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Andersson, C., Magnusson, M. & Sjödahl, R. (2019). Mortalitet bland sjukhusvårdade tycktes inte öka under sommaren [Mortality among hospitalized patients did not appear to increase during the summer]. Läkartidningen, 116
Öppna denna publikation i ny flik eller fönster >>Mortalitet bland sjukhusvårdade tycktes inte öka under sommaren [Mortality among hospitalized patients did not appear to increase during the summer]
2019 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

A retrospective review of medical records (2017-2018) at Linköping University Hospital compared hospital mortality for the 2-month period of summer vacations (group A) with two months of regular activity (group B). The mortality was 163 patients in group A and 216 in group B. Emergency admittance dominated (95%) in both groups. Comorbidity was found in 81%, and at admittance the risk for death during the hospital stay was estimated to more than 50% in three out of four patients. There was no difference between the groups regarding demography, hospital stay, or diagnosis. Due to a 30% reduction of hospital beds during the summer some patients were relocated to other specialties. No relocated patient died in group A but six in group B. Eight deaths were judged as probably preventable, but none definitely preventable. The similarity between the groups regarding mortality does not allow estimations of differences in adverse events in general. Low mortality among relocated patients is probably due to identification of high-risk patients not suitable for relocation.

Abstract [sv]

Mortaliteten på Universitetssjukhuset i Linköping ökade inte under sommaren (1,5 procent) jämfört med under våren (1,6 procent).

Mer än 9 av 10 patienter lades in oplanerat. 

De flesta (75–77 procent) hade dåligt allmäntillstånd vid ankomsten.

Patienternas samsjuklighet var hög (81 procent) under såväl sommar som vår.

Ingen utlokaliserad patient avled under sommaren, däremot avled 6 patienter under våren.

Ingen av patienterna hade en uppenbart undvikbar dödsorsak. Däremot var dödsorsaken sannolikt undvikbar hos 8 patienter under både våren och sommaren.

Ort, förlag, år, upplaga, sidor
Stockholm, Sweden: Sveriges Läkarförbund, 2019
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:liu:diva-164813 (URN)31192377 (PubMedID)
Tillgänglig från: 2020-04-01 Skapad: 2020-04-01 Senast uppdaterad: 2020-04-08Bibliografiskt granskad
Heedman, P.-A., Lagerfelt, M., Magnusson, M. & Sjödahl, R. (2019). Standardiserade vårdförlopp kan ge svårt cancersjuka bättre stöd [High prevalence of advanced cancer disease in patients with serious non-specific symtoms. Experience of a diagnostic pathway in a defined population area in Sweden]. Läkartidningen, 116
Öppna denna publikation i ny flik eller fönster >>Standardiserade vårdförlopp kan ge svårt cancersjuka bättre stöd [High prevalence of advanced cancer disease in patients with serious non-specific symtoms. Experience of a diagnostic pathway in a defined population area in Sweden]
2019 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The Swedish fast-track diagnostic pathway was applied during 2017 for 146 patients with serious non-specific symptoms including weight loss, fatigue and anemia. Within five days all patients had a physical examination and a decision was made of radiologic investigations. The waiting time was short for e.g. CT-scan of the abdomen and thorax. A diagnosis of a malignant condition was made in 38 patients (26%) with a median age of 75 (48-91) years. There were 24 men and 14 women. Most common diagnoses were lung cancer and colorectal cancer. Hematologic malignancy was diagnosed in 8 patients. Stage IV disease occurred in 17 of the patients with carcinoma (57%). About 60 benign main diagnoses were made in 108 patients without malignant disease. Two of them have developed cancer during 2018 (breast cancer, pancreatic cancer).

Abstract [sv]

Av 146 patienter med allvarliga ospecifika symtom som kunde vara associerade med cancer diagnostiserades 38 (26 procent) med malign sjukdom.

Gruppen med diagnostiserad malignitet bestod av 24 män och 14 kvinnor. Medianåldern var 75 år (48–91 år).

Generaliserad tumörsjukdom förekom hos mer än hälften av cancerpatienterna.

Gruppen där malign sjukdom avskrevs bestod av 61 män och 47 kvinnor. Medianåldern var 70 år (23–93 år).

Där cancermisstanken kunde avskrivas förekom ett 60-tal diagnoser. De tre vanligaste diagnosgrupperna var gastrointestinal sjukdom, psykoneurotisk sjukdom och lungsjukdom.

En cancerutredning bör göras med utgångspunkt från patientens samtliga behov.

Ort, förlag, år, upplaga, sidor
Sveriges Läkarförbund, 2019
Nationell ämneskategori
Cancer och onkologi
Identifikatorer
urn:nbn:se:liu:diva-164741 (URN)31192376 (PubMedID)
Tillgänglig från: 2020-04-02 Skapad: 2020-04-02 Senast uppdaterad: 2020-04-02
Hedin, C., Sjödahl, R., Aldman, Å., Davidson, T., Kammerlind, A.-S., Nodbrant, P., . . . Theodorsson, E. (2018). Intraoperativ strålbehandling vid primar operation for bröstcancer: TARGIT-A-studien ej konklusiv. Läkartidningen, 115, Article ID EWFF.
Öppna denna publikation i ny flik eller fönster >>Intraoperativ strålbehandling vid primar operation for bröstcancer: TARGIT-A-studien ej konklusiv
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2018 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, artikel-id EWFFArtikel, forskningsöversikt (Refereegranskat) Published
Abstract [sv]

The TARGIT-A (TARGeted Intraoperative radioTherapy) multicentre study of early breast cancer compared intraoperative radiotherapy with external radiotherapy. While the intraoperative radiotherapy was standardised, the external postoperative comparison treatment followed established routines in the participating treatment centres resulting in substantial variations in dosages and treatment durations. The uncertainties in the interpretation of the study results created by the design of the TARGIT-A study constitute substantial obstacles to the possible introduction of intraoperative radiotherapy for early breast cancer.

Ort, förlag, år, upplaga, sidor
Stockholm, Sweden: Läkartidningen Förlag AB, 2018
Nationell ämneskategori
Radiologi och bildbehandling
Identifikatorer
urn:nbn:se:liu:diva-154595 (URN)29381183 (PubMedID)
Tillgänglig från: 2019-02-21 Skapad: 2019-02-21 Senast uppdaterad: 2019-04-18Bibliografiskt granskad
Hallböök, O. & Sjödahl, R. (2018). Långvarigt Trendelenburgs läge kan orsaka ögonskador: Kortad operationstid i tippat läge och justering av tippningsvinkeln kan minska risken. Läkartidningen, 115
Öppna denna publikation i ny flik eller fönster >>Långvarigt Trendelenburgs läge kan orsaka ögonskador: Kortad operationstid i tippat läge och justering av tippningsvinkeln kan minska risken
2018 (Engelska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115Artikel i tidskrift, Editorial material (Refereegranskat) Published
Abstract [en]

Risk of optic nerve injury after prolonged Trendelenburgs position Postoperative loss of vision due to acute ischaemic optic nerve injury is a rare complication following pelvic surgery. A steep Trendelenburgs position of the patient, high intraabdominal pressure and a long operative time in Trendelenburgs position are recognised risk factors associated with robot-assisted pelvic surgery. This manuscript presents the underlying pathophysiologic mechanism. Practical tips and tricks for prevention are discussed.

Ort, förlag, år, upplaga, sidor
Stockholm, Sweden: Läkartidningen Förlag AB, 2018
Nationell ämneskategori
Kirurgi
Identifikatorer
urn:nbn:se:liu:diva-152534 (URN)29337339 (PubMedID)
Tillgänglig från: 2019-03-28 Skapad: 2019-03-28 Senast uppdaterad: 2019-04-02Bibliografiskt granskad
Ahlberg, E.-L., Elfström, J., Borgstedt Risberg, M., Öhrn, A., Andersson, C., Sjödahl, R. & Nilsen, P. (2017). Learning From Incident Reporting?: Analysis of Incidents Resulting in Patient Injuries in a Web-Based System in Swedish Health Care. Journal of patient safety
Öppna denna publikation i ny flik eller fönster >>Learning From Incident Reporting?: Analysis of Incidents Resulting in Patient Injuries in a Web-Based System in Swedish Health Care
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2017 (Engelska)Ingår i: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425Artikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

Objectives Incident reporting (IR) systems have the potential to improve patient safety if they enable learningfrom the reported risks and incidents. The aim of this study was to investigate incidents registered in an IR system in a Swedish county council.

Methods The study was conducted in the County Council of Östergötland, Sweden. Data were retrieved from the IR system, which included 4755 incidents occurring in somatic care that resulted in patient injuries from 2004 to 2012. One hundred correctly classified patient injuries were randomly sampled from 3 injury severity levels: injuries leading to deaths, permanent harm, and temporary harm. Three aspects were analyzed: handling of the incident, causes of the incident, and actions taken to prevent its recurrence.

Results Of the 300 injuries, 79% were handled in the departments where they occurred. The department head decided what actions should be taken to prevent recurrence in response to 95% of the injuries. A total of 448 causes were identified for the injuries; problems associated with procedures, routines, and guidelines were most common. Decisions taken for 80% of the injuries could be classified using the IR system documentation and root cause analysis. The most commonly pursued type of action was change of work routine or guideline.

Conclusions The handling, causes, and actions taken to prevent recurrence were similar for injuries of different severity levels. Various forms of feedback (information, education, and dialogue) were an integral aspect of the IR system. However, this feedback was primarily intradepartmental and did not yield much organizational learning.

Ort, förlag, år, upplaga, sidor
Wolters Kluwer, 2017
Nyckelord
patient safety;incident reporting;feedback;learning
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:liu:diva-154047 (URN)10.1097/PTS.0000000000000343 (DOI)29112034 (PubMedID)
Tillgänglig från: 2019-01-24 Skapad: 2019-01-24 Senast uppdaterad: 2019-02-06Bibliografiskt granskad
Nordqvist, P., Roberg, M., Magnusson, M. & Sjödahl, R. (2017). Vårdrelaterade infektioner en betydande del av vårdskadorna på sjukhus - Studie i Linköping visar att fler fall borde kunna undvikas. Läkartidningen, 114
Öppna denna publikation i ny flik eller fönster >>Vårdrelaterade infektioner en betydande del av vårdskadorna på sjukhus - Studie i Linköping visar att fler fall borde kunna undvikas
2017 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Preventable hospital acquired infections are common A modified GTT (Global trigger tool) was used for 480 patient records from 15 departments at Linköping University Hospital. Sixty-three hospital-acquired infections (HAI) were detected at 59 admissions. Postoperative wound infections were most common (44.4 %). Catheter-related urinary infections occurred in 15.9 %, infections associated with a central venous catheter in 7.9 % and hospital-acquired pneumonia in 6.3 % of all HAI.  Other types of HAI consisting of any abscess or oral Candida infection composed 17.5 %. Some 221 patients were operated (46.0 %). Postoperative wound infections were diagnosed in 28 of them (12.7 %), the majority after discharge from hospital. Most urinary infections were diagnosed in emergency patients (8/10). Prolonged hospital stay or unplanned return to hospital occurred in 54 %. Out of 63 HAI some 76.2 % were judged as probably preventable, and 11.1 % as preventable.

Ort, förlag, år, upplaga, sidor
Stockholm, Sweden: Läkartidningen Förlag AB, 2017
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
urn:nbn:se:liu:diva-146065 (URN)28375527 (PubMedID)
Tillgänglig från: 2018-04-07 Skapad: 2018-04-07 Senast uppdaterad: 2019-09-18Bibliografiskt granskad
Nilsson, L., Borgstedt Risberg, M., Montgomery, A., Sjödahl, R., Schildmeijer, K. & Rutberg, H. (2016). Preventable Adverse Events in Surgical Care in Sweden: A Nationwide Review of Patient Notes. Medicine (Baltimore, Md.), 95(11), e3047
Öppna denna publikation i ny flik eller fönster >>Preventable Adverse Events in Surgical Care in Sweden: A Nationwide Review of Patient Notes
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2016 (Engelska)Ingår i: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 95, nr 11, s. e3047-Artikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

Adverse events (AEs) occur in health care and may result in harm to patients especially in the field of surgery. Our objective was to analyze AEs in surgical patient care from a nationwide perspective and to analyze the frequency of AEs that may be preventable. In total 19,141 randomly selected admissions in 63 Swedish hospitals were reviewed each month during 2013 using a 2-stage record review method based on the identification of predefined triggers. The subgroup of 3301 surgical admissions was analyzed. All AEs were categorized according to site, type, level of severity, and degree of preventability. We reviewed 3301 patients records and 507 (15.4%) were associated with AEs. A total of 62.5% of the AEs were considered probably preventable, over half contributed to prolonged hospital care or readmission, and 4.7% to permanent harm or death. Healthcare acquired infections composed of more than one third of AEs. The majority of the most serious AEs composed of healthcare acquired infections and surgical or other invasive AEs. The incidence of AEs was 13% in patients 18 to 64 years old and 17% in >= 65 years. Pressure sores and drug-related AEs were more common in patients being >= 65 years. Urinary retention and pressure sores showed the highest degree of preventability. Patients with probably preventable AEs had in median 7.1 days longer hospital stay. We conclude that AEs are common in surgical care and the majority are probably preventable.

Ort, förlag, år, upplaga, sidor
LIPPINCOTT WILLIAMS & WILKINS, 2016
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:liu:diva-128765 (URN)10.1097/MD.0000000000003047 (DOI)000375211900057 ()26986126 (PubMedID)
Anmärkning

Funding Agencies|Swedish Association of Local Authorities and Regions

Tillgänglig från: 2016-06-07 Skapad: 2016-05-30 Senast uppdaterad: 2019-02-11Bibliografiskt granskad
Sakari, T., Sjödahl, R., Pahlman, L. & Karlbom, U. (2016). Role of icodextrin in the prevention of small bowel obstruction. Safety randomized patients control of the first 300 in the ADEPT trial. Colorectal Disease, 18(3), 295-300
Öppna denna publikation i ny flik eller fönster >>Role of icodextrin in the prevention of small bowel obstruction. Safety randomized patients control of the first 300 in the ADEPT trial
2016 (Engelska)Ingår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 18, nr 3, s. 295-300Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

AimAdhesions are the most common cause of small bowel obstruction (SBO). The costs of hospitalization and surgery for SBO are substantial for the health-care system. The adhesion-limiting potential of icodextrin has been shown in patients undergoing surgery for gynaecological diseases. A randomized, multicentre trial in colorectal cancer surgery started in 2009 with the aim of evaluating whether icodextrin could reduce the long-term risk of surgery for SBO. Because of some concerns about complications (especially anastomotic leakage) after icodextrin use, a preplanned interim analysis of morbidity and mortality was conducted. MethodPatients with colorectal cancer without metastasis were randomized 1:1 to receive standard surgery, with or without instillation of icodextrin in the abdominal cavity. For the first 300 patients, the 30-day follow-up data were collected from the Swedish ColoRectal Cancer Registry (SCRCR). Pre-, per- and postoperative data, morbidity and mortality were analysed. ResultsOf the 300 randomized patients, 288 had a data file in the SCRCR. Twelve patients did not have cancer and another five did not have a resection, leaving 283 for analysis. The authors were blinded to the randomization groups. Demographic data were similar in both groups. The overall complication rate was 24% in Group 1 and 23% in Group 2 (P=0.89). Four cases of anastomotic leakage were reported in Group 1 and five were reported in Group 2 (P=1.0). Mortality, intensive care unit (ICU) stay and re-operations did not differ between the groups. ConclusionThe pre-planned safety analysis of the first 300 patients enrolled in this randomized trial did not show any differences in adverse effects related to the use of icodextrin. All data were gathered from the SCRCR, giving us a strong message that we can continue to include patients in the trial.

Ort, förlag, år, upplaga, sidor
WILEY-BLACKWELL, 2016
Nyckelord
Adhesions; small bowel obstruction; complications; colorectal cancer
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:liu:diva-127051 (URN)10.1111/codi.13095 (DOI)000372036000014 ()26934850 (PubMedID)
Anmärkning

Funding Agencies|Makarna Edvin Erikssons Foundation; Swedish Cancer Foundation; ALF grants in Uppsala University

Tillgänglig från: 2016-04-13 Skapad: 2016-04-13 Senast uppdaterad: 2017-11-30
Gerdin, L., Eriksson, A. S., Olaison, G., Sjödahl, R., Ström, M., Söderholm, J. D. & Myrelid, P. (2016). The Swedish Crohn Trial: A Prematurely Terminated Randomized Controlled Trial of Thiopurines or Open Surgery for Primary Treatment of Ileocaecal Crohns Disease. Journal of Crohn's & Colitis, 10(1), 50-54
Öppna denna publikation i ny flik eller fönster >>The Swedish Crohn Trial: A Prematurely Terminated Randomized Controlled Trial of Thiopurines or Open Surgery for Primary Treatment of Ileocaecal Crohns Disease
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2016 (Engelska)Ingår i: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 10, nr 1, s. 50-54Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background and aims: The importance of efficient and safe treatment of Crohns disease is highlighted by its chronicity. Both medical and surgical treatments have shown good results in the symptomatic control of limited ileocaecal Crohns disease. The aim of this study was to compare medical treatment with surgical treatment of ileocaecal Crohns disease. Methods: Thirty-six patients from seven hospitals with primary ileocaecal Crohns disease were randomized to either medical or surgical treatment. The medical treatment was induction of remission with budesonide and thereafter maintenance treatment with azathioprine. The surgical treatment was open ileocaecal resection. Crohns disease activity index over time, expressed as area under the curve at 1, 3 and 5 years, was the primary endpoint. Subjective health measured with the 36-item Short Form Survey Instrument (SF36) and a visual analogue scale (VAS) were secondary endpoints. Results: There were no differences between the treatment groups in Crohns disease activity index over time. General health, measured as SF36 score, was higher in patients receiving surgical treatment than in those receiving medical treatment at 1 year, but there was no corresponding difference in VAS. Due to the slow inclusion rate and changes in clinical practice, the study was t = erminated prematurely. Conclusion: The study ended up being underpowered and should be interpreted with caution, but there was no clinically significant difference between the two treatment arms. Further studies are needed to address this important clinical question.

Ort, förlag, år, upplaga, sidor
OXFORD UNIV PRESS, 2016
Nyckelord
Surgery; clinical trials; quality of life; socio-economical and psychological endpoints
Nationell ämneskategori
Klinisk medicin Gastroenterologi
Identifikatorer
urn:nbn:se:liu:diva-126143 (URN)10.1093/ecco-jcc/jjv184 (DOI)000370275900010 ()26507858 (PubMedID)
Tillgänglig från: 2016-03-15 Skapad: 2016-03-15 Senast uppdaterad: 2018-03-21
Falk, M., Sjödahl, R., Wiréhn, A.-B., Lagerfelt, M., Woisetschläger, M., Ahlström, U. & Myrelid, P. (2015). Modifierad brittisk modell kortade ledtid till datortomografi av kolon. Läkartidningen, 112
Öppna denna publikation i ny flik eller fönster >>Modifierad brittisk modell kortade ledtid till datortomografi av kolon
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2015 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The British national Institute for Health and Care Excellence (NICE) has presented guidelines based on signs and symptoms which should raise a suspicion of colorectal cancer. A slightly modified version of these guidelines, adapted to Swedish conditions, named Swedish NICE (sNICE) criteria, was implemented at eight primary care centres. By following the sNICE criteria, cases with higher degree of suspicion of colorectal cancer were advised for computer tomography (CT) of the colon, whereas cases of low degree of suspicion were advised for the considerably less time and patient demanding CT of the abdomen. For patients with isolated anal symptoms without presence of sNICE criteria, active expectancy for six weeks was recommended, followed by renewed consideration. Results showed that the ratio between CT colon and CT abdomen was reduced from 2.2 to 1.1 after introduction of the sNICE criteria. Also, the proportion of patients undergoing CT colon within two weeks from admittance was increased from 3 to 25 %. We conclude that the sNICE criteria may be a useful supportive tool for the primary care physician.

Abstract [sv]

Vid misstanke om kolorektal cancer är det angeläget att patienter där misstankegraden är hög får genomgå snar utredning och diagnostik. På många håll i landet föreligger oönskat långa väntetider för sådan utredning.

Användningen av ett evidensbaserat beslutsstöd för kolonutredning, baserat på riktlinjer från brittiska NICE (National Institute for Health and Care Excellence), implementerades på 8 vårdcentraler i Östergötland.

Efter implementeringen förkortades ledtider till datortomografi av kolon, diagnos och behandling.

Beslutsstödet bidrog till att patienter där graden av misstanke om kolorektal cancer var låg kunde styras om till att genomgå datortomografi av buken i stället för av kolon.

Ort, förlag, år, upplaga, sidor
Stockholm, Sweden: Läkartidningen Förlag AB, 2015
Nationell ämneskategori
Radiologi och bildbehandling
Identifikatorer
urn:nbn:se:liu:diva-126059 (URN)26485132 (PubMedID)
Tillgänglig från: 2016-03-14 Skapad: 2016-03-14 Senast uppdaterad: 2018-03-23Bibliografiskt granskad
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