| 1. |
|
|
| 2. |
- Hayden, Jane M., et al.
(författare)
-
Intraperitoneal ropivacaine reduces time interval to initiation of chemotherapy after surgery for advanced ovarian cancer: randomised controlled double-blind pilot study.
- 2020
-
Ingår i: British journal of anaesthesia. - : Elsevier BV. - 1471-6771 .- 0007-0912. ; 124:5, s. 562-70
-
Tidskriftsartikel (refereegranskat)abstract
- Advanced-stage ovarian cancer has a poor prognosis; surgical resection with the intent to leave no residual tumour followed by adjuvant chemotherapy is the standard treatment. Local anaesthetics (LA) have anti-inflammatory and analgesic effects. We hypothesised that intraperitoneal LA (IPLA) would lead to improved postoperative recovery, better pain relief, and earlier start of chemotherapy.This was a prospective, randomised, double-blind, placebo-controlled pilot study in 40 women undergoing open abdominal cytoreductive surgery. Patients were randomised to receive either intraperitoneal ropivacaine (Group IPLA) or saline (Group Placebo) perioperatively. Except for study drug, patients were treated similarly. Intraoperatively, ropivacaine 2 mg ml-1 or 0.9% saline was injected thrice intraperitoneally, and after operation via a catheter and analgesic pump into the peritoneal cavity for 72 h. Postoperative pain, time to recovery, home discharge, time to start of chemotherapy, and postoperative complications were recorded.No complications from LA administration were recorded. Pain intensity and rescue analgesic consumption were similar between groups. Time to initiation of chemotherapy was significantly shorter in Group IPLA (median 21 [inter-quartile range 21-29] vs 29 [inter-quartile range 21-40] days; P=0.021). Other parameters including time to home readiness, home discharge and incidence, and complexity of postoperative complications were similar between the groups.Intraperitoneal ropivacaine during and for 72 h after operation after cytoreductive surgery for ovarian cancer is safe and reduces the time interval to initiation of chemotherapy. Larger studies are warranted to confirm these initial findings.NCT02256228.
|
|
| 3. |
|
|
| 4. |
- Palmqvist, Charlotte
(författare)
-
Centralized Ovarian Cancer Care - Complications, Costs and Survival
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Ovarian cancer is often diagnosed at advanced stages, and its mortality is high. Surgical treatment of advanced ovarian cancer strives toward complex primary debulking surgery (PDS), aiming for complete cytoreduction (R0) and improved survival. With more complex surgery, complications may increase and affect the crucial adjuvant chemotherapy, which is aimed to start within 21 days. New treatment strategies may cause health care costs to rise, although the cost of illness may fall due to lower costs of production loss. Aim: The overall aim of this thesis was to explore survival, surgical complications, and costs in a population-based cohort in which ovarian cancer care has been centralized. Material and methods: The thesis is based on four population-based cohort studies with data from the Swedish Quality Register for Gynecological Cancer. Cost analyses added data from the regional health care database and data on sick leave and income levels from Statistics Sweden. Results: Paper I reports that R0 at PDS increased from 37% to 49%, and the interval between PDS and chemotherapy decreased from 36 days to 24 days after centralization. The 3-year relative survival (RS) rate in women treated with PDS increased from 44% to 65% and, in the entire cohort regardless of primary treatment, from 40% to 61%. The subsequent Paper II shows an increased 5-year RS from 24% to 37% after centralization. Median survival increased from 27 months to 44 months, and median disease-free survival (DFS) increased 23%. Centralization and R0 were independent factors associated with increased RS and DFS. Paper III examines complications within 30 days of surgery after centralization. We found that complex surgery is an independent prognostic factor associated with severe complications. Low preoperative albumin level, residual disease and PDS were found to be associated with severe complications. Severe complications do not seem to affect the completion of adjuvant chemotherapy. Paper IV examines the cost of illness of ovarian cancer after centralization. More than half the cost of illness, or 59.1%, consisted of the indirect costs of production loss due to sick leave and premature death. There was no difference in the cost of illness depending on income level. The direct outpatient cost differed depending on residential area. Conclusions: Survival increased after the centralization of primary care for advanced ovar-ian cancer. Complex surgery is associated with severe complications, but these complica-tions do not affect the completion of adjuvant chemotherapy. The societal cost of ovarian cancer may fall with treatments that prolong survival and cost-of-illness studies needs to be incorporated in the analysis of major organisation and treatment changes.
|
|
| 5. |
- Palmqvist, Charlotte, et al.
(författare)
-
Complications after advanced ovarian cancer surgery-A population-based cohort study
- 2022
-
Ingår i: Acta Obstetricia Et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 101:7, s. 747-757
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction Surgical complications after primary or interval debulking surgery in advanced ovarian cancer were investigated and associations with patient characteristics and surgical outcomes were explored. Material and methods A population-based cohort study including all women with ovarian cancer, FIGO III-IV, treated with primary or interval debulking surgery, 2013-2017. Patient characteristics, surgical outcomes and complications according to the Clavien-Dindo (CD) classification system <= 30 days postoperatively, were registered. Uni- and multivariable regression analyses were performed with severe complications (CD >= III) as endpoint. PFS in relation was analyzed using the Kaplan-Meier method. Results The cohort included 384 women, where 304 (79%) were treated with primary and 80 (21%) with interval debulking surgery. Complications CD I-V were registered in 112 (29%) patients and CD >= III in 42 (11%). Preoperative albumin was significantly lower in the CD >= III cohort compared with CD 0-II (P = 0.018). For every increase per unit in albumin, the risk of complications decreased by a factor of 0.93. There was no significant difference in completed chemotherapy between the cohorts CD 0-II 90.1% and CD >= III 83.3% (P = 0.236). In the univariable analysis; albumin <30 g/L, primary debulking surgery, complete cytoreduction and intermediate/high surgical complexity score (SCS) were associated with CD >= III. In the following multivariable analysis, only intermediate/high SCS was found to be an independent significant prognostic factor. Low (n = 180) vs intermediate/high SCS (n = 204) showed a median PFS of 17.2 months (95% confidence interval [CI] 15.2-20.7) vs 21.5 months (95% CI 18.2-25.7), respectively, with a significant log-rank; P = 0.038. Conclusions Advanced ovarian cancer surgery is associated with complications but no significant difference was seen in completion of adjuvant chemotherapy when severe complications occur. Importantly, our study shows that intermediate/high SCS is an independent prognostic risk factor for complications. Low albumin, residual disease and primary debulking surgery were found to be associated with severe complications. These results may facilitate forming algorithms in the decision-making procedure of surgical treatment protocols.
|
|
| 6. |
- Palmqvist, Charlotte
(författare)
-
Hygiene at CT and MRI
- 2020
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Preventing the spread of infections is a constant battle against microorganisms. Hospital-acquired infections (HAIs) with multidrug-resistant (MDR) bacteria are a global problem today and causes suffering for patients and have high costs for society. In a hospital environment, patients with various illnesses and injuries meet, a large proportion of these people will also pass the radiology department, which places high demands on good hygienic standards to avoid HAIs. Although much research has been conducted on hygiene routines and the spread of infection in healthcare, most of the research has not focused on the radiology department. Aims: The overall goal of this thesis was to study hygiene in public and private radiology departments’ CT and MRI facilities with a focus on bacterial growth and the attitude of staff and managers to hygiene guidelines. The purpose of Study I was to identify selected hand-touched surfaces inside and outside the CT and MRI examination rooms that are prone to contamination and might represent a risk for transmission of HAI pathogens. We also aimed to examine if there were differences in bacterial contamination between public and private radiology departments. The purpose of Study II was to investigate the compliance with basic hygiene guidelines among the staff working with CT and MRI and the managers' approaches to basic hygiene routines. Finally, we aimed to examine differences in adherence to hygiene guidelines among staff employees within public and private radiology departments. Material and Methods: The same radiology departments participated in Study I and II (six public and four private radiology departments). For Study I, bacterial samples were taken from selected hand-touched surfaces inside and outside CT and MRI examination rooms. Sampling was carried out between patients after standard cleaning procedure, using flocked nylon swabs. The swab was applied over a 100 cm2 surface, and after cultivation the number of, bacterial colony forming units (CFU) per cm2 was calculated, with values >2.5 CFU/cm2 being indicative of contamination. Study II was based on a survey data. One questionnaire was distributed to the staff working with CT and MRI with questions about basic hygiene guidelines. The second questionnaire was distributed to managers, also with questions about basic hygiene guidelines. A total of 250 surveys (210 for CT- and MRI staff and 40 for managers) were distributed in paper format at the radiology departments during the autumn of 2016. Closed questions were summarised in frequency tables, and comparisons between groups regarding categorical data were analysed using Fisher ́s exact test, and t-test was carried out to compare continuous variables. The open questions were analysed with inspiration from manifest qualitative and quantitative content analysis. Results: The results of Study I did not show any growth of MDR bacteria, however surfaces were found where the number of CFU exceeded the limit value of 2.5 2 CFU/cm . Keyboards, chairs in the patient changing rooms, headphones, and the alarm control/buzzer were found to be the most contaminated surfaces. The least contaminated surfaces were the medicine trolley and the sides of the MRI tunnel. There was no significant difference between public and private radiology departments. The results of Study II showed that the main reasons why staff working with CT and MRI did not follow basic hygiene guidelines were stress, lack of time, and the occurrence of emergency situations. The managers also believed that stress and lack of time were strong reasons for why staff did not follow the basic hygiene guidelines. Most staff working with CT and MRI in both public and private radiology departments reported adequate hygiene knowledge. Among the variances that emerged between staff working in public and private radiology departments, there, was a significant difference (p = 0.007) regarding the compliance with not wearing rings, bracelets or nail polish while performing patient- related work. There was also a significant difference (p < 0.001) regarding the use of plastic aprons when there was a risk of contaminating the work clothes. There was also a significant difference (p = 0.003) between how the staff of public and private CT and MRI facilities cleaned the examination tables between each patient. Conclusion: Identified areas within CT and MRI in both public and private radiology departments, that need more disinfection are keyboards, chairs in the patient changing rooms, headphones, and the alarm control/buzzer. No MDR indicator microorganisms were found in the study, and there were no significant differences between public and private radiology departments. The main reasons why the staff both in public and private CT and MRI did not follow the hygiene guidelines were stress, lack of time, and emergency situations. Among the significant differences that emerged between staff working in public and private radiology departments were wearing bracelets, rings and nail polish in patient- related work, and the use of plastic aprons, and disinfection of the examination table between patients.
|
|
| 7. |
- Palmqvist, Charlotte, et al.
(författare)
-
Increased disease-free and relative survival in advanced ovarian cancer after centralized primary treatment
- 2020
-
Ingår i: Gynecologic Oncology. - : Elsevier BV. - 0090-8258. ; 159:2, s. 409-417
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To analyze 5-year disease-free survival (DFS) and relative survival (RS) before and after the 2011 implementation of centralized primary treatment of patients with advanced ovarian cancer. Methods. A population-based cohort study using the Swedish Quality Registry for Gynecological Cancer (SQRGC). Women with FIGO stage III and IV epithelial ovarian and Fallopian tube cancers were divided into two cohorts: before and after centralization. We estimated RS using the Ederer II method, analyzed the difference in the excess mortality rate ratio (EMRR) and estimated 5-year DFS in a Cox proportional hazard regression model with centralization, age, primary treatment and complete cytoreduction as variables. Results. A total of 495 women were identified with 244 women before (2008-2010) and 251 after (2011-2013) centralization. An increased 5-year RS from 24% (95%CI:19-31) to 37% (95%CI:31-44) and an increased median RS from 27 months (95%CI:23-34) to 44 months (95%CI:40-52), p < 0.001 (log-rank), were observed in the total cohort regardless of primary treatment. EMRR was found to be 0.62 (95%CI:0.51-0.76) in 2011-2013 compared to 2008-2010 for all patients. After centralization, 5-year DFS was significantly longer, hazard ratio of 0.77 (95%CI:0.64-0.93) and centralization was found to be an independent significant factor for both survival and DFS. Complete cytoreduction was found to be a significant independent factor associated with increased RS and DFS. Conclusion. Centralization of primary treatment of advanced ovarian cancer was associated with significantly increased complete cytoreduction, 5-year RS and DFS, and was found to be a significant independent factor for both RS and DFS. (C) 2020 The Authors. Published by Elsevier Inc.
|
|
| 8. |
- Palmqvist, Charlotte, et al.
(författare)
-
Sexuellt beteende hos daghemsbarn
- 1993
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet är att studera daghemsbarns sexualitet i åldrarna 2 - 5 år. I en stor stad valdes 11 daghem ut slumpmässigt bland över 100 st. I fas I intervjuades en slumpmässigt vald personal på varje daghem för att utröna vilka sexuella beteenden som förekommer och hur de bemöts. I fas II skattade ytterligare två slumpvis valda personer från varje daghem vanligheten för respektive ålder och kön gällande de beteenden som framkom i den första fasen. Sammanlagt deltog därmed 33 personal. I den explorativa fasen framkom nio beteenden: pratsexualitet, onani, samlagsrörelser, tar på personalen-intim beröring, förälskelse mellan pojke och flicka, jaga-lek, leka sexuella lekar, teckningar och visa sitt kön för andra. För några beteenden fanns en tendens till ökning med åldern och några ökade inte.
|
|
| 9. |
- Palmqvist, Charlotte, et al.
(författare)
-
Societal costs of ovarian cancer in a population-based cohort - a cost of illness analysis
- 2022
-
Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 61:11, s. 1369-1376
-
Tidskriftsartikel (refereegranskat)abstract
- Background The societal cost associated with ovarian cancer (OC) is not well known. Increasing costs for new treatments and/or the impact of organizational changes motivates these costs to be described and communicated. This study aims to evaluate the cost of illness of OC in a population-based cohort. Material and methods All patients diagnosed with ovarian, fallopian tube, primary peritoneal cancer, and serous cancer of undesignated primary site (UPS) in 2011-2012 were followed for six years. Direct costs, i.e., costs for health care expenditures, were gathered from the regional healthcare database. Information on indirect costs, i.e., costs of loss of production due to sick leave, was retrieved from Statistics Sweden. Sub-group analyses were conducted regarding stage, income levels, residential area, and diagnosis. Results The cost of illness for all stages during the six years of follow-up was euro201,086 per patient, where indirect costs constituted 43.7%. The mean cost of illness per year per patient for all stages was euro33,514. Direct costs were higher in advanced stages compared to early stages for every year from diagnosis. During the first two years, there were no differences in indirect costs between early and advanced stages. However, during the third year there was a difference with higher indirect costs in advanced stages. There was no difference in direct costs depending on income levels. Regarding residential area, there was a difference in the outpatient cost during the index and second year with higher costs when chemotherapy and follow-up were provided at county hospitals, compared to at the tertiary hospital. Conclusions Indirect costs constituted a large part of the cost of illness over 6 years from diagnosis. This could indicate that even though treatment costs can be expected to rise with the introduction of new therapies, the societal cost may decrease when survival increase.
|
|
| 10. |
- Pereira, Joana B., et al.
(författare)
-
Plasma GFAP is an early marker of amyloid-β but not tau pathology in Alzheimer's disease
- 2021
-
Ingår i: Brain. - : Oxford University Press (OUP). - 0006-8950 .- 1460-2156. ; 144:11, s. 3505-3516
-
Tidskriftsartikel (refereegranskat)abstract
- Although recent clinical trials targeting amyloid-β in Alzheimer's disease have shown promising results, there is increasing evidence suggesting that understanding alternative disease pathways that interact with amyloid-β metabolism and amyloid pathology might be important to halt the clinical deterioration. In particular, there is evidence supporting a critical role of astroglial activation and astrocytosis in Alzheimer's disease. However, so far, no studies have assessed whether astrocytosis is independently related to either amyloid-β or tau pathology in vivo. To address this question, we determined the levels of the astrocytic marker GFAP in plasma and CSF of 217 amyloid-β-negative cognitively unimpaired individuals, 71 amyloid-β-positive cognitively unimpaired individuals, 78 amyloid-β-positive cognitively impaired individuals, 63 amyloid-β-negative cognitively impaired individuals and 75 patients with a non-Alzheimer's disease neurodegenerative disorder from the Swedish BioFINDER-2 study. Participants underwent longitudinal amyloid-β (18F-flutemetamol) and tau (18F-RO948) PET as well as cognitive testing. We found that plasma GFAP concentration was significantly increased in all amyloid-β-positive groups compared with participants without amyloid-β pathology (P < 0.01). In addition, there were significant associations between plasma GFAP with higher amyloid-β-PET signal in all amyloid-β-positive groups, but also in cognitively normal individuals with normal amyloid-β values (P < 0.001), which remained significant after controlling for tau-PET signal. Furthermore, plasma GFAP could predict amyloid-β-PET positivity with an area under the curve of 0.76, which was greater than the performance achieved by CSF GFAP (0.69) and other glial markers (CSF YKL-40: 0.64, soluble TREM2: 0.71). Although correlations were also observed between tau-PET and plasma GFAP, these were no longer significant after controlling for amyloid-β-PET. In contrast to plasma GFAP, CSF GFAP concentration was significantly increased in non-Alzheimer's disease patients compared to other groups (P < 0.05) and correlated with amyloid-β-PET only in amyloid-β-positive cognitively impaired individuals (P = 0.005). Finally, plasma GFAP was associated with both longitudinal amyloid-β-PET and cognitive decline, and mediated the effect of amyloid-β-PET on tau-PET burden, suggesting that astrocytosis secondary to amyloid-β aggregation might promote tau accumulation. Altogether, these findings indicate that plasma GFAP is an early marker associated with brain amyloid-β pathology but not tau aggregation, even in cognitively normal individuals with a normal amyloid-β status. This suggests that plasma GFAP should be incorporated in current hypothetical models of Alzheimer's disease pathogenesis and be used as a non-invasive and accessible tool to detect early astrocytosis secondary to amyloid-β pathology.
|
|
