Lena Nilsson

Introduction Robot-assisted laparoscopic surgical procedures are commonly perceived to result in fast recovery; however, the postoperative course can be challenging for many patients. We have previously found severe pain and a significant decrease in the patient-reported outcome measure Quality-of-Recovery 15 (QoR-15) in a cohort of patients undergoing robot-assisted upper urinary tract surgery. In similar settings, intrathecal analgesia is sometimes used to improve recovery; however, its benefits have not been established. Therefore, this study aims to examine the effects of intrathecal analgesia in this setting compared with an active comparator intravenous lidocaine. Methods and analysis In this randomised, assessor-blinded multicentre trial, 220 patients scheduled for robot-assisted upper urinary tract surgery under general anaesthesia are recruited after obtaining informed consent. They are randomised to receive either intrathecal analgesia or an intraoperative infusion with lidocaine. The primary study outcome is the decrease in QoR-15 from baseline to postoperative day 1. Other outcomes of interest include postoperative pain, length of stay and postoperative complications. Differences in intraoperative haemodynamics and postoperative inflammatory parameters will also be analysed. Ethics and dissemination This study has been approved by the Swedish Medical Products Agency (5.1.1-2023-69740 and 5.1.2-2025-030145). The results of this study will be presented at national and international meetings and submitted for publication in peer-reviewed international medical journals. Trial registration number NCT06349668.

Introduction: This study aimed to determine preoperative risk factors for nonsatisfaction 1 year after hysterectomy for benign indication and to analyze whether multiple co‐occurring preoperative risk factors increase the rate of nonsatisfaction. Material and Methods: A historical register study was conducted using data from the Swedish National Register for Gynecological Surgery of women aged 18–56 years, who underwent hysterectomy for benign conditions between 2004 and 2023. Satisfaction 1 year postoperatively was dichotomized into satisfaction or nonsatisfaction. Multiple logistic regression was used to evaluate preoperative risk factors, with results presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Nagelkerke's coefficient of determination ( R ² ) assessed the explanatory power of the models. Results: Among the 38 044 participating women, 3335 (8.8%) were not satisfied after 1 year. Preoperative risk factors for nonsatisfaction were smoking (aOR 1.34, 95% CI: 1.18–1.53), not being gainfully employed (aOR 1.60, 95% CI: 1.40–1.82), and the main symptoms leading to hysterectomy (pain (aOR 1.91, 95% CI: 1.70–2.15), pressure/heaviness (aOR 1.90, 95% CI: 1.53–2.21), other symptoms (aOR 2.24, 95% CI: 1.95–2.59), or several main symptoms (aOR 1.92, 95% CI: 1.53–2.41)). Protective factors for nonsatisfaction were age 46–50 years (aOR 0.87, 95% CI: 0.76–1.00) and minimally invasive hysterectomy (vaginal [aOR 0.69, 95% CI: 0.59–0.81], laparoscopic [aOR 0.79, 95% CI: 0.68–0.91], and robot‐assisted laparoscopic [aOR 0.82, 95% CI: 0.71–0.95]). The likelihood of being nonsatisfied rose with the accumulation of preoperative risk factors, as reflected by the full model's explanatory power ( R ² = 0.141). Among individual predictors, the main symptom leading to hysterectomy contributed most to the explained variance ( R ² = 0.029), followed by employment status ( R ² = 0.009), while other factors, such as surgical route, age, and smoking only marginally contributed to the variance. Conclusions: Nearly, 9% of the women were nonsatisfied with the outcome of the hysterectomy after 1 year. Lack of satisfaction appeared predictable from preoperative factors, notably smoking, not being gainfully employed, and nonbleeding symptoms leading to hysterectomy. These findings emphasize the need for individualized counseling before surgery. Given that most preoperative risk factors are resistant to immediate modification, more research is needed to develop targeted interventions that can reduce nonsatisfaction and enhance patient outcomes.

Purpose: The aim of the study was to evaluate the health economics of nurse-led telephone follow-up contacts (TFUs) within six weeks after benign hysterectomy in a societal perspective, using a cost minimization analysis model. Methods: A randomized, single-blinded, controlled, Swedish multicenter study comprising 487 women undergoing benign hysterectomy. The women were allocated 1:1:1:1 to either Group A (no TFUs), Group B (one clinically structured TFU the day after discharge), Group C (as B, but with additional TFUs once weekly for six weeks, in total six TFUs), or Group D (as C, but by applying a coaching technique). Time consumption for planned TFUs, informal care, and the number of unplanned telephone contacts and visits were recorded. Costs were assessed using a cost-per-patient price list for Linköping University Hospital. Results: The total cost per patient more than doubled in the groups with repeated TFUs (Groups C and D) compared with no TFUs (Group A). Group D demonstrated fewer unplanned telephone contacts and lower informal care costs. Group B, with only one TFU, exhibited the highest time consumption for TFU. The additional costs of six TFUs, with or without coaching, substantially increased the costs. The coaching TFU group (Group D) had the lowest cost for informal care. Conclusion: TFUs appeared to be costly and an inefficient way of using healthcare resources after benign hysterectomy. The coaching TFU seemed to reduce unplanned telephone contacts and lower informal care costs. Careful consideration of the costs and the impact on clinical outcomes is important before implementing TFU after surgery. Trial registration: This study is registered retrospectively in ClinicalTrial.gov: NCT01526668 on January 27, 2012. Date of enrollment of first patient: October 11; 2011.

Trauma teams handle severely injured patients under high temporal demands and need to coordinate and achieve collaborative decision-making and task execution through communication. Specific coordination and communication behaviours are taught in simulation training to enhance team performance. An examination of the role and nature of communication could increase the understanding of educational possibilities and assess the validity of in situ simulation on behalf of communication. Our study aim was to describe the relative use of communication within information and task management, the use of coordinating behaviours, and the use of talking to the room and closed-loop communication in in-real-life trauma assessment and in the simulated domain. We video-recorded all verbal communicative events in four real-world trauma teams and four teams during simulation training. The analysis showed that although the teamwork was task-oriented, information management dominated task management at 64% of all the utterances in-real-life and 68% during simulation. In-real-life, information management was dominated by the codes “request information” (24%) and “confirmation” (21%), whereas “task distribution” (43%) was most frequently used for task management. The only difference between domains was that “give information after request” represented a smaller proportion of the utterances in-real-life compared to simulation (p ≤ 0.001). Talking to the room was primarily used by the teams in both domains to provide information without request and to delegate tasks. Closed-loop communication was used at a low frequency, 3.6% in-real-life, but was significantly higher, 7.7%, in simulation training. We suspect that this outcome reflects the Hawthorne effect. In the simulations, greater information delivery was provided in response to questions, probably accounting for instructor information. Our results may be valuable for research on trauma team behaviour in a simulated environment to draw conclusions about similar activities in-real-life.

To investigate the experiences of healthcare staff in nursing homes during the COVID-19 pandemic. Individual interviews. Latent qualitative content analysis. Ten nursing homes in Sweden. Physicians, nurses and nurse assistants working in Swedish nursing homes. Participants' experiences of working in nursing homes during the COVID-19 pandemic. Four manifest categories were found, namely: Balancing restrictions and allocation of scarce resources with care needs; Prioritizing and acting against moral values in advance care planning; Distrust in cooperation and Leadership and staff turnover - a factor for moral distress. The latent theme Experiences of handling ethical challenges caused by the COVID-19 pandemic gave a deeper meaning to the categories. During the pandemic, nursing home staff encountered ethical challenges that caused moral distress. Moral distress stemmed from not being given adequate conditions to perform their work properly, and thus not being able to give the residents adequate care. Another aspect of moral distress originated from feeling forced to act against their moral values when a course of action was considered to cause discomfort or harm to a resident. Alerting employers and policymakers to the harm and inequality experienced by staff and the difficulty in delivering appropriate care is essential. Making proposals for improvements and developing guidelines together with staff to recognize their role and to develop better guidance for good care is vital in order to support and sustain the nursing home workforce.

In trauma teams, coordination can be established through a centralised leader. The team can also use a decentralised strategy.In this descriptive study of video-recorded trauma resuscitations, using quantification of qualitative data, Social Network analysis of all real-time communications of eight in-real-life (IRL) and simulated trauma teams explained team social structure.The communication network structures in the simulated scenarios were more centralised using individually directed speech and had a high proportion of communication to up-date all team members. Such a structure might be the result of work performed in a complexity-stripped simulation environment where simplified task-executions required less interactions, or from work revolving around a deteriorating patient, imposing high demands on rapid decision-making and taskwork. Communication IRL was mostly decentralised, with more variability between cases, possibly due to unpredictability of the IRL case. The flexibility to act in a decentralised manner potentiates adaptability and seems beneficial in rapidly changing situations.

Corrigendum for the article Association Between Experimental Pain Thresholds and Trajectories of Postoperative Recovery Measures After Benign Hysterectomy

The aim of this study was to explore interaction of interprofessional hospital trauma teams. A theory about how team cognition is developed through a dynamical process was established using grounded theory methodology. Video recordings of in-real-life resuscitations performed in the emergency ward of a Scandinavian mid-size urban hospital were collected and eligible for inclusion using theoretical sampling. By analyzing interactions during seven trauma resuscitations, the theory that trauma teams perform patient assessment and resuscitation by alternating between two process modes, the two main categories “team positioning” and “sensitivity to the patient,” was generated. The core category “working with split vision” explicates how the teams interplay between the two modes to coordinate team focus with an emergent mental model of the specific situation. Split vision ensures that deeper aspects of the team, such as culture, knowledge, empathy, and patient needs are absorbed to continuously adapt team positioning and create precision in care for the specific patient.