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Article: The Swedish Standardized Course of Care-Diagnostic Efficacy in Esophageal and Gastric Cancer.

Kanold, Philip / Nyhlin, Nils / Szabo, Eva / van Nieuwenhoven, Michiel

2023 Volume 13, Issue 23

Abstract: Fast-track pathways for diagnosing esophageal or gastric cancer (EGC) have been implemented in several European countries. In Sweden, symptoms such as dysphagia, early satiety, and other alarm symptoms call for a referral for gastroscopy, according to ... ...

Abstract	Fast-track pathways for diagnosing esophageal or gastric cancer (EGC) have been implemented in several European countries. In Sweden, symptoms such as dysphagia, early satiety, and other alarm symptoms call for a referral for gastroscopy, according to the Swedish Standardized Course of Care (SCC). The aim of this study was to evaluate the diagnostic yield of the SCC criteria for EGC, to review all known EGC cases in Region Örebro County between March 2017 and February 2021, and to compare referral indication(s), waiting times, and tumor stage. In our material, EGC was found in 6.2% of the SCC referrals. Esophageal dysphagia had a positive predictive value (PPV) of 5.6%. The criterion with the highest PPV for EGC was suspicious radiological findings, with a PPV of 24.5%. A total of 139 EGCs were diagnosed, 99 (71%) through other pathways than via the SCC. Waiting times were approximately 14 days longer for patients evaluated via non-SCC pathways. There was no statistically significant association between referral pathway and primary tumor characteristics. The results show that a majority of the current SCC criteria are poor predictors of EGC, and some alarm symptoms lack a sufficiently specific definition, e.g., dysphagia. Referral through this fast track does not seem to have a positive impact on disease outcomes.
Language	English
Publishing date	2023-12-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13233577
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Article: Colorectal Cancer Fast Tracks: Cancer Yield and the Predictive Value of Entry Criteria.

Uebel, Linnea / Kromodikoro, Indy / Nyhlin, Nils / van Nieuwenhoven, Michiel

Cancers

2023 Volume 15, Issue 19

Abstract: Background: Fast-track pathways for diagnosing colorectal cancer (CRC) have been implemented in several European countries. In Sweden, a substantial number of CRC are diagnosed via the Swedish Standardized Course of Care for colorectal cancer (SCC-CRC). ...

Abstract	Background: Fast-track pathways for diagnosing colorectal cancer (CRC) have been implemented in several European countries. In Sweden, a substantial number of CRC are diagnosed via the Swedish Standardized Course of Care for colorectal cancer (SCC-CRC). We evaluated the SCC-CRC in terms of CRC yield, and predictive values and odds ratios (OR) for the entry criteria. Methods: We retrospectively analyzed all 2539 patients referred for SCC-CRC colonoscopy between September 2016 and December 2020. Entry criteria and colonoscopy outcomes were analyzed. Results: CRC yield was 16.4%. Highest positive predictive values (PPVs) were seen for abnormal radiology (PPV 30.5%, OR 4.7 (95% CI 3.4-6.4) Conclusions: CRC yield from the SCC-CRC is slightly higher compared to other European fast tracks. A number of entry criteria showed no benefit towards assessing CRC risk. FIT testing should be included in CRC fast tracks to increase diagnostic efficacy.
Language	English
Publishing date	2023-09-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15194778
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Article ; Online: The effectiveness of the colorectal cancer referral pathway - identification of colorectal cancer in a Swedish region.

Andersson, Emilia / Nyhlin, Nils / van Nieuwenhoven, Michiel A

Scandinavian journal of gastroenterology

2021 Volume 56, Issue 5, Page(s) 552–558

Abstract: Introduction: To shorten the time for diagnosis of suspected colorectal cancer (CRC), a standardized colorectal cancer referral pathway (CCRP) was introduced in Sweden in September 2016. However, the effects of the CCRP are still uncertain, and CRC is ... ...

Abstract	Introduction: To shorten the time for diagnosis of suspected colorectal cancer (CRC), a standardized colorectal cancer referral pathway (CCRP) was introduced in Sweden in September 2016. However, the effects of the CCRP are still uncertain, and CRC is also found in patients undergoing a routine colonoscopy. Objective: To identify all CRC-cases in the Region Örebro County and to investigate Methods: Review of medical records of patients with CRC referred to the department of surgery in the Region Örebro County in 2016-2018 ( Results: In CRC-cases found through colonoscopy ( Conclusion: The CCRP did not appear to improve prognostic outcomes for CRC-patients.
MeSH term(s)	Colonoscopy ; Colorectal Neoplasms/diagnosis ; Early Detection of Cancer ; Humans ; Referral and Consultation ; Sweden ; Waiting Lists
Language	English
Publishing date	2021-03-22
Publishing country	England
Document type	Journal Article
ZDB-ID	82042-8
ISSN	1502-7708 ; 0036-5521
ISSN (online)	1502-7708
ISSN	0036-5521
DOI	10.1080/00365521.2021.1899276
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Article: The Effectiveness and Tolerability of a Very Low-Volume Bowel Preparation for Colonoscopy Compared to Low and High-Volume Polyethylene Glycol-Solutions in the Real-Life Setting.

Bednarska, Olga / Nyhlin, Nils / Schmidt, Peter Thelin / Johansson, Gabriele Wurm / Toth, Ervin / Lindfors, Perjohan

Diagnostics (Basel, Switzerland)

2022 Volume 12, Issue 5

Abstract: Adequate bowel cleansing is essential for high-quality colonoscopy. Recently, a new very low-volume 1 litre (1L) polyethylene glycol (PEG) plus ascorbate solution (ASC) has been introduced. Our aims were to assess the effectiveness and tolerability of ... ...

Abstract	Adequate bowel cleansing is essential for high-quality colonoscopy. Recently, a new very low-volume 1 litre (1L) polyethylene glycol (PEG) plus ascorbate solution (ASC) has been introduced. Our aims were to assess the effectiveness and tolerability of this product compared to low-volume 2L PEG-ASC and high-volume 4L PEG solutions, in a real-life setting. In six endoscopy units in Sweden, outpatients undergoing colonoscopy were either prescribed solutions according to local routines, or the very low-volume solution in split dose regimen. Bowel cleansing effectiveness and patient experience was assessed using the Boston Bowel preparation scale (BBPS) and a patient questionnaire. A total of 1098 patients (mean age 58 years, 52% women) were included. All subsegment and the total BBPS scores were significantly greater for 1L PEG-ASC in comparison to other solutions (p < 0.05 for 1L PEG-ASC and 4L PEG for transverse and left colon, otherwise p < 0.001). Nausea was more frequent with 1L PEG-ASC compared to 2L PEG-ASC (p < 0.001) and vomiting were more often reported compared to both other solutions (p < 0.01 and p < 0.05 for 2L PEG-ASC and 4L PEG, respectively). Smell, taste, and total experience was better for 1L PEG-ASC compared to 4L PEG (p < 0.001), and similar compared to the 2L PEG-ASC. In conclusion, 1L PEG-ASC leads to better bowel cleansing compared to 2L PEG-ASC or 4L PEG products, with similar or greater patient satisfaction.
Language	English
Publishing date	2022-05-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics12051155
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Book ; Thesis: Patients' experiences in the self-management of diabetes mellitus

Nyhlin, Kerstin T.

walking a fine line

(Umeå University medical dissertations ; N.s., 288)

1990

Author's details	by Kerstin Ternulf Nyhlin
Series title	Umeå University medical dissertations ; N.s., 288
Collection
Size	Getr. Zählung
Publishing country	Sweden
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Umeå, Univ., Diss., 1990
HBZ-ID	HT003981483
ISBN	91-7174-529-7 ; 978-91-7174-529-3
Database	Catalogue ZB MED Medicine, Health

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92 E 279

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Article ; Conference proceedings: THE EFFECTIVENESS AND TOLERABILITY OF VERY LOW VOLUME PREPARATION FOR COLONOSCOPY COMPARED TO STANDARD 2 L AND 4 L PEG-SOLUTIONS IN A REAL-LIFE SETTING

Nyhlin, N. / Bednarska, O. / Thelin Schmidt, P. / Wurm Johansson, G. / Toth, E. / Lindfors, P.

Endoscopy

2022 Volume 54, Issue S 01

Event/congress	ESGE Days 2022, Prague, Czech Republic, 2022-04-28
Language	English
Publishing date	2022-04-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	80120-3
ISSN	1438-8812 ; 0013-726X
ISSN (online)	1438-8812
ISSN	0013-726X
DOI	10.1055/s-0042-1745065
Database	Thieme publisher's database

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Zs.A 669: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 162: Show issues

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Article ; Online: Clinical outcomes and sick leave in relation to UDCA treatment in Swedish patients with primary biliary cholangitis.

Henriksson, Ida / Udumyan, Ruzan / Nilsson, Emma / Önnerhag, Kristina / Rorsman, Fredrik / Werner, Mårten / Marschall, Hanns-Ulrich / Wahlin, Staffan / Nyhlin, Nils

Scandinavian journal of gastroenterology

2022 Volume 58, Issue 1, Page(s) 70–75

Abstract: Objectives: Primary biliary cholangitis (PBC) is an autoimmune liver disease that may progress into liver cirrhosis. Ursodeoxycholic acid (UDCA) is known to prevent or delay the disease progression, but little is known about work incapacity in PBC ... ...

Abstract	Objectives: Primary biliary cholangitis (PBC) is an autoimmune liver disease that may progress into liver cirrhosis. Ursodeoxycholic acid (UDCA) is known to prevent or delay the disease progression, but little is known about work incapacity in PBC patients. We aimed to compare clinical outcomes (transplantation-free survival; cirrhosis development) and sick leave in patients with PBC with and without UDCA therapy. Methods: The medical records of 526 patients with PBC diagnosed from 2004 to 2016 were reviewed retrospectively. Sick leave data retrieved from the Swedish Social Insurance Agency were analysed for a sub-cohort of patients and matched controls. Cox regression was used for analysis of clinical outcomes. Logistic and conditional logistic regressions were used for sick leave analysis. Results: A total of 10.6% of patients died and 3.4% received liver transplantation over a median follow-up time of 5.7 years. UDCA-untreated patients (HR 3.62 (95%CI 2.02-6.49)) and UDCA non-responders (HR 3.78 (95% CI 1.87-7.66)) had higher mortality or transplantation rates than UDCA responders. Patients with PBC had higher odds of sick leave (OR 2.50; 95% CI 1.69-3.70) than matched controls. Untreated patients were more likely to be on sick leave (OR 3.22; 95% CI 1.12-9.25) two years after diagnosis than UDCA responders. Conclusion: Both untreated patients and UDCA non-responders had lower liver transplantation-free survival rates than UDCA responders. Patients with PBC were more likely to be on sick leave compared to matched controls from the general population.
MeSH term(s)	Humans ; Ursodeoxycholic Acid/therapeutic use ; Liver Cirrhosis, Biliary/drug therapy ; Retrospective Studies ; Cholagogues and Choleretics/therapeutic use ; Sick Leave ; Sweden ; Treatment Outcome
Chemical Substances	Ursodeoxycholic Acid (724L30Y2QR) ; Cholagogues and Choleretics
Language	English
Publishing date	2022-08-21
Publishing country	England
Document type	Journal Article
ZDB-ID	82042-8
ISSN	1502-7708 ; 0036-5521
ISSN (online)	1502-7708
ISSN	0036-5521
DOI	10.1080/00365521.2022.2103729
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Article ; Online: Prospective surveillance for cholangiocarcinoma in unselected individuals with primary sclerosing cholangitis.

Villard, Christina / Friis-Liby, Ingalill / Rorsman, Fredrik / Said, Karouk / Warnqvist, Anna / Cornillet, Martin / Kechagias, Stergios / Nyhlin, Nils / Werner, Mårten / Janczewska, Izabella / Hagström, Therese / Nilsson, Emma / Bergquist, Annika

Journal of hepatology

2022 Volume 78, Issue 3, Page(s) 604–613

Abstract: ... The primary indication for LT (n = 54) was biliary dysplasia in nine patients (17%) and ...

Abstract	Background & aims: The evidence for hepatobiliary tumour surveillance in patients with primary sclerosing cholangitis (PSC) is scarce. In this study, we aimed to prospectively evaluate cholangiocarcinoma (CCA) surveillance with yearly MRI with cholangiopancreatography (MRI/MRCP) in a nationwide cohort. Methods: In total, 512 patients with PSC from 11 Swedish hospitals were recruited. The study protocol included yearly clinical follow-ups, liver function tests and contrast-enhanced MRI/MRCP and carbohydrate antigen (CA) 19-9. Patients with severe/progressive bile duct changes on MRI/MRCP were further investigated with endoscopic retrograde cholangiopancreatography. Patients were followed for 5 years or until a diagnosis of CCA, liver transplantation (LT) and/or death. Risk factors associated with CCA were analysed with Cox regression. Results: Eleven patients (2%) were diagnosed with CCA, and two (0.5%) with high-grade bile duct dysplasia. Severe/progressive bile duct changes on MRI/MRCP were detected in 122 patients (24%), of whom 10% had an underlying malignancy. The primary indication for LT (n = 54) was biliary dysplasia in nine patients (17%) and end-stage liver disease in 45 patients (83%), of whom three patients (7%) had unexpected malignancy in the explants. The median survival for patients with CCA was 13 months (3-22 months). Time to diagnosis of high-grade dysplasia and/or hepatobiliary malignancy was significantly associated with severe/progressive bile duct changes on MRI/MRCP (hazard ratio 10.50; 95% CI 2.49-44.31) and increased levels of CA19-9 (hazard ratio 1.00; 95% CI 1.00-1.01). Conclusion: In an unselected cohort of patients with PSC, yearly CA19-9 and MRI/MRCP surveillance followed by ERCP was ineffective in detecting cancer early enough to support long-term survival. Given the low occurrence of CCA, studies on individualised strategies for follow-up and improved diagnostic methods for PSC-related CCA are warranted. Impact and implications: A prospective nationwide 5-year study was conducted to evaluate yearly cholangiocarcinoma surveillance using MRI and CA19-9 in patients with primary sclerosing cholangitis. Only 2% of the patients were diagnosed with cholangiocarcinoma during follow-up and their prognosis remained poor despite surveillance. This surveillance strategy failed to detect cancer early enough to support long-term survival. Therefore, individualised strategies and improved diagnostic methods will be required to improve the early detection of cholangiocarcinoma in patients with primary sclerosing cholangitis.
MeSH term(s)	Humans ; Cholangitis, Sclerosing/diagnosis ; CA-19-9 Antigen ; Prospective Studies ; Bile Duct Neoplasms/pathology ; Cholangiocarcinoma/pathology ; Bile Ducts, Intrahepatic/pathology
Chemical Substances	CA-19-9 Antigen
Language	English
Publishing date	2022-11-19
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605953-3
ISSN	1600-0641 ; 0168-8278
ISSN (online)	1600-0641
ISSN	0168-8278
DOI	10.1016/j.jhep.2022.11.011
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Article ; Online: Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine.

Giannakopoulos, Georgios / Verbaan, Hans / Friis-Liby, Inga-Lill / Sangfelt, Per / Nyhlin, Nils / Almer, Sven

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

2018 Volume 51, Issue 2, Page(s) 253–257

Abstract: ... events (n = 14, 64%), lack of remission (n = 5, 23%) or a combination (n = 3, 13%).: Results ... aminotransferase levels were obtained (n = 3) or maintained (n = 7) in 10 patients (45%) after three to 30 weeks ...

Abstract	Background: Data on rescue treatment of autoimmune hepatitis in patients that fail standard treatment are sparse. Aims: To report our long-term experience with mycophenolate mofetil. Methods: Retrospective study in 22 patients with autoimmune hepatitis who failed azathioprine and prednisolone due to adverse events (n = 14, 64%), lack of remission (n = 5, 23%) or a combination (n = 3, 13%). Results: Mycophenolate mofetil was started at a dose of 20 mg/kg/day and increased to a maximum of 3 g/day. Follow-up was 0-6 months in 7 patients; more than 12 months in 15 (68%) and more than 24 months in 10. Normal aminotransferase levels were obtained (n = 3) or maintained (n = 7) in 10 patients (45%) after three to 30 weeks. 12 patients (55%) were withdrawn during the first 6 months, due to adverse events. Three patients were switched to cyclosporine and one underwent liver transplantation. Successful treatment with mycophenolate mofetil continued in 10 patients (45%) for a median of 71 months (range 20-124). Of these, one stopped prednisolone, five have a prednisolone dose <5 mg daily and four patients 5-10 mg. Conclusion: Approximately one of two patients with autoimmune hepatitis that fail standard treatment benefit from long-term maintenance with mycophenolate mofetil, especially those with previous intolerance to thiopurines, where mycophenolate mofetil is effective in two thirds.
MeSH term(s)	Adolescent ; Adult ; Aged ; Alanine Transaminase/blood ; Azathioprine/administration & dosage ; Azathioprine/adverse effects ; Drug Monitoring/methods ; Drug Resistance ; Drug Substitution/methods ; Female ; Hepatitis, Autoimmune/blood ; Hepatitis, Autoimmune/diagnosis ; Hepatitis, Autoimmune/drug therapy ; Hepatitis, Autoimmune/epidemiology ; Humans ; Immunosuppressive Agents/administration & dosage ; Immunosuppressive Agents/adverse effects ; Liver Function Tests/methods ; Maintenance Chemotherapy/methods ; Maintenance Chemotherapy/statistics & numerical data ; Male ; Mycophenolic Acid/administration & dosage ; Mycophenolic Acid/adverse effects ; Prednisolone/administration & dosage ; Prednisolone/adverse effects ; Retrospective Studies ; Sweden/epidemiology ; Treatment Outcome
Chemical Substances	Immunosuppressive Agents ; Prednisolone (9PHQ9Y1OLM) ; Alanine Transaminase (EC 2.6.1.2) ; Mycophenolic Acid (HU9DX48N0T) ; Azathioprine (MRK240IY2L)
Language	English
Publishing date	2018-10-12
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1459373-7
ISSN	1878-3562 ; 1125-8055
ISSN (online)	1878-3562
ISSN	1125-8055
DOI	10.1016/j.dld.2018.10.004
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Article ; Online: Time and Motion at the Endoscopy Unit-A University Hospital Experience.

Söderberg, Simon / Nyhlin, Nils / Moro, Axelina / Figaro, Christina / Fransson, Emelie / Stefansdotter, Jennie / Schagerström, Malin / Lindblad, Maria / Ahlzén, Martin / Zukovets, Olga / Borell, Sofia / Johansson, Viktoria / Axman, Marianne / Wendt, Anette / Falck, Hanna / van Nieuwenhoven, Michiel A

Health services research and managerial epidemiology

2023 Volume 10, Page(s) 23333928231159808

Abstract: Background/aims: An effective workflow at the endoscopy unit is important for optimal production. We conducted a time-and-motion study to identify the amount of time that patients spend during the different steps of a regular endoscopy procedure and ... ...

Abstract	Background/aims: An effective workflow at the endoscopy unit is important for optimal production. We conducted a time-and-motion study to identify the amount of time that patients spend during the different steps of a regular endoscopy procedure and compared propofol with midazolam sedation. Methods: Data from 376 patients were prospectively collected. Durations of the different procedure steps were measured. Correlations between recovery times, age, and dose of sedative were calculated. Multiple regression analysis was performed to evaluate how various factors affect recovery time. Results: The use of midazolam resulted in significantly shorter procedure duration for gastroscopy (5.1 vs 8.3 min), shorter endoscopist delay duration for either types of endoscopy (5.9 vs 8.3 min for gastroscopy and 6.7 vs 11.4 min for colonoscopy), shorter endoscopy room duration for gastroscopy (22.2 vs 30.0 min), shorter recovery time for colonoscopy (23.4 vs 27.4 min) and shorter Endoscopy Unit Duration for either type of endoscopy (77.1 vs 101.4 min for gastroscopy and 99.6 vs 123.2 min for colonoscopy). There was a weak correlation between dose of midazolam and recovery time. Conclusions: In contrast to other studies, propofol administration leads to more time spent at different steps in the workflow at our unit. Implementing propofol sedation will not improve efficacy if other steps in the workflow are not taken into account.
Language	English
Publishing date	2023-03-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2805732-6
ISSN	2333-3928 ; 2333-3928
ISSN (online)	2333-3928
ISSN	2333-3928
DOI	10.1177/23333928231159808
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