Return to work after subacromial decompression, diagnostic arthroscopy, or exercise therapy for shoulder impingement : a randomised, placebo-surgery controlled FIMPACT clinical trial with five-year follow-up

Background: Arthroscopic subacromial decompression is one of the most commonly performed shoulder surgeries in the world. It is performed to treat patients with suspected shoulder impingement syndrome, i.e., subacromial pain syndrome. Only few studies have specifically assessed return-to-work rates after subacromial decompression surgery. All existing evidence comes from open, unblinded study designs and this lack of blinding introduces the potential for bias. We assessed return to work and its predictors in patients with shoulder impingement syndrome in a secondary analysis of a placebo-surgery controlled trial. Methods: One hundred eighty-four patients in a randomised trial had undergone arthroscopic subacromial decompression (n = 57), diagnostic arthroscopy, a placebo surgical intervention, (n = 59), or exercise therapy (n = 68). We assessed return to work, defined as having returned to work for at least two follow-up visits by the primary 24-month time point, work status at 24 and 60 months, and trajectories of return to work per follow-up time point. Patients and outcome assessors were blinded to the assignment regarding the arthroscopic subacromial decompression vs. diagnostic arthroscopy comparison. We assessed the treatment effect on the full analysis set as the difference between the groups in return-to-work rates and work status at 24 months and at 60 months using Chi-square test and the predictors of return to work with logistic regression analysis. Results: There was no difference in the trajectories of return to work between the study groups. By 24 months, 50 of 57 patients (88%) had returned to work in the arthroscopic subacromial decompression group, while the respective figures were 52 of 59 (88%) in the diagnostic arthroscopy group and 61 of 68 (90%) in the exercise therapy group. No clinically relevant predictors of return to work were found. The proportion of patients at work was 80% (147/184) at 24 months and 73% (124/184) at 60 months, with no difference between the treatment groups (p-values 0.842 and 0.943, respectively). Conclusions: Arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy or exercise therapy on return to work in patients with shoulder impingement syndrome. We did not find clinically relevant predictors of return to work either.Peer reviewe

Transoral Robotic Surgery in the Nordic Countries : Current Status and Perspectives

Background: The five Nordic countries with a population of 27 M people form a rather homogenous region in terms of health care. The management of head and neck cancer is centralized to the 21 university hospitals in these countries. Our aim was to gain an overview of the volume and role of transoral robotic surgery (TORS) and to evaluate the need to centralize it in this area as the field is rapidly developing. Materials and Methods: A structured questionnaire was sent to all 10 Departments of Otorhinolaryngology-Head and Neck Surgery in the Nordic countries having an active programme for TORS in December 2017. Results: The total cumulative number of performed robotic surgeries at these 10 Nordic centers was 528 and varied between 5 and 240 per center. The median annual number of robotic surgeries was 38 (range, 5-60). The observed number of annually operated cases remained fairly low ( Conclusions: The present results showing a limited volume of performed surgeries call for considerations to further centralize TORS in the Nordic countries.Peer reviewe

An adaptable application structure for multi-touch screens

Klassisk mus-interaktion har begränsningen att bara en punkt kan aktiveras på skärmen i taget. Interaktionen med de flesta applikationer blir, på grund av detta, sekventiell vilket kan vara en begränsning eftersom människan är van att utforska problem simultant med båda händerna. Flerpunktspekskärmar är en relativt ny teknik som möjliggör nya interaktionsmöjligheter där flera pekpunkter kan vara aktiva simultant. Det här examensarbetet fokuserar på problemen kring att skapa en applikation med användargränssnitt för flerpunktspekskärmar. Applikationen som utvecklats har en grundstruktur vilken är möjlig att vidareutveckla och på så sätt anpassas för att passa nya behov, till skillnad från de implementationer som granskats vid förstudien vilka fokuserar på att lösa specifika problem. Under examensarbetet har också en flerpunktspekskärm byggts av komponenter som kunnat köpas i detaljhandeln.Classical mouse interaction is limited in that only a single screen point at a time can be activated. Most application interaction is, due to this, performed in a sequential manner. This may be a limiting factor as humans by nature explore problems with both hands simultaneously. Multi-touch screens are a relatively new type of technology that enables new ways of interaction where multiple touch points can exist simultaneously. This thesis focuses on the problem with developing an application with a user interface designed for multi-touch screens. The application that has been developed defines a base structure from which future applications can be developed, unlike implementations examined in the feasibility study which mainly focus on solving specific problems. A multi-touch screen is also built using standard off the shelf components