| 1. |
- Axelsson, Bertil, et al.
(författare)
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Analgesic effect of paracetamol on cancer related pain in concurrent strong opioid therapy. A prospective clinical study
- 2008
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 47:5, s. 891-895
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. In palliative cancer care, when approaching death, swallowing difficulties and the burden of tablet intake frequently makes us reconsider each individual drug prescribed. Through the last two decades the routine of always combining a strong opioid with paracetamol has been widely spread in Sweden. Clinical experience has challenged this routine as many patients seem to manage equally well without paracetamol. To find out whether this might be of clinical importance, we wanted to perform a more systematic registration. Material and methods. Thirty-four incurable cancer patients with well controlled pain (NRS 4), treated by specialised palliative home care teams, with ongoing medication with the strong opioid paracetamol combination was recruited to this prospective clinical study. The effect of completely stopping paracetamol medication was evaluated four days later at follow-up. Results. At follow-up nine patients (26%) felt more pain compared to when they entered the study, two patients (6%) felt less pain and 23 (68%) felt no difference. When asked about their preference about future paracetamol treatment 18 patients (53%) wanted to stop taking it, six patients (18%) wanted to continue with regular paracetamol medication as before, and ten patients (29%) wanted to take paracetamol as needed. No clinical predictors of paracetamol response could be identified. Discussion. The results of this study indicate that a critical evaluation, in every patient, of the subjective additive analgesic effect of paracetamol in concurrent strong opioid therapy is advisable and that stopping paracetamol medication not necessarily implies increased pain. Rather in some patients the cessation of paracetamol medication is experienced as a relief as pain control is maintained with a lesser tablet burden.
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| 2. |
- Jönsson, Arne, 1955-, et al.
(författare)
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Skim reading of audio information
- 2008
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Ingår i: The second Swedish Language Technology Conference SLTC-08,2008. ; , s. 23-24
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Konferensbidrag (refereegranskat)
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| 3. |
- Jönsson, Arne, 1955-, et al.
(författare)
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Using Language Technology to Improve Interaction and Provide Skim Reading Abilities to Audio Information Services
- 2008
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Ingår i: Collaboration and the Knowledge Economy: Issues, Applications, Case Studies. - : IOS Press. - 9781586039240 ; , s. 1289-
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In this paper we present language technology enhancements to audio-based information services (i.e. services where information is presented using spoken language). The enhancements presented in the paper addresses two issues for audio-based services: 1) interaction with the service is rigid and 2) the ability to listen to summaries is limited. Our developments allow for more natural and efficient control of the service and means that facilitates skim reading. Using speech dialogue instead of traditional buttons provides means for more advanced navigation in the audio material. Vector space techniques are used to collect the most relevant sentences in a text and allows for skim reading of varying depth.
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| 4. |
- Larsson, Anne, 1972-
(författare)
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Corrections for improved quantitative accuracy in SPECT and planar scintigraphic imaging
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A quantitative evaluation of single photon emission computed tomography (SPECT) and planar scintigraphic imaging may be valuable for both diagnostic and therapeutic purposes. For an accurate quantification it is usually necessary to correct for attenuation and scatter and in some cases also for septal penetration. For planar imaging a background correction for the contribution from over- and underlying tissues is needed. In this work a few correction methods have been evaluated and further developed. Much of the work relies on the Monte Carlo method as a tool for evaluation and optimisation. A method for quantifying the activity of I-125 labelled antibodies in a tumour inoculated in the flank of a mouse, based on planar scintigraphic imaging with a pin-hole collimator, has been developed and two different methods for background subtraction have been compared. The activity estimates of the tumours were compared with measurements in vitro. The major part of this work is attributed to SPECT. A method for attenuation and scatter correction of brain SPECT based on computed tomography (CT) images of the same patient has been developed, using an attenuation map calculated from the CT image volume. The attenuation map is utilised not only for attenuation correction, but also for scatter correction with transmission dependent convolution subtraction (TDCS). A registration method based on fiducial markers, placed on three chosen points during the SPECT examination, was evaluated. The scatter correction method, TDCS, was then optimised for regional cerebral blood flow (rCBF) SPECT with Tc-99m, and was also compared with a related method, convolution scatter subtraction (CSS). TDCS has been claimed to be an iterative technique. This requires however some modifications of the method, which have been demonstrated and evaluated for a simulation with a point source. When the Monte Carlo method is used for evaluation of corrections for septal penetration, it is important that interactions in the collimator are taken into account. A new version of the Monte Carlo program SIMIND with this capability has been evaluated by comparing measured and simulated images and energy spectra. This code was later used for the evaluation of a few different methods for correction of scatter and septal penetration of I-123 brain SPECT. The methods were CSS, TDCS and a method where correction for scatter and septal penetration are included in the iterative reconstruction. This study shows that quantitative accuracy in I-123 brain SPECT benefits from separate modelling of scatter and septal penetration.
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| 5. |
- Larsson, Peter, 1963-
(författare)
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Calibration of Ionization Chambers for Measuring Air Kerma Integrated over Beam Area in Diagnostic Radiology
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The air kerma area product PKA is an important quantity used by hospital physicists in quality assurance and optimization processes in diagnostic radiology and is recommended by national authorities for setting of diagnostic reference levels. PKA can be measured using a transmission ionization chamber (kerma area product (KAP) meter) mounted on the collimator housing. Its signal QKAP must be calibrated to give values of PKA. The objective of this thesis is to analyze the factors influencing the accuracy of the calibration coefficients k= PKA/QKAP and of reported PKA-values.Due to attenuation and scatter in the KAP-meter and presence of extra-focal radiation, values of PKA depend on the choice of integration area A and the distance of the reference plane from the focal spot yielding values of PKA that may differ by as much as 23% depending on this choice. The two extremes correspond to (1) PKA=PKA,o integrated over the exit surface of the KAP-meter resulting in geometry independent calibration coefficients and (2) PKA=PKA,Anom integrated over the nominal beam area in the patient entrance plane resulting in geometry dependent calibration coefficients.Three calibration methods are analysed. Method 1 aims at determine PKA,Anom, for clinical use at the patient entrance plane. At standard laboratories, the method is used to calibrate with respect to radiation incident on the KAP-meter. Problems with extra-focal and scattered radiation are then avoided resulting in calibration coefficients with low standard uncertainty (±1.5 %, coverage factor 2). Method 2 was designed in this work to approach determination of PKA,o using thermoluminescent detectors to monitor contributions from extra-focal radiation and account for the heel effect. The uncertainty in derived calibration coefficients was ± 3% (coverage factor 2). Method 3 uses a Master KAP-meter calibrated at a standard laboratory for incident radiation to calibrate clinical KAP-meters. It has potential to become the standard method in the future replacing the tedious method 2 for calibrations aiming at determination of PKA,o.Commercially available KAP-meters use conducting layers of indium oxide causing a strong energy dependence of their calibration coefficients. This dependence is investigated using Monte Carlo simulations and measurements. It may introduce substantial uncertainties in reported PKA– values since calibration coefficients as obtained from standard laboratories are often available only at one filtration (2.5 mm Al) as function of tube voltage or HVL. This is not sufficient since higher filtrations are commonly used in practice, including filters of Cu. In extreme cases, calibration coefficients for the same value of HVL but using different tube voltages and filtrations can deviate by as much as 30%. If standardised calibration methods are not used and choice of calibration coefficients not carefully chosen with respect to beam quality, the total uncertainty in reported PKA–values may be as large as 40-45%. Conversion of PKA-values to risk related quantities is briefly discussed. The large energy dependence of the conversion coefficients, ε/PKA, for determination of energy imparted,ε, to the patient reduces to a lower energy dependence of calibration coefficients CQ,ε = ε/QKAP for determination of ε from the KAP-meter signal.
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| 6. |
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| 7. |
- Melin Johansson, Titti, et al.
(författare)
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Caregivers' perceptions about terminally ill family members' quality of life
- 2007
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Ingår i: European Journal of Cancer Care. - : Hindawi Limited. - 0961-5423 .- 1365-2354. ; 16:4, s. 338-345
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Tidskriftsartikel (refereegranskat)abstract
- Caregivers' perceptions on terminally ill family members' quality of life is rarely described. The aim of this study was to describe caregivers' perceptions about terminally ill family members' quality of life when suffering from cancer. Four caregivers participated in repeated focus group, and the data were analysed using qualitative content analysis. The findings were presented through five themes: 'living a normal life', 'being relieved from burdens', 'having a sense of belonging', 'being a symbol of incurable illness' and 'having a sense of dignity'. We found that to manage daily life it was significant to keep up a normal life and participate in social life. One new insight in this study was that caregivers contributed to an extending understanding to the term meaning in which the sense of belonging was fundamental. An obstacle for the sense of belonging was illuminated as the visible signs of incurable illness that stigmatized the ill person, and influenced the dignity. This study highlights the importance of supportive actions from significant others and healthcare professionals for terminally ill family members' quality of life.
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| 8. |
- Melin Johansson, Titti, et al.
(författare)
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The meaning of quality of life: narrations by patients with incurable cancer in palliative home care
- 2008
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Ingår i: Palliative & Supportive Care. - 1478-9515 .- 1478-9523. ; 6:3, s. 231-238
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective of this qualitative study was to elucidate the meaning of quality of life as narrated by patients with incurable cancer approaching death in palliative home care in Sweden. METHODS: To gain a deeper understanding of what quality of life means for dying patients, data were collected from narrative interviews with eight patients in their homes in 2004-2006. Qualitative content analysis was used to interpret the meaning regarding quality of life. RESULTS: Three main themes were found: being in intense suffering, having breathing space in suffering, and being at home. Living with incurable cancer at the end of life was experienced as living in physical distress as the body became incapacitated by unexpected physical complications. This incapacity had consequences on patients' psychological, social, and existential well-being. As the complication phase abated, the patients experienced that they regained hopefulness and had time to reflect on existential issues. Patients were provided affirmative care at home from family caregivers and the palliative home care team. SIGNIFICANCE OF RESULTS: This study shows that it is feasible to perform individual interviews with patients approaching death and elucidate the meaning of patients' quality of life in palliative home care. Patients oscillate between being in intense suffering and having breathing space in this suffering, which somewhat opposes the traditional picture of a continuous linear deterioration. Being cared for at home by family caregivers and health care professionals provided a sense of independency and security. Being at home safeguards patients' entire life situation and increases quality of life.
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| 9. |
- Norrman, Eva, 1966-
(författare)
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Optimisation of radiographic imaging by means of factorial experiments
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the optimisation process of radiographic imaging, factorial designed experiments can be applied. The parameters (factors) are varied together instead of one at a time, making it possible to discover interactions between the factors as well as main influences of them on the result variable. A 2k design implies having k number of factors each one set to two different levels (low and high).A computer program, CoCIQ, designed to automatically analyse and evaluate test images of a contrast-detail phantom, was evaluated and adjusted to clinical situations using a flat panel detector. The program gives a quantified measurement of image quality by calculating an Image Quality Figure (IQF) for the X-ray image. It was shown that the program produces IQF with small variations. It was also found that there was a strong linear statistical relation between the computerised evaluation and the evaluation performed by human observers.2k factorial experiments were evaluated by investigating the influence of tube potential, tube loading, focus size and filtration on the result variables IQF, Kerma Area Product (KAP) and effective dose using a flat panel detector. It was found that the result variables were mainly influenced by tube loading, tube potential and filtration. Interactions between tube potential and filtration as well as between tube loading and filtration were observed, too. This work demonstrates that accepted knowledge was reproduced and that the effects of interactions between parameters were revealed.Extended 2k experiments were then applied at three different optimisation procedures. Two studies were performed using a flat panel detector for lumbar spine radiography. The aim was to find optimal settings for tube potential, system sensitivity and filtration for different sized patients and, in a separate study, to investigate the effect of the image post processing parameters and the possibility for dose reduction by adjusting these. The parameters are ROI (Region Of Interest) density, gamma, detail contrast enhancement, unsharp masking, kernel size and noise compensation.After determining the optimal settings from these experiments, X-ray images of the lumbar spine of an Alderson phantom were acquired and evaluated in a visual grading analysis (VGA).The results illustrated that the image quality was maintained at a lower effective dose by operating with a reduced tube potential and increased sensitivity of the X-ray system.The experiments on image post process parameters revealed their influence on image quality and indicated that image quality could be improved by changing the settings of the process parameters.Factorial experiments were also performed, using a multislice CT scanner to investigate the possibility for dose reduction at paediatric head examinations. An anthropomorphic phantom simulating a one-year-old child was scanned using different settings of tube potential, tube loading and reconstruction filter.The study showed that a 25 % reduction of dose was possible with maintained image quality by reducing the tube loading.Factorial designed experiments provide an effective method to simultaneously predict the influence of various parameters on image quality and radiation dose in the optimisation in diagnostic radiology.
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| 10. |
- Wohlin, Martin, et al.
(författare)
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Apolipoprotein E epsilon 4 genotype is independently associated with increased intima-media thickness in a recessive pattern
- 2007
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Ingår i: Lipids. - : Wiley. - 0024-4201 .- 1558-9307. ; 42:5, s. 451-456
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Tidskriftsartikel (refereegranskat)abstract
- Polymorphisms in the apolipoprotein E (Apo E) gene have been associated with lipid levels, carotid intima media thickness (CCA-IMT), inflammation and cardiovascular disease (CVD). Earlier findings suggested an association of the Apo E alleles with increased CCA-IMT following a recessive pattern. Whether associations might be independent of C-reactive protein (CRP), lipid levels and other CVD risk factors is not known. We investigated the relationships between Apo E (epsilon2, epsilon3 and epsilon4 alleles) and CCA-IMT, measured by B-mode ultrasound, in dominant and recessive models in a community-based sample of 437 men 75 years of age. In men homozygous for the epsilon4 allele CCA-IMT was significantly increased by 0.13 mm to 0.86 +/- 0.16 mm compared to 0.73 +/- 0.19 mm in non- epsilon4-carriers (P = 0.0012) and 0.73 +/- 0.21 mm in epsilon4 heterozygous (P = 0.0044) in unadjusted recessive models. The association between Apo E epsilon4 genotype and CCA-IMT was independent of Apo E epsilon2 and Apo E epsilon3 alleles, CRP, lipid variables (TG, LDL, HDL) and other CVD risk factors (smoking, hypertension, body mass index, diabetes) (P = 0.018). No relations between Apo E genotype and CCA-IMT were observed in dominant models. No significant associations between the Apo E epsilon2 and epsilon3 alleles and CCA-IMT were found. In this study, men homozygous with the ApoE epsilon4 allele had thicker CCA-IMT, independently of Apo E epsilon2 and epsilon3 alleles, CRP, lipid variables (TG, LDL, HDL) and other CVD risk factors (smoking, hypertension, body mass index, diabetes), suggesting CCA-IMT to be modified by the ApoE epsilon4 genotype in a recessive pattern.
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