Karuna Dahlberg

Introduction: Same‐day discharge after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) is increasing, but the optimal anaesthetic technique for outpatient pathways remains uncertain. Neuraxial anaesthesia is widely recommended based on observational evidence, whereas fast‐track programmes using short‐acting total intravenous anaesthesia may facilitate early mobilisation and discharge. No randomised controlled trial has compared general anaesthesia (GA) with spinal anaesthesia (SA) specifically in outpatient primary THA/TKA using a same‐day discharge target. Methods and Analysis: GASPS is a pragmatic, multicentre, parallel‐group superiority randomised controlled trial. Adults scheduled for outpatient primary THA or TKA will be randomised 1:1 to GA or SA, with stratification by site and procedure (THA/TKA). The primary outcome is successful same‐day discharge (discharge on the day of surgery) without readmission within 48 h after discharge. The five key secondary outcomes are time to fulfilment of hospital discharge indicators, quality‐of‐recovery (QoR‐15) trajectories over postoperative Days 1–35, patients' qualitative experiences of anaesthesia and recovery, cost per quality‐adjusted life‐year and safety (adverse events); all remaining outcomes—including pain, postoperative nausea and vomiting, opioid consumption, mobilisation and patient‐reported outcomes (EQ‐5D‐5L and HOOS/KOOS)—are exploratory. An embedded qualitative study will explore patient experiences using semi‐structured interviews, and an economic evaluation will compare costs and outcomes from healthcare and societal perspectives. Analyses will follow the intention‐to‐treat principle; a group sequential design with O'Brien‐Fleming boundaries is planned for an interim analysis. Approval has been obtained from the Swedish Medical Products Agency. Written informed consent will be obtained from all participants. Results will be disseminated through peer‐reviewed publications, conference presentations and reporting in the EU Clinical Trials Information System (CTIS). Conclusion: This study is designed to determine the most effective anaesthetic method for same‐day discharge after primary TKA and THA. With increasing outpatient surgeries, this study will be helpful for optimisation of outpatient processes. Trial Registration: EU CT/CTIS: 2024‐520127‐89‐00. ClinicalTrials.gov : NCT07334132

Objectives: To explore health-related quality of life (HRQoL), anxiety, depression and fatigue among persons with ANCA-associated vasculitis (AAV). Methods: In this cross-sectional study, patients were assessed with the EuroQoL five-dimension three-level questionnaire (EQ-5D-3L) and visual analogue scale (EQ-VAS), the Hospital Anxiety and Depression Score (HADS) and the Multidimensional Assessment of Fatigue questionnaire (MAF). Results: HRQoL measured with EQ-VAS was higher in younger patients, those with inactive disease (BVAS = 0) and those with long disease duration (≥3 years), while EQ-5D-3L only varied with disease activity. Women, patients with active disease and patients with shorter disease duration reported more anxiety, and younger persons with active disease and short disease duration reported more fatigue. In the total group, disease activity and disease duration were both associated with HRQoL, anxiety, depression and fatigue. Four clusters based on EQ-5D, EQ-5D index and HADS were identified, containing patients with various levels of HRQoL and psychological distress across the disease course. Conclusion: In patients with AAV, HRQoL, anxiety, depression and fatigue are persistent but vary depending on disease activity, disease duration, gender and age. Associations between disease activity and duration and HRQOL, anxiety, depression and fatigue were present in all patients. Four clusters revealed the ongoing influence of AAV, emphasizing the continuous need for multiprofessional support during the disease course. In this study, EQ-VAS was better able than the EQ-5D-index to effectively distinguish subgroups with different levels of HRQoL.

Health literacy (HL) is a critical determinant of health, as it affects health behavior and outcomes, in addition to equity in health. This study aimed to translate, culturally adapt, and validate the Swedish version of HLS19-Q12 (HLS19-Q12-SE). The HLS19-Q12 is a widely used instrument that consists of 12-items and is often used to assess HL in Europe. A convergent mixed-methods design was applied, including cognitive interviews (n = 8) and psychometric testing with a survey sample (n = 374) and test–retest group (n = 28). The instrument was forward and backwards translated and culturally adapted. Data was analyzed using confirmatory and exploratory factor analysis, correlation testing, and reliability assessments. Cognitive interviews explored the clarity, interpretation, and contextual relevance of the items. Participants found the HLS19-Q12-SE clear and easy to understand, though some reported difficulties with unfamiliar health situations and uncertainty of the term “health information.” Based on the interviews, the examples for one of the items were culturally adapted. Psychometric testing showed good feasibility, no floor or ceiling effects on scale level, and moderate positive correlations with other HL instruments, supporting internal and external validity. Structural validity was confirmed, and internal consistency and test–retest reliability were satisfactory. However, ceiling effects were observed at the dichotomous item level, and correlations with self-rated health and social status were low. The HLS19-Q12-SE is a reliable and valid instrument for assessing general HL in Sweden. While psychometric properties were strong overall, future research should address ceiling effects on item level and explore the instrument’s performance in more diverse populations.

Aim: To identify key aspects of recovery‐oriented practice in caring for people with mental ill‐health in general emergency departments.Design: A modified Delphi study with three rounds.Methods: A 24‐member expert panel was recruited consisting of people with lived experience of mental ill‐health, registered nurses working in emergency care, registered nurses specialised in psychiatric and mental health nursing and mental health recovery researchers. In the initial round, important aspects of recovery‐oriented practice were identified through focus group interviews. Thematic analysis generated statements that were then reformulated as a questionnaire for subsequent rounds. The experts rated each statement's perceived importance on a 5‐point Likert scale. The consensus level was set at ≥ 80%. Descriptive statistics were used to analyse the data.Results: Consensus was reached on the importance of 39 of 73 statements, with ≥ 80% deemed ‘very important’ in recovery‐oriented practice in general emergency departments.Conclusion: The study emphasises the delicate balance between the essential elements of recovery‐oriented practice, their practical feasibility and the predominant biomedical perspective in general emergency department care. It proposes strategies to empower nursing staff and managers to adopt recovery‐oriented practices that enhance the quality of care for people with mental ill‐health. Enabling staff by providing the necessary prerequisites and a care environment that supports reflective practices is crucial. The responsibility for facilitating these changes needs to be a shared commitment between nursing staff and managers.Implications for the Profession and/or Patient Care: The identified issues can serve as a framework for interventions, education and training to support the integration of recovery‐oriented practice in general emergency care. They can also be used to develop tools for evaluating emergency care environments and promoting alignment with recovery‐oriented principles.Impact: Problem addressed: People with mental ill‐health are at risk of being neglected, judged and dismissed in general emergency department care, creating obstacles to their mental health recovery. Main results: The Delphi study identified 39 key aspects of recovery‐oriented practice in general emergency departments, emphasising person‐centred, strength‐based, collaborative and reflective care. Impact: The research seeks to establish a foundation for developing training programmes, education and interventions and for the integration of recovery‐oriented practices in general emergency care. It thus has the potential to enhance the quality and equality of care for patients with mental ill‐health in emergency care. The impact extends to nursing staff and managers as it seeks to empower them to systematically reflect on and reevaluate established emergency department practices to ensure that every person, irrespective of their health condition, is treated with dignity and respect in emergency department settings. Reporting Method: The CREDES guidance on conducting and reporting Delphi studies.Patient or Public Contribution: The authors have nothing to report.

Background: The COVID-19 pandemic has affected healthcare organizations in many areas. The aim of this study was to describe surgical interventions, anesthesia, and postoperative outcomes in adult patients during the first wave and 1 year into the COVID-19 pandemic in Sweden, and to compare these outcomes with outcomes during the same period the year before the pandemic. Methods: Data were collected from the Swedish PeriOperative Register, and included 417, 233 perioperative registration of patients ≥ 18 years old between period 1 (March–June 2019), period 2 (March–June 2020), and period 3 (March–June 2021). Results: Compared with pre-pandemic (period 1), the number of surgical interventions decreased by 28% in the first wave (period 2); 1 year into the pandemic (period 3), the number of interventions was still 7.5% lower than pre-pandemic. The largest drops between periods 1 and 2 were noted in the specialties of ear, nose, and larynx surgery, – 55.6%; teeth, jaws, mouth, and pharynx surgery, – 45.0%; endocrine system surgery, – 38.8%. The number of acute surgeries remained stable during all three periods. Volatiles were more frequently used for the maintenance of general anesthesia in period 2 than in either period 1 or 3 (p < 0.001). Minor differences were noted throughout the periods in postoperative nausea and vomiting as well as postoperative pain. Conclusions: The COVID-19 pandemic has had an impact on perioperative care in Sweden. During the first wave of the pandemic, the number of surgical interventions decreased, but the number of acute surgeries remained stable compared with pre-pandemic numbers. Perioperative organizations have had and will continue to have challenges handling the increased number of patients needing perioperative care.

Summary: The aims of this study were to evaluate the longitudinal risk of self‐harm and the risk factors for self‐harm after bariatric surgery in patients and control subjects without prior self‐harm. This observational cohort study was based on prospectively registered data. Patients 18–70 years at time of surgery, body mass index (BMI) > 30 kg/m², who underwent a primary Roux‐en‐Y gastric bypass (RYGB) procedure or a primary sleeve gastrectomy between 2007 and 2019 were considered for inclusion. All patients who met the inclusion criteria were matched 1:10 to the general population in Sweden (69 492 patients vs. 694 920 controls). After excluding patients and controls with previous self‐harm, a self‐harm event occurred in 1408 patients in the surgical group (incidence rate (IR) 3.54/1000 person‐years, 95% confidence interval (CI) 3.36–3.73) versus in 3162 patients in the control group (IR 0.81/1000 person‐years, 95% CI 0.78–0.84), with a hazard ratio (HR) of 4.38 (95% CI 4.11–4.66, p < .001). Median follow‐up time was 6.1 years. Risk factors were younger age, lower BMI, cardiovascular, and chronic obstructive pulmonary disease, all aspects of psychiatric comorbidities (except neuropsychiatric disorder), lower socioeconomic status, RYGB, lower health‐related quality of life, lower postoperative weight loss, and not attending postoperative follow‐up visits. Self‐harm is clearly higher after bariatric surgery than in the general population. A qualitative follow‐up may be particularly important for patients at increased risk.

Objective: The aim was to describe how the patient perspective is captured in clinical research on ANCA-associated vasculitis (AAV). Methods: This integrative review included 2149 publications found in four different databases and manual searches. After screening, 156 articles remained. All articles were sorted and categorized, and 77 original articles were analysed further. Results: The patient perspective was captured with patient-reported outcome measures (PROMs), single-item questionnaires, project-specific questionnaires and interviews. The most common aspects measured were health-related quality of life, anxiety and depression, and fatigue, and the least common were lifestyle habits, relationships and self-management. Conclusion: The patient perspective was captured predominantly with generic PROMs and occasionally with a qualitative approach. AVV is a lifelong disease, and the results from this review show that not all aspects of importance to patients are covered with the PROMs used in research. Future studies should include the areas that are the most important for patients.

Objectives This study psychometrically evaluated General Self-Efficacy (GSE) Scale in patients planned for bariatric surgery in Sweden. Design A cross-sectional psychometric study. The psychometric evaluation was guided by the COnsensus-based Standards for the selection of health status Measurement Instruments checklist for health-related reported-patient outcomes. Setting Three bariatric centres in Sweden. Participants Adult patients≥18 years old scheduled for primary bariatric surgery (with sleeve gastrectomy or Roux-en-Y gastric bypass). Primary and secondary measures Psychometric properties of the GSE. Results In total, 704 patients were included in the analysis. Mean values for GSE items were 2.9–3.4 and the mean GSE sum score was 31.4 (SD 4.7). There were no floor or ceiling effects. Cronbach’s alpha was 0.89. Men reported a higher mean GSE than did women, that is, 31.2 (SD 4.8) for women versus 32.1 (SD 4.3) for men, p=0.03. Correlation coefficients were weak or negligible: GSE and mental component summary score of 36-Item Short Form Health Survey (SF-36)/RAND 36, r=0.18 (pConclusions The GSE scale is a valid and reliable scale that can be used to assess general self-efficacy in patients undergoing bariatric surgery.