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Franzén, Karin
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Publications (10 of 15) Show all publications
Wadensten, T., Nyström, E., Franzén, K., Stenzelius, K., Lindam, A. & Samuelsson, E. (2019). A smartphone app for self-management of urgency and mixed urinary incontinence: a randomized controlled trial. Paper presented at 49th Annual Meeting of the International-Continence-Society (ICS), Gothenburg, Sweden, September 3-6, 2019. Neurourology and Urodynamics, 38(S3), S361-S363
Open this publication in new window or tab >>A smartphone app for self-management of urgency and mixed urinary incontinence: a randomized controlled trial
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2019 (English)In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 38, no S3, p. S361-S363Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-75787 (URN)000477753000250 ()
Conference
49th Annual Meeting of the International-Continence-Society (ICS), Gothenburg, Sweden, September 3-6, 2019
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareThe Kamprad Family Foundation
Note

Funding Agency:

The Region Jämtland Härjedalen

Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2020-01-31Bibliographically approved
Jansson, M., Nilsson, K. & Franzén, K. (2019). Development and validation of a protocol for documentation of obstetric perineal lacerations. International Urogynecology Journal, 30(12), 2069-2076
Open this publication in new window or tab >>Development and validation of a protocol for documentation of obstetric perineal lacerations
2019 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 30, no 12, p. 2069-2076Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION AND HYPOTHESIS: The aim of this study was to develop a new protocol for documentation of perineal lacerations and to validate the latter against the most common obstetric record system in Sweden. The hypothesis was that the new protocol would render more complete data on perineal lacerations than the current documentation method.

METHODS: A protocol for documentation of perineal lacerations was developed to be sufficiently comprehensive to serve research purposes. All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the validation study. Perineal lacerations were documented using the protocol in parallel with the regular obstetric record system (ObstetriX). Cross tabulations were used to compare the coverage regarding perineal lacerations between the two documentation methods. McNemar's test was used to evaluate systematic differences between the methods.

RESULTS: A total of 187 women were included. The coverage of documentation regarding perineal laceration was significantly higher (p < 0.001) in the new protocol (89%) compared with ObstetriX (18%). Incidence of second-degree perineal tears was 26% according to the new protocol and 11% according to ObstetriX. The incidence of third-degree perineal tears A, B, and C was 2.7%, 2.1%, and 2.1%, respectively, according to the new protocol, and 3.2%, 2.7%, and 1.1% according to ObstetriX.

CONCLUSIONS: This validation study of a new documentation protocol showed that it delivered significantly more comprehensive information regarding perineal lacerations than the most common obstetric record system in Sweden.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Health administrative data, Obstetric anal sphincter injuries, Perineal tear, Validation studies
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-73244 (URN)10.1007/s00192-019-03915-y (DOI)000499749200011 ()30888454 (PubMedID)2-s2.0-85063196573 (Scopus ID)
Note

Funding Agency:

Research committee of Örebro County 

Available from: 2019-03-20 Created: 2019-03-20 Last updated: 2019-12-19Bibliographically approved
Wadensten, T., Nyström, E., Franzén, K., Stenzelius, K., Malmberg, L. & Samuelsson, E. (2018). DEVELOPMENT AND USE OF AN ALGORITHM FOR IDENTIFYING WOMEN WITH URGENCY OR MIXED URINARY INCONTINENCE SUITABLE FOR E-HEALTH TREATMENT. Paper presented at Meeting of the International-Continence-Society (ICS), Philadelphia, PA, USA, August 28-31, 2018. Neurourology and Urodynamics, 37(Suppl. 5), S72-S74
Open this publication in new window or tab >>DEVELOPMENT AND USE OF AN ALGORITHM FOR IDENTIFYING WOMEN WITH URGENCY OR MIXED URINARY INCONTINENCE SUITABLE FOR E-HEALTH TREATMENT
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2018 (English)In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 37, no Suppl. 5, p. S72-S74Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-68250 (URN)000437692900027 ()
Conference
Meeting of the International-Continence-Society (ICS), Philadelphia, PA, USA, August 28-31, 2018
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Note

Funding Agencies:

The Kamprad Family Foundation  

Region Jämtland Härjedalen 

Available from: 2018-07-27 Created: 2018-07-27 Last updated: 2018-09-11Bibliographically approved
Wijk, L., Franzén, K., Ljungqvist, O. & Nilsson, K. (2016). Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease. Gynecologic and Obstetric Investigation, 81(5), 461-467
Open this publication in new window or tab >>Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease
2016 (English)In: Gynecologic and Obstetric Investigation, ISSN 0378-7346, E-ISSN 1423-002X, Vol. 81, no 5, p. 461-467Article in journal (Refereed) Published
Abstract [en]

Background: The enhanced recovery after surgery (ERAS) protocol combines unimodal evidence-based interventions aiming to enhance recovery after surgery and reduce length of stay (LOS). We introduced an ERAS protocol in gynecological surgery and compared outcomes after hysterectomies performed for malignant vs. benign indications.

Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Örebro University Hospital, Sweden, among 121 consecutive patients undergoing abdominal hysterectomy and salpingo-oophorectomy for malignant (n = 40) or benign (n = 81) indications between 2012 and 2014. Clinical data were prospectively collected and extracted from the patient records and from a specific database. The primary outcomes were LOS and proportion of patients achieving target LOS (2 days).

Results: Patients operated for malignant vs. benign disease did not differ significantly in terms of LOS (2 (1-5) vs. 2 (1-11) days; p = 0.505), proportion discharged at target LOS (62 vs. 69%; p = 0.465; OR 0.74, 95% CI 0.3-1.6), complications (2 vs. 7% in primary stay, 8 vs. 11% within 30 days after discharge), re operations (0 vs. 2%), or readmissions (2 vs. 1%).

Conclusion: The ERAS protocol may be equally applicable to patients undergoing hysterectomy either for a malignant or for a benign disease.

Place, publisher, year, edition, pages
Basel: S. Karger, 2016
Keywords
ERAS, Fast-track, Hysterectomy, Length of stay, Perioperative care
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-53181 (URN)10.1159/000443396 (DOI)000384034700012 ()26799328 (PubMedID)2-s2.0-84955604181 (Scopus ID)
Note

Funding Agencies:

Research Committee of Örebro County Council

Nyckelfonden, Örebro, Sweden

Available from: 2016-10-24 Created: 2016-10-24 Last updated: 2018-07-17Bibliographically approved
Franzén, K. M., Andersson, G., Odeberg, J., Midlöv, P., Samuelsson, E., Stenzelius, K. & Hammarström, M. (2015). Surgery for urinary incontinence in women 65 years and older: a systematic review. International Urogynecology Journal, 26(8), 1095-1102
Open this publication in new window or tab >>Surgery for urinary incontinence in women 65 years and older: a systematic review
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2015 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 26, no 8, p. 1095-1102Article in journal (Refereed) Published
Abstract [en]

Introduction and hypothesis: Urinary incontinence (UI) is common among the elderly, but the literature is sparse on the surgical treatment of UI among the elderly. This systematic review aims to assess the effectiveness of surgical interventions as treatment for urinary incontinence in the elderly population ≥65 years of age.

Methods: Randomized controlled trials (RCT) and prospective nonrandomized studies (NRS) were included. The databases PubMed (NLM), EMBASE (Elsevier), Cochrane Library (Wiley), and Cinahl (EBSCO) were searched for the period 1966 up to October 2013. The population had to be ≥65 years of age and had to have undergone urethral sling procedures, periurethral injection of bulking agents, artificial urinary sphincter surgery, bladder injection treatment with onabotulinumtoxin A or sacral neuromodulation treatment. Eligible outcomes were episodes of incontinence/urine leakage, adverse events, and quality of life.

The studies included had to be at a moderate or low risk of bias. Mean difference (MD) or standard mean difference (SMD)as well as risk difference (RD) and the 95 % CI were calculated.

Results: Five studies-all on the suburethral sling procedure in women- that fulfilled the inclusion criteria were identified. The proportion of patients reporting persistent SUI after surgery ranged from 5.2 to 17.6 %. One study evaluating quality of life (QoL) showed a significant improvement after surgery. The complication rates varied between 1 and 26 %, mainly bladder perforation, bladder emptying disturbances, and de novo urge.

Conclusion: The suburethral sling procedure improves continence as well as QoL among elderly women with SUI; however, evidence is limited.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
Elderly; Surgery; Systematic review; Urinary incontinence
National Category
Urology and Nephrology Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-39470 (URN)10.1007/s00192-014-2573-9 (DOI)000361229500002 ()25477140 (PubMedID)2-s2.0-84938954854 (Scopus ID)
Note

Funding Agency:

Swedish Council on Technology Assessment in Health Care (SBU)

Available from: 2014-12-10 Created: 2014-12-10 Last updated: 2018-06-26Bibliographically approved
Stenzelius, K., Molander, U., Odeberg, J., Hammarström, M., Franzen, K. M., Midlöv, P., . . . Andersson, G. (2015). The effect of conservative treatment of urinary incontinence among older and frail older people: a systematic review. Age and Ageing, 44(5), 736-744
Open this publication in new window or tab >>The effect of conservative treatment of urinary incontinence among older and frail older people: a systematic review
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2015 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 5, p. 736-744Article in journal (Refereed) Published
Abstract [en]

Background: urinary incontinence (UI) is a common symptom among older people, with a higher prevalence among frail older persons living in nursing homes. Despite consequences such as reduced health and quality of life, many older people do not seek help for their symptoms, resulting in missed opportunity for treatment.

Objective: the aim of this study was to investigate the evidence and the effect of conservative treatment of UI and the quality of life among older and frail older persons.

Methods: a systematic review of randomised controlled studies and prospective, non-randomised studies was conducted, evaluating interventions of conservative treatment of UI in an older population (65 years or older). A total of 23 studies fulfilled the inclusion criteria and 9 were of high or moderate quality. Fourteen studies were of low quality and were therefore excluded from the analysis.

Results: documented and effective conservative treatments are available even for older persons with UI. Pelvic muscle exercise, physical training in combination with ADL, prompted voiding and attention training, and help to toilet are important treatments. In some studies, however, the evidence of effectiveness is limited.

Conclusions: this systematic review concludes that there are conservative treatments for UI for older and frail older persons that reduce leakage and increase quality of life. There is however a need for further high-quality studies.

Place, publisher, year, edition, pages
Oxford, United Kingdom: Oxford University Press, 2015
Keywords
Bladder training; Conservative treatment; Older and frail older; Older people; Pelvic floor exercise; Prompted voiding; Systematic review; Toilet assistance; Urinary incontinence
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:oru:diva-43570 (URN)10.1093/ageing/afv070 (DOI)000361388400006 ()26112402 (PubMedID)2-s2.0-84940663952 (Scopus ID)
Note

Funding Agency:

Swedish Council on Technology Assessment in Health Care (SBU)

Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2018-06-27Bibliographically approved
Samuelsson, E., Odeberg, J., Stenzelius, K., Molander, U., Hammarström, M., Franzén, K. M., . . . Midlöv, P. (2015). The effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: a systematic review. Geriatrics & Gerontology International, 15(5), 521-534
Open this publication in new window or tab >>The effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: a systematic review
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2015 (English)In: Geriatrics & Gerontology International, ISSN 1444-1586, E-ISSN 1447-0594, Vol. 15, no 5, p. 521-534Article in journal (Refereed) Published
Abstract [en]

Aim: The prevalence and severity of urinary incontinence (UI) increase with age and comorbidity. The benefits ofpharmacotherapy for UI in the elderly are questionable. The aim of the present study was to systematically review theefficacy of pharmacological treatment for UI in the elderly and frail elderly.

Methods: We searched PubMed, EMBASE, Cochrane library and Cinahl databases through October 2013 toidentify prospective controlled trials that evaluated pharmacological treatment for UI in persons aged ≥65 years.Elderly persons living in nursing homes were regarded as frail elderly. Outcomes were urinary leakage, quality of lifeand adverse events.

Results: We screened 1038 abstracts and assessed 309 full-text articles. We identified 13 trials of high or moderatequality; 11 evaluated anticholinergic drugs and two evaluated duloxetine. Oxybutynin, the only drug studied in thefrail elderly population, had no effect on urinary leakage or quality of life in elderly with urgency UI (UUI). Seven trialsevaluated the effects of darifenacin, fesoterodine, solifenacin, tolterodine or trospium. Urinary leakage decreased(standard mean difference: −0.24, 95% confidence interval −0.32–0.15), corresponding to a reduction of half a leakageper 24 h. Common side-effects of treatment were dry mouth and constipation. Data were insufficient for evaluationof the effect on quality of life or cognition. The evidence was insufficient to evaluate the effects of duloxetine. Noeligible studies on mirabegron and estrogen were found.

Conclusions: Anticholinergics have a small, but significant, effect on urinary leakage in older adults with UUI.Treatment with drugs for UUI in the frail elderly is not evidence based.

Keywords
elderly, frail elderly, pharmacotherapy, systematic review, urinary incontinence
National Category
Urology and Nephrology Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:oru:diva-39929 (URN)10.1111/ggi.12451 (DOI)000355732800001 ()25656412 (PubMedID)2-s2.0-84928209691 (Scopus ID)
Available from: 2014-12-19 Created: 2014-12-19 Last updated: 2017-12-05Bibliographically approved
Wijk, L., Franzén, K., Ljungqvist, O. & Nilsson, K. (2014). Implementing a structured Enhanced Recovery After Surgery (ERAS) protocol reduces length of stay after abdominal hysterectomy. Acta Obstetricia et Gynecologica Scandinavica, 93(8), 749-756
Open this publication in new window or tab >>Implementing a structured Enhanced Recovery After Surgery (ERAS) protocol reduces length of stay after abdominal hysterectomy
2014 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 8, p. 749-756Article in journal (Refereed) Published
Abstract [en]

Objective: To study the effects of introducing an Enhanced Recovery After Surgery (ERAS) protocol, modified for gynecological surgery, on length of stay and complications following abdominal hysterectomy.

Design: Observational study.

Setting: Department of Obstetrics and Gynecology, Orebro University Hospital, Sweden.

Population: Eighty-five patients undergoing abdominal hysterectomy for benign or malignant indications between January and December 2012, with or without salpingo-oophorectomy. Outcomes were compared with all consecutive patients who had undergone the same surgery from January to December 2011, immediately before establishing the ERAS protocol (n = 120).

Methods: The ERAS protocol was initiated in January 2012 as part of a targeted implementation program. Data were extracted from patient records and from a specific database.

Main outcome measures: Length of stay and the proportion of patients achieving target length of stay (2 days).

Results: Length of stay was significantly reduced in the study population after introducing the ERAS protocol from a mean of 2.6 (SD 1.1) days to a mean of 2.3 (SD 1.2) days (p = 0.011). The proportion of patients discharged at 2 days was significantly increased from 56% pre-ERAS to 73% after ERAS (p = 0.012). No differences were found in complications (5% vs. 3.5% in primary stay, 12% vs. 15% within 30 days after discharge), reoperations (2% vs. 1%) or readmission (4% vs. 4%).

Conclusions: Introducing the ERAS protocol for abdominal hysterectomy reduced length of stay without increasing complications or readmissions.

Keywords
Fast track, hysterectomy, length of stay, perioperative care, perioperative period
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-36157 (URN)10.1111/aogs.12423 (DOI)000339616100004 ()24828471 (PubMedID)2-s2.0-84904260752 (Scopus ID)
Note

Funding Agency:

Research Committee of Örebro County Council

Available from: 2014-09-03 Created: 2014-08-28 Last updated: 2018-06-09Bibliographically approved
(2013). Behandling av urininkontinens hos äldre och sköra äldre: en systematisk litteraturöversikt.
Open this publication in new window or tab >>Behandling av urininkontinens hos äldre och sköra äldre: en systematisk litteraturöversikt
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2013 (Swedish)Report (Refereed)
Publisher
p. 237
Series
SBU-rapport, ISSN 1400-1403 ; 219
National Category
Clinical Medicine
Identifiers
urn:nbn:se:oru:diva-35929 (URN)978-91-85413-60-7 (ISBN)
Available from: 2014-08-12 Created: 2014-08-12 Last updated: 2019-03-27Bibliographically approved
Franzén, K., Johansson, J.-E., Karlsson, J. & Nilsson, K. (2013). Validation of the Swedish version of the incontinence impact questionnaire and the urogenital distress inventory. Acta Obstetricia et Gynecologica Scandinavica, 92(5), 555-561
Open this publication in new window or tab >>Validation of the Swedish version of the incontinence impact questionnaire and the urogenital distress inventory
2013 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 5, p. 555-561Article in journal (Refereed) Published
Abstract [en]

Objective. To validate the Swedish versions of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6). Design and setting. Prospective study, university hospital. Population and method. We analyzed reliability, validity, and responsiveness in a clinical sample of 96 women with urinary incontinence. Main outcome measures. Construct and criterion validity, reliability via test-retest and internal consistency. Responsiveness via calculation of effect size. Result. Test-retest reliability ranged from moderate to almost perfect. Cronbach's alpha was 0.39 (UDI-6) and 0.83 (IIQ-7). Effect size calculation of change after treatment demonstrated good responsiveness. The effect size at six months was moderate in the Stress Urinary Incontinence group and small in the Urge Urinary Incontinence + Mixed Urinary Incontinence group. There was a moderate to strong correlation between UDI-6 and IIQ-7 and treatment satisfaction at six, 12, and 24 months for both groups. Conclusion. The UDI-6 scale did not produce the same solid result in the psychometric analysis as the IIQ-7 scale, but these newly translated Swedish forms of UDI-6 and IIQ-7 show good responsiveness and are easy to administer and to fill out.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-27451 (URN)10.1111/j.1600-0412.2012.01481.x (DOI)000319060200009 ()22686542 (PubMedID)
Available from: 2013-02-06 Created: 2013-02-06 Last updated: 2017-12-06Bibliographically approved
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