Browsing by Author "Nilsson, Olof"

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    Reasons for and outcomes of performing secondary patella resurfacing after total knee arthroplasy
    (2021-08-03) Nilsson, Olof; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
    This study aims to investigate reasons for and outcomes of performing Secondary Patella Resurfacing (SPR) after Total Knee Arthroplasty (TKA). Since there is no consensus regarding whether to perform primary patella resurfacing along with TKA or not it is of interest to study the patients undergoing SPR in order to shed some light on the usefulness of this surgery. Methods: This is a descriptive case-series study conducted at Lund University Hospital, including patients from all hospitals in region Skåne. Data has been extracted from a registry for orthopedic surgery, patient journals and from X-ray images. Logistic regression is used to compute odds ratios for risk of re-revision. Patient Reported Outcome Measures (PROM) have been used to investigate the impact of SPR on patients. Results: The most common cause for SPR is found to be progression of femuropatellar osteoarthritis (66.7%). The risk of re-revision is high; 6.3%, 9.4% respective 12.1% at one year, five years respective ten years after SPR. Only a small proportion of all cases of TKA (1.05%) has had their patella resurfaced. The risk of re-revision is found to be greater for men than for women, odds ratios 9.6, 5.2 respective 6.1 at one year, five years respective ten years after SPR. Corresponding hazard ratios 8.9, 4.9 respective 5.5. Patients belonging to ASA class 3 are more likely to undergo re-revision than ASA 1 patients; odds ratios 10.7 respective 6.2 at one year respective five years after SPR. Corresponding hazard ratios being 9.3 respective 5.6. No such effect could be found at ten years after SPR. Surgical duration was found to significantly impact the risk of re-revision, but this result might have been affected by outliers. Comparison of Knee injury and Osteoarthritis Outcome scale (KOOS) and self-assessed pain according to Visual Analog Scale (VAS) before and one year after SPR indicates that, in general, patients undergoing SPR are benefited by the procedure. Self-assessed satisfaction (VAS) is in average 4.6. Conclusion: Femuropatellar osteoarthritis is the main reason for performing SPR. The prosthesis survival of SPR is not great, patients having a high risk of re-revision. predictors as to which SPR patients undergo re-revision; sex and ASA class. SPR seems to benefit the patients in general but the spread is large, making the outcome unpredictable. The patients are in general neither satisfied nor dissatisfied with the SPR. There seems to be merit to the policy of only performing primary patella resurfacing in special cases, although the high risk of complications for SPR indicates that it would be desirable to be able to predict which case patella resurfacing can be performed primarily in these cases.
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    Upplevelser av Deliberate Practice inom psykoterapi: att praktiskt träna på kliniska färdigheter i svenska vårdorganisationer
    (2022-03-17) Argani Olsson, Karl-Oskar; Nilsson, Olof; University of Gothenburg/ Department of Psychology; Göteborgs universitet/Psykologiska institutionen
    Yrkesverksamma psykologers kliniska arbete är i huvudsak praktiskt och ska i svenska vårdorganisationer enligt gällande lagstiftning ske enligt evidensbaserad praktik, vilket ställer höga krav på kompetens. Deliberate Practice (DP) är en relativ ny inlärningsmetod som möjliggör målinriktad och praktisk inlärning av psykoterapifärdigheter. I denna studie undersöktes yrkesverksamma psykologers erfarenheter av att träna kliniska färdigheter genom DP inom svenska vårdorganisationer, så kallad beteendeträning baserad på DP-principer. Ur åtta semistrukturerade intervjuer som analyserades med tematisk analys konstruerades fyra teman vilka illustrerar hur beteendeträningen interagerade med omgivande organisation. I intervjumaterialet framkom starka drivkrafter hos informanterna att skapa utrymme för att utveckla sin kliniska skicklighet med eller utan organisationens stöd. Utifrån intervjumaterialet framstod informanterna ta ansvar för hela sitt terapiutövande och såg det terapeutiska arbetet som ett hantverk och DP som ett verktyg att träna upp skicklighet. Det upplevdes gynnsamt om beteendeträningen var en del av ett gemensamt projekt tillsammans med organisationen och/eller kollegor snarare än ett enskilt projekt. Flera informanter upplevde en motsättning mellan att organisationen sätter värde på kvantitet avseende utförda patientbesök och beteendeträningens fokus på kvalitet i terapiarbetet. Resultatet diskuteras i relation till forskning om DP.