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Sandberg, Anna
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Publications (3 of 3) Show all publications
Granberg Sandlund, M., Diamant, A., Granåsen, G. & Salzer, J. (2019). Effectiveness of care in acute dizziness presentations. European Archives of Oto-Rhino-Laryngology, 276(9), 2389-2396
Open this publication in new window or tab >>Effectiveness of care in acute dizziness presentations
2019 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 276, no 9, p. 2389-2396Article in journal (Refereed) Published
Abstract [en]

Purpose: This study aims to evaluate whether a management algorithm has improved the effectiveness of care for dizzy patients at Umea University Hospital.

Methods: This was an interventional study using medical records to collect data for acute dizziness presentations before (period 1, 2012-2014) and after (period 2, 2016-2017) the implementation of a management algorithm. Outcomes were changes in a set of pre-defined effectiveness markers and health economic effects.

Results: Total n = 2126 and n = 1487 acute dizziness presentations were identified in period 1 and 2, respectively. Baseline characteristics were similar. The proportion of patients undergoing Dix-Hallpike testing increased, 20.8% [95% confidence interval (CI) 18.8-23.0%] vs. 37.7% (95% CI 35.2-40.2%), as did BPPV diagnoses, 7.6% (95% CI 6.6-8.8%) vs. 15.3% (95% CI 13.6-17.3%). Hospitalization became less common, 61.5% (95% CI 59.4-63.6%) vs. 47.6% (95% CI 45.1-50.2%). The proportion undergoing any neuroradiological investigation decreased, 44.8% (95% CI 42.7-47.0%) vs. 36.3% (95% CI 33.8-38.7%) with a shift from CT to MRI, with unchanged sensitivity for diagnosing cerebrovascular causes. The average cost for the care of one dizzy patient decreased from $2561 during period 1 to $1808 during period 2.

Conclusions: This study shows that the implementation of a management algorithm for dizzy patients was associated with improved effectiveness of care.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Dizziness, Vertigo, Health economics, Management algorithms, Effectiveness of care
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:umu:diva-162655 (URN)10.1007/s00405-019-05470-0 (DOI)000478901700003 ()31098875 (PubMedID)2-s2.0-85066050193 (Scopus ID)
Available from: 2019-09-05 Created: 2019-09-05 Last updated: 2023-03-24Bibliographically approved
Granberg Sandlund, M., Diamant, A., Granåsen, G. & Salzer, J. (2019). Quality of care in acute dizziness presentations. Paper presented at 5th Congress of the European Academy of Neurology, Oslo, Norway, June 29 – July 2, 2019. European Journal of Neurology, 26(S1), 926-926
Open this publication in new window or tab >>Quality of care in acute dizziness presentations
2019 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 26, no S1, p. 926-926Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background and aims: Dizziness is a common symptom at emergency departments. Studies have shown poor quality of care in acute dizziness presentations, including the overuse of computed tomography (CT) and failure to detect benign causes. This study aims to evaluate whether a management algorithm has improved the quality of care for dizzy patients at Umeå University Hospital, Sweden.

Methods: This was an interventional study using medical records to collect data for acute dizziness presentations before (period 1, 2012–2014) and after (period 2, 2016-2017) the implementation of a management algorithm (see figure). Outcomes were changes in a set of pre-defined quality markers and health economic effects.

Results: Total n=2126 and n=1487 acute dizziness presentations were identified in period 1 and 2, respectively. Baseline characteristics were similar. The proportion of patients undergoing Dix-Hallpike testing increased, 20.8% vs. 37.7%, (p<0.01), as did BPPV diagnoses, 7.6% vs. 15.3%, (p<0.01). Hospitalization became less common, 61.5% vs. 47.6% (p<0.01). The proportion undergoing any neuroradiological investigation decreased, 44.8% vs. 36.3% (p<0.01) with a shift from CT to MRI, with unchanged sensitivity for diagnosing cerebrovascular causes. The average cost for the care of one dizzy patient decreased from $2561 during period 1 to $1808 during period 2.

Conclusion: This study shows how the implementation of a management algorithm for dizzy patients can improve the quality of care and lower the expenses, without an increased number of missed stroke cases.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-161916 (URN)10.1111/ene.14019 (DOI)000474481004132 ()
Conference
5th Congress of the European Academy of Neurology, Oslo, Norway, June 29 – July 2, 2019
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-11-28Bibliographically approved
Törnqvist, G., Sandberg, A., Hägglund, A.-C. & Carlsson, L. (2010). Cyclic expression of lhx2 regulates hair formation.. PLoS genetics, 6(4), e1000904
Open this publication in new window or tab >>Cyclic expression of lhx2 regulates hair formation.
2010 (English)In: PLoS genetics, ISSN 1553-7404, Vol. 6, no 4, p. e1000904-Article in journal (Refereed) Published
Abstract [en]

Hair is important for thermoregulation, physical protection, sensory activity, seasonal camouflage, and social interactions. Hair is generated in hair follicles (HFs) and, following morphogenesis, HFs undergo cyclic phases of active growth (anagen), regression (catagen), and inactivity (telogen) throughout life. The transcriptional regulation of this process is not well understood. We show that the transcription factor Lhx2 is expressed in cells of the outer root sheath and a subpopulation of matrix cells during both morphogenesis and anagen. As the HFs enter telogen, expression becomes undetectable and reappears prior to initiation of anagen in the secondary hair germ. In contrast to previously published results, we find that Lhx2 is primarily expressed by precursor cells outside of the bulge region where the HF stem cells are located. This developmental, stage- and cell-specific expression suggests that Lhx2 regulates the generation and regeneration of hair. In support of this hypothesis, we show that Lhx2 is required for anagen progression and HF morphogenesis. Moreover, transgenic expression of Lhx2 in postnatal HFs is sufficient to induce anagen. Thus, our results reveal an alternative interpretation of Lhx2 function in HFs compared to previously published results, since Lhx2 is periodically expressed, primarily in precursor cells distinct from those in the bulge region, and is an essential positive regulator of hair formation.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-33655 (URN)10.1371/journal.pgen.1000904 (DOI)000277354200021 ()20386748 (PubMedID)2-s2.0-77952347826 (Scopus ID)
Available from: 2010-04-30 Created: 2010-04-30 Last updated: 2023-03-24Bibliographically approved
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