| 1. |
- Zackrisson, Björn, et al.
(författare)
-
Two-year results from a Swedish study on conventional versus accelerated radiotherapy in head and neck squamous cell carcinoma - The ARTSCAN study
- 2011
-
Ingår i: Radiotherapy and Oncology. - : Elsevier. - 0167-8140 .- 1879-0887. ; 100:1, s. 41-48
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Studies on accelerated fractionation (AF) in head and neck cancer have shown increased local control and survival compared with conventional fractionation (CF), while others have been non-conclusive. In 1998 a national Swedish group decided to perform a randomised controlled clinical study of AF. Materials and methods: Patients with verified squamous cell carcinoma of the oral cavity, oropharynx, larynx (except glottic T1-T2, N0) and hypopharynx were included. Patients with prior chemotherapy or surgery were excluded. Patients were randomised to either CF (2Gy/day, 5days/week for 7 weeks, total dose 68Gy) or to AF (1.1Gy+2.0Gy/day, 5days/week for 4.5weeks, total dose 68Gy). An extensive quality assurance protocol was followed throughout the study. The primary end point was loco-regional tumour control (LRC) at two years after treatment. RESULTS: The study was closed in 2006 when 750 patients had been randomised. Eighty-three percent of the patients had stages III-IV disease. Forty eight percent had oropharyngeal, 21% laryngeal, 17% hypopharyngeal and 14% oral cancers. There were no significant differences regarding overall survival (OS) or LRC between the two regimens. The OS at two years was 68% for AF and 67% for CF. The corresponding figures for LRC were 71% and 67%, respectively. There was a trend towards improved LRC for oral cancers treated (p=0.07) and for large tumours (T3-T4) (p=0.07) treated with AF. The AF group had significantly worse acute reactions, while there was no significant increase in late effects. Conclusion: Overall the AF regimen did not prove to be more efficacious than CF. However, the trend towards improved results in AF for oral cancers needs to be further investigated.
|
|
| 2. |
- Alwin, Jenny, 1978-, et al.
(författare)
-
Health economic and process evaluation of AT interventions for persons with dementia and their relatives - A suggested assessment model
- 2007
-
Ingår i: Technology and Disability. - 1055-4181. ; 19:2-3, s. 61-71
-
Tidskriftsartikel (refereegranskat)abstract
- There is growing interest in assistive technology (AT) as a means of enabling participation in everyday activities for persons with dementia and their relatives. Health economic assessment of AT in dementia is of importance due to the consequences of the disease for both patients and relatives and to the high societal costs for dementia care. The aim of this article is to outline a model for assessment of AT interventions for persons with dementia. The model expands existing assessment models as it also includes evaluation of the intervention process. Methodological challenges and possibilities in making health economic assessments, including outcomes and costs, as well as process evaluation, are discussed in the article. © 2007 IOS Press. All rights reserved.
|
|
| 3. |
|
|
| 4. |
- Alwin, Jenny, 1978-, et al.
(författare)
-
Teknik för personer med demens : En utvärderingsstudie av teknikintervention för personer med demenssjukdom och deras närstående
- 2008
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport är framtagen av Centrum för utvärdering av medicinsk teknologi (CMT), Institutionen för medicin och hälsa, vid Linköpings universitet på uppdrag av Hjälpmedelsinstitutet. Utvärderingsstudien1 som presenteras i rapporten har gjorts av en intervention som utvecklats inom ramen för projektet ”Teknik och Demens”.Författarna till rapporten vill tacka medarbetare i Teknik och Demensprojektet:Arbetsterapeuter på de kliniska enheterna: Barbro Askenborg, Carina Boström, Ulla Haraldson, Malin Lundberg, Anna Rosshagen, Sofia Starkhammar samt Inger Lindblad från Stockholms sjukhem och Margret Rosenberg från Arbetsterapeuterna primärvården Gästrikland.Medarbetare på FoU-enheterna: Ulla Johansson, Staffan Josephsson och Åke Seiger.Projektledningsgruppen: Susann Forsberg och Ingela Månsson från Hjälpmedelsinstitutet, Inge Dahlenborg från Demensförbundet och Kerstin Lundström från Alzheimerföreningen i Sverige.Vi vill även tacka Magnus Husberg, CMT, för konsultinsatser vad gäller analys och databehandling samt Olle Eriksson, LiU, som rådgivare vad gäller statistiska beräkningar. Tack till alla personer som bidragit med synpunkter på rapporten.Slutligen ett varmt tack till alla deltagare i Teknik och Demensprojektet som under studiens gång besvarat många frågor.Linköping 2008-04-22Jenny Alwin Jan Persson Barbro Krevers
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Cuttini, M., et al.
(författare)
-
Should euthanasia be legal? An international survey of neonatal intensive care units staff
- 2004
-
Ingår i: Archives of Disease in Childhood. - 0003-9888 .- 1468-2044. ; 89:1
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To present the views of a representative sample of neonatal doctors and nurses in 10 European countries on the moral acceptability of active euthanasia and its legal regulation. Design: A total of 142 neonatal intensive care units were recruited by census (in the Netherlands, Sweden, Hungary, and the Baltic countries) or random sampling (in France, Germany, Italy, Spain, and the United Kingdom), 1391 doctors and 3410 nurses completed an anonymous questionnaire (response rates 89% and 86% respectively). Main outcome measure: The staff opinion that the law in their country should be changed to allow active euthanasia "more than now". Results: Active euthanasia appeared to be both acceptable and practiced in the Netherlands, France, and to a lesser extent Lithuania, and less acceptable in Sweden, Hungary, Italy, and Spain. More then half (53%) of the doctors in the Netherlands, but only a quarter (24%) in France felt that the law should be changed to allow active euthanasia "more than now". For 40% of French doctors, end of life issues should not be regulated by law. Being male, regular involvement in research, less than six years professional experience, and having ever participated in a decision of active euthanasia were positively associated with an opinion favouring relaxation of legal constraints. Having had children, religiousness, and believing in the absolute value of human life showed a negative association. Nurses were slightly more likely to consider active euthanasia acceptable in selected circumstances, and to feel that the law should be changed to allow it more than now. Conclusions: Opinions of health professionals vary widely between countries, and, even where neonatal euthanasia is already practiced, do not uniformly support its legalisation.
|
|
| 11. |
- Ekberg, Kerstin, 1948-, et al.
(författare)
-
Is Mobility in the Labor Market a Solution to Sustainable Return to Work for Some Sick Listed Persons?
- 2011
-
Ingår i: Journal of occupational rehabilitation. - : Springer. - 1053-0487 .- 1573-3688. ; 21:3, s. 355-365
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The study aims to identify characteristics associated with long-term expectations of professional stability or mobility among recently sick-listed workers, and to study whether expectations of professional mobility and turnover intentions were associated with duration of sick leave.Methods: A cross-sectional study was performed on baseline measures in a prospective cohort study of patients who were granted sick leave due to musculoskeletal (MSD) or mental (MD) disorders. A total of 1,375 individuals fulfilled the inclusion criteria. A baseline questionnaire was sent by mail within 3 weeks of their first day of certified medical sickness; 962 individuals responded (70%). The main diagnosis was MSD in 595 (62%) individuals and MD in 367 (38%).Results: Expectations of ability to remain in the present profession in 2 years was associated with better health and health-related resources, younger age, higher education, and better effort-reward balance. Effort-reward imbalance, MD, high burnout scores, and better educational and occupational position were associated with turnover intentions. Low expectations of ability to remain in the present profession defined two vulnerable groups with regard to RTW, those with no turnover intentions were older, had lower personal resources, more often had MSD, and slower RTW rate. Those with turnover intentions had a clear effort-reward imbalance and high burnout scores.Conclusions: The results of this explorative study underline the importance of differentiating RTW-interventions based on knowledge about the sick-listed person's resources in relation to the labor market and the work place, and their expectations of future employment and employability.
|
|
| 12. |
|
|
| 13. |
- Götherström, Ulla-Christel, 1974-, et al.
(författare)
-
A comparative study of text telephone and videophone relay services
- 2004
-
Ingår i: Technology and Disability. - 1055-4181. ; 16:2, s. 101-109
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to compare text telephone relay service and videophone relay service. The target group was people borne deaf. The following aspects were investigated: (1) socioeconomic costs, (2) costs of different actors, (3) qualitative aspects of the services, (4) outcomes (intermediate effects and quality of life). The study was longitudinal and measurements were made at three occasions. Data collection was made by post-mailed questionnaires. Of the 41 respondents, 16 persons had access to the text telephone relay service only and 25 persons had access to text telephone relay service supplemented with videophone relay service. The ratings of the quality of the services and the outcomes were significantly higher for videophone relay service than for text telephone relay service (at a 95%-level). The incremental cost was approximately SEK 40 000, or EUR 4 510 (1 EUR = 8.87 SEK, as of 31 December 2000) higher per person and year for the group with access to both text telephone relay service and videophone relay service compared with the group with access to text telephone relay service only.
|
|
| 14. |
- Götherström, Ulla-Christel, 1974-, et al.
(författare)
-
A socioeconomic model for evaluation of postal and telecommunication services for disabled persons
- 2004
-
Ingår i: Technology and Disability. - 1055-4181. ; 16:2, s. 91-99
-
Tidskriftsartikel (refereegranskat)abstract
- The Swedish National Post and Telecom Agency provides services in the postal and telecommunication area for disabled persons. The text telephone relay service, videophone relay service, free directory enquiries and extended rural postal service are aimed for various groups of persons with disabilities. The aim of this study was to develop a socioeconomic model for assessing such telecommunication services for disabled persons. The model development included the WHO Classification ICIDH-2 and ICF, literature review, reference panel opinions, expert opinions and pilot studies. The developed model encompasses quality of the services, costs and outcomes. The quality of the services refers to quality in structure and process. Costs for different actors are included, e.g. the user, family members, county councils, local authorities and the government. Outcomes of the services refer to intermediate outcomes (direct communicative outcomes) and generic outcomes (quality of life). The socioeconomic model is general and is applicable to different rehabilitation interventions.
|
|
| 15. |
- Johansson, Karl-Axel, et al.
(författare)
-
The quality assurance process for the ARTSCAN head and neck study - a practical interactive approach for QA in 3DCRT and IMRT.
- 2008
-
Ingår i: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 87:2, s. 290-9
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper describes the quality assurance (QA) work performed in the Swedish multicenter ARTSCAN (Accelerated RadioTherapy of Squamous cell CArcinomas in the head and Neck) trial to guarantee high quality in a multicenter study which involved modern radiotherapy such as 3DCRT or IMRT. MATERIALS AND METHODS: The study was closed in June 2006 with 750 randomised patients. Radiation therapy-related data for every patient were sent by each participating centre to the QA office where all trial data were reviewed, analysed and stored. In case of any deviation from the protocol, an interactive process was started between the QA office and the local responsible clinician and/or physicist to increase the compliance to the protocol for future randomised patients. Meetings and workshops were held on a regular basis for discussions on various trial-related issues and for the QA office to report on updated results. RESULTS AND DISCUSSION: This review covers the 734 patients out of a total of 750 who had entered the study. Deviations early in the study were corrected so that the overall compliance to the protocol was very high. There were only negligible variations in doses and dose distributions to target volumes for each specific site and stage. The quality of the treatments was high. Furthermore, an extensive database of treatment parameters was accumulated for future dose-volume vs. endpoint evaluations. CONCLUSIONS: This comprehensive QA programme increased the probability to draw firm conclusions from our study and may serve as a concept for QA work in future radiotherapy trials where comparatively small effects are searched for in a heterogeneous tumour population.
|
|
| 16. |
|
|
| 17. |
|
|
| 18. |
- Persson, Jan, 1941-, et al.
(författare)
-
Cost-effectiveness in rehabilitation of hearing impaired people.
- 2005
-
Ingår i: Assistive Technology. - : IOS Press. - 1586035436 - 9781586035433 ; , s. 750-754
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- The title of this book points towards the difficulty encountered in research and development carried out by laboratories to reach the users. From Virtuality to Reality aims at alerting developers so that they pay a particular attention to the outcome of their work. Inventive research as well as new technologies which have a very high potential in the field of assistive technology are described in this publication. Despite the fact that recent products take more and more frequently into account the specific needs of the handicapped people, there remains a long road ahead until these products become available to everyone. Assistive technology has to adapt to today’s fast technological developments. Because new technologies are developing too rapidly, there is no choice but to adapt to this ceaseless evolution. The elderly or handicapped people are facing more and more difficulties in interacting with the assistive technology experts. Technology is an essential component of the activity but it is even more important to take into account the human factor if the aim is to enable users to benefit from assistive technologies. As a consequence, developers must work with a unique objective based on a user-centered approach. This requires a multidisciplinary collaboration which is one of the prime movers of their research and also one of the keys of success.
|
|
| 19. |
|
|
| 20. |
|
|
| 21. |
- Persson, Jan, 1941-, et al.
(författare)
-
Kostnader och effekter vid förskrivning av hörapparat
- 2008
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Studiens syfte var att undersöka effektivitet och kostnadseffektivitet för nyförskrivning av hörapparater, inkluderande jämförelse mellan ”enkel” apparat (analog) och ”avancerad” (digital). Studien var randomiserad ”cross-over”- studie, enkelblind genom att apparaternas höljen gjorts likartade och utan beteckningar. Som utfallsmått användes dels ett primärt utfallsmått, ”tal i brus”, dels generiska mått relaterade till problemlösningsförmåga (IPPA, PIRS) och hälsorelaterad livskvalitet (EQ-5D, HUI3). Vidare studerades brukarnas preferenser vad gäller apparat såväl utan som med kännedom om kostnader. Studien gjordes i samverkan med hörcentraler vid landstingen i Östergötlands, Kalmar och Jönköpings län. Under 2002 och 2003 rekryterades 161 brukare till studien; medelåldern var ca 70 år, 60 procent män och 40 procent kvinnor.Nyförskrivning av hörapparat, ”bakom örat”-modell bilateralt om ej kontraindikation för detta förelåg, ger för samtliga ovan nämnda utfallsmått en avsevärd förbättring. Förskrivningens kostnadseffektivitet, med fritt val mellan apparattyperna (ungefärligen lika många väljer enkel som avancerad), ger en kostnad per vunnet kvalitetsjusterat levnadsår av 80 000 kronor mätt med EQ-5D och 17 300 kronor mätt med HUI3. Härvid har vi antagit att livskvalitetsförhöjningen står sig över fem år, vidare har kostnader inkluderats för läkarbesök, audiogram, utprovning, tillverkning av två insatser samt apparatkostnader.I en jämförelse mellan apparattyperna ger den avancerade apparaten signifikant högre andel uppfattade ord i ”tal i brus”-testet samt signifikant bättre problemlösningsförmåga (IPPA), dock endast något svagare förbättring enlig PIRS. Livskvaliteten (EQ-5D) skattades något högre för den enkla apparaten.När brukaren genomgått testperioder med respektive apparattyp erbjöds han/hon att välja apparat. Utan kännedom om egenavgifterna valde 62 procent den avancerade apparaten. Med kostnadskännedom ändrade sig 11 personer och valde enkel apparat, en valde unilateral anpassning men bibehöll avancerad apparat. Med kostnadskännedom var således fördelningen mellan apparattyperna lika. Betalningsviljan är således för många brukare betydande och kan uppgå till en merkostnad av ca 8000 kronor för att få den avancerade apparaten i stället för den enkla. Utan kostnadskännedom valde 88% dubbelsidig anpassning och 12% hörapparat till enbart ett öra. Med kostnadskännedom ändrades detta till 87% respektive 13%.Studien har visat att hörapparatförskrivning för förstagångsanvändare har hög kostnadseffektivitet. Avancerad apparat ger signifikant förbättrad taluppfattning jämfört med enkel apparat. Livskvalitetsmätningarna i studien tyder på att det är svårt att utifrån dessa avgöra värdet av specifika olikheter mellan apparattyper.
|
|
| 22. |
- Persson, Jan, 1941-, et al.
(författare)
-
Kostnader och effekter vid förskrivning av rollatorer
- 2007
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to investigate effectiveness and cost-effectiveness of rehabilitation by means of walkers for persons with restricted mobility (fourwheeled walkers). The walkers were of a number of different brands and models.The study group included 205 first time users with several different diagnoses. The study was designed as a pre/post study with follow-up three months after the delivery of the walker. The “functional diagnosis” of the user the walker models prescribed and labour time used by thew staff were reported by the prescribing staff (physiotherapists and occupational therapists). Background data and various outcomes were reported through questionnaires by the users themselves.The users reported a number of positive effects of the intervention:less need for help on a daily basis,increased possibilities to participate in "activities outside home",less problems in carrying out daily activities,significant improvement in generic quality of life, measured by means of the instrument EuroQol (EQ-5D).The average cost of the walkers amounted to SEK 1 300. In addition, there were labour costs related to examinations and the delivery of the walkers, amounting to SEK 300. The direct costs per case amounts to about SEK 1 600 on average.The only indirect cost where a change due to the delivery of the walker could be expected was “special transport service”. There was a slight, although nonsignificant, increase in this cost, after delivery of the walkers.With the estimated gain in quality of life of 0,07 (on the scale of EQ-5D, ranging from 0,0 to 1,0), we derived a cost per quality adjusted years gained (cost/QALY) of SEK 24 000. This means a very favourable balance between costs and effects, supporting high ranking in priority lists.
|
|
| 23. |
|
|
| 24. |
|
|
| 25. |
|
|
| 26. |
|
|
| 27. |
- Roback, Kerstin, 1953-, et al.
(författare)
-
Spridning av MTP - fallstudier
- 2004
-
Ingår i: Svenska Läkaresällskapets riksstämma,2004.
-
Konferensbidrag (refereegranskat)
|
|
| 28. |
|
|
| 29. |
|
|
| 30. |
- Wåhlin, Charlotte, 1961-, et al.
(författare)
-
Association between clinical and work-related interventions and return to work for patients with musculoskeletal or mental disorders
- 2012
-
Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 44:4, s. 355-362
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to explore what characterizes patients receiving clinical interventions vs combined clinical and work-related interventions in a cohort of sick-listed subjects with musculoskeletal or mental disorders. Factors associated with return-to-work were also analysed.Design: A prospective cohort study.Methods: A total of 699 newly sick-listed patients responded to a questionnaire on sociodemographics, measures of health, functioning, work ability, self-efficacy, social support, work conditions, and expectations. The 3-month follow-up questionnaire included patients' self-reported measures of return-to-work, work ability and type of interventions. The most frequent International Classification of Diseases-10 diagnoses for patients' musculoskeletal disorders were dorsopathies (M50-54) and soft tissue disorders (M70-79), and for patients with mental disorders, depression (F32-39) and stress reactions (F43).Results: Patients with mental disorders who received combined interventions returned to work to a higher degree than those who received only clinical intervention. The prevalence of work-related interventions was higher for those who were younger and more highly educated. For patients with musculoskeletal disorders better health, work ability and positive expectations of return-to-work were associated with return-to-work. However, combined interventions did not affect return-to-work in this group.Conclusion: Receiving combined interventions increased the probability of return-to-work for patients with mental disorders, but not for patients with musculoskeletal disorders. Better health, positive expectations of return-to-work and better work ability were associated with return-to-work for patients with musculoskeletal disorders.
|
|
| 31. |
- Wåhlin, Charlotte, 1961-, et al.
(författare)
-
Evaluation of self-reported work ability and usefulness of interventions among sick-listed patients
- 2013
-
Ingår i: Journal of occupational rehabilitation. - : Springer Verlag (Germany). - 1053-0487 .- 1573-3688. ; 23:1, s. 32-43
-
Tidskriftsartikel (refereegranskat)abstract
- Aim To describe the types of intervention offered, to investigate the relationship between the type of intervention given, patient-reported usefulness of interventions and the effect on self-reported work ability in a cohort of sick-listed patients with musculoskeletal disorders (MSD) or mental disorders (MD).Methods A prospective cohort study was performed including 810 newly sick-listed patients (MSD 62 % and MD 38 %). The baseline questionnaire included sociodemographic characteristics and measures of work ability. The 3-month follow-up questionnaire included measures of work ability, type of intervention received, and judgment of usefulness.Results Twenty-five percent received medical intervention modalities (MI) only, 45 % received a combination of medical and rehabilitative intervention modalities (CRI) and 31 % received work-related interventions combined with medical or rehabilitative intervention modalities (WI). Behavioural treatments were more common for patients with MD compared with MSD and exercise therapy were more common for patients with MSD. The most prevalent workplace interventions were adjustment of work tasks or the work environment. Among patients with MD, WI was found to be useful and improved work ability significantly more compared with only MI or CRI. For patients with MSD, no significant differences in improved work ability were found between interventions.Conclusions Patients with MD who received a combination of work-related and clinical interventions reported best usefulness and best improvement in work ability. There was no difference in improvements in work ability between rehabilitation methods in the MSD group. There seems to be a gap between scientific evidence and praxis behaviour in the rehabilitation process. Unimodal rehabilitation was widely applied in the early rehabilitation process, a multimodal treatment approach was rare and only one-third received work-related interventions. It remains a challenge to understand who needs what type of intervention.
|
|
