| 1. |
- Baldetorp, Bo, et al.
(författare)
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Proliferative index obtained by DNA image cytometry. Does it add prognostic information in Auer IV breast cancer?
- 1998
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Ingår i: Analytical and Quantitative Cytology and Histology. - 0884-6812. ; 20:2, s. 144-152
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether the S + G2/M fraction (proliferative index) is a prognostic determinant in breast cancers classified as Auer IV. STUDY DESIGN: Prognostic evaluation of Auer IV DNA histograms with respect to the high versus low S + G2/M fraction, obtained by image cytometry on consecutive breast cancer imprint preparations. RESULTS: When studying recurrence-free survival (n = 136), the prognostic value of S + G2/M was found to vary with time: it was negligible before the median time to relapse (1.5 years) but thereafter statistically significant, in both univariate and multivariate analysis. The same pattern was found when overall survival was used as the end point; the effect was delayed to about the median time until death (three years). Tumors with a low S + G2/M fraction were smaller and more often estrogen receptor- and progesterone receptor-positive than those with a high S + G2/M fraction. CONCLUSION: According to ICM-DNA values corresponding to the S + G2/M region, patients with breast cancers classified as Auer IV can be divided into subgroups with different tumor characteristics and prognoses.
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| 2. |
- Boiesen, P, et al.
(författare)
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Histologic grading in breast cancer--reproducibility between seven pathologic departments. South Sweden Breast Cancer Group
- 2000
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 39:1, s. 41-45
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Tidskriftsartikel (refereegranskat)abstract
- Histologic grade, including tubular formations, nuclear grade, and mitotic activity, is a well-documented prognostic factor in breast cancer. In comparison with other prognostic parameters, the evaluation of histologic grade is cheap and can be performed, in principle, in all cases of breast cancer. One possible disadvantage is that the evaluation may vary between different pathological departments. The aim of the present work was therefore to study the reproducibility of the histologic grading system by distributing haematoxylin-erythrosin-stained slides from 93 invasive breast cancers to the seven pathology departments within the southern healthcare region of Sweden. The evaluation was performed blindly and without any knowledge of other clinical parameters. In 31% of the cases the same histologic grade was obtained for all departments. The overall mean kappa was 0.54, indicating a moderate reproducibility. Of the three factors included in histologic grade, the agreement was best for tubular formations and poorest for nuclear grade and mitotic activity. The overall moderate reproducibility should be considered when the clinical usefulness of histologic grading is compared with other prognostic instruments.
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| 3. |
- Chebil, G, et al.
(författare)
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Comparison of immunohistochemical and biochemical assay of steroid receptors in primary breast cancer - Clinical associations and reasons for discrepancies
- 2003
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 42:7, s. 719-725
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Tidskriftsartikel (refereegranskat)abstract
- Estrogen ( ER) and progesterone receptor (PgR) status was analysed in paraffin-embedded breast cancer material with immunohistochemical (IHC) technique and compared with corresponding analyses in cytosols ( CYT). ER showed the same status (positive/negative) with both methods in 88% of the samples (352/ 402). The concordance was also high for PgR status (81% [321/394]). Besides values near cut-off, heterogeneity in the distribution of receptor positive and negative nuclei within a tumour sample was the main reason for discordances. Histological type, presence of sclerosis, necrosis and non-invasive cells, and technical artefacts seem to be of only limited importance for explaining discordances. All patients have been treated with adjuvant tamoxifen for two years. The two subgroups, which were ERCYT+/ ERIHC+ or ERCYT-/ERIHC+, both had a significantly better progression-free survival (PFS; median follow-up: almost 6 years) than the ERCYT -/ERIHC- group (p< 0.001 and p = 0.007, respectively). The remaining group, ERCYT+/ERIHC-, had an intermediate PFS. For PgR, the associations with PFS were weaker, with significantly better PFS than the PgR(CYT)-/PgR(IHC)- group being found only for the PgR(CYT)+/PgR(IHC) - group (p = 0.03).
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| 4. |
- Fernö, Mårten, et al.
(författare)
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One or multiple samplings for flow cytometric DNA analyses in breast cancer-prognostic implications?
- 1992
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Ingår i: Cytometry. - : Wiley. - 0196-4763 .- 1097-0320. ; 13:3, s. 241-249
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Tidskriftsartikel (refereegranskat)abstract
- Flow cytometric assessments of DNA ploidy status and the S-phase fraction (SPF) have been shown to yield prognostic information in breast cancer. The aim of the present investigation was to elucidate the reproducibility of results with regard to tumor DNA heterogeneity, and to ascertain whether the prognostic value of DNA measurements might be enhanced by analyzing two pieces of a tumor instead of one. Agreement with regard to ploidy status (diploid versus non-diploid) was obtained in 90% of cases (71/79) when two adjacent sections of the tumor were investigated, and in 77% of cases (10/13) when four biopsies from different quadrants of the tumor specimen were investigated. The corresponding figures for agreement in SPF (divided into three categories, less than 7.0%, 7.0-11.9%, and greater than or equal to 12%) were 75% (59/79; 2-sample series) and 55% (7/13; 4-biopsy series). The main reason for variance in ploidy results was the difficulties in distinguishing near diploid cell populations. Discrepancies in SPF categories could be explained by minor fluctuations in SPF values near the cut-off levels, or by variance in ploidy status, the fraction of non-diploid nuclei, and background noise due to cell debris. There was a stepwise increase in recurrence rate (RR) among patients with increasing SPF category (RR: 20%, 41%, and 53%). Patients whose SPF categories varied, from low or intermediate in one part of the tumor to high in another, seemed to have a poor prognosis (RR = 57%).(ABSTRACT TRUNCATED AT 250 WORDS)
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| 5. |
- Fernö, Mårten, et al.
(författare)
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Preoperative fine needle aspiration from human breast cancer is a valuable sampling material for progesterone receptor and cytometric DNA analysis
- 1996
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 35:S8, s. 19-25
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Tidskriftsartikel (refereegranskat)abstract
- In a breast cancer series (n = 54), preoperative fine needle aspiration (FNA) was compared with biopsy at primary surgery as a source of material for the determination of progesterone receptor (PgR) content by enzyme immuno assay. The respective results manifested a strong correlation (r(s) = 0.82). The fact that PgR content was usually higher in FNA samples than in the corresponding biopsy samples and the finding that 11% of the tumours were PgR positive in FNA but PgR negative in the corresponding biopsy samples suggest a greater proportion of malignant cells to be obtained with FNA than in surgical biopsy. In another breast cancer series (n = 50), corresponding comparisons for DNA flow cytometry showed concordance in ploidy status (diploid vs. non-diploid) in 84% of cases and a strong correlation in S-phase fraction values (r(s) = 0.70). At DNA image cytometry, concordant results (Auer I + II vs. Auer III + IV) were obtained in 87% of the cases. To sum up, FNA seems to be a useful sampling technique for PgR determination and DNA cytometry.
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| 6. |
- Holst-Hansson, Annette, et al.
(författare)
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Hoping to reach a safe haven :Swedish families' lived experience when a family member is diagnosed with breast cancer
- 2017
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Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 31, s. 52-58
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: When a woman is diagnosed with breast cancer, it affects all family members. Therefore, the aim of this study was to elucidate family members lived experience when a family member is diagnosed with breast cancer. Method: The study had a hermeneutic phenomenological design including individual conversational interviews conducted face-to-face with six women with breast cancer and their family members at two different points of time, in order to elucidate families' lived experience, both as individuals and as a unit, from each family member's perspective. Results: Living as a family in the presence of breast cancer is a challenging endeavour to regain an ordinary, safe life, hoping to reach a safe haven. The families felt that life as they knew it had disappeared and they were fumbling in the dark, trying to find support and guidance on their path to ordinary life. The family members were pursuing balance by attempting to keep the family together and maintaining a positive attitude while battling against fear and treatment-related side effects. Finally, the families were struggling with guilt and inadequacy, due to their difficulties in communicating the emotional distress that the illness brought upon them, at the same time as they felt abandoned by the healthcare professionals. Conclusions: Families experience an unmet need of information and support, which implies that healthcare professionals may want to acknowledge and include the family already at the time of diagnosis in order to help them endure and cope with the distressing experience and thus increase their wellbeing.
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| 7. |
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| 8. |
- Holst-Hansson, Annette, et al.
(författare)
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The breath of life : womens' experiences of breathing adapted radiation therapy
- 2013
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Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 17:3, s. 354-359
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To describe and analyze how women with breast cancer experience breathing adapted radiation therapy (BART) and to explore how women manage daily radiation therapy. Method Individual interviews were conducted with 20 women treated with BART for breast cancer concerning their perception of radiation therapy. The transcribed interviews were analyzed using qualitative content analysis. Results ‘The breath of life’ was the overall theme, as the women experienced the breathing as a way in which to influence their treatment and thus their survival. ‘Participating in one's treatment, for good or ill’, was the main category with four subcategories, ‘Knowing one has done something good’, ‘Getting an extra bonus – healthwise’, ‘The experience of being in control’ and ‘Being in a high-technology environment’. The breathing technique became the strategy by which they could manage their treatment and gave them a sense of participation which led to a feeling of being in control. The women also felt that breathing benefited their health both mentally and physically. The high-technology environment was experienced as both hopeful and frightening. Conclusion Survival or increasing the chances of survival, are of ultimate importance for a woman with breast cancer. BART requires commitment from the women, which was perceived as offering them an opportunity to participate in their own treatment, for their survival. Increasing the women's possibilities to participate in their treatment benefits their health and welfare during an otherwise turbulent time and allow the rehabilitation process to start during treatment.
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| 9. |
- Holst-Hansson, Annette, et al.
(författare)
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The narrow treatment road to survival : Everyday life perspectives of women with breast cancer from Iraq and the former Yugoslavia undergoing radiation therapy in Sweden
- 2018
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Ingår i: European Journal of Cancer Care. - : John Wiley & Sons. - 0961-5423 .- 1365-2354. ; 27:2
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed at exploring how women from Iraq and the former Yugoslavia, diagnosed with breast cancer and living in Sweden, experience their everyday life during radiation therapy. A qualitative research design was used comprising interviews with ten women, five originating from Iraq and five from the former Yugoslavia. Striving to survive, the women experienced their everyday life during radiation therapy as extremely challenging. This experience can be placed into three categories: strategies for survival, keeping up appearances and staying in control. Because of these specific challenges, immigrant women may need additional information and guidance in conjunction with the diagnosis, which may enable them to identify possible sources of support from those closest to them. Also, greater attention should focus on acknowledging the woman behind the diagnosis, regardless of her origin, to develop an individualised support programme to help her cope with everyday life during radiation therapy.
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| 10. |
- Idvall, Ewa, 1950-, et al.
(författare)
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Pain experiences and non-pharmacological strategies for pain management after tonsillectomy : a qualitative interview study of children and parents.
- 2005
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Ingår i: Journal of Child Health Care. - 1367-4935 .- 1741-2889. ; 9:3, s. 196-207
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Tidskriftsartikel (refereegranskat)abstract
- Tonsillectomy is one of the most common paediatric surgical procedures. This study aimed to investigate children's experience of pain and the nonpharmacological strategies that they used to manage pain after tonsillectomy. A further aim was to investigate parental views on these same phenomena. Six children (aged seven to 18 years) and their parents (four mothers and two fathers) were interviewed separately on the day after tonsillectomy. The data were analysed using a qualitative approach. Pain experiences were divided into the categories of physiological pain and psychological pain. Children rated their 'worst pain' during the past 24 hours between 6 and 10 (visual analogue scale, 0-10). The non-pharmacological strategies used most frequently to manage pain were thermal regulation (physical method) and distraction (cognitive-behavioural method) according to the framework used. Specific non-pharmacological strategies for pain management relative to different surgical procedures need to be considered.
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| 11. |
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| 12. |
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| 13. |
- Idvall, Ingrid, et al.
(författare)
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Histopathological and cell biological factors of ductal carcinoma in situ before and after the introduction of mammographic screening
- 2001
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 40:5, s. 653-659
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Tidskriftsartikel (refereegranskat)abstract
- With the introduction of mammographic screening the incidence of ductal carcinoma in situ (DCIS) has increased to 10-15% of all breast cancers. The aim of this study was to investigate whether there were any morphological and cell biological differences between DCIS detected during the pre-screening (n = 39) as opposed to the screening period (n = 120). We could not demonstrate any statistically significant differences between the pre-screening and the screening period with regard to nuclear grade, presence of necrosis, the Van Nuys classification system, growth pattern, or cell biological factors (estrogen and progesterone receptors, c-erbB-2, p53, DNA ploidy status, Ki67, and Auer classes). These findings suggest that DCIS tumors detected during the two time periods have a similar malignant potential. DCIS detected during the screening period was further divided into the prevalence period versus the period thereafter, and symptomatic versus screening-detected asymptomatic cases. More cases with diffuse growth patterns were seen during the prevalence period than after the prevalence period, and screening-detected asymptomatic DCISs were more often 15 mm or smaller in diameter than DCISs detected symptomatically.
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| 14. |
- Johannsson, Oscar Thor, et al.
(författare)
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Tumor Biological Features of BRCA1-Induced Breast Cancer
- 1997
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Ingår i: European Journal of Cancer. - 1879-0852. ; 33:3, s. 362-371
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Tidskriftsartikel (refereegranskat)abstract
- BRCA1 mutations, although implicated in disease predisposition in a major part of the hereditary breast cancer population, do not seem to be crucially involved in tumorigenesis of sporadic breast and ovarian cancers. This suggests that tumours arising in BRCA1 mutation carriers may differ from BRCA1 negative hereditary and sporadic cancer in genetic and biological features, as well as in clinical behaviour. Prior to BRCA1 analysis, 79 breast and 19 ovarian tumours from 57 breast and breast-ovarian cancer families, and 170 tumours from a comparison group of stage II breast cancers were studied with regard to histopathological features; immunohistochemistry [c-erbB-2, p53, oestrogen receptor (ER) and progesterone receptor (PR)], DNA flow cytometry and S-phase fraction. BRCA1 mutations were found in 40 breast and 15 ovarian tumours. The BRCA1 positive breast tumours were significantly more often of ductal type, histological grade III and manifested a heavy lymphocyte infiltration. Additionally, as compared to BRCA1 negative tumours, the BRCA1 positive tumours were significantly more often ER, PgR and c-erbB-2 negative. Furthermore, they were significantly more often DNA non-diploid, as well as being characterised by higher S-phase fraction values. These results suggest that BRCA1-induced breast cancers may manifest distinct tumour biological features of clinical importance.
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| 15. |
- Lilja, Åsa, et al.
(författare)
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Psychological profile in patients with Stages I and II breast cancer: associations of psychological profile with tumor biological prognosticators.
- 2003
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Ingår i: Psychological Reports. - 0033-2941. ; 92:3 Pt 2, s. 1187-1198
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Tidskriftsartikel (refereegranskat)abstract
- We have earlier shown that breast cancer patients with moderately or well differentiated tumors seem to be able to inhibit stress evoked from anger in a successful manner, while those with poorer prognosis do not. We now report a study with an enlarged group of patients, investigating associations between tumor biological factors and psychological profile. 129 patients with Stages I and II breast cancer undergoing adjuvant radiation therapy were interviewed and tested with three projective personality tests assessing attitude to aggression and coping with stress and anxiety. Creative functioning was also tested. Patients with Stage I (smaller) tumors reported a "fighting spirit" attitude toward the disease, but they also showed depressive reaction patterns. Moreover, if the patient could successfully avoid or inhibit the stress evoked from perceiving an aggressive motif in the picture shown in the aggression test, the tumor biological situation was better. Patients who did not inhibit stress reactions on the aggression test and also on the anxiety test had a poorer tumor biological situation. Surprisingly, low speed of tumor cell proliferation (DNA S-phase fraction) correlated with high scores on the creativity test. Successful denial or inhibition of stress evoked by aggression combined with a creative, flexible attitude was associated with a better tumor biological situation.
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| 16. |
- Malmström, Per, et al.
(författare)
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S-phase fraction and urokinase plasminogen activator are better markers for distant recurrences than Nottingham Prognostic Index and histologic grade in a prospective study of premenopausal lymph node-negative breast cancer
- 2001
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Ingår i: Journal of Clinical Oncology. - 1527-7755. ; 19:7, s. 2010-2019
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Histologic grade, Nottingham Prognostic Index (NPI), estrogen receptor (ER) and progesterone receptor (PSR) status, and tumor size have previously been shown to be important prognostic indicators for distant recurrence of breast cancer. The purpose of this study was to compare the prognostic value of these factors with flow cytometric S-phase fraction (SPF), urokinase plasminogen activator (uPA), and plasminogen activator inhibitor type 1 (PAI-1) in premenopausal patients with lymph node-negative breast cancer. Patients and Methods: In 237 consecutive premenopausal patients with lymph node-negative breast cancer and freshly frozen tumor material available, SPF, ER and PgR status, uPA and its inhibitor PAI-1, histologic grade, and NPI were evaluated. Results: SPF was univariately the most powerful prognostic factor for distant recurrence, followed by uPA, histologic grade, PgR, age, ER, NPI, and PAI-l,the latter being nonsignificant. Multivariate analysis revealed that neither NPI nor histologic grade was significant after adjustment for SPF, ct fact that may be explained by the strong association between these factors. uPA was, however, an independent prognostic factor in addition to SPF, NPI, or histologic grade. Conclusion: In this prospective study, SPF and uPA were found to be independent prognostic factors in premenopausal women with lymph node-negative breast cancer. We suggest that SPF, if performed under standardised conditions, can replace histologic grade as a selection instrument for adjuvant medical treatment. The value of the combination of SPF and uPA needs to be confirmed in an independent prospective trial.
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| 17. |
- Nilsson, Martin, et al.
(författare)
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Long-term prognosis of early-onset breast cancer in a population-based cohort with a known BRCA1/2 mutation status.
- 2014
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Ingår i: Breast Cancer Research and Treatment. - : Springer Science and Business Media LLC. - 1573-7217 .- 0167-6806. ; 144:1, s. 133-142
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Tidskriftsartikel (refereegranskat)abstract
- All women in the South Sweden Health Care Region with breast cancer diagnosed aged less than 41 during the period between 1990 and 1995 were contacted in 1996 and offered germline mutation analysis of the BRCA1 and BRCA2 genes. Mutation carriers (n = 20) were compared with noncarriers (n = 201) for overall survival (OS) and risk of contralateral breast cancer (CBC). Mutation carriers were younger at diagnosis and more likely to have ER-negative, PgR-negative and grade III tumors. Median follow-up was 19 years. The 5-, 10-, 15-, and 20-year OS were 60, 45, 39, and 39 % for mutation carriers and 82, 70, 59, and 53 % for noncarriers, respectively (5-year log-rank P = 0.013; 10-year P = 0.008; 15-year P = 0.020; and 20-year P = 0.046). In univariable analysis, there was a trend for an inferior OS for mutation carriers (HR 1.8; 95 % CI 1.0-3.3). When stratified for use of (neo)adjuvant chemotherapy, an inferior OS was significant only for the subgroup of patients who did not receive chemotherapy (HR 3.0; 95 % CI 1.2-7.7). In multivarible analysis, BRCA1/2 mutation status was a significant predictor of OS when adjusting for tumor stage, age, and use of chemotherapy, but not when ER status was also included in the model. The 15-year cumulative risk of CBC was 53 % for mutation carriers and 10 % for noncarriers (HR 5.9; 95 % CI 1.9-18.6); among the noncarriers the risks were 5, 22, and 30 % for patients without close relatives having breast cancer, with second-degree relatives having breast cancer, and with firstdegree relatives with breast cancer, respectively. In conclusion, the poor prognosis of young BRCA1/2 mutation carriers with breast cancer is mainly explained by the prevalent occurrence of negative prognostic factors rather than mutation status per se, and can to at least some extent be abrogated by the use of chemotherapy.
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| 18. |
- Ringberg, Anita, et al.
(författare)
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Cell biological factors in ductal carcinoma in situ (DCIS) of the breast-relationship to ipsilateral local recurrence and histopathological characteristics
- 2001
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Ingår i: European Journal of Cancer. - 1879-0852. ; 37:12, s. 1514-1522
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Tidskriftsartikel (refereegranskat)abstract
- All cases of ductal carcinoma in situ (DCIS) diagnosed from 1987 to 1991 in the Southern Health Care Region of Sweden, and operated upon with breast conserving treatment (BCT) with (n=66) or without (n=121) postoperative radiation (RT) were clinically followed, morphologically re-evaluated and analysed for cell biological factors (immunohistochemical assays or DNA flow cytometry). Median age at diagnosis was 58 years (range 29--83 years) and median follow-up was 62 months. Oestrogen (ER)- and progesterone receptor (PR)-negativity, c-erbB-2 overexpression, low bcl-2 expression, p53 accumulation, DNA non-diploidy and high Ki67, were strongly associated with high grade DCIS, and comedo-type necrosis. In contrast, significant associations to growth pattern (not diffuse versus diffuse) were seen only for c-erbB-2 and PgR. There was also a strong relationship between the cell biological factors, and a summary cell biological index based on principal component analysis was introduced (CBI-7). In the group that had not received postoperative RT, 31 ipsilateral local recurrences occurred (13 invasive, 18 DCIS). Ipsilateral recurrence-free interval (IL-RFI) was in univariate analyses significantly, or almost significantly, shorter for patients showing p53 accumulation, high Ki67 or low bcl-2, compared with patients with normal p53, low Ki67 and high bcl-2. The prognostic importance of the remaining cell biological factors was less pronounced. On the other hand, the index CBI-7, was a strong predictor for recurrence.
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| 19. |
- Ringberg, Anita, et al.
(författare)
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Histopathological risk factors for ipsilateral breast events after breast conserving treatment for ductal carcinoma in situ of the breast--results from the Swedish randomised trial.
- 2007
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Ingår i: European journal of cancer (Oxford, England : 1990). - : Elsevier BV. - 0959-8049 .- 1879-0852. ; 43:2, s. 291-8
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The primary aims were to study risk factors for an ipsilateral breast event (IBE) after sector resection for ductal carcinoma in situ of the breast (DCIS) in a trial comparing adjuvant radiotherapy to no therapy and to assess predictive factors for response to radiotherapy. Secondary aims were to analyse reproducibility of the histopathological evaluation and to estimate correctness of diagnosis in the trial. SETTING: A randomised trial in Sweden (the SweDCIS trial), including 1046 women with a median of 5.2 years of follow-up in a population, offered routine mammographic screening. METHODS: A case-cohort design with a total of 161 cases of IBE (42 of those being members of the subcohort) and 284 sampled for the sub-cohort. Ninety five percent of the participants' slides could be retrieved and were re-evaluated by three experienced pathologists. RESULTS: Low nuclear grade (NG 1-2) and absence of necrosis halves the risk of IBE in both irradiated and non-irradiated patients. Lesion size, margins of excision and age at diagnosis did not modify these associations. The presence of necrosis modified the effect of radiotherapy: relative risk was 0.40 with necrosis present and 0.07 with necrosis absent (p-value for interaction 0.068). In all subsets of prognostic factors, radiotherapy conferred a substantial benefit. The risk factors for in situ and invasive IBE were similar. The agreement between pathologists was moderate (kappa=0.486). Correctness of diagnosis in the subcohort of SweDCIS was 84.8%. CONCLUSION: Although nuclear grade and necrosis carry prognostic information, we could not define a group with very low risk after sector resection alone. Radiotherapy has a protective effect in all substrata of risk factors studied. The interaction between the presence of necrosis and radiotherapy is a clinically and biologically relevant research area.
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| 20. |
- Ringberg, Anita, et al.
(författare)
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Ipsilateral local recurrence in relation to therapy and morphological characteristics in patients with ductal carcinoma in situ of the breast
- 2000
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 1532-2157 .- 0748-7983. ; 26:5, s. 444-451
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Tidskriftsartikel (refereegranskat)abstract
- METHOD AND RESULTS: A standardized histopathological protocol has been designed, in which different histological characteristics of ductal carcinoma in situ (DCIS) are reported: nuclear grade (ng), growth pattern according to Andersen et al., necrosis, size of the lesion, resection margins and focality. Using this protocol a re-evaluation of a population-based consecutive series of 306 cases of DCIS has been done as well as a thorough clinical follow-up. After a median follow-up of 63 months, 13% have developed ipsilateral local recurrences, invasive and/or in situ. Ipsilateral local recurrence-free survival (IL-RFS) was significantly better for patients operated with mastectomy (ME) or breast conserving therapy (BCT) with radiotherapy (RT) than for patients operated with BCT without RT (5-year IL-RFS 96% vs 94% vs 79%, P<0.001). In the subgroup of BCT without RT there were significant differences in IL-RFS between histopathological subgroups: ng 1 + 2 (non-high grade) vs ng 3 (high grade; P=0.014), non-high-grade without comedo-type necrosis vs non-high-grade with comedo-type necrosis vs high-grade (the Van Nuys classification system; P=0.025). Growth pattern (not diffuse vs diffuse) and margins (free vs involved or not evaluated) showed a tendency (P=0.07 and 0.05, respectively) to be associated to IL-RFS. In contrast, no significant differences in IL-RFS were found in subgroups based on mode of detection, focality or size. Ninety-four per cent of the local recurrences after BCT appeared at the previous operation site. CONCLUSIONS: In the BCT without RT group, combinations of either non-high grade and not a diffuse growth pattern or non-high grade and free margins identified groups (constituting approximately 30% of the patients) were at low risk of developing ipsilateral recurrences (6-10%), compared to a 31-37% recurrence risk in the remaining groups during the observed follow-up time. The beneficial effect of post-operative RT for these low-risk groups can be questioned, and should be studied further.
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| 21. |
- Runeson, Ingrid, et al.
(författare)
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Ethical dilemmas before and during anaesthetic induction of young children, as described by nurse anaesthetists
- 2010
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Ingår i: JOURNAL OF CHILD HEALTH CARE. - : Greycoat Publishing. - 1367-4935 .- 1741-2889. ; 14:4, s. 345-354
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Tidskriftsartikel (refereegranskat)abstract
- Research on physicians, nurses and enrolled nurses experiences of ethical dilemmas have been conducted in many healthcare fields. The aim of this study was to elucidate ethical dilemmas before and during the induction of anaesthesia of children aged three to six years as described by nurse anaesthetists (NAs). Two group interviews with NAs were conducted where they were asked to describe ethically problematic situations. Three situations were chosen from a total of 15: administration of anaesthesia to an already sleeping child, lack of information given to a child, and a child is anaesthetized against his/her will. Conceivable and reasonable alternative options were identified and consequences of the different actions were presented. Finally the conflicts of value were discussed and commented on. The cases describe when a childs rights are given less weight and the child has little opportunity to participate in the decision making. However, parents and NAs acted in the best interest of the child. Analysing and reflecting on situations involving ethical dilemmas would enhance NAs critical thinking and guide NAs in their decision making when providing anaesthesia care.
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| 22. |
- Runeson, Ingrid, 1951-, et al.
(författare)
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Ethical dilemmas before and during narcosis induction of young children as told by nurse anaesthetists
- 2010
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Ingår i: Journal of Child Health Care. - : SAGE Publications. - 1367-4935 .- 1741-2889. ; 14:4, s. 345-354
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Forskningsöversikt (refereegranskat)abstract
- Research on physicians’, nurses’ and enrolled nurses’ experiences of ethical dilemmas have been conducted in many healthcare fields. The aim of this study was to elucidate ethical dilemmas before and during the induction of anaesthesia of children aged three to six years as described by nurse anaesthetists (NAs). Two group interviews with NAs were conducted where they were asked to describe ethically problematic situations. Three situations were chosen from a total of 15: administration of anaesthesia to an already sleeping child, lack of information given to a child, and a child is anaesthetized against his/her will. Conceivable and reasonable alternative options were identified and consequences of the different actions were presented. Finally the conflicts of value were discussed and commented on. The cases describe when a child’s rights are given less weight and the child has little opportunity to participate in the decision making. However, parents and NAs acted in the best interest of the child. Analysing and reflecting on situations involving ethical dilemmas would enhance NAs critical thinking and guide NAs in their decision making when providing anaesthesia care.
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| 23. |
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| 24. |
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| 25. |
- Wåhlin, Ingrid, 1955-, et al.
(författare)
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Empowerment from the perspective of next of kin in intensive care
- 2009
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 18:18, s. 2580-2587
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. The aim of the study was to describe next of kin empowerment in an intensive care situation. Background. Next of kin is important in reducing intensive care patients’ fear and anxiety. However, admission to an intensive care unit is often recognised as an extremely stressful event, causing next of kin to experience shock, fear, anxiety and vulnerability. More knowledge is needed about how next of kin in intensive care can be strengthen and empowered. Design and methodology. The study was conducted using a phenomenological method and is based on ten interviews with intensive care patients’ next of kin. Findings. Perceptions of both a genuine will and a capacity to help and relieve were found to be essential for next of kin’s experiences of empowerment in an intensive care situation. All informants were strengthened and empowered by a caring atmosphere in which they received continuous, straightforward and honest information that left room for hope, and in which closeness to the patient was facilitated and medical care was experienced as the best possible. Some of the informants were also strengthened by support from other family members and/or by being involved in caring for the patient. Conclusions. The findings emphasise the essential entirety of what is done and how these acts are performed. A warm and positive atmosphere in which next of kin always feel welcome, are met with empathy in an unaffected way, are confirmed and receive support or advice when needed, are crucial to next of kin’s experiences of empowerment. Relevance to clinical practice. Knowledge of how to empower next of kin in an intensive care situation allows caring staff to support these persons in a more sensitive and appropriate way. Findings underline the importance of creating caring relations.
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| 26. |
- Wåhlin, Ingrid, et al.
(författare)
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Empowerment in intensive care : patient experiences compared to next of kin and staff beliefs
- 2009
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 25:6, s. 332-340
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Tidskriftsartikel (refereegranskat)abstract
- Experiences of critically ill patients are an important aspect of the quality of care in intensive care units. If next of kin and staff try to empower the patient, this is probably performed in accordance with their beliefs about what patients experience as empowering. As intensive care patients often have difficulties communicating, staff and next of kin need to interpret their wishes, but there is limited knowledge about how correct picture next of kin and staff have of the intensive care patient's experiences. The aim of this study was to compare intensive care patients' experiences of empowerment with next of kin and staff beliefs. Interviews with 11 intensive care patients, 12 next of kin and 12 staff were conducted and analysed using a content analysis method. The findings showed that the main content is quite similar between patient experiences, next of kin beliefs and staff beliefs, but a number of important differences were identified. Some of these differences were regarding how joy of life and the will to fight were generated, the character of relationships, teamwork, humour, hope and spiritual experiences. Staff and next of kin seemed to regard the patient as more unconscious than the patient him/herself did.
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| 27. |
- Wåhlin, Ingrid, et al.
(författare)
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Patient empowerment in intensive care : an interview study
- 2006
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 22:6, s. 370-377
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Tidskriftsartikel (refereegranskat)abstract
- Intensive care patients often experience a lack of control, as well as inner chaos. Experiences from intensive care can continue to affect patients for a long time. Empowerment is a positive and dynamic process that focuses on people's strengths, rights and abilities. It takes on different expressions for different people in different environments and must be described by the people involved. The aim of this study was to describe patient empowerment in an intensive care situation. The study was based on open-ended interviews with 11 patients in two intensive care units. The interviews were analysed according to the empirical phenomenological psychological method. The results showed that patient empowerment in intensive care consists of strengthening and stimulating the patients' own inherent joy of life and will to fight. A positive environment that encouraged feelings of value and motivation and in which the patient felt safe, received additional care and participated as he/she wished had a positive influence.
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| 28. |
- Wåhlin, Ingrid, 1955-, et al.
(författare)
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Staff empowerment in intensive care : nurses' and physicians' lived experiences
- 2010
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 26:5, s. 262-269
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim The purpose of the study was to describe empowerment from the perspective of intensive care staff. What makes intensive care staff experience inner strength and power? Background Intensive care staff are repeatedly exposed to traumatic situations and demanding events, which could result in stress and burnout symptoms. A higher level of psychological empowerment at the workplace is associated with increased work satisfaction and mental health, fewer burnout symptoms and a decreased number of sick leave days. Method Open-ended interviews were conducted with 12 intensive care unit (ICU) staff (four registered nurses, four enrolled nurses and four physicians) in southern Sweden. Data were analysed using a phenomenological method. Findings Intensive care staff were found to be empowered both by internal processes such as feelings of doing good, increased self-esteem/self-confidence and increased knowledge and skills, and by external processes such as nourishing meetings, well functioning teamwork and a good atmosphere. Conclusion Findings show that not only personal knowledge and skills, but also a supporting atmosphere and a good teamwork, has to be focused and encouraged by supervisors in order to increase staff's experiences of empowerment. Staff also need a chance to feel that they do something good for patients, next of kin and other staff members.
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| 29. |
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| 30. |
- Wåhlin, Ingrid, 1955-
(författare)
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The circle of strength and power : Experiences of empowerment in intensive care
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients and next of kin in intensive care often experience powerlessness, anxiety and distress and intensive care staff are repeatedly exposed to traumatic situations and demanding events. Empowerment has been described as a process of overcoming a sense of powerlessness and a model through which people may develop a sense of inner strength through connections with others. The aim of this thesis was to describe empowerment as experienced by patients, next of kin and staff in intensive care and to compare patient's experiences with staff and next of kin beliefs. Empowerment is reflected in this thesis as experiences of inner strength and power and of participation/self-determination.The study was based on open-ended interviews with 11 patients, 12 next of kin and 12 staff members from two intensive care units in southern Sweden. A phenomenological perspective was applied in three studies, while a qualitative content analysis was used in the forth study.Findings showed that nourishing relationships were of crucial importance, and contributed to every participant's experiences of empowerment regardless of whether he/she was an intensive care patient, a next of kin or a staff member. Patients were found to be strengthened and empowered by a positive environment where their own inherent joy of life and will to fight was stimulated, where they felt safe and a sense of value and motivation were encouraged and where they were taken seriously and listened to. Next of kin were extremely important to patients' experiences of safety, value, human warmth and motivation, and patients were strengthened when their next of kin were acknowledge and welcomed by staff.Next of kin in intensive care were strengthened and empowered by a caring atmosphere in which they received continuous, straightforward and honest information that left room for some hope and in which closeness to the patient was facilitated and medical care was experienced as the best possible. Some informants were also empowered by family support and/or participation in caring for the patient. Intensive care staff were empowered by both internal processes such as feelings of doing good, increased self-esteem/self-confidence and increased knowledge and skills, and by external processes such as nourishing meetings, excitement and challenge, well functioning teamwork and good atmosphere.When comparing patient experiences with staff and next of kin beliefs, there was agreement regarding joy of life and will to fight being essential to patients' experiences of inner strength and power, but staff and next of kin seemed to see this as a more constant individual viewpoint or characteristic than the patient did. Next of kin, and especially staff, seemed to regard the patient as more unconscious and unable to participate in the communication and interaction process than the patient him/herself experienced. A mutual and friendly relationship was experienced by the patients as highly empowering, while a more professional relationship was emphasized by the staff. These findings could serve as a basis for reflection about patient, next of kin and staff experiences of strength and power and if empowerment is seen as a dimension in quality of care, the findings from this thesis ought to be taken into consideration to increase the quality of care in intensive care.
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