| 1. |
- Axelsson, Ida, et al.
(författare)
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Does microbiological contamination of homografts prior to decontamination affect the outcome after right ventricular outflow tract reconstruction?
- 2021
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 33:4, s. 605-613
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Homografts are often in short supply. Today, European guidelines recommend that all tissues contaminated by any of 18 different bacteria and fungi be discarded before antibiotic decontamination has been conducted. The tissue bank in Lund uses more liberal protocols: It accepts all microbes prior to decontamination except multiresistant microbes and Pseudomonas species. The aim of this study was to analyse the effect of contamination on the long-term outcome and occurrence of endocarditis in recipients. METHODS: Data were collected on homografts and on recipients of homografts in the right ventricular (RV) outflow tract who were operated on between 1995 and 2018 in Lund. The long-term outcome of recipients was analysed in relation to different types of contamination using Cox proportional hazard regression. The proportion of patients with endocarditis was analysed with the χ2 test. RESULTS: The study included 509 implanted homografts. Follow-up was a maximum of 24 years and 99% complete. A total of 156 (31%) homografts were contaminated prior to antibiotic decontamination. Homografts contaminated with low-risk microbes had the lowest reintervention rate, but there was no significant difference compared to no contamination [hazard ratio (HR) 1.1, 95% confidence interval (CI) 0.73-1.7] or contamination with high-risk microbes (HR 1.6, 95% CI 0.87-2.8) in the multivariable analysis. There was no significant difference in the proportion of cases of endocarditis during the follow-up period between recipients of homografts contaminated prior to decontamination and recipients of homografts with no contamination (P = 0.83). CONCLUSIONS: Contamination of homograft tissue prior to decontamination did not show any significant effect on the long-term outcome or the occurrence of endocarditis after implantation in the RV outflow tract. Most contaminated homografts can be used safely after approved decontamination.
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| 2. |
- Axelsson, Ida, et al.
(författare)
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Impact of storage time prior to cryopreservation on mechanical properties of aortic homografts
- 2024
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Ingår i: Cell and Tissue Banking. - : Springer Science and Business Media LLC. - 1389-9333 .- 1573-6814.
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Tidskriftsartikel (refereegranskat)abstract
- Optimal time spans in homograft procurement are still debatable among tissue banks and needs to be further investigated. Cell viability decreases at longer preparation intervals, but the effect on collagen and elastic fibers has not been investigated to the same extent. These fibers are of importance to the homograft elasticity and strength. The objective of this study was to analyze the mechanical properties of homograft tissue at different time spans in the procurement process. Ten aortic homografts were collected at the Tissue Bank in Lund. Twelve samples were obtained from each homograft, cryopreserved in groups of three after 2–4 days, 7–9 days, 28–30 days, and 60–62 days in antibiotic decontamination. Mechanical testing was performed with uniaxial tensile tests, calculating elastic modulus, yield stress and energy at yield stress. Two randomly selected samples were assessed with light microscopy. Procurement generated a total of 120 samples, with 30 samples in each time group. Elastic modulus and yield stress was significantly higher in samples cryopreserved after 2–4 days (2.7 MPa (2.5-5.0) and 0.78 MPa (0.68-1.0)) compared to 7–9 days (2.2 MPa (2.0-2.6) and 0.53 MPa (0.46–0.69)), p = 0.008 and 0.011 respectively. Light microscopy did not show any difference in collagen and elastin at different time spans. There was a significant decrease in elastic modulus and yield stress after 7 days of decontamination at 4 °C compared to 2–4 days. This could indicate some deterioration of elastin and collagen at longer decontamination intervals. Clinical significance of these findings remains to be clarified.
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| 3. |
- Axelsson, Ida, et al.
(författare)
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Impact of valve fenestrations and structural changes in homografts on the long-term outcome in the recipient
- 2021
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Ingår i: Cell and Tissue Banking. - : Springer Science and Business Media LLC. - 1389-9333 .- 1573-6814. ; 22:3, s. 399-408
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Tidskriftsartikel (refereegranskat)abstract
- Homografts have long been used for right ventricular outflow tract (RVOT) reconstruction. Tissue banks struggle to meet the clinical demand of tissue, with insufficient donor availability and strict recommendations on tissue quality with high proportions of discards. This study analyzes the long-term outcome of patients receiving a homograft with small fenestrations of the cusps or other structural changes, to evaluate if minor impairment of the homograft affects the durability. Homograft characteristics and patient outcome were described. Follow-up was maximum 24 years. Structural changes of the homografts were analyzed in relation to patient outcome, using univariable and multivariable Cox proportional hazard regression. Between 1995 and 2018, 468 patients received 535 homografts in the RVOT in Lund. Median recipient age was 13 years. There were 137 (26.9%) reinterventions. Freedom from reintervention was 75.8% (95% CI 71.3–79.7%) at 10 years and 57.4% (95% CI 50.0–64.0%) at 20 years. Small fenestrations of the cusps, fibrosis of the cusps and minor atheromatosis of the vessel did not show any statistically significant impact on long-term outcome, hazard ratio = 0.46 (95% CI 0.11–1.87, p = 0.276) and hazard ratio = 0.80 (95% CI 0.25–2.56, p = 0.704). Minor structural changes of the homografts seem to be acceptable without affecting the long-term durability.
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| 4. |
- Axelsson, Karin, 1968-, et al.
(författare)
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Developing public e-services for several stakeholders : a multifaceted view of the needs for an e-service
- 2009
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Ingår i: Proceeding of the 17th European Conference on Information Systems (ECIS 2009). - 9788861293915 ; , s. 653-664
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Konferensbidrag (refereegranskat)abstract
- This paper discusses how several stakeholders in a public e-service development project consider a future e-service and expected changes in administrative processes and working routines. Our findings indicate a much more multi facetted view than the common win-win situation, with increased quality for citizens and increased efficiency for agencies, which is rhetorically put forth as an effect of public e-service implementation. We have studied a development project resulting in an e-service for handling student anonymity when marking written exams in higher education. In this case we have identified five stakeholder groups related to this e-service; students, teachers, course administrators, exam guards, and the university at an agency level. All of them having certain expectations and fears about the new situation. By presenting this diversity in opinions we add further complexity to the discussion of building trust or mistrust for administration and technology when developing public e-services.
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| 5. |
- Axelsson, Karin, 1968-, et al.
(författare)
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Exploring the importance of citizen participation and involvement in e-government projects : Practice, incentives, and organization
- 2010
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Ingår i: Transforming Government. - : Emerald Group Publishing Limited. - 1750-6166 .- 1750-6174. ; 4:4, s. 299-321
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this research is to investigate if, and in that case, how and what the e-government field can learn from user participation concepts and theories in general IS research. We aim to contribute with further understanding of the importance of citizen participation and involvement within the e-government research body of knowledge and when developing public e-services in practice.Design/Methodology/Approach – The analysis in the article is made from a comparative, qualitative case study of two e-government projects. Three analysis themes are induced from the literature review; practice of participation, incentives for participation, and organization of participation. These themes are guiding the comparative analysis of our data with a concurrent openness to interpretations from the field.Findings – The main results in this article are that the e-government field can get inspiration and learn from methods and approaches in traditional IS projects concerning user participation, but in e-government we also need methods to handle the challenges that arise when designing public e-services for large, heterogeneous user groups. Citizen engagement cannot be seen as a separate challenge in e-government, but rather as an integrated part of the process of organizing, managing, and performing e-government projects. Our analysis themes of participation generated from literature; practice, incentives and organization can be used in order to highlight, analyze, and discuss main issues regarding the challenges of citizen participation within e-government. This is an important implication based on our study that contributes both to theory on and practice of e-government.Practical implications – Lessons to learn from this study concern that many e-government projects have a public e-service as one outcome and an internal e-administration system as another outcome. A dominating internal, agency perspective in such projects might imply that citizens as the user group of the e-service are only seen as passive receivers of the outcome – not as active participants in the development. By applying the analysis themes, proposed in this article, citizens as active participants can be thoroughly discussed when initiating (or evaluating) an e-government project.Originality/value – This article addresses challenges regarding citizen participation in e-government development projects. User participation is well-researched within the IS discipline, but the e-government setting implies new challenges, that are not explored enough.
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| 6. |
- Axelsson, Karin, et al.
(författare)
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Public e-services for agency efficiency and citizen benefit : findings from a stakeholder centered analysis
- 2013
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Ingår i: Government Information Quarterly. - : Elsevier BV. - 0740-624X .- 1872-9517. ; 30:1, s. 10-22
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Tidskriftsartikel (refereegranskat)abstract
- The main goals of e-government are to increase agency efficiency and offer benefits to citizens. These goals have often been addressed as two interplaying outcomes of public e-service development, which are possible to achieve in parallel. This article shows that the two frequently applied stakeholders of e-government (agencies and citizens) are much too extensive and heterogeneous in order to be meaningfully addressed in public e-service conceptualization and development. We conduct a stakeholder centered analysis of a public e-service development and implementation process in order to identify stakeholder groups and discuss how they differ in their perceptions and, consequently, also in their feelings of relevance and need related to the e-service. By adopting a multi-faceted perspective on stakeholders, public e-service development can be analyzed and understood in a way that takes several stakeholder groups into account. Our study contributes with deeper insights about a situation where stakeholder salience changes over time, while some stakeholder groups have low salience during the entire process. The result of conducting a stakeholder centered analysis is that we, by visualizing the stakeholder groups' differences, are better prepared to meet and combine different needs related to a planned e-service. Thus, we argue that a stakeholder centered analysis of expectations and opinions concerning the e-service help to develop e-services possible to succeed in offering both external service and internal efficiency.
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| 7. |
- Axelsson, Karin, et al.
(författare)
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Stakeholder Salience Changes in an e-Government Implementation Project
- 2013
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Ingår i: Stakeholder Salience Changes in an e-Government Implementation Project. - Berlin, Heidelberg : Springer Berlin/Heidelberg. - 9783642403576 - 9783642403583 ; , s. 237-249
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Bokkapitel (refereegranskat)abstract
- In this article we discuss in what ways an e-government project can give both expected and unexpected effects for agency employees and their working tasks. The purpose of this article is to illustrate the fact that, besides the aim to increase agency efficiency and citizen benefit, e-government implementation might also change the salience of involved stakeholders. We do this by focusing on one stakeholder group which was reluctant and hesitating in the beginning of the studied project; marginalized, passive, easily convinced, and old-fashioned. After the e-government implementation, this group had turned to satisfied, proud, influential, active, powerful, and modern IT users. The case shows how stakeholder salience might change over time in an e-government project. Stakeholder influence aspects and IT driven change aspects are intertwined. This makes it necessary for any e-government project to address the notion of stakeholder involvement in decision-making during the development and implementation phases, but also to acknowledge e-services force to change how things and people are perceived during these phases.
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| 8. |
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| 9. |
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| 10. |
- Hedman-Lagerlöf, Maria, et al.
(författare)
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Internet-Delivered Exposure Therapy for Fibromyalgia : A Randomized Controlled Trial
- 2018
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 34:6, s. 532-542
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fibromyalgia (FM) is a common and disabling chronic pain disorder, for which existing pharmacological and psychological treatments have yet yielded insufficient effects. Previous literature has shown that exposure therapy may be an effective treatment for chronic pain. This study constitutes the first randomized controlled trial evaluating exposure therapy for FM.Methods: A total of 140 participants with diagnosed FM were randomized to a 10-week Internet-delivered exposure treatment (iExp; n=70) or a waitlist control condition (WLC; n=70). Primary outcome measure were FM symptoms and impact, and secondary outcome measures were fatigue, disability, quality of life, pain-related distress and avoidance behaviors, insomnia, depression, and anxiety.Results: Data retention was high (100% data completion at posttreatment for primary outcome, 96% at 6-month follow-up and 94% at 12-month follow-up). Results showed that participants in the iExp group made large and superior improvements compared with WLC on FM symptoms and impact (B, ?1.93; z, ?10.14; P<0.001, betweengroup Cohen d=0.90), as well as all secondary outcomes (betweengroup Cohen d ranging from 0.44 to 1.38) with sustained results.Conclusions: We conclude that iExp seems to be an efficacious treatment for FM compared with no treatment, and the results also highlight the potential increase of accessibility by using the Internet format to deliver psychological treatments for these patients. Future trials with active control conditions are warranted.
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