Bakgrund–På USÖ noterades att ett flertal patienter drabbades av feber efter borttagning av uretärkatetrar som placerats i uretärerna efter en urinavledningsoperation. Detta gav upphov till en rutinändring där urinodling tas och riktad antibiotika administreras inför kateterutsättning. Det finns studier som har visat effekt av antibiotikaprofylax på kateterassocierade urinvägsinfektioner och även på feberincidens efter avlägsnande av uretärstentar, medan andra studier indikerar en icke-signifikant effekt av antibiotikaprofylax i samband med kateterutsättning. Syfte–Attundersöka om administrering av antibiotika i samband med avlägsnande av uretärkatetrar resulterar ien lägre incidens av feber som uppstår efter kateterutsättning jämfört med om antibiotika ej ges,samt attta reda på om dettapåverkar vårdtidens längd. Metoder–Studien inkluderade 200 patienter (143 män och 57 kvinnor) som opererats med urinavledning på USÖvid något tillfälle under åren 2006-2012. Uppgifter inhämtades via retrospektiv journalgranskning. Resultat–Andelen som insjuknade i feberefter kateterutsättning var tioprocent av de som fick antibiotika respektive tolvprocent av de som ej fick antibiotika (p=0.592). Feberfrekvensen varierade mellan urinavledningstyperna. Andelen drabbade var 28 procent, 6 procent respektive 0 procentav patienter opererade med ortotopt blåssubstitut, urostomi respektive kontinent kutan urostomi (p<0.001). Vårdtiden per patient var tolvdygn i gruppen som drabbades av nytillkommen feber och elvadygn i gruppen som ej drabbades (p=0.151). Slutsatser-Antibiotikaprofylax tycks ej minska incidensen av feber som uppstår efter borttagning av uretärkatetrar, och ej heller påverka vårdtidens längd. Feberincidensen varierar mellan urinavledningstyperna, varav patienter opererade med ortotopt blåssubstitut har den högsta frekvensen feberinsjuknanden.

Introduktion:Centralt inom problembaserat lärande är att studenternas samlas i grupper som kallas basgrupper där de diskuterar fall som ska stimulera studenterna till att aktivt engagera sig i sitt lärande. En avgörande aspekt för gruppens produktivitet är gruppdynamiken. I alla basgrupper sker händelser som påverkar gruppdynamiken negativt och kan på så sätt minska gruppensproduktivitet. Tidigare studier har visat att frekvensen och inverkan som dessa kritiska incidenter har på basgruppsarbetet ökar utmed läkarprogrammens gång men ingen forskning finns gjord på Örebros läkarprogram. Syfte:Syftet med denna studie är att undersöka studenternas uppfattning om frekvensen och allvarlighetsgraden hos kritiska incidenter som uppkommer under basgruppsarbetet samt få en förståelse för i vilken utsträckning de förekommer utmed de olika stadierna på läkarprogrammet i Örebro universitet. Metod:En enkät delades ut till alla studenter på Örebro universitets läkarprogram. Totalt inkom 201 svar. Studenterna delades upp i fyra grupper beroende på stadieindelning (stadie I-IV).Analysmetoden som användes var en analysis of varianceoch post hoc Bonferroni. Resultat: Brist på elaboration, brist på interaktionoch ojämnt deltagande var faktorerna som studenterna upplevde mest frekvent. För majoriteten av faktorerna som undersöktes såg man en signifikant ökning i medelvärde över stadierna. Ojämnt deltagande, svåra personligheter, brist på motivationvar faktorerna som studenterna upplevde som störst vad gäller allvarlighetsgrad. Man såg ingen signifikant skillnad mellan medelvärdena över stadierna. Slutsats: Studenternas upplevelse av kritiska incidenter inom faktorerna, brist på elaboration, brist på interaktion, brist på motivation och brist på sammanhållning ökar med stadienivån.Studenternas upplevelse av kritiska incidenter skilde sig inte signifikant i allvarlighetsgrad mellan stadienivåerna.

Introduction: Syncope, is a transient, self-limited loss of consciousness (T-LOC) with an inability to maintain postural tone that is followed by spontaneous recovery.Depending on the mechanism, it has different prognosis. Syncope of cardiac origin has the worst prognosis without treatment. A lot of patients with unexplained syncope need to carry out a variety of different tests, in a variety of specialists. Continuous ECG-monitoring has been a useful clinical tool to establishing the correlation between the symptoms and ECG-results,for example at confirming or excluding an arrhythmia as a mechanism of syncope.Objective:The purpose of this study was to assess the importance of ECG-monitoring in the diagnosis and management of patients with unexplained syncope. We wanted to investigate if it is possible to diagnose those patients earlier and also find the underlying cause of their syncope.Method:This wasaretrospective and descriptive study, which wasperformed by reviewing 60 patients’ files at the department of Cardiology, USÖ.The patients that were referred to the Department of Cardiology, were from September 2009 until December 2017. In order to find the underlying cause of syncope, several diagnostic tests were used, including ECG, Echocardiography, tilt-test, ILR and Holter-ECG.Result:The patients were referredfrom different places, but the most common was the GP(31,6%). 100% of the patients performed ECG but only 28,3% of them had an ILR.From them only 35,2%showed findingsthat successfully helped the diagnosis. The final diagnosisbehind the syncopeafter workup wasvasovagal reaction in33,5%of cases, in 11,6% cardiacreason, 5% orthostatic, 3,32% other causes and 25% unexplained/unknown.Conclusion:Finding themainunderlying cause of syncope still remains difficult to establish. The use of more special diagnostic tests, especially ILR and tilt-test helpsto identify the cause, but still not in high rates. The continuous ECG-monitoring can be a valuable tool for discovering and revealing the underlying causes of unexplained syncope.

BackgroundNew military experiences of cryopreserved platelets and whole blood for the therapeutic treatment of acute hemorrhagehave led to an extensive academic debate on whether to include these blood products into civilian healthcare, where blood components and room temperature platelets serve as a one-size-fits-all productfor both prophylactic and therapeutic transfusions.PurposeTo evaluate the possible benefit ofother preparation methods of platelets, as well as whole blood, in civilian health care.MethodPlatelet transfusions of two Swedish counties were analyzed, and divided into three groups depending on which department that made the transfusion. One group for hematology and oncology departments/wards, one group for intensive care units(ICU), emergency departments(ED)and acute care wards(AC), and one group for all other departments/wards that made transfusions during the studied period. Each group was then divided into more specific categories.ResultsDepending on the region,7%-20% of all platelet transfusions were made in ICUs,5%-14% were made in surgical wardsand 1%-3% were made in ACs and EDs, and may be platelet transfusions madein conjunction with an active bleeding.44%-72% of all platelet transfusions were made in hematology departments/wards.ConclusionAccordingto this limited study, about 38% of all platelet transfusions in a county with a university hospital and 13% in a county without a university hospital, could benefit from transfusion with activated platelets, instead of those platelets that is today’s routine for prophylactic treatment.

Introduction:Ulcerative colitis (UC) and microscopic colitis (MC) are two different inflammatory bowel disorders. Previous studies claimthatUC patients haveincreased risk for developmentof colorectal cancer(CRC). However, this association has not been detected with MC. Moreover, studies have shownthataltered expression of microRNAs(miRNAs) plays an important role inthe CRC development. Additionally, UC and MC also showed an altered expression of miRNAs.Objective:The aim was to investigate if an altered expression of miRNAs in UC and MC canpartly explain the difference between UC and MC regarding theirrisk of developing CRC. Method:A systematic literature reviewwas performed on priorstudies that investigated the expression of miRNAs in UC, MC and CRC. Studies were obtained from four databases andwere further evaluated, reviewed and compiled with regard to inclusion and exclusion criteria.Result:Multiple studies showed a positive association between altered expression of miRNAs in UC patients and their risk of CRC development. The studies suggested that these altered expressed miRNAs function as potential drivers in thecarcinogenesis. However, the association between altered expression of miRNAs in MC patients regarding their risk to develop CRC remain unclear due to the lack of publications related to this. Conclusion:Due to the lack of publications regarding the association between miRNAs and MC, it remains unclear if miRNAs partly explain UC and MC differences in the risk of developing CRC.

Background: Low back pain may be treated surgically if a mechanical cause can be identified. In elite athletes,certain spinal adaptations have been described, from the diver’s kyphosis to the gymnast’s spondylolysis. Some of these chronic spinal changes have previously been identified to influence the long-term result of spinal surgery of untrained patients. Purpose:The aim of this study is to determine whether elite athletes have a betteror worse outcome of spinal surgery compared tophysicallyinactivepatients.Methods:Data from patients registered in Swedish National Spine Register SWESPINE between 1996-2014 were analyzed. The patient reported outcome measures (PROM: s)preoperatively, after one year, and two yearswere evaluated with the following instruments: Visual Analogue Scale (VAS) for leg-and back pain, Oswestry Disability Index (ODI) and EuroQol five-dimension scale(EQ5D)for health-related quality of life. Results:Surgical treatmentwas associated withimprovements in VAS for leg pain in both groups (-48 for elite athletes vs. -53 for physically inactive patients) with nostatistically significant difference between the two groups (p = 0.203). VAS forback pain improved in both groups (-37 vs. -44) without a statistically significant difference between the two groups (p=0.073). ODI improved in both groups (-32 vs. -37)withouta statistically significant difference between the two groups (p = 0.142). EQ5D improved the first year for both groups (0.15 vs.0.11)with a decline the second year (-0.15 vs. -0.13) for both groups without a statistically significant difference between both groups (p = 0.140). There was no statistically significant difference forAUC VAS leg (p = 0.178) and AUC VAS back (p= 0.99). However, there was a statistically significant difference for ODI (p = 0.017) and EQ5D (p = 0.002). Conclusion:Disability, back-and leg pain decreasedafter spinal surgery. Quality of life increased the first year but decreased the second year. There was only astatistical difference of outcome between elite-active patients and non-active patients of the AUC for ODI and EQ5D.

Removal of tonsillar tissue is one of the most common procedures in the Oto-Rhino-Laryngology field. There are two types of tonsil surgeries: tonsillectomy and tonsillotomy. The most dreaded complicationis postoperative hemorrhage. The aim of this study is to analyze the difference in incidence of such postoperative hemorrhage after tonsillectomy in comparison to tonsillotomy. The empirical analysis is based on the medical records of all 505 patients whounderwent tonsil surgery in Region Örebro Län in 2017. Of these, 341 patients underwent tonsillectomy and 164 patients underwent tonsillotomy. The result showed that 21 patients suffered from postoperative hemorrhage (4,2 %). Except for postoperative hemorrhage, the patient’s age, sex, type of surgery, smoking habits and hospital of surgery was recorded. In total 249 patients were women (49,3 %)and 232 were men (45,9%), 4,8 % of the patients sex was unknown. Regarding age were 176 of the patients under 18 years old (34,9 %), 86 patients were between the ages 18-65 (17,0 %) and 4 patients were over 65 years old (0,8 %). The result of the analysis shows a statistically significant difference between the two operations in terms of incidence of postoperative hemorrhage. However, the incidence of postoperative hemorrhage in Region Örebro Län is in accordance with previously reported National Data. Moreover, no significant difference in incidence of postoperative hemorrhage is found between males and females.

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