02-20 Created: 2020-02-20 Last updated: 2020-02-20
Grossmann, B., Nilsson, A., Sjöberg, F. & Nilsson, L. (2020). Patient-controlled Sedation During Flexible Bronchoscopy: A Randomized Controlled Trial. Journal of Bronchology & Interventional Pulmonology, 27(2), 77-85
Open this publication in new window or tab >>Patient-controlled Sedation During Flexible Bronchoscopy: A Randomized Controlled Trial
2020 (English)In: Journal of Bronchology & Interventional Pulmonology, ISSN 1944-6586, E-ISSN 1948-8270, Vol. 27, no 2, p. 77-85Article in journal (Refereed) Published
Abstract [en]

Background: Patient-controlled sedation (PCS) is a documented method for endoscopic procedures considered to facilitate early recovery. Limited data have been reported, however, on its use during flexible bronchoscopy (FB).

Materials and Methods: This study hypothesized that PCS with propofol during FB would facilitate early recovery, with similar bronchoscopist and patient satisfaction compared with nurse-controlled sedation (NCS) with midazolam. A total of 150 patients were randomized 1:1:1 into a control group (premedication with morphine-scopolamine and NCS with midazolam), PCS-MS group (premedication with morphine-scopolamine and PCS with propofol), and PCS-G group (premedication with glycopyrronium and PCS with propofol).

Results: The procedures included transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy, and/or multistation endobronchial ultrasound. FB duration values in median (range) were 40 (10 to 80), 39 (12 to 68), and 44 (10 to 82) minutes for the groups NCS, PCS-MS, and PCS-G, respectively. An overall 81% of the patients in the combined PCS groups were ready for discharge (modified Post Anaesthetic Discharge Scoring System, score 10) 2 hours after bronchoscopy compared with 40% in the control group (P<0.0001). Between PCS groups, 96% of the PCS-G group patients were ready for discharge compared with 65% in the PCS-MS group (P=0.0002) at 2 hours. Bronchoscopists’ and patients’ satisfaction scores were high in all groups. Postdischarge quality scores showed no differences among the groups.

Conclusion: PCS with propofol during FB is feasible, as it shortened recovery time without compromising procedure conditions for bronchoscopists or patients. A rapid postsedation stabilization of vital signs facilitates surveillance before the patient leaves the hospital.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2020
Keywords
analgesia, patient-controlled, conscious sedation, anesthesia, intravenous, bronchoscopy, propofol
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-161081 (URN)10.1097/LBR.0000000000000610 (DOI)31478938 (PubMedID)2-s2.0-85072015123 (Scopus ID)
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2020-04-16Bibliographically approved
Grossmann, B., Nilsson, A., Sjöberg, F., Bernfort, L. & Nilsson, L. (2020). Patient-controlled sedation with propofol for endoscopic procedures: A cost analysis. Acta Anaesthesiologica Scandinavica, 64(1), 53-62
Open this publication in new window or tab >>Patient-controlled sedation with propofol for endoscopic procedures: A cost analysis
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2020 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 64, no 1, p. 53-62Article in journal (Refereed) Published
Abstract [en]

Background

Patient‐controlled sedation (PCS) with propofol accompanied by a bedside nurse anaesthetist is an alternative sedation method for endoscopic procedures compared with midazolam administered by a nurse or endoscopist. Increasing costs in health care demands an economic perspective when introducing alternative methods. We applied a hospital perspective on a cost analysis comparing different methods of sedation and the resource use that were expected to affect cost differences related to the sedation.

Methods

Based on two randomised previous studies, the direct costs were determined for different sedation methods during two advanced endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy including endobronchial ultrasound. ERCP comparisons were made between midazolam sedation by the endoscopic team, PCS with a bedside nurse anaesthetist and propofol sedation administered by a nurse anaesthetist. Bronchoscopy comparisons were made between midazolam sedation by the endoscopic team and PCS with a bedside nurse anaesthetist, categorised by premedication morphine‐scopolamine or glycopyrronium.

Results

Propofol PCS with a bedside nurse anaesthetist resulted in lower costs per patient for sedation for both ERCP (233 USD) and bronchoscopy (premedication morphine‐scopolamine 267 USD, premedication glycopyrronium 269 USD) compared with midazolam (ERCP 425 USD, bronchoscopy 337 USD). Aborted procedures that needed to be repeated and prolonged hospital stays significantly increased the cost for the midazolam groups.

Conclusion

Propofol PCS with a bedside nurse anaesthetist reduces the direct sedation costs for ERCP and bronchoscopy procedures compared with midazolam sedation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-161080 (URN)10.1111/aas.13463 (DOI)31436310 (PubMedID)
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2020-04-16Bibliographically approved
Nilsson, A., Orwelius, L., Sveen, J., Willebrand, M., Ekselius, L., Gerdin, B. & Sjöberg, F. (2019). Anxiety and depression after burn, not as bad as we think-A nationwide study. Burns, 45(6), 1367-1374
Open this publication in new window or tab >>Anxiety and depression after burn, not as bad as we think-A nationwide study
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2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 6, p. 1367-1374Article in journal (Refereed) Published
Abstract [en]

Objective: A history of psychiatric disorders is more common among patients who have had burns than in the general population. To try and find out the scale of the problem we have assessed self-reported symptoms of anxiety and depression after a burn. Methods: Consecutive patients with burns measuring more than 10% total body surface area or duration of stay in hospital of seven days or more were included. Personal and clinical details about the patients were extracted from the database at each center. Data were collected from the Hospital Anxiety and Depression Scale, as well as Health-Related Quality of Life (HRQoL; Short Form-36, SF-36) and questionnaires about socioeconomic factors. All results were obtained 12 and 24 months after the burn, and compared with those from a reference group. Results: A total of 156 patients responded to the questionnaires. Mean (SD) age and TBSA (%) were 46 (16.4) years and 23.6 (19.2) %, respectively. There were no differences in incidence between the burn and reference groups in anxiety or depression either 12 or 24 months after the burn. Those who reported higher anxiety and depression scores also had consistently poorer HRQoL as assessed by the SF-36. Conclusion: Seen as a group, people who have had burns report anxiety and depression the same range as a reference group. Some patients, however, express more anxiety and depression, and concomitantly poorer HRQoL. These patients should be identified, and offered additional support. (C) 2019 Elsevier Ltd and ISBI. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
Keywords
Burns; Quality of life; Anxiety; Depression; Follow-up studies
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-160408 (URN)10.1016/j.burns.2019.03.014 (DOI)000483339500013 ()31378623 (PubMedID)
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2020-04-30
Larsson Viksten, J., Engerström, L., Steinvall, I., Samuelsson, A., Fredrikson, M., Walther, S. & Sjöberg, F. (2019). Children aged 0-16 admitted to Swedish intensive care units and paediatric intensive care units showed low mortality rates.. Acta Paediatrica, 108(8), 1460-1466
Open this publication in new window or tab >>Children aged 0-16 admitted to Swedish intensive care units and paediatric intensive care units showed low mortality rates.
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 8, p. 1460-1466Article in journal (Refereed) Published
Abstract [en]

AIM: This study described the basic characteristics of children aged 0-16 years who were treated in intensive care units (ICUs) and paediatric ICUs (PICUs), compared their outcomes and examined any causes of death.

METHODS: This was a retrospective cohort study of admissions to 74 ICUs and three PICUs in Sweden that were recorded in the Swedish Intensive Care Registry from January 1, 2008 to December 31, 2012.

RESULTS: We retrieved data on 12 756 children who were admitted 17 003 times. The case mix differed between the ICUs, which were mainly admissions for injuries, accidents and observation, and PICUs, which were mainly admissions for malformations, genetic abnormalities and respiratory problems (p < 0.001). The median stays in the ICUs and PICUs were 1.4 and 3.5 days (p < 0.001), respectively. The respective crude mortality rates were 1.1% and 2.0, and the Paediatric Index of Mortality version 2 standardised mortality ratios were 0.43 and 0.50. None of these differences were significant. Most deaths were within 24 hours: About 57% in the ICUs, mainly from brain anomalies, and 13% in the PICUs, mainly from circulatory problems.

CONCLUSION: Sweden had a low mortality rate in both ICUs and PICUs and the children admitted to these two types of unit differed.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
Child mortality, Demographics, Intensive care unit, Length of stay, Paediatric intensive care unit
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-154075 (URN)10.1111/apa.14708 (DOI)000474935600016 ()30582755 (PubMedID)
Funder
Region Östergötland
Note

Funding agencies: Region Ostergotland and Linkoping University

Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2020-05-06
Abdelrahman, I. M., Steinvall, I., Mossaad, B., Sjöberg, F. & Elmasry, M. (2019). Evaluation of Male Breast Glandular Liposculpturing, Response on Commentary [Letter to the editor]. Aesthetic Plastic Surgery, 43(2), 548-549
Open this publication in new window or tab >>Evaluation of Male Breast Glandular Liposculpturing, Response on Commentary
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2019 (English)In: Aesthetic Plastic Surgery, ISSN 0364-216X, E-ISSN 1432-5241, Vol. 43, no 2, p. 548-549Article in journal, Letter (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Springer, 2019
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-155912 (URN)10.1007/s00266-018-1295-7 (DOI)000461390200034 ()30564913 (PubMedID)2-s2.0-85062963423 (Scopus ID)
Available from: 2019-04-02 Created: 2019-04-02 Last updated: 2020-04-30Bibliographically approved
Larsen, R., Bäckström, D., Fredrikson, M., Steinvall, I., Rolf, G. & Sjöberg, F. (2019). Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), Article ID 24.
Open this publication in new window or tab >>Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study
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2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, no 1, article id 24Article in journal (Refereed) Published
Abstract [en]

Background: A female survival advantage after injury has been observed, and animal models of trauma have suggested either hormonal or genetic mechanisms as component causes. Our aim was to compare age and riskadjusted sex-related mortality in hospital for the three most common mechanisms of injury in relation to hormonal effects as seen by age.

Methods: All hospital admissions for injury in Sweden during the period 2001–2011 were retrieved from the National Patient Registry and linked to the Cause of Death Registry. The International Classification of Diseases Injury Severity Score (ICISS) was used to adjust for injury severity, and the Charlson Comorbidity Index to adjust for comorbidity. Age categories (0–14, 15–50, and ≥ 51 years) were used to represent pre-menarche, reproductive and post- menopausal women.

Results: Women had overall a survival benefit (OR 0.51; 95% CI 0.50 to 0.53) after adjustment for injury severity and comorbidity. A similar pattern was seen across the age categories (0–14 years OR 0.56 (95% CI 0.25 to 1.25), 15–50 years OR 0.70 (95% CI 0.57 to 0.87), and ≥ 51 years OR 0.49 (95% CI 0.48 to 0.51)).

Conclusion: In this 11-year population-based study we found no support for an oestrogen-related mechanism to explain the survival advantage for females compared to males following hospitalisation for injury.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Risk-adjusted mortality; ICISS; Trauma; injury; Nationwide; Epidemiological
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-155087 (URN)10.1186/s13049-019-0597-3 (DOI)000461309000001 ()30871611 (PubMedID)
Note

Funding agencies: Linkoping University, Linkoping, Sweden; Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns

Available from: 2019-03-15 Created: 2019-03-15 Last updated: 2019-04-17Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5903-2918

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