Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.1.5 continued Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Grant 1992 [15] USA RCT Comparison of two broadspectrum cephalasporins. Multicenter (8 hospitals). Blinded high-risk pts (obesity, >70 years, acute cholecystitis, DM, obstructive jaundice). Bile cultures. SSI defined. n=292 I1: Cefanandole 1 g iv 30 min prior to skin incision (n=144) I2: Cefotaxime 1 g iv at same schedule (n=148) SSI I1: 6 pts (4%) I2: 2 pts (1%) No difference. 55% positive cultures. Infections ocurred in high-risk pts Not stated Moderate Hjortrup 1991 [17] Denmark RCT Compare to cephalosporins. with OC, high risk for infection – not defined. Sealed envelopes. SSI defined. Power calculation. n=219 Follow-up 4 weeks. I: Ceftriaxone 1 g iv at skin incision (n=112) C: 1.5 g cefuroxime iv at skin incision + 8 h (n=107) Wound infection I: 3 pts (3%) C: 4 pts (4%) Intraabdominal abscess I: 1 pt (1%) C: 2 pts (2%) None Moderate No difference. High risk not defined Hjortrup 1991 [17] Denmark RCT Compare one dose to two doses. OC – high risk, not defined. SSI defined. Sealed envelopes. Power calculation. n=219 Follow-up 4 weeks I1: Ceftriaxone 1 g iv at skin incision (n=112) I2: Ceftriaxone 1.5 g at skin incision + 1 dose 8 h later (n=107) SSI I1: 4 pts I2: 6 pts None Moderate One dose as effective. High risk not defined Krajden 1993 [18] Canada RCT High-risk pats with OC. Age >70 years, acute cholecystitis, obstructive jaundice, CBC, previous biliary surgery, diabetes, uremia, immuno-suppressive drugs. Randomisation by computer. n=103 Follow-up 6 weeks I1: Piperacillin 2 g iv < lb before op and q 6 h for 24 h (n=41). I2: Cefazolin 1 g iv as above schedule (n=40) SSI I1: 3 pts I2: 1 pt 22 reasons not given High Defined high-risk pts. From cultures it was shown that all isolated were sensitive to piperacillin but only 60% to cefazolin The table continues on the next page 110 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 111
Table 4.1.5 continued Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Leaper 1986 [28] United Kingdom RCT Compare 3rd generation cephalosporin to routine. n=100 Follow-up 6 weeks. I1: Cefotetan 1 g iv at induction of anesthesia I2: Cephazolin 1 g iv induction of anesthesia Wound infection I1: 0 pts I2: 5 pts Chest infection I1: 5 pts I2: 6 pts 6 pts violation Moderate Equally effective. Placebo unethical. Cultures without reaction to infection. Cefotetan: good penetration to site Lewis 1995 [13] Canada RCT Clean surgery. 52 thyroid/ head and neck; 112 breast; biliary 225; other laparotomy 120; vascular 92; hernia 165. High/low risk. (Contamination, length of op) SSI defined. Blinded. Sample size of 800 pts calculated. n=775 Follow-up 6 weeks I: Cefotaxime 2 g iv at call for operation C: Placebo SSI I: 3/306 low-risk pts 2/70 high-risk pts C: 12/306 lowrisk pts 4/86 high-risk pts 23 pts Moderate Mixture of pts. Conclude that prophylactic ab is of benefit, but questionally proven Mayer 1982 [31] United Kingdom RCT Consecutive pts in one surgeon’s hand. Carefully controlled. Randomisation. SSI defined. Blinded. All types of gastrointestinal surgery. n=500 Follow-up 4 weeks I: Cephaloridine 1 g iv at induction of anesthesia C: Cefuroxime 1.5 g iv at induction of anasthesia SSI I: Gallbladder 6/45 pts (11.1%), Gastrodueodenal 1/15 pts (6.7%), C: Gallbladder 4/47 pts (8.5%), Gastroduodenal 3/24 pts (12.5%) Moderate One surgeon series. Admits risk of type II error. No difference between groups Cephaloridine most cost effective McArdle 1991 [21] United Kingdom Open study with random allocation. Cefuroxime or ciprofloxacin iv; Ciprofoxacin po. Bile tract surgery, mostly OC, mostly elective. Relation bile culture, post-op infection. Follow-up 4 weeks I1: Cefuroxime 1.5 mg iv on induction (n=69) I2: Ciprofloxacin 200 mg iv on induction (n=67) I3: Ciprofoxacin 750 mg po 1 hour before anesthesia (n=72) Positive cultures I1: 32% I2: 33% I3: 32% Wound infection I1: 7 pts (10.9%) I2: 6 pts (9.7%) I3: 6 pts (9%) Moderate Relation of infection and positive culture. Choice of antibiotics should be governed by costs The table continues on the next page 112 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 113
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Antibiotikaprofylax vid kirurgiska
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Antibiotikaprofylax vid kirurgiska
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3. Antibiotikaprofylax - praxis 57
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Har antibiotikaimpregnerade grafter
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Resultat av litteratursökningen oc
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4.11 Sluten inläggning av thoraxdr
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5. Infektionsprofylax utan antibiot
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SBU:s sammanfattning och slutsatser
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Bakgrund och syfte Antibiotika i pr
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arhet. Kvalitetsgranskningen av de
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Det vetenskapliga underlaget saknas
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tagning av livmoder (måttligt star
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Bröstcancerkirurgi • Vid bröstc
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sårinfektion, empyem (varansamling
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• Antibiotikaprofylax vid öppen
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Infektiös endokardit Infektiös en
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• Endovaskulära ingrepp, speciel
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1.2 Avgränsningar Projektet omfatt
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Tabell 1.1 Effektmått förutom pos
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Tabell 1.2 fortsättning Antal bakt
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Proteinbindning Många antibiotika
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Till allmänna faktorer räknas ock
Page 49 and 50: 2. Metodik för systematisk littera
Page 51 and 52: Figur 2.1 Granskningsprocessen. Fas
Page 53 and 54: Evidensstyrkan graderades i fyra ni
Page 55 and 56: 3. Antibiotikaprofylax - praxis KAP
Page 57 and 58: 3.1 Praxisundersökning om användn
Page 59 and 60: 100 90 80 70 Procent Ja-svar 60 50
Page 61 and 62: De 37 kliniker som uppgav att de re
Page 63 and 64: Urologi Samtliga 13 kliniker som be
Page 65 and 66: Tabell 3.1.2 Finns skriftliga anvis
Page 67 and 68: 72 antibiotikaprofylax vid kirurgis
Page 69 and 70: esistens). STRAMA-gruppen har delat
Page 71 and 72: Tabell 3.2.2 fortsättning Preparat
Page 73 and 74: Tabell 3.2.2 fortsättning Preparat
Page 76 and 77: 4. Den systematiska litteraturöver
Page 78 and 79: 4.1 Antibiotikaprofylax vid gastroi
Page 80 and 81: • Blindtarmsinflammation: Antibio
Page 82 and 83: Frågeställningar • Vilken typ a
Page 84 and 85: Weber och medarbetare publicerade 2
Page 86 and 87: Accidentell perforation under opera
Page 88 and 89: Ventrikelkirurgi (Tabell 4.1.10) Ba
Page 90 and 91: Det finns idag inga RCT av antibiot
Page 92 and 93: Table 4.1.3 Timing. Author Year Ref
Page 94 and 95: Table 4.1.4 continued Author Year R
Page 102 and 103: Table 4.1.6 ERCP. Author Year Refer
Page 104 and 105: Table 4.1.9 Oesophagus. Author Year
Page 106 and 107: Table 4.1.10 continued Author Year
Page 110 and 111: Table 4.1.12 Hernia repair. Author
Page 114 and 115: Table 4.1.13 Appendectomy. Author Y
Page 116 and 117: Referenser 1. Bai Y, Gao F, Gao J,
Page 118 and 119: laxis during elective upper gastroi
Page 120 and 121: 57. Sanchez-Manuel FJ, Lozano Garci
Page 122 and 123: 152 antibiotikaprofylax vid kirurgi
Page 124 and 125: • De flesta studier har jämfört
Page 126 and 127: Frågeställningar • Vilken antib
Page 128 and 129: (RR = 0,41; 95 procent KI = 0,23-0,
Page 130 and 131: Diskussion Idag använder 67 procen
Page 132 and 133: Table 4.2.2 Elective colorectal sur
Page 142 and 143: Table 4.2.3 Elective colorectal sur
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Page 146 and 147: Bakgrund Infektioner hos patienter
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Beskrivning av studier och resultat
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Table 4.3.2 Vascular surgery. Autho
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Table 4.3.2 continued Author Year R
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Table 4.3.3 Low study quality and r
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Referenser 1. Christenson JT, Eklof
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a randomized, prospective trial. So
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Elektivt sectio (generellt) • Ant
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Transcervikala intrauterina ingrepp
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Vid bakteriell vaginos som kan vara
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endometrit (1 procent vs 5 procent)
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[4]. Inga av de förhållandevis f
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frekvens av infektioner efter profy
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Det finns inga data som visar att f
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Sterilisering I en stor studie frå
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Table 4.4.2 Caesarean section, anti
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Table 4.4.3 Caesarean section, comp
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Table 4.4.5 Caesarean section, mult
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Table 4.4.8 Hysterectomy, antibioti
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Table 4.4.10 Hysterectomy, duration
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Table 4.4.12 continued Author Year
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Table 4.4.14 Intrauterine contracep
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15. Sullivan SA, Smith T, Chang E,
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hysterectomy. Clin Infect Dis 1995;
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urethropexy. Journal of Pelvic Medi
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97. Mangioni C, Bianchi L, Bolis PF
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4.5 Antibiotikaprofylax vid ortoped
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inte sällan i kronisk form. Insät
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Inklusionskriterier Enbart prospekt
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och medarbetare från år 1987 [9]
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(från 1998) samtidigt som man helt
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KAPITEL 4 • den systematiska litt
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Thomsen 1990 [44] Denmark RCT, open
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Table 4.5.3 Closed fractures; durat
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Table 4.5.5 Studies comparing diffe
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Table 4.5.7 Prosthesis, different d
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Table 4.5.9 Prosthesis and antibiot
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Table 4.5.11 Low study quality and
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prophylaxis in trochanteric hip fra
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45. Nungu KS, Olerud C, Rehnberg L,
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324 antibiotikaprofylax vid kirurgi
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Det är oklart om antibiotikaprofyl
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Två artiklar med medelhög kvalite
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Övrig plastikkirurgi Två artiklar
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Table 4.6.2 Skin surgery. Author Ye
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Table 4.6.3 Breast surgery. Author
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Table 4.6.4 Abdominoplasty. Author
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Referenser 1. Amland PF, Andenaes K
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I en del situationer görs en omede
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Bröstcancerbehandling har genomgå
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Table 4.7.2 Breast cancer operation
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4.8 Antibiotikaprofylax vid hjärtk
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Det finns flera för hjärtkirurgi
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Bakteriologi/bakteriologisk miljö
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Alternativ till antibiotikaprofylax
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Preparatval (Tabell 4.8.3) Det stor
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av dessa studier för få patienter
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studier av effektivitet och resiste
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Table 4.8.3 Choice of antibiotics.
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Table 4.8.5 Alternatives to intrave
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14. Kadurugamuwa JL, Beveridge TJ.
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infections after cardiac surgery: a
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4.9 Antibiotikaprofylax vid implant
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KAPITEL 4 • den systematiska litt
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4.10 Antibiotikaprofylax vid allmä
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tionstekniken har även ändrats se
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penicillin och ett dygns cefuroxim
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etiologi som uppkomstmekanism. Dett
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Referenser 1. Aznar R, Mateu M, Mir
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Tabell 4.11.1 Antibiotikaprofylax j
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medelhög kvalitet. Fyra av de ing
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av hemothorax har vidare angivits s
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Table 4.11.1 Penetrating injuries o
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Referenser 1. Fallon WF, Jr, Wears
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• Stötvågsbehandling av njurste
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ersatt den öppna kirurgin för van
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är fastställd. I en undersökning
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0 och 5,1 procent hos patienter uta
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Här följer några exempel: Abdomi
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infektion. Det finns i de redovisad
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Table 4.12.3 Cystoscopy. Author Yea
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Table 4.12.4 Transrectal prostatic
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Table 4.12.6 Transurethral resectio
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Table 4.12.8 Extracorporeal Shockwa
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Table 4.12.10 Percutaneous nephroli
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Referenser 1. Berry A, Barratt A. P
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cin and chloramphenicol. Int Braz J
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urine culture and sensitivity are b
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• Det vetenskapliga underlaget f
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Kirurgiska ingrepp inom öron-näsa
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ständiga artiklarna resulterade i
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Cancerkirurgi (Tabell 4.13.5) En RC
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Sinuskirurgi (Tabell 4.13.8) En ran
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Typ av antibiotika och dos varierad
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Table 4.13.3 Tonsillectomy. Author
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Table 4.13.5 Cancer. Author Year Re
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Table 4.13.6 Rhinosurgery. Author Y
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and neck oncologic surgery. Ann Oto
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• Det vetenskapliga underlaget ä
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Frågeställningar • Vid vilka ki
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Anomalikirurgi (Tabell 4.14.3) Anom
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Övriga kirurgiska ingrepp i käkar
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utförde Lockhart och medarbetare (
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Table 4.14.2 Third molar surgery. A
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Table 4.14.3 Orthognatic surgery. A
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Table 4.14.4 Implant surgery. Autho
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Table 4.14.6 Other dentoalveolar su
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Table 4.14.8 Low quality and releva
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Referenser 1. Esposito M, Grusovin
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preoperative single-dose clindamyci
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• Sjukvården får kostnader för
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358 (p
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Table 4.15.1 Antibiotic prophylaxis
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Table 4.15.2 Antibiotic prophylaxis
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5. Infektionsprofylax utan antibiot
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frekvensen postoperativa sårinfekt
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6. Etiska aspekter Infektioner rela
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komplikation roll. Vissa komplikati
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• Hur garanterades bästa möjlig
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Etisk analys med hjälp av aktörsm
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Referens 1. Hermerén G. Kunskapens
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Granskningen av hälsoekonomisk lit
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Distala Duodenum E Coli ”Efficien
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KNS Kolecystektomi Kolecystit Koled
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Preoperativa Protesendokoardit Pseu
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9. Projektgrupp, externa granskare,
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Adjungerade Mats Bergström Läkare
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Principal Investigator för Sepsiss
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Därutöver konsult/rådgivningsarv
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Rapporter publicerade av SBU Gula r
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Självtestning och egenvård vid an
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