| 1. |
- Bjöhle, Judith, et al.
(författare)
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Post-mastectomy radiation therapy with or without implant-based reconstruction is safe in terms of clinical target volume coverage and survival : A matched cohort study
- 2019
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 131, s. 229-236
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Patients with breast cancer receiving mastectomy in our institution are offered immediate breast reconstruction (IBR). IBR may have an impact on the optimisation of radiation therapy (RT). Therefore, we aimed to evaluate the clinical target volume (CTV) dose coverage when disregarding the dose received by the breast implant in women treated for breast cancer. Furthermore, to investigate the safety of immediate breast reconstruction (IBR) with an implant (IBR+) in terms of recurrence and survival compared to patients without an implant (IBR-).PATIENTS AND METHODS: This matched-cohort included 128 patients with IBR+ and 252 IBR- patients (controls). The potential confounding effects of tumour stage and treatment were controlled for. For IBR+ patients, the implant volume was excluded from the CTV in the RT planning images, and the RT target coverage (V95%: CTV covered by ≥the 95% isodose) was compared between the IBR+ and IBR- groups.RESULTS: A limited under dosage was observed in patients without lymph-node irradiation; the V95% mean values for the CTV subtracting the implant were 84% and 92%, for IBR+ and IBR- groups, respectively. Median follow-up duration was 5.8 years (0.1-7.5 years). In comparing IBR+ and IBR- groups, no statistically significant differences were found in the incidence of recurrence rate ratios or recurrence free survival (log-rank p = 0.142), overall survival (log-rank p = 0.096), or breast cancer specific survival (log-rank p = 0.147).CONCLUSIONS: Post-mastectomy radiation therapy and implant-based reconstruction lead to minor under dosage of the target, due to the projection of the subcutaneous tissue in the presence of the implant. However, recurrence and survival rates were equally distributed among IBR+ and IBR- patients indicating that the overall treatment protocol used in our institution is safe.
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| 4. |
- Johansson, Björn Axel, et al.
(författare)
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Introducing brief admissions by self-referral in child and adolescent psychiatry : an observational cohort study in Sweden
- 2023
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Ingår i: The Lancet Psychiatry. - 2215-0366. ; 10:8, s. 598-607
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Brief admission by self-referral, a novel crisis intervention designed to reduce suicide and self-harm in adults, was adopted for adolescents in paediatric psychiatry in Malmö, Sweden, in 2018. We aimed to investigate changes in utilisation of emergency psychiatric care.METHODS: We did an observational longitudinal cohort study in The University Hospital in Malmö, Sweden, which provides the only psychiatric emergency unit with 24 h psychiatric facilities in Region Skåne. Eligible patients were those aged 13-17 years who were admitted to the psychiatric facility, who had at least one emergency visit or admission during the 6 months before admission, and had prominent features of instability and self-harm, corresponding to at least three of the nine criteria for borderline personality disorder as per the DSM-5 as assessed by a paediatric psychiatrist during the admission. Patients with intellectual disabilities, psychosis, or language barriers were excluded. Patients who signed a brief admissions contract between April 1, 2018, and April 30, 2021, were eligible for inclusion in the study. A brief admissions contract allows patients to admit themselves to psychiatric emergency care for a transitory time. The primary outcome measures were the number of emergency visits, emergency admissions, inpatient days, and episodes of coercive (involuntary) care, compared at individual level before and after signing the brief admissions contract until end of follow-up. The number of visits and days were modelled using random-effects Poisson regression models, and the relative changes in the expected numbers of days per time unit were reported as rate ratios (RRs).FINDINGS: Of the 928 patients admitted to the psychiatric facility between April 1, 2018, and April 30, 2021, 60 were excluded, and a further 801 did not meet the inclusion criteria for age, previous emergency visits, or having at least three of the nine criteria of borderline personality disorder. 67 patients were eligible for inclusion, but four patients did not sign a contract. 63 patients were included in the study, including 60 females (95%) and three (5%) males, with a mean age of 14·8 years (SD 1·7). Ethnicity data were not collected. Patients were followed up for a median of 13·5 months (IQR 9·2 -19·6). After signing the contract, there was a decrease in the number of emergency visits (RR 0·22 [95% CI 0·15-0·32]; p<0·0001), emergency admissions (RR 0·26 [0·19-0·35]; p<0·0001), inpatient days (RR 0·29 [0·26-0·32]; p<0·0001), and inpatient days including brief admissions (RR 0·44 [95% CI 0·40-0·48]; p<0·0001). Episodes of coercive care did not change significantly (RR 0·99 [95% CI 0·40-2·43]; p=0·98). Psychiatric evaluation due to persistent suicidal ideations immediately after discharge was required for five patients.INTERPRETATION: Our findings suggest that brief admissions can be successfully implemented in paediatric psychiatry and appear to be an effective crisis management method for adolescents, associated with reduced demand for emergency care. Future randomised controlled trials are warranted.FUNDING: Region Skåne Health Care Authority.
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| 5. |
- Liljegren, Eva, 1967-
(författare)
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Contracting out road maintenance. A study on quality, transaction costs and learning organization
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This report studies the effect the opening up of routineroad maintenance in Sweden, traditionally carried out by theSwedish National Road Administration (SNRA). The main aim is tostudy the effect contracting out has had on work quality,transaction costs and the learning organization year 2001. Theresearch is built upon three hypotheses: Hypotheses 1: The SNRAcannot determine if the quality of the work is as contracted.Hypotheses 2: Transaction costs are less than 5% of theproduction costs. Hypotheses 3: The lack of cooperation ofSNRA's regional offices with each other and with the headoffice makes it difficult for SNRA to function as a learningorganization. The main research methods used were interviews, aquestionnaire, and participation in various meetings, such assite meetings and quality audits. Great emphasis has been puton the detailed questionnaire, which was sent to clientrepresentatives. The report includes a description of thebackground, definition and use of three theoretical concepts;quality, transaction costs and learning organization. Theresults show that client representatives at the regional levelcan determine that the SNRA receives the contracted quality,but at the central level it is not possible to determinequality fulfillment due to lack of complete and comparabledata. The study also concludes that it is not possible tocompletely separate transaction costs from the other productioncosts, mainly because man-hours spent per task is not accountedfor at the regional level. The questionnaire results show thatthe largest single transaction costs are those associated withreviewing the contracted work. This study shows that the clientrepresentatives think that the SNRA receives the contractedquality. The client representatives believe that the reviewprocess plays an important role in assuring the quality of theentrepreneurs' work. This study also shows that the client'swork is carried out differently in the different SNRA regionsstudied. This lack of administrative control by a centralauthority has lead to the main offices in the regions becoming"head offices" for the offices at the local level. The freedomallowed each regional office affords its employees theopportunity to develop new methods and organizationalstructures. At the same time substantial differences betweenthe regions and the lack of cooperation between the regionaloffices and the regional offices with the head office makes itdifficult for the SNRA to function as a learningorganization.
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| 7. |
- Liljegren, Eva
(författare)
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Trafikolyckor vid vägarbeten 2003-2021
- 2024
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Ingår i: Sammanställning av referat från Transportforum 2024. - Linköping : Statens väg- och transportforskningsinstitut. ; , s. 268-269
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Varje år inträffar minst 300 trafikolyckor med personskador i anslutning till vägarbeten. För att kunna öka säkerheten vid vägarbeten, för såväl vägarbetare som passerande trafikanter, är det viktigt att känna till vilken typ av trafikolyckor som inträffar, varför de sker och hur de kan förhindras. Metoden består främst av att sammanställa, bearbeta och analysera data från Strada (Swedish Traffic Accident Data Acquisition). Även data från Trafikverkets djupstudier av dödsolyckor har använts. I presentationen kommer även resultat från en pågående fördjupad analys av energiupptagande skydd, TMA (Truck Mounted Attenuator), att redovisas. Metoden i den analys består främst i att sammanställa och analysera data från TMA-olyckor och incidenter. Datat kommer från Strada, massmedia, entreprenörer, incidentrapporteringssystemet Synergi och det branschgemensamma systemet BIA. Totalt inträffade 5 667 trafikolyckor med personskador i eller i anslutning till vägarbeten under åren 2003-2021. 46 % av olyckorna inträffade på statligt vägnät, 48 % på kommunalt vägnät och resterande 6 % på övrigt vägnät. Nästan 74 % av det totala antalet olyckorna var lindriga olyckor, 22 % var måttliga, 3 % var allvarliga olyckor och 1,3 % dödsolyckor. Totalt inträffade 74 dödsolyckor. Passerande trafikanter skadas i drygt 94% av olyckorna och vägarbetarna i 6% av olyckorna. Den vanligaste olyckstypen är en upphinnandeolycka vilken kan bero på att trafikanten inte har uppmärksammat vägarbetet i tid eller inte förstått hur de ska agera när de passerar vägarbetet. Vägarbetare skadas främst i samband med vinterväghållning, eller när de arbetar utanför sitt vägarbetsfordon, t.ex. som vakt som dirigerar trafiken.Vid vägarbeten används olika typer av energiupptagande skydd som TMA (Truck Mounted Attenuator), däcksbuffert och betongbarriärer. Påkörningar på dessa skydd har skett i minst 236 olyckor som resulterat i personskador under åren 2003-2021. Preliminära resultat från en pågående analys visar dock att det inträffade så många som drygt 80 olyckor/incidenter år 2023 där TMA blivit påkört. Dessa rapporteras sällan som trafikolyckor i Strada eller är svåra att identifiera i det statistiska underlaget. Resultaten från TMA-analysen beräknas klara i oktober 2023.
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| 8. |
- Michielsen, Astrid, et al.
(författare)
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Predicting and communicating flood risk of transport infrastructure based on watershed characteristics
- 2016
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Ingår i: Journal of Environmental Management. - : Elsevier. - 0301-4797 .- 1095-8630. ; 182, s. 505-518
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Tidskriftsartikel (refereegranskat)abstract
- This research aims to identify and communicate water-related vulnerabilities in transport infrastructure, specifically flood risk of road/rail-stream intersections, based on watershed characteristics. This was done using flooding in Varmland and Vastra Gotaland, Sweden in August 2014 as case studies on which risk models are built. Three different statistical modelling approaches were considered: a partial least square regression, a binomial logistic regression, and artificial neural networks. Using the results of the different modelling approaches together in an ensemble makes it possible to cross-validate their results. To help visualize this and provide a tool for communication with stakeholders (e.g., the Swedish Transport Administration - Trafikverket), a flood 'thermometer' indicating the level of flooding risk at a given point was developed. This tool improved stakeholder interaction and helped highlight the need for better data collection in order to increase the accuracy and generalizability of modelling approaches.
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| 9. |
- Näslund, Olivia, et al.
(författare)
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Amino acid tracers in PET imaging of diffuse low-grade gliomas : a systematic review of preoperative applications
- 2018
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Ingår i: Acta Neurochirurgica. - : Springer Nature. - 0001-6268 .- 0942-0940. ; 160:7, s. 1451-1460
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Tidskriftsartikel (refereegranskat)abstract
- Positron emission tomography (PET) imaging using amino acid tracers has in recent years become widely used in the diagnosis and prediction of disease course in diffuse low-grade gliomas (LGG). However, implications of preoperative PET for treatment and prognosis in this patient group have not been systematically studied. The aim of this systematic review was to evaluate the preoperative diagnostic and prognostic value of amino acid PET in suspected diffuse LGG. Medline, Cochrane Library, and Embase databases were systematically searched using keywords "PET," "low-grade glioma," and "amino acids tracers" with their respective synonyms. Out of 2137 eligible studies, 28 met the inclusion criteria. Increased amino acid uptake (lesion/brain) was consistently reported among included studies; in 25-92% of subsequently histopathology-verified LGG, in 83-100% of histopathology-verified HGG, and also in some non-neoplastic lesions. No consistent results were found in studies reporting hot spot areas on PET in MRI-suspected LGG. Thus, the diagnostic value of amino acid PET imaging in suspected LGG has proven difficult to interpret, showing clear overlap and inconsistencies among reported results. Similarly, the results regarding the prognostic value of PET in suspected LGG and the correlation between uptake ratios and the molecular tumor status of LGG were conflicting. This systematic review illustrates the difficulties with prognostic studies presenting data on group-level without adjustment for established clinical prognostic factors, leading to a loss of additional prognostic information. We conclude that the prognostic value of PET is limited to analysis of histological subgroups of LGG and is probably strongest when using kinetic analysis of dynamic FET uptake parameters.
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| 10. |
- Rydstedt Nyman, Monika, 1961-
(författare)
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Managing knowledge sharing of extreme weather induced impacts on land transport infrastructure : Case study of the Swedish Transport Administration
- 2016
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Extreme weather events and effects of climate change are threats to the transport sector’s functionality and safety. Risk management in this context implies a necessity to focus on the connection between near-term experiences and coping strategies on one hand, and long-term adaptation analyses on the other. How learning from past events and subsequent knowledge sharing can be adopted is a question that needs to be explored, discussed and tested. A systematic approach to lessons learned calls for measures of investigation, reporting, planning, implementation and evaluation. A qualitative case study approach was used in this thesis. In the first paper the practices of accident investigation in operation and maintenance were inventoried within the Swedish Transport Administration (STA). Three accident investigation methods were applied and tested on a cloudburst event, causing flooding in a railway tunnel in Sweden. In the second paper, semi-structured interviews, documents, and archival records were used as means for penetrating deeper into the attitudes and understanding of lessons learned concerning extreme weather events within a procured public-private partnership. The results of the two studies showed weak signals of feedback on lessons learned. Partly, these weak signals could be traced back to weak steering signals. Various obstacles impeded learning curves from lessons learned. The obstacles were of both hard and soft values, e.g. resources in time and equipment, systematic investigation methods, incentives for lessons learned, education and knowledge, values, norms and attitudes towards how and why identified problems should be solved. Successful knowledge sharing requires that close attention is paid to such obstacles and that an adaptive approach is adopted.
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