| 1. |
- Aydin-Schmidt, Berit, et al.
(författare)
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Loop mediated isothermal amplification (LAMP) accurately detects malaria DNA from filter paper blood samples of low density parasitaemias
- 2014
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:8, s. e103905-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Loop mediated isothermal amplification (LAMP) provides an opportunity for improved, field-friendly detection of malaria infections in endemic areas. However data on the diagnostic accuracy of LAMP for active case detection, particularly low-density parasitaemias, are lacking. We therefore evaluated the performance of a new LAMP kit compared with PCR using DNA from filter paper blood spots.METHODS AND FINDINGS:Samples from 865 fever patients and 465 asymptomatic individuals collected in Zanzibar were analysed for Pan (all species) and Pf (P. falciparum) DNA with the Loopamp MALARIA Pan/Pf kit. Samples were amplified at 65°C for 40 minutes in a real-time turbidimeter and results were compared with nested PCR. Samples with discordant results between LAMP and nested PCR were analysed with real-time PCR. The real-time PCR corrected nested PCR result was defined as gold standard. Among the 117 (13.5%) PCR detected P. falciparum infections from fever patients (mean parasite density 7491/µL, range 6-782,400) 115, 115 and 111 were positive by Pan-LAMP, Pf-LAMP and nested PCR, respectively. The sensitivities were 98.3% (95%CI 94-99.8) for both Pan and Pf-LAMP. Among the 54 (11.6%) PCR positive samples from asymptomatic individuals (mean parasite density 10/µL, range 0-4972) Pf-LAMP had a sensitivity of 92.7% (95%CI 80.1-98.5) for detection of the 41 P. falciparum infections. Pan-LAMP had sensitivities of 97% (95%CI 84.2-99.9) and 76.9% (95%CI 46.2-95) for detection of P. falciparum and P. malariae, respectively. The specificities for both Pan and Pf-LAMP were 100% (95%CI 99.1-100) in both study groups.CONCLUSION:Both components of the Loopamp MALARIA Pan/Pf detection kit revealed high diagnostic accuracy for parasite detection among fever patients and importantly also among asymptomatic individuals of low parasite densities from minute blood volumes preserved on filter paper. These data support LAMPs potential role for improved detection of low-density malaria infections in pre-elimination settings.
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| 2. |
- Aydin-Schmidt, Berit, et al.
(författare)
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Usefulness of Plasmodium falciparum-specific rapid diagnostic tests for assessment of parasite clearance and detection of recurrent infections after artemisinin-based combination therapy.
- 2013
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Ingår i: Malaria journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Rapid diagnostic test (RDT) is an important tool for parasite-based malaria diagnosis. High specificity of RDTs to distinguish an active Plasmodium falciparum infection from residual antigens from a previous infection is crucial in endemic areas where residents are repeatedly exposed to malaria. The efficiency of two RDTs based on histidine-rich protein 2 (HRP2) and lactate dehydrogenase (LDH) antigens were studied and compared with two microscopy techniques (Giemsa and acridine orange-stained blood smears) and real-time polymerase chain reaction (PCR) for assessment of initial clearance and detection of recurrent P. falciparum infections after artemisinin-based combination therapy (ACT) in a moderately high endemic area of rural Tanzania.
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| 3. |
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| 4. |
- Björkman, Berit, et al.
(författare)
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Adult limb and breast amputees' experience and descriptions of phantom phenomena : a qualitative study
- 2010
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 1:1, s. 43-49
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Tidskriftsartikel (refereegranskat)abstract
- Background Phantom phenomena – pain or other sensations appearing to come from amputated body parts – are frequent consequences of amputation and can cause considerable suffering. Also, stump pain, located in the residual limb, is in the literature often related to the phantom phenomena. The condition is not specific to amputated limbs and has, to a lesser extent, been reported to be present after radical surgery in other body parts such as breast, rectum and teeth. Multi-causal theories are used when trying to understand these phenomena, which are recognized as the result of complex interaction among various parts of the central nervous system confirmed in studies using functional brain imaging techniques. Functional brain imaging has yielded important results, but without certainty being related to phantom pain as a subjective clinical experience. There is a wide range of treatment methods for the condition but no documented treatment of choice. Aims In this study a qualitative, explorative and prospective design was selected, in the aim to understand the patients’ personal experience of phantom phenomena. The research questions focused at how patients affected by phantom pain and or phantom sensations describe, understand, and live with these phenomena in their daily life. This study expanded ‘phantom phenomena’ to also encompass phantom breast phenomenon. Since the latter phenomenon is not as well investigated as the phantom limb, there is clinical concern that this is an underestimated problem for women who have had breasts removed. Methods The present study forms the first part of a larger, longitudinal study. Only results associated with data from the first interviews with patients, one month after an amputation, are presented here. At this occasion, 28 patients who had undergone limb amputation (20) or mastectomy (8) were interviewed. The focused, semi-structured interviews were recorded, transcribed, and then analyzed using discourse-narrative analysis. Results The interviewees had no conceptual problems in talking about the phenomena or distinguishing between various types of discomfort and discomfort episodes. Their experience originated from a vivid, functioning body that had lost one of its parts. Further, the interviewees reported the importance of rehabilitation and advances in prosthetic technology. Loss of mobility struck older amputees as loss of social functioning, which distressed them more than it did younger amputees. Phantom sensations, kinetic and kinesthetic perceptions, constituted a greater problem than phantom pain experienced from the amputated body parts. The descriptions by patients who had had mastectomies differed from those by patients who had lost limbs in that the phantom breast could be difficult to describe and position spatially. The clinical implication of this study is that when phantom phenomena are described as everyday experience, they become a psychosocial reality that supplements the definition of phantom phenomena in scientific literature and clinical documentation. Conclusions There is a need for clinical dialogues with patients, which besides, providing necessary information about the phenomena to the patients creates possibilities for health professionals to carefully listen to the patients’ own descriptions of which functional losses or life changes patients fear the most. There is a need for more qualitative studies in order to capture the extreme complexity of the pain–control system will be highlighted.
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| 5. |
- Björkman, Berit
(författare)
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Amputees' experience and descriptions of phantom phenomena : a qualitative study
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In phantom phenomena, pain and/ or other sensations appear to be experienced from amputated body parts. The phenomena have long been the object of research and their underlying mechanisms have been discussed over the years. The condition is not specific to amputated limbs, having to a lesser extent been reported after radical surgery in other amputated body parts such as the breast. The phantom limb phenomenon is a well-documented, post-operative pain condition, but phantom breast phenomena are less documented. Multi-causal theories are used when trying to understand these phenomena, recognising them as the result of complex interaction among various parts of the central nervous system. This has been confirmed through studies using functional brain-imaging techniques. There is a wide range of treatment methods but no documented treatment of choice. In particular, there is a lack of knowledge about how amputees experience the meaning and consequences of their phantom phenomena. The overall aim of the work presented in this thesis was thus to elicit and understand how amputees describe their phantom experience in everyday words, and how far their descriptions are influenced by different sociocultural factors. The approach adopted complements existing, predominantly neurobiological, knowledge. The work is based on a two-year, prospective, explorative interview study with 28 women and men who had undergone limb amputation or mastectomy. The focused, narrative-oriented interviews were transcribed verbatim and the scripts were analysed with a combination of narrative and discourse analysis (Studies I and II). Content analysis was used for Studies III and IV. The approach in Study II was longitudinal, since all the four interviews with the eight women (out of the 28 sample) who had undergone mastectomy were analysed. In Studies I, III and IV only the interviews collected one month after the amputation/mastectomy were used. One month after the amputation 22 out of the 28 interviewees described and related their phantom pain and or phantom sensations in sensory-discriminative, motivational-affective and cognitive-evaluative dimensions. The phantom sensations were experienced mainly as more agonizing than the phantom pain, while the phantom breast phenomena differed from classic phantom extremity phenomena, not seeming to cause much distress. Further, the interviewees reported the importance of rehabilitation and advances in prosthetic technology. Loss of mobility struck older amputees as loss of social functioning, which distressed them more than it did younger amputees. Thus, when phantom phenomena were described as everyday experience, they become a psychosocial reality, which made it possible to find out what in the interviewees’ phantom experience constituted suffering. The findings supplement the definition of phantom phenomena in scientific literature and clinical documentation. In conclusion these findings highlight the importance of approaching the phenomena on an individual basis as a process of evaluation and selection. In addition, experience and understanding of the phantoms have sociocultural aspects. There follows the need for individualized communication and information from the clinician, and for incorporating a meaning-centred approach in future studies. The present insights may also be of value in other iatrogenic pain conditions.
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| 6. |
- Björkman, Berit
(författare)
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Children in the Radiology Department : a study of anxiety, pain, distress and verbal interaction
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation focuses on children’s experiences of going through an acute radiographic examination due to a suspected fracture. The findings from interviews with children aged 3-15 years showed anxiety, pain and distress to be a concern in conjunction with an examination (Paper I). These initial findings entailed empirical studies being undertaken in order to further study children’s pain and distress in conjunction with an examination (Paper II) as well as children’s anxiety, pain and distress related to the perception of care in the periradiographic process (Paper III). Finally, the verbal interaction between the child and radiographer during the examination was studied (Paper IV).The research was conducted through qualitative, quantitative and mixed method studies. The data collection methods comprised interviews (Paper I), children’s self-reports (Papers II and III), drawings (Paper III), questionnaire (Paper III) and video recordings (Papers I, II and IV). Altogether, 142 children (3-15 years) and 20 female radiographers participated in the studies.Children aged 5-15 years were observed and they completed selfreports on pain and distress. The children were also provided with an opportunity to express their perceptions of the peri-radiographic process and to make a drawing that was analysed with regard to their level of anxiety. Finally, the verbal interaction between the child and radiographer during the examination was analysed.Qualitative content analysis was used to analyse the interviews and the written comments in the questionnaire (Papers I and III). The Child Drawing: Hospital Manual (CD:H) was used when analysing the children’s drawings (Paper III), and the Roter Interaction Analysis System (RIAS) was used when analysing the verbal interaction derived from the video recordings (Paper IV). Non-parametric statistics were applied when analysing the quantitative data (Papers II, III and IV). The findings showed that children aged 5-15 years reported pain on the Coloured Analogue Scale (CAS) and distress on the Facial Affective Scale (FAS) above levels at which treatment or further intervention is recommended. These findings corresponded to the observed pain behaviour measured on the Face, Legs, Activity, Cry and Consolability Scale (FLACC) and anxiety expressed through drawings (CD:H). The children’s perception of the care being provided in the peri-radiographic process, was not related to the experience of anxiety, pain and distress however. The children were confident in the radiographers, who they perceived to be skilled in the task and sensitive to their needs. These findings are supported by the analysis of the verbal interaction (RIAS), which showed that the radiographer adjusted the communication when balancing the task-focused and socio-emotional interaction according to the child’s age.The findings point to the conclusion that children going through an acute radiographic examination should be assessed regarding the anxiety, pain and distress they experience. This is a prerequisite for the radiographer to provide care according to the child’s ability and preferences when interacting with children in the peri-radiographic process.
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| 7. |
- Björkman, Berit, et al.
(författare)
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Children's Anxiety, Pain, and Distress Related to the Perception of Care While Undergoing an Acute Radiographic Examination
- 2014
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Ingår i: Journal of Radiology Nursing. - : Elsevier BV. - 1546-0843. ; 33:2, s. 69-78
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Tidskriftsartikel (refereegranskat)abstract
- Visiting the hospital is likely a frightening experience for a child, and going through a radiographic examination has been reported as both distressing and painful. More knowledge from the children's perspective is needed on this subject, however, and thus, the aim of this study was to investigate children's anxiety, pain, and distress in conjunction with an acute radiographic procedure and whether these factors can be related to the perception of care. A mixed method design was used to analyze data from 110 participants between 5 and 15 years of age, who were examined in a Swedish radiology department. The quantitative findings showed anxiety, pain, and distress to be a concern during a radiographic examination. Significant correlations were obtained between anxiety and pain as well as between anxiety and distress. In addition, also the qualitative findings showed pain and the waiting time to be concerns. Regardless of the quantitative findings, however, children of all ages were satisfied with the care performed in the periradiographic process, perceiving the examination as supportive and geared to their needs. Robust assessment of anxiety, pain, and distress is imperative when interacting with children in acute examination situations to avoid both negative short-term and long-term consequences.
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| 8. |
- Björkman, Berit, et al.
(författare)
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Children's experience of going through an acute radiographic examination
- 2012
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Ingår i: Radiography. - : Elsevier. - 1078-8174 .- 1532-2831. ; 18:2, s. 84-89
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Tidskriftsartikel (refereegranskat)abstract
- Children’s experience of radiographic examinations remains largely unexplored, although most radiographers examine children on a daily basis. In order to provide the high quality care that meets the needs of patients it was considered important to undertake research focused upon the patients’ experience of radiographic practice.The aim of the study was to investigate children’s experiences undergoing a radiographic examination for a suspected fracture.Inclusion criteria were Swedish-speaking children between 3 and 15 years of age who were submitted for a radiographic examination with an acute condition of the upper or lower extremity. Patients were informed of the study and together with the escorting parent or relative asked for consent to participate.During the examination the child was videotaped and immediately after, the child was interviewed in a nearby facility. The interview contained open-ended questions and was conducted while watching the videotape together with the child and their parent or relative and the researcher.Qualitative content analysis was used in analyzing the collected data. The analysis resulted in two categories - “feeling uncomfortable” and “feeling confident”. The subcategories contained in these categories were “pain in relation to injury and examination”, “the waiting time is strenuous”, “worries for the future and consequences of the injury”, “confidence in parental presence”, “confidence in radiographic staff and examination procedure”, and finally “recognition entails familiarity”.The results revealed that for the younger children, the experience of undergoing an acute radiographic examination was associated with pain and anxiety, but for the older children, the anxiety was more connected to whether the injury had caused a fracture and any anticipated future consequences or complications.
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| 9. |
- Björkman, Berit, et al.
(författare)
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Children’s pain and distress while undergoing an acute radiographic examination
- 2012
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Ingår i: Radiography. - Elsevier : Elsevier BV. - 1078-8174 .- 1532-2831. ; 18:3, s. 191-196
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Tidskriftsartikel (refereegranskat)abstract
- Pain has been highlighted as a main concern for children in conjunction with an acute radiographic examination. The aim of this study was to further investigate children’s pain and distress while undergoing an acute radiographic examination.The study comprised 29 participants with an age range of 5–15 years who were injured and submitted to an acute radiographic examination of the upper or lower extremity when the question at issue was fracture. The Coloured Analogue Scale (CAS) and the Facial Affective Scale (FAS) were used as self-reporting scales to measure the children’s pain and distress. The Face, Legs, Activity, Cry and Consolability Behavioural scale (FLACC) was used as an observation tool to assess behaviours associated with pain in children.Descriptive statistics were used when analysing the scores, and the results showed that children experience pain and distress in conjunction with a radiographic examination after an injury. Spearman’s correlation was used to compare variables, and significant correlations were obtained between the self-reported pain and the observed pain behaviour. Fischer’s Exact test was used to compare groups, and when using the cut-off 3.0 on the self-reporting scale no significant correlation was found concerning the pain reported by children diagnosed with and without a fracture. No significant correlations were found concerning the self-reported distress and pain either, regardless of whether it was a first-time visit and whether a parent was near during the examination.
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| 10. |
- Björkman, Berit, 1944-, et al.
(författare)
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Phantom phenomena – Their perceived qualities and consequences from the patient’s perspective
- 2012
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Ingår i: Scandinavian Journal of Pain. - : Elsevier. - 1877-8860 .- 1877-8879. ; 3:3, s. 134-140
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Tidskriftsartikel (refereegranskat)abstract
- Background and aim: The curious phenomenon phantom limbs early became the object of research, and its underlying mechanisms have been discussed over the years. The complex nature of phantom phenom- ena makes interpretation of the results ambiguous, regarding both prevalence and the accompanying suffering. There is a lack of knowledge about how amputees experience the meaning and consequences of phantom phenomena. The present aim, therefore, was to investigate how individuals, in an interview situation, described the qualities of possible perceived phantom phenomena, and how their experience affected their lives one month after the amputation/mastectomy.Methods: Twenty-eight women and men who had undergone a limb amputation or mastectomy were interviewed. The focused, narrative-oriented interviews were transcribed verbatim and the scripts were analysed with content analysis.Results: One month after the amputation the informants described and related their phantom pain and phantom sensations in sensory-discriminative, motivational-affective and cognitive-evaluative dimen- sions. The phantom sensations were experienced mainly as more agonizing than the phantom pain.Despite both the high intensity of and the high annoyance at the phantom pain and phantom sensations, a majority felt that the phantom phenomena were not a hindrance in their attempts to recapture ordinary life. But when the hindrance was evaluated as high, the annoyance was evaluated as the highest possible for both phenomena or for the phantom sensations alone, never for phantom pain alone. The interviewees’ reported attitudes of hindrance were also described and estimated in the light of their sociocultural circumstances. Thus, other preceding and/or co-existent pain conditions as well as factors such as pre- operative information, the respondents’ views on pain treatment, and their knowledge and understanding of phantom phenomena were mentioned and related to the pain-producing situation.Two-thirds of the interviewees had received post-surgical information and for some, the phenomena were well-known from earlier experience. A majority applied some version of the medical explanation model, irrespective of age or level of education. However neither information nor medical explanation, or both, sufficed for them to understand their own phantom phenomena. Thus, differences between the concepts explanation and understanding seemed significant for the annoyance related to the phantom phenomena.Regarding background data: (i) the majority of the interviewees had had pre-amputation pain prob- lems; (ii) the breast-cancer phantoms differed in several ways; (iii) there were some age and gender differences in the descriptions of hindrance.Conclusions and implications: These findings highlight the importance of observing the individual approach to the phenomena as a process of evaluation and selection. In addition, experience and under- standing of the phantoms also have sociocultural aspects. There follows the need for individualized communication and information from the clinician, and for incorporating a socioscientific and meaning- centred approach in future studies. The present insights could also be of value in other iatrogenic pain conditions.
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