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- Baldewpersad Tewarie, N., et al.
(författare)
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An overview of Clinical Quality Registries (CQRs) on gynecological oncology worldwide
- 2022
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983. ; 48:10, s. 2094-2103
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Forskningsöversikt (refereegranskat)abstract
- Introduction: Clinical Quality Registries (CQRs) were initiated in order to compare clinical outcomes between hospitals or regions within a country. To get an overview of these CQRs worldwide the aim of this study was to identify these CQRs for gynecological oncology and to summarize their characteristics, processes and QI's and to establish whether it is feasible to make an international comparison in the future. Methods: To identify CQRs in gynecological oncology a literature search in Pubmed was performed. All papers describing the use of a CQR were included. Administrative, epidemiological and cancer registries were excluded as these registries do not primarily serve to measure quality of care through QI's. The taskforce or contact person of the included CQR were asked to participate and share information on registered items, processes and indicators. Results: Five nations agreed to collaborate: Australia, Denmark, Italy, the Netherlands and Sweden. Denmark, Netherlands and Sweden established a nationwide registry, collecting data on multiple tumor types, and various QI's. Australia and Italy included patients with ovarian cancer only. All nations had a different process to report feedback results to participating hospitals. Conclusion: CQRs serve the same purpose to improve quality of care but vary on different aspects. Although similarities are observed in the topics measured by the QI's, an international comparison was not feasible as numerators or denominators differ between registries. In order to compare on an international level it would be useful to harmonize these registries and to set an international standard to measure the quality of care with similar indicators.
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- Lee, C.K., et al.
(författare)
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Prognostic nomogram to predict progression-free survival in patients with platinum-sensitive recurrent ovarian cancer
- 2011
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Ingår i: British Journal of Cancer. - : Cancer Research UK. - 0007-0920 .- 1532-1827. ; 105:8, s. 1144-1150
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with platinum-sensitive recurrent ovarian cancer are a heterogeneous group, and it is not possible to accurately predict the progression-free survival (PFS) in these patients. We developed and validated a nomogram to help improve prediction of PFS in patients treated with platinum-based chemotherapy. METHODS: The nomogram was developed in a training cohort (n = 955) from the CALYPSO trial and validated in the AGO-OVAR 2.5 Study (n = 340). The proportional-hazards model (nomogram) was based on pre-treatment characteristics. RESULTS: The nomogram had a concordance index (C-index) of 0.645. Significant predictors were tumour size platinum-chemotherapy-free interval, CA-125, number of organ metastatic sites and white blood count. When the nomogram was applied without CA-125 (CA-125 was not available in validation cohort), the C-indices were 0.624 (training) and 0.594 (validation). When classification was based only on the platinum-chemotherapy-free interval, the indices were 0.571 (training) and 0.560 (validation). The calibration plot in the validation cohort based on four predictors (without CA-125) suggested good agreement between actual and nomogram-predicted 12-month PFS probabilities. CONCLUSION: This nomogram, using five pre-treatment characteristics, improves prediction of PFS in patients with platinum-sensitive ovarian cancer having platinum-based chemotherapy. It will be useful for the design and stratification of patients in clinical trials and also for counselling patients.
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- Hogberg, C., et al.
(författare)
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Diagnostic validity of the MINI-KID disorder classifications in specialized child and adolescent psychiatric outpatient clinics in Sweden
- 2019
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Ingår i: Bmc Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMissing diagnostic information often results poor accuracy of the clinical diagnostic decision process. The Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) is a short standardized diagnostic interview and covers a rather broad range of diagnoses applicable to children and adolescents. MINI-KID disorder classifications have shown test-retest reliability and validity comparable to other standardized diagnostic interviews and is claimed to be a useful tool for diagnostic screening in Child and Adolescent Psychiatric care. The concordance between the Swedish language version of the MINI-KID Interview and LEAD (Longitudinal, Expert, All Data) research diagnoses was studied in secondary child and adolescent psychiatric outpatient care.MethodsMINI-KID interviews were performed for 101 patients, boys n=50, girls n=51, aged 4 to 18years. The duration of the interview was on average 46min, the child/adolescent participating together with the parent(s) in most cases. The seven most prevalent diagnoses were included in the analyses.ResultsThe average overall percent agreement (OPA) between MINI-KID and LEAD was 79.5%, the average percent positive agreement (PPA) 35.4 and the average percent negative agreement (NPA) 92.7. OPA was highest for Obsessive-Compulsive Disorder (OCD) (0.89), Tic disorders (0.88) and Pervasive developmental disorders (0.81). There were similar results in diagnostic agreement comparing the two versions: the standard MINI-KID and MINI-KID for parents. The specific screening questions in MINI-KID resulted in additional preliminary diagnoses compared with the regular initial clinical assessment.ConclusionsOverall, there was an acceptable agreement between MINI-KID disorder classifications and research diagnoses according to LEAD. The standardized interview MINI-KID could be considered as a tool with the possibility to give valuable information in the diagnostic process in child and adolescent care which is similar to the setting in the present study.
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- Popat, S, et al.
(författare)
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Genome screening of coeliac disease
- 2002
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Ingår i: Journal of Medical Genetics. - : BMJ. - 0022-2593 .- 1468-6244. ; 39:5, s. 328-331
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Tidskriftsartikel (refereegranskat)
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- Rosenberg, P., et al.
(författare)
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Data quality in the Swedish Quality Register of Gynecologic Cancer - a Swedish Gynecologic Cancer Group (SweGCG) study
- 2018
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 57:3, s. 346-353
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study is to evaluate the quality of data on endometrial (EC) and ovarian, fallopian tube, peritoneal, abdominal or pelvic cancers (OC) registered in the Swedish Quality Register of Gynecologic Cancer (SQRGC).Method: A random sample of 500 patients was identified in the SQRGC and their medical charts were reviewed for re-abstraction of 31 selected core variables by an independent validator. The data in the SQRGC and the re-abstracted data were compared. The data were collected from 25 hospitals evenly distributed throughout Sweden. The main outcomes were comparability, timeliness, completeness and validity. Coverage was compared with the National Cancer Register (NCR). Timeliness was defined as the speed of registration i.e. when patients were registered in the SQRGC relative to date of diagnosis. Internationally accepted coding systems for stage, grading and histologic type were used ensuring a high degree of comparability. Correlations were estimated using Pearson's correlation coefficient and Cohens kappa coefficient.Results: The completeness was 95%. The timeliness was 88-91% within 12 months of diagnosis. The median degree of agreement between re-abstracted data and data in the SQRGC was 82.1%, with a median kappa value of 0.73 for ordinate variables and a median Pearson's correlation coefficient of 0.96. The agreements for the type of surgery were 76% (95% CI 70-81%; kappa 0.49) and type of primary treatment 90% (95% CI 87-94%; kappa 0.85) in OC and in EC 88% (95% CI 84-93%; kappa 0.84). The agreements for the FIGO stage were in OC and EC 74% (95% CI 68-80%; kappa 0.69) and 87% (95% CI 82-91%; kappa 0.79), respectively.Conclusions: The data in the Swedish Quality Register for Gynecologic Cancer are of adequate quality in order to be used as a basis for research and to evaluate possible differences in treatment, lead times and treatment results.
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- Hogberg, L, et al.
(författare)
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The impact of active intervention on the spread of penicillin-resistant streptococcus pneumoniae in Swedish day-care centres
- 2004
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 36:9, s. 629-635
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Tidskriftsartikel (refereegranskat)abstract
- Policies for handling cases of penicillin-non-susceptible Streptococcus pneumoniae (PNSP) in day-care groups vary between different counties in Sweden. The aim of this study was to evaluate the epidemiological effect of excluding PNSP-carriers from children's day-care centres (DCC). We followed the incidence in 14 DCC groups with ongoing PNSP-spread, by repeated group screens until no further cases could be identified. All identified carriers were excluded from DCC attendance in study area A (Skane region) while they remained in the group in study area B (Goteborg and Orebro), according to local policies. The intervention effect was evaluated by comparing the number of additional cases after the baseline screen (start of the intervention period) between the 2 study areas. All PNSP-isolates were characterized by resistance pattern, serotype and pulse-field gel electrophoresis. The relative risk for children in DCCs without active intervention was 6.4 (95% CI: 2.0-20.7). Each prevented case in area A can be estimated to have demanded the exclusion of 2 other children from day care for approximately 4 weeks each. The total cost-benefit outcome of this action has to be seen in the light of the local situation with regard to the population prevalence and the distribution of other risk factors.
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- Marcickiewicz, J., et al.
(författare)
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The wait time to primary surgery in endometrial cancer - impact on survival and predictive factors: a population-based SweGCG study
- 2022
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 61:1, s. 30-37
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Tidskriftsartikel (refereegranskat)abstract
- Background Poor survival rates in different cancer types are sometimes blamed on diagnostic and treatment delays, and it has been suggested that such delays might be related to sociodemographic factors such as education and ethnicity. We examined associations of the wait time from diagnosis to surgery and survival in endometrial cancer (EC) and explored patient and tumour factors influencing the wait time. Material and methods In this historical population-based cohort study, The Swedish Quality Registry for Gynaecologic Cancer (SQRGC) was used to identify EC patients who underwent primary surgery between 2010 and 2018. Factors associated with a wait time > 32 d were analysed with logistic regression. The 32-d time point was defined in accordance with the Swedish Standardisation Cancer Care programme. Adjusted Poisson regression analyses were used to analyse excess mortality rate ratio (EMRR). Results Out of 7366 women, 5535 waited > 32 d for surgery and 1098 > 70 d. The overall median wait time was 44 d. The factors most strongly associated with a wait time > 32 d were surgery at a university hospital (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.08-1.66) followed by country of birth (OR 1.31, 95% CI 1.10-1.55) and year of diagnosis. There were no associations between wait time and histology or age. A wait time < 15 d was associated with higher mortality (adjusted EMRR 2.29,95% CI 1.36-3.84) whereas no negative survival impact was seen with a wait time of 70 d. Age, tumour stage, histology and risk group were highly associated with survival, whereas education, country of origin and hospital level did not have any impact on survival. Conclusions Surgery within the first two weeks after EC diagnosis was associated with worsened survival. A prolonged wait time did not seem to have any significant adverse effect on prognosis.
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- Orejuela, Silvia, et al.
(författare)
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Establishing factors to consider while adopting the agile approach in manufacturing companies
- 2022
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Ingår i: SPS 2022 - Proceedings of the 10th Swedish Production Symposium. - : IOS Press BV. - 9781614994398 ; 21, s. 341-353
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Konferensbidrag (refereegranskat)abstract
- Due to the current fast-paced business environment, new approaches to product development (PD) have been requested. In that matter, the agile approach has gained interest among researchers and practitioners. Based on its positive results in the software industry, it has started to be adopted in the manufacturing industry. Nevertheless, there are factors that manufacturing companies must consider while adopting the agile approach, and there is a lack of in-depth empirical studies about those factors. In that matter, this paper presents the preliminary findings of a single case study of a large manufacturing company. The data collection consisted of fifteen semi-structured interviews with persons with key roles in different organizational functions. The identified factors were analyzed and presented according to a product development system (PDS) perspective which encompasses people, process, and technology and tools subsystems. For the people subsystem, the study identified factors related to cross-functional integration and coordination, cross-functional communication, organizational culture, understanding of the agile approach, definition of roles and responsibilities, and people involvement and support. In respect of the process subsystem, the study identified factors associated with workload leveling and development interfaces. Regarding the technology and tools subsystem, the study identified factors related to the integration of information systems, and technology and manufacturing readiness levels. As a result, the study contributes further to the establishment of the factors that may influence the adoption of the agile approach in the PDS of a large manufacturing company.
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- Quist, E, et al.
(författare)
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Responses of a nitrogen-saturated forest to a sharp decrease in nitrogen input
- 1999
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Ingår i: Journal of Environmental Quality. - 0047-2425 .- 1537-2537. ; 28, s. 1970-1977
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Tidskriftsartikel (refereegranskat)abstract
- The reversibility of induced N saturation was investigated in a 46- yr-old pine (Pinus sylvestris L.) forest in northern Sweden Ammonium nitrate has been applied annually since 1971 to plots (30 by 30 m) at average dosages of 36 (N1), 72 (N2), and 108 (N3) kg N ha(-1) yr(-1): with or without P and K addition (background N deposition is <4 kg ha(-1) yr(-1)). In 1990, after two decades of treatment, the largest N application (N3) was suspended, while N1 and N2 still received ammonium nitrate applications. Seven gears after the last application in N3, the N availability measured as N concentration in plants spine roots and needles and in leaves of the grass Deschampsia flexuosa (L.) Trin.] and activity of the enzyme nitrate reductase in leaves of D. flexuosa, and N-15 uptake by excised pine roots, was at the same levels as in N1, although more than twice the amount of N has been applied in total to N3. The arginine concentrations in pine needles, concentrations of exchangeable mineral N in the organic layer and the uppermost 20 cm of the mineral soil were at the same levels as in the control plots. Thus, an experimentally induced N excess was, according to these measurements, to a high degree reversed 7 yr after the last N application. However, the composition of the understory vegetation still differed markedly from the untreated control 8 yr after the last N3 application.
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| 40. |
- Rai, Chinthan, et al.
(författare)
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Additive Manufacturing Decision Support Systems : A Systematic Literature Review Discerning Current and Future Directions
- 2022
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Ingår i: SPS 2022 - Proceedings of the 10th Swedish Production Symposium. - 2352-7528 .- 2352-751X. - 9781614994398 ; 21, s. 553-565
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Konferensbidrag (refereegranskat)abstract
- Additive manufacturing (AM) was introduced the 1980's for rapid prototyping (RP) purposes but now AM provides complementary techniques to conventional manufacturing processes and offers advantages when components can be exacting, impossible, and too costly to be produced by conventional methods due to complex structures and geometric configurations, which require tailored designs. They are also often mass-customized components, with custom-made properties and low volume production requirements making AM the 'technology of choice' since its added-value aspects cannot be achieved by any other manufacturing technologies. These advancements in manufacturing, demand standardized fact-based decision support systems (DSSs), to support AM practitioners in their task selecting the most suitable techniques for given applications. Hence, this paper aims to increase the understanding of what - of how - DSSs are used in selecting and utilizing AM in various applications. This paper's core message, considering practical implications, is to guide and support AM researchers with an overview of the DSSs for AM landscape. This paper presents and compares different models and tools classified within four categories used as DSS for AM and identifies their advantages and disadvantages by conducting a 3-step systematic literature review (SLR). A total of 388 literatures were initially retrieved, and according to an inclusion criteria analysis, the literatures were evaluated. This is the first SLR emphasizing and synthesizing obtainable literatures on AM DSS. Until now, this topic has acquired narrow exploration; however, the authors believe it is of rapidly growing importance to both scientists and practitioners.
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- Stalberg, K., et al.
(författare)
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Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer - a Swedish Gynecologic Cancer Group (SweGCG) study
- 2019
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 58:11, s. 1628-1633
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study is to evaluate the impact of lymphovascular space invasion (LVSI) on the risk of lymph node metastases and survival in endometrioid endometrial adenocarcinoma. Material and methods: As regard the study design, this is a cohort study based on prospectively recorded data. Patients with endometrioid endometrial adenocarcinoma registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2017 with FIGO stages I-III and verified nodal status were identified (n = 1587). LVSI together with established risk factors, namely DNA ploidy, FIGO grade, myometrial invasion and age, were included in multivariable regression analyses with lymph node metastases as the dependent variable. Associations between the risk factors and overall and relative survival were included in multivariable models. Estimates of risk ratios (RR), hazard ratios (HR), excess mortality rate ratios (EMR), and 95% confidence intervals (95% CI) were calculated. Results: The presence of LVSI presented the strongest association with lymph node metastases (RR = 5.46, CI 3.69-8.07, p < .001) followed by deep myometrial invasion (RR = 1.64, CI 1.13-2.37). In the multivariable survival analyses, LVSI (EMR = 7.69, CI 2.03-29.10,) and non-diploidy (EMR = 3.23, CI 1.25-8.41) were associated with decreased relative survival. In sub-analyses including only patients with complete para-aortic and pelvic lymphadenectomy and negative lymph nodes (n = 404), only LVSI (HR = 2.50, CI 1.05-5.98) was associated with a worsened overall survival. Conclusion: This large nationwide study identified LVSI as the strongest independent risk factor for lymph node metastases and decreased survival in patients with endometrioid adenocarcinomas. Moreover, decreased overall survival was also seen in patients with LVSI-positive tumors and negative lymph nodes, indicating that hematogenous dissemination might also be important.
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- Tropé, C, et al.
(författare)
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Randomized study on adjuvant chemotherapy in stage I high-risk ovarian cancer with evaluation of DNA-ploidy as prognostic instrument
- 2000
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Ingår i: Annals of oncology : official journal of the European Society for Medical Oncology. - : Elsevier BV. - 0923-7534. ; 11:3, s. 8-281
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Adjuvant chemotherapy versus observation and chemotherapy at progression was evaluated in 162 patients in a prospective randomized multicenter study. We also evaluated DNA-measurements as an additional prognostic factor.PATIENTS AND METHODS: Patients received adjuvant carboplatin AUC 7 every 28 days for six courses (n = 81) or no adjuvant treatment (n = 81). Eligibility included surgically staged and treated patients with FIGO stage I disease, grade 1 aneuploid or grade 2 or 3 non-clear cell carcinomas or clear cell carcinomas. Disease-free (DFS) and disease-specific (DSS) survival were end-points.RESULTS: Median follow-up time was 46 months and progression was observed in 20 patients in the treatment group and 19 in the control group. Estimated five-year DFS and DSS were 70% and 86% in the treatment group and 71% and 85% in the control group. The hazard ratio was 0.98 (95% confidence interval (95% CI): 0.52-1.83) regarding DFS and 0.94 (95% CI: 0.37-2.36) regarding DSS. No significant differences in DFS or DSS could be seen when the log-rank test was stratified for prognostic variables. Therefore, data from both groups were pooled for the analysis of prognostic factors. DNA-ploidy (P = 0.003), extracapsular growth (P = 0.005), tumor rupture (P = 0.04), and WHO histologic grade (P = 0.04) were significant independent prognostic factors for DFS with P < 0.0001 for the model in the multivariate Cox analysis. FIGO substage (P = 0.01), DNA ploidy (P < 0.05), and histologic grade (P = 0.05) were prognostic for DSS with a P-value for the model < 0.0001.CONCLUSIONS: Due to the small number of patients the study was inconclusive as regards the question of adjuvant chemotherapy. The survival curves were superimposable, but with wide confidence intervals. DNA-ploidy adds objective independent prognostic information regarding both DFS and DSS in early ovarian cancer.
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