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1.	Aydin-Schmidt, Berit, et al. (författare) Field Evaluation of a High Throughput Loop Mediated Isothermal Amplification Test for the Detection of Asymptomatic Plasmodium Infections in Zanzibar 2017 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:1 Tidskriftsartikel (refereegranskat)abstract Background New field applicable diagnostic tools are needed for highly sensitive detection of residual malaria infections in pre-elimination settings. Field performance of a high throughput DNA extraction system for loop mediated isothermal amplification (HTP-LAMP) was therefore evaluated for detecting malaria parasites among asymptomatic individuals in Zanzibar. Methods HTP-LAMP performance was evaluated against real-time PCR on 3008 paired blood samples collected on filter papers in a community-based survey in 2015. Results The PCR and HTP-LAMP determined malaria prevalences were 1.6% (95% CI 1.3-2.4) and 0.7% (95% CI 0.4-1.1), respectively. The sensitivity of HTP-LAMP compared to PCR was 40.8% (CI95% 27.0-55.8) and the specificity was 99.9% (CI95% 99.8-100). For the PCR positive samples, there was no statistically significant difference between the geometric mean parasite densities among the HTP-LAMP positive (2.5 p/mu L, range 0.2-770) and HTP-LAMP negative (1.4 p/mu L, range 0.1-7) samples (p = 0.088). Two lab technicians analysed up to 282 samples per day and the HTP-LAMP method was experienced as user friendly. Conclusions Although field applicable, this high throughput format of LAMP as used here was not sensitive enough to be recommended for detection of asymptomatic low-density infections in areas like Zanzibar, approaching malaria elimination.
2.	Aydin-Schmidt, Berit, et al. (författare) Loop mediated isothermal amplification (LAMP) accurately detects malaria DNA from filter paper blood samples of low density parasitaemias 2014 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:8, s. e103905- 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.
3.	Aydin-Schmidt, Berit, et al. (författare) Usefulness of Plasmodium falciparum-specific rapid diagnostic tests for assessment of parasite clearance and detection of recurrent infections after artemisinin-based combination therapy. 2013 Ingår i: Malaria journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 12:1 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.
4.	Berlin Kolm, Sofia, et al. (författare) Nya salixsorter med modern växtförädlingsteknik 2011 Ingår i: Fakta. Jordbruk. - 1403-1744. Annan publikation (populärvet., debatt m.m.)
5.	Björkman, Berit, et al. (författare) Adult limb and breast amputees' experience and descriptions of phantom phenomena : a qualitative study 2010 Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 1:1, s. 43-49 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.
6.	Björkman, Berit (författare) Amputees' experience and descriptions of phantom phenomena : a qualitative study 2012 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.
7.	Björkman, Berit, et al. (författare) Are radiographers prepared to meet children with special needs, when seen for an examination? 2017 Ingår i: Acta Radiologica. - : Sage Publications. - 0284-1851 .- 1600-0455. ; 58:1 Suppl., s. 16-16 Tidskriftsartikel (refereegranskat)abstract Introduction: Anxiety is often experienced by children undergoing health care procedures, and children with autism spectrum disorders (ADS) experience more anxiety than typically developed children. A prerequisite for obtaining an optimum procedure is firstly based on the health care provider’s knowledge about children with ASD, but may also depend on the use of guidelines. Two previous national surveys showed, that none radiology or paediatric departments and a minority of anaesthesiology departments throughout Sweden use specific guidelines when seeing children with ASD. Following, the purpose was to develop guidelines to use when caring for and preparing children with ASD in those settings.Methods: A modified Delphi method was used, including19 experts identified from the two afore mentioned surveys. The questions considered in the process, proceeded from previous research and the results from the surveys. The experts’ responses regarding the importance of each item, were analysed and scrutinized between each round.Results: The Delphi process resulted in guidelines consisting of 15 items and a checklist with 16 aspects. The items cover the areas: planning and involving parents, features in the environment, use of time, communication, thehealth care professionals. The checklist covers the child’spattern of communication, anxiety, sensory stimuli, special interests and likes/dislikes.Conclusions: To obtain an optimum caring encounter when a child with ASD is seen in the preoperative and radiology setting, a meticulous planning is important and the environment should be adjusted for the needs of the child. To accomplish this, guidelines need to be in place and be followed.
8.	Björkman, Berit (författare) Children in the Radiology Department : a study of anxiety, pain, distress and verbal interaction 2014 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.
9.	Björkman, Berit, et al. (författare) Children's and parents' perceptions of care during the peri-radiographic process when the child is seen for a suspected fracture 2016 Ingår i: Radiography. - : Elsevier BV. - 1078-8174 .- 1532-2831. ; 22:1, s. 71-76 Tidskriftsartikel (refereegranskat)abstract Background Visiting a Radiology department may elicit both positive and negative feelings for children and parents alike. This study investigated children's and parents' perceptions of care during the peri-radiographic process and whether these perceptions correlated with the child's perceptions of pain and distress. Methods This study utilized a quantitative descriptive design. Its data was collected in five Radiology departments, two where examinations are performed exclusively on children and three that treat both children and adults. Data collection contained questionnaires from children (n = 110) and their parent (n = 110) as well as children's self-reports of pain and distress. Results The findings illustrated that the children and their parent were satisfied with the care provided throughout the peri-radiographic process, unrelated to the child's self-reported levels of pain and distress or examination setting (i.e. children's department or general department). The highest scores of satisfaction were ascribed to “the radiographer's kindness and ability to help in a sufficient way,” whereas “available time to ask questions and to meet the child's emotional needs” received the lowest scores. Conclusions Parents and children alike perceived the radiographers as skilled and sensitive throughout the examination, while radiographers' time allocated to interacting with the child was not perceived be sufficiently covered.
10.	Björkman, Berit, et al. (författare) Children's Anxiety, Pain, and Distress Related to the Perception of Care While Undergoing an Acute Radiographic Examination 2014 Ingår i: Journal of Radiology Nursing. - : Elsevier BV. - 1546-0843. ; 33:2, s. 69-78 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.
11.	Björkman, Berit, et al. (författare) Children's experience of going through an acute radiographic examination 2012 Ingår i: Radiography. - : Elsevier. - 1078-8174 .- 1532-2831. ; 18:2, s. 84-89 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.
12.	Björkman, Berit, et al. (författare) Children’s pain and distress while undergoing an acute radiographic examination 2012 Ingår i: Radiography. - Elsevier : Elsevier BV. - 1078-8174 .- 1532-2831. ; 18:3, s. 191-196 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.
13.	Björkman, Berit, et al. (författare) Peri-radiographic guidelines for children with autism spectrum disorder : a nationwide survey in Sweden 2017 Ingår i: Child Care Health and Development. - : Wiley-Blackwell. - 0305-1862 .- 1365-2214. ; 43:1, s. 31-36 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: This study aimed to investigate the prevalence of guidelines and routines used nationwide when children with autism spectrum disorder (ASD) are taken care of and examined in a radiology department during a peri-radiographic process.METHOD: A nationwide survey was compiled and distributed to 94 radiology departments throughout Sweden, i.e. those performing more than 100 000 radiographic examinations annually. The survey was designed as a web questionnaire with seven questions on possible guidelines and/or routines for the departments when preparing and taking care of children with ASD in conjunction with a radiographic procedure. The data were scrutinized, using descriptive statistics.RESULTS: In total, 86 radiology departments responded to the survey (response rate 92%). Of those departments, 40 did not examine children with ASD. None of the departments included in the study had existing guidelines underpinning the routines when preparing and performing radiographic examinations for children diagnosed with ASD. A few departments (n = 8) would set aside more time for the procedure if it were known in advance that the child to be examined had been diagnosed with ASD. Also, some departments (n = 7) had radiographers who were more experienced in the care of children who would be appointed to perform examinations for children with ASD.CONCLUSION: It is suggested that guidelines should be developed in order to increase interaction in a supportive way and decrease anxiety during the peri-radiographic process with children with ASD.
14.	Björkman, Berit, 1944-, et al. (författare) Phantom phenomena – Their perceived qualities and consequences from the patient’s perspective 2012 Ingår i: Scandinavian Journal of Pain. - : Elsevier. - 1877-8860 .- 1877-8879. ; 3:3, s. 134-140 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.
15.	Björkman, Berit, et al. (författare) Plausible scenarios for the radiography profession in Sweden in 2025 2017 Ingår i: Radiography. - : Elsevier. - 1078-8174 .- 1532-2831. ; 23:4, s. 314-320 Tidskriftsartikel (refereegranskat)abstract Introduction: Radiography is a healthcare speciality with many technical challenges. Advances in engineering and information technology applications may continue to drive and be driven by radiographers. The world of diagnostic imaging is changing rapidly and radiographers must be proactive in order to survive. To ensure sustainable development, organisations have to identify future opportunities and threats in a timely manner and incorporate them into their strategic planning. Hence, the aim of this study was to analyse and describe plausible scenarios for the radiography profession in 2025.Method: The study has a qualitative design with an inductive approach based on focus group interviews. The interviews were inspired by the Scenario-Planning method.Results: Of the seven trends identified in a previous study, the radiographers considered two as the most uncertain scenarios that would have the greatest impact on the profession should they occur. These trends, labelled "Access to career advancement" and "A sufficient number of radiographers", were inserted into the scenario cross. The resulting four plausible future scenarios were: The happy radiographer, the specialist radiographer, the dying profession and the assembly line.Conclusion: It is suggested that "The dying profession" scenario could probably be turned in the opposite direction by facilitating career development opportunities for radiographers within the profession. Changing the direction would probably lead to a profession composed of "happy radiographers" who are specialists, proud of their profession and competent to carry out advanced tasks, in contrast to being solely occupied by "the assembly line".
16.	Björkman, Berit, et al. (författare) Swedish radiographer’s experiences of their work-performance when possessing increased knowledge in reporting 2017 Ingår i: Acta Radiologica. - : Sage Publications. - 0284-1851 .- 1600-0455. ; 58:1 Suppl., s. 24-24 Tidskriftsartikel (refereegranskat)abstract Introduction: Radiographers are today facing various challenges as the technical equipment is getting more advanced and the examinations encounter patients with complex medical records. Furthermore, in the Swedish context, radiology departments are struggling with shortage of both radiologists and radiographers. Following, this has led to a work-situation where radiologists are not always in place during emergency duty, and radiographers’are taking on additional responsibility. Hence, there is a need for further and deeper knowledge within areas that previously was undertaken solely by radiologists. One such area is reporting; and a 7.5 ECTS course was designed and offered to registered radiographers. The aim was to investigate radiographer’s experience of their work-performance and contribution to the clinic after attending this particular course in reporting.Methods: The study had a qualitative design based on individual and semi-structured interviews with 34 radiographers who attended the course in reporting the fall of 2013, 2014 and 2015. The interviews were transcribed verbatim and analysed using qualitative content analysis.Results: The analysis resulted in a comprehensive theme: Width and depth in the professional practice. This theme embraced three categories: Increased knowledge, Professional recognition, Work satisfaction.Conclusions: Increased knowledge in reporting is necessary to meet the demands from the diagnostic departments. A course in reporting on advanced level is a tool for deeper understanding of the medical image. However, there will still be challenges and constraints during the path to be a fully specialized radiographer in reporting. There is a need for more courses in this area on the second and third level.
17.	Björkman, Berit, et al. (författare) The meaning and consequences of amputation and mastectomy from the perspective of pain and suffering 2017 Ingår i: Scandinavian Journal of Pain. - : Elsevier. - 1877-8860 .- 1877-8879. ; 14:1, s. 100-107 Tidskriftsartikel (refereegranskat)abstract BackgroundThe concepts ‘pain’ and ‘suffering’ are frequently treated as synonymous. However, they are clearly distinct phenomena. Phantom phenomena including pain and sensory disturbances are still recognized as long-lasting problems after limb amputation and after mastectomy. The complex nature of phantom phenomena makes the interpretation of its results ambiguous, regarding the prevalence of pain, sensory disturbances and the accompanying suffering. There is clinical experience that suffering is a great burden for the individual but there is a lack of systematic studies of patients’ own evaluations of the suffering caused by their phantom phenomena.ObjectivesThe overall aim of this study was to identify and describe patients’ suffering related to, and as a part, of their post-amputation situation.MethodsThe present study constitutes a part of a prospective, two-year follow up project investigating interviews of 28 men and women in different ages and who have undergone a limb amputation or mastectomy. The reason for amputation or mastectomy varied among the patients and included vascular diseases, cancer (sarcoma and breast-cancer) and trauma. Our ambition was to extract as much variations as possible in different, individualized aspects of the actual pain and suffering producing situation. The participants were, here, invited to open-ended, narrative-oriented interviews one month after the surgery. The interviews were transcribed verbatim and analyzed within qualitative methodology: thematic content analysis.ResultsTwenty-two of 28 interviewees experienced phantom pain and phantom sensations. The two surgical processes amputation and mastectomy meant for a majority of the interviewees a critical event with threatening consequences for everyday life such as loss of function and personal integrity. Nine interviewees felt even stigmatized as a result of their lost body part. Numerous inter-related factors following the amputation/mastectomy, which can inflict severe suffering on the amputee, were uncovered. The context in which the interviewees were informed about the decision to amputate proved to be one such critical and important factor.ConclusionTo understand potential suffering in relation to phantom phenomena, it will never be enough merely to have knowledge of the underlying physiological or neurological mechanisms and/or the intensity of phantom pain and phantom sensations. Rather, it is necessary to find out how the loss of the body part and its everyday consequences are experienced by patients.ImplicationsIt is important to create time for real dialogue with the patients both during pre-operative preparation and post-operative rehabilitation in order to clarify and verbalize elements that constitute the patients individual suffering. Hopefully this strategy can alleviate future chronic pain problems, severe psycho-social distress and suffering. Such an approach ought to have impact also for perceived suffering after other types of surgery or different invasive treatments.
18.	Björkman, Berit, et al. (författare) Will it Hurt? Verbal Interaction between Child and Radiographer during Radiographic Examination 2013 Ingår i: Journal of Pediatric Nursing. - : Elsevier BV. - 0882-5963. ; 28:6, s. e10-e18 Tidskriftsartikel (refereegranskat)abstract This study investigated the nature of verbal interactions between child, parent and radiographer and theextent to which it varied as a function of the child's age. The participants were 20 female radiographersand 32 children (3–15 years) examined for acute injuries. The verbal interactions during theexamination were video recorded and analyzed using the Roter Interaction Analysis System (RIAS).Results indicated that 80% of the verbal interaction was accounted for by the radiographer, 17% by thechild and 3% by the parent. The distribution of utterances varied with regard to children's age.
19.	Gamble, Carrol, et al. (författare) Timing of Primary Surgery for Cleft Palate. 2023 Ingår i: The New England journal of medicine. - : Massachusetts Medical Society. - 1533-4406 .- 0028-4793. ; 389:9, s. 795-807 Tidskriftsartikel (refereegranskat)abstract Among infants with isolated cleft palate, whether primary surgery at 6 months of age is more beneficial than surgery at 12 months of age with respect to speech outcomes, hearing outcomes, dentofacial development, and safety is unknown.We randomly assigned infants with nonsyndromic isolated cleft palate, in a 1:1 ratio, to undergo standardized primary surgery at 6 months of age (6-month group) or at 12 months of age (12-month group) for closure of the cleft. Standardized assessments of quality-checked video and audio recordings at 1, 3, and 5 years of age were performed independently by speech and language therapists who were unaware of the trial-group assignments. The primary outcome was velopharyngeal insufficiency at 5 years of age, defined as a velopharyngeal composite summary score of at least 4 (scores range from 0 to 6, with higher scores indicating greater severity). Secondary outcomes included speech development, postoperative complications, hearing sensitivity, dentofacial development, and growth.We randomly assigned 558 infants at 23 centers across Europe and South America to undergo surgery at 6 months of age (281 infants) or at 12 months of age (277 infants). Speech recordings from 235 infants (83.6%) in the 6-month group and 226 (81.6%) in the 12-month group were analyzable. Insufficient velopharyngeal function at 5 years of age was observed in 21 of 235 infants (8.9%) in the 6-month group as compared with 34 of 226 (15.0%) in the 12-month group (risk ratio, 0.59; 95% confidence interval, 0.36 to 0.99; P=0.04). Postoperative complications were infrequent and similar in the 6-month and 12-month groups. Four serious adverse events were reported (three in the 6-month group and one in the 12-month group) and had resolved at follow-up.Medically fit infants who underwent primary surgery for isolated cleft palate in adequately resourced settings at 6 months of age were less likely to have velopharyngeal insufficiency at the age of 5 years than those who had surgery at 12 months of age. (Funded by the National Institute of Dental and Craniofacial Research; TOPS ClinicalTrials.gov number, NCT00993551.).
20.	Gimbler Berglund, Ingalill (författare) Developing guidelines in nursing care of children with Autism Spectrum Disorder in high technology health care settings 2017 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Introduction. The high technology environment such as a radiology and anaesthesia department in a typical health care setting can many times be a frightening environment for children. Children with neurodevelopmental disorders, such as Autism Spectrum Disorder (ASD), have problems with communication and social interaction. They are dependent on routines and can have higher sensitivity to sensory stimuli than other children. These children are one group who constitutes special challenges in reducing anxiety and creating participation in a high technology environment. This can make them prone to frightening encounters in health care settings if not cared for with special consideration.Aim: The overall aim of this thesis was to audit and enhance the care of children in a high technology environment in the health care system with a focus on children with Autism Spectrum Disorder.Methods: A descriptive design was used with both qualitative and quantitative methods. In Study I, 32 nurse anaesthetists were interviewed to explore the actions and experiences of caring for children in a high technology environment using a qualitative method, known as the Critical Incident Technique (CIT). In the two following studies (Study II, III) a cross-sectional design was used and two national surveys were performed to obtain knowledge on the status in Sweden regarding the care of children with ASD in high technology environments. Sixty-eight anaesthesia departments, 38 paediatric departments and 86 radiology departments responded to the survey. Descriptive statistic was used for the answers apart from the comments part of the questionnaire where qualitative content analysis was used. Due to the limited existence of guidelines in these environments, the creation ofevidence-based guidelines was performed in Study IV, using a Delphi method. The Delphi study was based on information gleaned from the previous studies and from the literature, and 21 experts identified in Study II and III were the expert panel developing the guidelines.Result: Nurses identified children with special needs such as children with ASD as a vulnerable group in a high technology environment (Study I). Seven departments in the anaesthesia context had guidelines for caring for children with ASD in the perioperative context. In the other departments, the care of children with ASD was dependent on the knowledge of the nurse presently working there (Study II). None of the radiology departments in Sweden had guidelines on how to care for children with ASD going through a radiographic examination without anaesthesia (Study III). As a result of Study I, II and III, the need for structured guidelines for caring for children with ASD in a high technology context was identified and a set of guidelines and a checklist was created. The guidelines relate to the organisational structure for the care of children with deficits in social interaction, communication, sensory sensitivity and dependence on routines. The checklist relates to gleaning information about the specific child to be able to give person-centred care based on the specific characteristic of the child (Study IV).Conclusion: Nurses working in a high technology environment in health care have diverse experiences of preventing anxiety in children with ASD coming for a challenging procedure. There are a limited number of evidence-based guidelines to decrease anxiety and to create participation in this group ofchildren. Evidence-based guidelines were created as a tool for enhancing person-centred care in a high technology environment for this group of children. The fact that several problems are assembled under one disorder makes ASD a useful condition to have as a basis for formulating national guidelines. Guidelines that cater for the care of children with ASD in a high technology environment using a person-centred approach may also extend to the care for children with other neurodevelopmental disorders that exhibit some of the same problems as children with ASD.
21.	Gimbler Berglund, Ingalill, et al. (författare) Management of children with Autism Spectrum Disorder in the anesthesia and radiographic context 2017 Ingår i: Journal of Developmental and Behavioral Pediatrics. - : Wolters Kluwer. - 0196-206X .- 1536-7312. ; 38:3, s. 187-196 Tidskriftsartikel (refereegranskat)abstract Objective: As a primary objective, this study purports to develop guidelines to better care for children with autism spectrum disorder (ASD), particularly regarding these children's preparation for anesthesia and radiologic procedures.Methods: Using a Delphi method with an online distribution of questionnaire, guidelines for caring for children with ASD were created. Twenty-one participants were included in the expert panel. These participants were working with children with ASD in several anesthesia and radiology departments in Sweden. A list of items was created from a previous survey and the literature. In the first round, the items with <60% agreement were discarded. Items were merged, and a new list was created. Two more similar rounds were performed. In the last 2 rounds, 21 participants responded, and 80% agreement was considered to be consensus.Results: The final guidelines consisted of 14 items and a checklist of 16 factors. The 5 areas covered by the items and the checklist were as follows: planning involving parents/guardians, features in the environment, and use of time, communication, and the health care professionals. The organization was important in making it possible for the health care professional to care for the individual child according to the child's needs. It was important to involve the parents/guardians to obtain knowledge about the functioning of the child.Conclusion: A caring encounter involving a child with ASD in the anesthesia and radiology contexts requires advance planning, catered specifically to the individual needs of each child. To accomplish this, general knowledge regarding ASD and ASD's particular manifestation in the child entrusted to their care, is required from the health care workers. The organization needs to have structures in place to facilitate this process.
22.	Gimbler Berglund, Ingalill, et al. (författare) Perioperative and anesthesia guidelines for children with autism : A nationwide survey from Sweden 2016 Ingår i: Journal of Developmental and Behavioral Pediatrics. - : Wolters Kluwer. - 0196-206X .- 1536-7312. ; 37:6, s. 457-464 Tidskriftsartikel (refereegranskat)abstract Objective: The overall aim of this study was to describe the current set of guidelines for the preparation and care for children with autism spectrum disorder (ASD) in the perioperative setting across Sweden and explore the content of these guidelines in detail.Method: An online questionnaire was distributed to the chairpersons of all anesthesia departments (n = 68) and pediatric departments (n = 38) throughout Sweden. Follow-up phone calls were made to those departments that did not return the questionnaire. The presence of guidelines was analyzed through descriptive statistics. These guidelines and comments on routines used in these departments were analyzed inspired by conventional content analysis.Results: Seven of the 68 anesthesia departments and none of the 38 pediatric departments across Sweden have guidelines for preparing and/or administering care to children with ASD within the perioperative setting. From the guidelines and routines used, 3 categories emerge: "lacking the necessary conditions," "no extra considerations needed," and "care with specific consideration for children with ASD." These 3 categories span a continuum in the care. In the first category, the anesthesia induction could result in the child with ASD being physically restrained. In the last category, the entire encounter with the health care service would be adapted to the specific needs of the child.Conclusion: There is a lack of evidence-based guidelines specifically designed to meet the needs of children with ASD in the preoperative period in Sweden. Further research is needed to understand if children with ASD would benefit from evidence-based guidelines.
23.	Morris, Ulrika, et al. (författare) A cluster randomised controlled trial of two rounds of mass drug administration in Zanzibar, a malaria pre-elimination setting-high coverage and safety, but no significant impact on transmission. 2018 Ingår i: BMC Medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 16:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Mass drug administration (MDA) has the potential to interrupt malaria transmission and has been suggested as a tool for malaria elimination in low-endemic settings. This study aimed to determine the effectiveness and safety of two rounds of MDA in Zanzibar, a pre-elimination setting.METHODS: A cluster randomised controlled trial was conducted in 16 areas considered as malaria hotspots, with an annual parasite index of > 0.8%. The areas were randomised to eight intervention and eight control clusters. The intervention included two rounds of MDA with dihydroartemisinin-piperaquine and single low-dose primaquine 4 weeks apart in May-June 2016. Primary and secondary outcomes were cumulative confirmed malaria case incidences 6 months post-MDA and parasite prevalences determined by PCR 3 months post-MDA. Additional outcomes included intervention coverage, treatment adherence, occurrence of adverse events, and cumulative incidences 3, 12, and 16 months post-MDA.RESULTS: Intervention coverage was 91.0% (9959/10944) and 87.7% (9355/10666) in the first and second rounds, respectively; self-reported adherence was 82.0% (881/1136) and 93.7% (985/1196). Adverse events were reported in 11.6% (147/1268) and 3.2% (37/1143) of post-MDA survey respondents after both rounds respectively. No serious adverse event was reported. No difference in cumulative malaria case incidence was observed between the control and intervention arms 6 months post-MDA (4.2 and 3.9 per 1000 population; p = 0.94). Neither was there a difference in PCR-determined parasite prevalences 3 months post-MDA (1.4% and 1.7%; OR = 1.0, p = 0.94), although having received at least the first MDA was associated with reduced odds of malaria infection (aOR = 0.35; p = 0.02). Among confirmed malaria cases at health facilities, 26.0% and 26.3% reported recent travel outside Zanzibar in the intervention and control shehias (aOR ≥ 85; p ≤ 0.001).CONCLUSIONS: MDA was implemented with high coverage, adherence, and tolerability. Despite this, no significant impact on transmission was observed. The findings suggest that two rounds of MDA in a single year may not be sufficient for a sustained impact on transmission in a pre-elimination setting, especially when the MDA impact is restricted by imported malaria. Importantly, this study adds to the limited evidence for the use of MDA in low transmission settings in sub-Saharan Africa.TRIAL REGISTRATION: ClinicalTrials.gov, NCT02721186 (registration date: March 29, 2016).
24.	Morris, Ulrika, et al. (författare) Field deployment of loop-mediated isothermal amplification for centralized mass-screening of asymptomatic malaria in Zanzibar : a pre-elimination setting 2015 Ingår i: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 14 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Molecular tools for detection of low-density asymptomatic Plasmodium infections are needed in malaria elimination efforts. This study reports results from the hitherto largest implementation of loop-mediated isothermal amplification (LAMP) for centralized mass screening of asymptomatic malaria in Zanzibar.METHODS: Healthy individuals present and willing to participate in randomly selected households in 60 villages throughout Zanzibar were screened for malaria by rapid diagnostic tests (RDT). In 50 % of the study households, participants were asked to provide 60 μL of finger-prick blood for additional LAMP screening. LAMP was conducted in two centralized laboratories in Zanzibar, by trained technicians with limited or no previous experience of molecular methods. The LAMP assay was performed with Loopamp(TM) MALARIA Pan/Pf Detection Kit (Eiken Chemical Company, Japan). Samples positive for Plasmodium genus (Pan)-LAMP were re-tested using Plasmodium falciparum-specific LAMP kits.RESULTS: Paired RDT and LAMP samples were available from 3983 individuals. The prevalence of asymptomatic malaria was 0.5 % (CI 95 % 0.1-0.8) and 1.6 % (CI 95 % 1.1-2.2) by RDT and Pan-LAMP, respectively. LAMP detected 3.4 (CI 95 % 2.2-5.2) times more Plasmodium positive samples than RDT. DNA contamination was experienced, but solved by repetitive decontamination of all equipment and reagents.CONCLUSIONS: LAMP is a simple and sensitive molecular tool, and has potential in active surveillance and mass-screening programmes for detection of low-density asymptomatic malaria in pre-elimination settings. However, in order to deploy LAMP more effectively in field settings, protocols may need to be adapted for processing larger numbers of samples. A higher throughput, affordable closed system would be ideal to avoid contamination.
25.	Morris, Ulrika, et al. (författare) Rapid diagnostic tests for molecular surveillance of Plasmodium falciparum malaria -assessment of DNA extraction methods and field applicability. 2013 Ingår i: Malaria journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 12 Tidskriftsartikel (refereegranskat)abstract The need for new malaria surveillance tools and strategies is critical, given improved global malaria control and regional elimination efforts. High quality Plasmodium falciparum DNA can reliably be extracted from malaria rapid diagnostic tests (RDTs). Together with highly sensitive molecular assays, wide scale collection of used RDTs may serve as a modern tool for improved malaria case detection and drug resistance surveillance. However, comparative studies of DNA extraction efficiency from RDTs and the field applicability are lacking. The aim of this study was to compare and evaluate different methods of DNA extraction from RDTs and to test the field applicability for the purpose of molecular epidemiological investigations.

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