Linköping University Hospital

Objectives. In September 2019, the preferred surgical approach shifted for patients undergoing mitral valve (MV) surgery at our institution. The aim of this study was to compare minimally invasive surgery (MIS) with prior conventional sternotomy (CS) approach, to assess quality and safety of MIS in a non-high volume center. Methods. This single-center retrospective observational study comprised 254 patients, 102 CS patients and 152 MIS patients, who underwent MV surgery for mitral regurgitation with or without concomitant procedures (i.e. tricuspid valve surgery, atrial fibrillation ablation, closure of ASD) between January 2015 and October 2023. Results. CS patients were older with a higher preoperative risk profile. Mitral repair was the predominant procedure regardless of surgical approach. MIS had longer intraoperative times, yet were equal to CS in regard to myocardial injury, intensive care unit stay and postoperative complications. MIS had lower rates of permanent pacemaker insertions (4% vs. 13%; p < .014) and a shorter postoperative length of stay (5 vs. 7 days; p < .001). The 30-day mortality was low (1% vs 2%; p > .5). Proposed learning curve of MIS was demonstrated by a tendency of reduced intraoperative times with growing experience. Conclusions. MIS is a feasible alternative to the CS approach for MV surgery even at non-high volume centers. MV surgery with MIS results in a shorter postoperative length of stay, with comparable outcomes in terms of low mortality as well as surgical and postoperative morbidity. We believe that the prolonged intraoperative times will shorten with increased experience of these procedures.

Restless legs syndrome (RLS) is a common, neurological disease. Primary healthcare (PHC) nurses are often the patient's first contact, but studies regarding their experience assessing RLS-associated symptoms and treatment needs in telephone nursing (TN) are lacking.

To describe how PHC nurses experience symptoms and treatment needs of patients with RLS-associated symptoms during TN.

A descriptive abductive design, including semi-structured interviews with 18 PHC nurses from six Swedish regions. Data was deductively analyzed using the Four Habits communication model. Facilitators and barriers were inductively identified.

Invest in the beginning included the use of professional competence, interpretation of influencing factors at the start of the conversation and initial understanding of the patient's RLS symptoms. Elicit the patient's perspective involved originate from the patient's perception of the symptoms and comprehending the symptoms' impact on the patient's life situation. Relate to the patient's situation and the importance of trust in the patient meeting described demonstrating empathy. Invest in the end involved triaging patients with RLS-associated symptoms, providing self-care advice to patients with RLS-associated symptoms and achieving consensus at the end of the conversation.

Using the Four Habits communication model could enrich communication regarding RLS-associated symptoms and treatment needs during TN.

The purpose of this study was to describe and evaluate the effectiveness of a six-month structured bowel management programme (SBMP) for children with therapy-resistant functional constipation (FC).

A retrospective review of medical records with a pre-post design was conducted at an outpatient paediatric clinic in Sweden. Bowel frequency, stool form, faecal incontinence, and abdominal pain were compared before and after the intervention. Predictive factors for successful discharge and duration of care through long-term follow-up were calculated.

Of the 142 children enrolled in the SBMP, 132 completed the programme. Despite previous FC therapy resistance, the SBMP achieved a treatment success rate of 44 % within 6 months, and 58 % after 12 months. The need for additional contacts beyond those scheduled and persistent faecal leakage were significant predictors of non-recovery. Long-term follow-ups indicate that after 2 years of care, approximately 80 % of the children achieved recovery.

This study highlights the effectiveness of the SBMP in managing therapy-resistant FC in children at a general outpatient paediatric clinic, while also emphasising the necessity of long-term follow-up for sustainable results.

The results suggest that a structured care programme like the SBMP helps set realistic expectations and ensures consistent quality of care for children with FC, despite the severity and complexities involved.