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  • 1. Agdal, Maren Lillehaug
    et al.
    Raadal, Magne
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Skaret, Erik
    Quality-of-life before and after cognitive behavioral therapy (CBT) in patients with intra-oral injection phobia2012In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 70, no 6, p. 463-470Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate quality-of-life (QoL), before and after cognitive behavioral therapy (CBT) in patients diagnosed with intra-oral injection phobia according to DSM-IV and to compare with the general population. This study also aimed to evaluate if QoL was associated with self-reported injection anxiety, dental anxiety, time since last dental treatment and oral health. Materials and methods. Subjects were 55 patients (mean age 35.5 +/- 12.2, 78.2% women) who participated in a treatment study in which 89% managed an intra-oral injection at 1 year follow-up. The patients completed a set of questionnaires including Quality of Life Inventory (QOLI), Injection Phobia Scale-Anxiety, Dental Anxiety Scale and a single-item question assessing self-perceived oral health. Objective measures of oral health and treatment needs were based on clinical examination. QOLI-scores from a non-clinical sample were used for comparison. Results. Before treatment the general and health specific QoL were lower among intra-oral injection phobics than in the non-clinical sample. At 1 year follow-up the QoL in general had improved significantly and was similar to that of the non-clinical sample. Poor self-reported oral health and long-term avoidance of dental treatment were associated with lower general and health-specific QoL. Self-reported injection anxiety and dental anxiety were not associated with QoL. Conclusions. Patients with intra-oral injection phobia report lower QoL compared with a general population. Phobia treatment seems to increase QoL to normative levels. Self-perceived poor oral health is associated with reduced QoL in these patients.

  • 2. Danielsson, D.
    et al.
    Gahm, C.
    Haghdoost, Siamak
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute. University of Caen Normandy, France.
    Munck-Wikland, E.
    Halle, M.
    Osteoradionecrosis, an increasing indication for microvascular head and neck reconstruction2020In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 49, no 1, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Better cancer treatment has led to a steadily growing population of cancer survivors suffering from late adverse effects after cancer treatment. The aim of this study was to investigate whether there has been an increase in free flap reconstruction due to osteoradionecrosis (ORN). A retrospective review was conducted to identify all consecutive head and neck free flap reconstructions performed over an 18-year period (1995-2012) at Karolinska University Hospital. A total of 235 free flaps were identified. Cases were divided into two groups: head and neck cancer reconstructions and ORN reconstructions. A comparison between the two groups showed longer survival (P < 0.001) and higher rates of late complications (P < 0.001) among ORN cases. ORN as an indication for reconstruction increased over time, from 7.0% of the total number of free flaps performed in 1995-2000, to 15.2% during the period 2001-2006, and to 27.3% in 2007-2012 (P < 0.001). This, in accordance with the results of other studies, highlights the importance of the appropriate allocation of resources within the healthcare system to treat this patient group within the steadily increasing population of cancer survivors.

  • 3. El Boghdady, Michael
    et al.
    Ewalds-Kvist, Béatrice Marianne
    Stockholm University, Faculty of Social Sciences, Department of Psychology. University of Turku, Finland.
    The influence of music on the surgical task performance: A systematic review2020In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, Vol. 73, p. 101-112Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Music is commonly played in operating theatres. Music was shown to diminish stress of the surgical team along with reducing the patients anxiety before surgery. On the other hand, it has been revealed that music might give rise to negative effects of divided attention causing distraction in surgical routines. Therefore, we aimed to systematically review the effect of music on the surgeon's task performance.

    Methods: A systematic review was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. A literature search using PubMed/Medline, ScienceDirect and Google Scholar, was performed by means of the search terms: music and operating theatre, as well as music and surgery. The search was limited to citations in English from year 2009-2018. Search items were considered from the nature of the articles, date of publication, forum of publication, aims and main findings in relation to use of music in operating theatres. Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied. Studies were included based on predetermined inclusion criteria where after the papers' quality assessments and evidence grading were completed by two independent reviewers. The protocol was registered with the PROSPERO register of systematic reviews.

    Results: Out of 18 studies that formed the base for evidence evaluations, 6 studies were assessed as having high quality and 8 studies of moderate quality. Five studies, provided both strong and moderate scientific evidence for a positive effect of music on surgeon's task performance. In contrast, strong scientific evidence for a negative effect of music on surgeon's task performance also was revealed in 2 high-quality studies. Nevertheless, the positive effect of music on the surgical task performance was significantly higher when compared to its negative effect (p < 0.0001).

    Conclusion: Certain music elements affect the surgical task performance in a positive or negative way. The total and significant outcome of the present study was that the positive effect of music on surgeon's task performance, overrides its negative effect. Classic music when played with a low to medium volume can improve the surgical task performance by increasing both accuracy and speed. The distracting effect of music should also be put in consideration when playing a loud or high-beat type of music in the operating theatres.

  • 4. El Boghdady, Michael
    et al.
    Ewalds-Kvist, Béatrice Marianne
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology. University of Turku, Finland.
    Alijani, Afshin
    A review of online platforms in training and surgical education2019In: European surgery, ISSN 1682-8631, E-ISSN 1682-4016, Vol. 51, no 2, p. 41-48Article, review/survey (Refereed)
    Abstract [en]

    Introduction The use of technology in surgical education has rapidly evolved. Blended learning refers to provision of online instruction platforms by international technology companies, prompting a combination of face-to-face teaching with computer-mediated tuition. This nonsystematic literature review focuses on online teaching platforms with applications for potential use in future surgical education. Methods A literature search was performed using PubMed, Embase, OVID, and Google Scholar. To identify studies on online platforms in surgical education, the following search terms were used: online platform, online learning, surgical education and online learning, and surgical education and blended learning. The search was limited to citations in English from 1998 to 2018. The first author performed the detailed literature search. The final list of the articles was included by consensus between authors. Search items were studied from the nature of the articles, country of origin, date of publication, and aims and findings in relation to use of online platforms surgical education. Results Altogether 279 relevant citations were reviewed, of which 22 articles met the inclusion criteria: 19 papers (ten original research, two review items, seven Internet articles) and three books were found to be relevant for this study. Their analysis comprised models of platforms along with their applications in surgical education. Data on the advantages and disadvantages of online platforms as well as authors' personal experience of this instruction manner in surgical education were extracted. Problems with determining, analyzing, and integrating reading matters in a nonsystematic literature review comprising different teaching methods combined with the use of online platforms in surgical education were discussed and resolved. Conclusion Online platforms were introduced by international technology companies to encourage paperless blended learning in schools. We envisaged the use of online classrooms in surgical education because of its simple format, easy access, low costs, and interaction-inspiring nature between teachers and students in professional surgical education.

  • 5. Kempf, Emmanuelle
    et al.
    Tournigand, Christophe
    Rochigneux, Philippe
    Aubry, Régis
    Morin, Lucas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Discrepancies in the use of chemotherapy and artificial nutrition near the end of life for hospitalised patients with metastatic gastric or oesophageal cancer. A countrywide, register-based study2017In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 79, p. 31-40Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the frequency and the factors associated with the use of chemotherapy and artificial nutrition near the end of life in hospitalised patients with metastatic oesophageal or gastric cancer.

    Methods: Nationwide, register-based study, including all hospitalised adults (>= 20 years) who died with metastatic oesophageal or gastric cancer between 2010 and 2013, in France. Chemotherapy and artificial nutrition during the final weeks of life were considered as primary outcomes.

    Results: A total of 4031 patients with oesophageal cancer and 10,423 patients with gastric cancer were included. While the proportion of patients receiving chemotherapy decreased from 35.9% during the 3rd month before death to 7.9% in the final week (p < 0.001 for trend), the use of artificial nutrition rose from 9.6% to 16.0% of patients. During the last week before death, patients with stomach cancer were more likely to receive chemotherapy (adjusted odds ratio (aOR) = 1.35, 95% CI = 1.17-1.56) but less likely to receive artificial nutrition (aOR = 0.80, 95% CI = 0.73-0.88) than patients with cancer of the oesophagus. The adjusted rates of chemotherapy use during the last week of life varied from 1.6% in rural hospitals to 11.2% in comprehensive cancer centres, while the adjusted probability to receive artificial nutrition varied from 12.1% in private for-profit clinics up to 19.9% in rehabilitation care facilities (p < 0.001).

    Conclusions: Our study shows that in hospitalised patients with metastatic oesophageal or gastric cancer, the use of chemotherapy decreases while the use of artificial nutrition increases as death approaches. This raises important questions, as clinical guidelines clearly recommend to limit the use of artificial nutrition in contexts of limited life expectancy.

  • 6. Marcano, Alejandro I.
    et al.
    Nordenvall, Richard
    Karlsson, Pär
    Gerdin, Martin
    Adami, Johanna
    Palme, Mårten
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Mattila, Ville M.
    Bahmanyar, Shahram
    Felländer-Tsai, Li
    Income change after cruciate ligament injury - A population-based study2019In: Knee (Oxford), ISSN 0968-0160, E-ISSN 1873-5800, Vol. 26, no 3, p. 603-611Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the association between choice of treatment and patients' income after cruciate ligament (CL) injury and assess the effect of different covariates such as sex, age, comorbidities and type of work.

    Methods: This entire-population cohort study in Sweden included working patients with a diagnosed CL injury between 2002 and 2005, identified in The National Swedish Patient Register (n = 13,662). The exposure was the treatment choice (operative or non-operative treatment). The main outcome measure was average yearly income five years after CL diagnosis, adjusted for the following covariates: sex, age, comorbidities, type of work, region, calendar year, education and income.

    Results: Relative to non-operative treatment, operative treatment was associated with greater average yearly incomes (nine to 15%) after injury among patients between 20 and 50 years, patients with partial university education, patients living in large cities and patients with one comorbidity, despite no overall significant association in the national cohort. Delayed operative treatment (>1 year) had no significant association with income change, whereas early operative treatment (<1 year) was associated with higher average yearly incomes (11 to 16%) among females, patients between 20 and 50 years, patients living in large cities and patients with one comorbidity.

    Conclusions: In a broad sense, treatment choice was not associated with changes in income five years after CL injuries among patients in the workforce, however earlier operative treatment was associated with higher average incomes among patients with ages between 20 and 50, females, living in large cities, with one comorbidity and with a high level of education.

  • 7.
    Molnar, Petra
    Stockholm University, Faculty of Humanities, Department of Archaeology and Classical Studies, Osteoarchaeological Research Laboratory.
    Extramasticatory dental wear reflecting habitual behavior and health in past populations2011In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 15, no 5, p. 681-689Article in journal (Refereed)
    Abstract [en]

    In skeletal remains, teeth are valuable sources of information regarding age, diet, and health. Dental wear is especially helpful in reconstructions of dietary patterns in populations of varying subsistence. In past societies, teeth have also been used as a third hand or as a tool. The present article examines this type of dental wear and traits attributed to habitual behavior during prehistoric and historic times. Terminology and classification of habitual dental wear are described mainly by appearance, for instance, notching, grooving, cuts, scrapes, and polished surfaces, and their characteristics are illuminated by different case studies. Secondary health effects caused by the extramasticatory use of teeth, such as periapical lesions, tilting, skeletal changes at the temporomandibular joint, chipping, and antemortem tooth loss are also examined. During the examination of extramasticatory dental wear, information should be recorded on morphology, size, frequency, intensity, and location within the dental arch, as well as descriptions and detailed photographic documentation. The advantage of using a low-to medium-resolution microscope in all dental examination is emphasized. By categorizing the wear marks, characteristics are emphasized rather than an exact causing agent. In this way, tentative analogies for the origin of different extramasticatory wear, and consequently for human behavior in the past, can be avoided.

  • 8.
    Mondlane, Gracinda
    et al.
    Stockholm University, Faculty of Science, Department of Physics. Universidade Eduardo Mondlane, Mozambique.
    Gubanski, Michael
    Lind, Pehr A.
    Henry, Thomas
    Stockholm University, Faculty of Science, Department of Physics.
    Ureba, Ana
    Stockholm University, Faculty of Science, Department of Physics.
    Siegbahn, Albert
    Stockholm University, Faculty of Science, Department of Physics.
    Dosimetric Comparison of Plans for Photon- or Proton-Beam Based Radiosurgery of Liver Metastases2016In: International Journal of Particle Therapy, ISSN 2331-5180, Vol. 3, no 2, p. 277-284Article in journal (Refereed)
    Abstract [en]

    Purpose: Radiosurgery treatment of liver metastases with photon beams has been an established method for more than a decade. One method commonly used is the stereotactic body radiation therapy (SBRT) technique. The aim of this study was to investigate the potential sparing of the organs at risk (OARs) that the use of intensity-modulated proton therapy (IMPT), instead of SBRT, could enable.

    Patients and Methods: A comparative treatment-planning study of photon-beam and proton-beam based liver-cancer radiosurgery was performed. Ten patients diagnosed with liver metastasis and previously treated with SBRT at the Karolinska University Hospital were included in the study. New IMPT plans were prepared for all patients, while the original plans were set as reference plans. The IMPT planning was performed with the objective of achieving the same target dose coverage as with the SBRT plans. Pairwise dosimetric comparisons of the treatment plans were then performed for the OARs. A 2-sided Wilcoxon signed-rank test with significance level of 5% was carried out.

    Results: Improved sparing of the OARs was made possible with the IMPT plans. There was a significant decrease of the mean doses delivered to the following risk organs: the nontargeted part of the liver (P = .002), the esophagus (P = .002), the right kidney (P = .008), the spinal cord (P = .004), and the lungs (P = .002). The volume of the liver receiving less than 15 Gy was significantly increased with the IMPT plans (P = .004).

    Conclusion: The IMPT-based radiosurgery plans provided similar target coverage and significant dose reductions for the OARs compared with the photon-beam based SBRT plans. Further studies including detailed information about varying tissue heterogeneities in the beam path, due to organ motion, are required to evaluate more accurately whether IMPT is preferable for the radiosurgical treatment of liver metastases.

  • 9. Nordenvall, Richard
    et al.
    Marcano, Alejandro I.
    Adami, Johanna
    Palme, Mårten
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Mattila, Ville M.
    Bahmanyar, Shahram
    Felländer-Tsai, Li
    The Effect of Socioeconomic Status on the Choice of Treatment for Patients With Cruciate Ligament Injuries in the Knee: A Population-Based Cohort Study2017In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 45, no 3, p. 535-540Article in journal (Refereed)
    Abstract [en]

    Background:

    The socioeconomic status (SES) of patients has been widely recognized as playing an important role in many health-related conditions, including orthopaedic conditions, in which a higher SES has been associated with a higher utilization of more advanced medical treatments such as drugs, diagnostics, and surgery. However, the association between SES and cruciate ligament surgery has not been thoroughly investigated.

    Purpose:

    To evaluate the association between SES and choice of treatment in patients with a cruciate ligament injury.

    Study Design:

    Cohort study; Level of evidence, 3.

    Methods:

    All Swedish patients with a diagnosed cruciate ligament injury between 1987 and 2010 were identified from the Swedish National Patient Register (N = 98,349). The Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA) provided information on household income and highest achieved educational level, which were used as socioeconomic indices. The exposure was the SES of patients as determined by the household income and educational level, and the main outcome measure was treatment choice (surgical reconstruction vs nonoperative treatment). Poisson regression models estimated the association.

    Results:

    A total of 52,566 patients were included in the study; of these, 20,660 (39%) were treated operatively. Patients in the highest quartile of household income had a significantly higher likelihood of undergoing surgery than those in the lowest quartile (relative risk [RR], 1.16; 95% CI, 1.11-1.20). Patients classified as highly educated had a significantly increased likelihood of being treated operatively compared with those with a low education (RR, 1.29; 95% CI, 1.19-1.39).

    Conclusion:

    This study provides a population-based validation that having a higher SES as determined by the household income and/or level of education increases the likelihood of undergoing operative treatment after a cruciate ligament injury.

    Clinical Relevance:

    All Swedish citizens are entitled by law to the same quality of health care; therefore, unmotivated differences in treatment between different socioeconomic groups are to be seen as a challenge. It is important to evaluate the specific mechanisms by which the patient's SES influences the decision of whether to treat a cruciate ligament injury operatively.

  • 10. Tiselius, Catarina
    et al.
    Kindler, Csaba
    Rosenblad, Andreas
    Stockholm University, Faculty of Social Sciences, Department of Statistics. Uppsala University, Västmanland Hospital Västerås, Sweden.
    Smedh, Kenneth
    Localization of mesenteric lymph node metastases in relation to the level of arterial ligation in rectal cancer surgery2019In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 45, no 6, p. 989-994Article in journal (Refereed)
    Abstract [en]

    Introduction

    For oncological reasons, central arterial ligation of the inferior mesenteric artery(IMA) is suggested in rectal cancer surgery although no conclusive evidence support this. We have therefore investigated the localization of lymph node metastases and compared central ligation of the IMA versus peripheral arterial ligation, in rectal cancer specimens.

    Methods

    This was a cross-sectional population-based study of consecutive recruited patients who underwent resection for rectal cancer in 2012–2015. Multiple linear regression analysis was used to explore the relationship between lymph node count and age, sex, body mass index, preoperative oncological treatment, type of surgery, tumour stage, and vessel and specimen length.

    Results

    151 patients (54 women) were included, with median (range) age 70 (45–87) years. The median (range) number of lymph nodes retrieved was 25 (3–70), which was associated with body mass index, type of surgery and vessel length. Vessel length, median (range) 9.6 (5–14) and 9.2 (5–15) cm for reported central and peripheral arterial ligation, respectively, was associated with body mass index. In 39 of 42 samples, metastatic lymph nodes were located in the mesorectum, and 13 of 42 samples also had metastatic lymph nodes in the sigmoid mesentery. None were found around the ligated artery.

    Conclusion

    To recruit all metastatic lymph nodes in rectal cancer surgery, it is important to include the sigmoid mesentery in the specimen, but not to perform a central ligation of the IMA compared with ligation of the SRA close to the left colic artery (LCA).

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