| 1. |
- Alevronta, Eleftheria, et al.
(författare)
-
Dose-response relationships for an atomized symptom of fecal incontinence after gynecological radiotherapy.
- 2013
-
Ingår i: Acta oncologica (Stockholm, Sweden). - : Taylor & Francis. - 1651-226X .- 0284-186X. ; 52:4, s. 719-26
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose. The aim of this study was to investigate what bowel organ and delivered dose levels are most relevant for the development of 'emptying of all stools into clothing without forewarning' so that the related dose-responses could be derived as an aid in avoiding this distressing symptom in the future. Material and methods. Of the 77 gynecological cancer survivors treated with radiotherapy (RT) for gynecological cancer, 13 developed the symptom. The survivors were treated between 1991 and 2003. The anal-sphincter region, the rectum, the sigmoid and the small intestines were all delineated and the dose-volume histograms were exported for each patient. The dose-volume parameters were estimated fitting the data to the Relative Seriality (RS), the Lyman and the generalized Equivalent Uniform Dose (gEUD) model. Results. The dose-response parameters for all three models and four organs at risk (OARs) were estimated. The data from the sigmoid fits the studied models best: D50 was 58.8 and 59.5 Gy (RS, Lyman), γ50 was 1.60 and 1.57 (RS, Lyman), s was 0.32, n was 0.13 and a was 7.7 (RS, Lyman, gEUD). The estimated volume parameters indicate that the investigated OARs behave serially for this endpoint. Our results for the three models studied indicate that they have the same predictive power (similar LL values) for the symptom as a function of the dose for all investigated OARs. Conclusions. In our study, the anal-sphincter region and sigmoid fit our data best, but all OARs were found to have steep dose-responses for 'emptying of all stools into clothing without forewarning' and thus, the outcome can be predicted with an NTCP model. In addition, the dose to the four studied OARs may be considered when minimizing the risk of the symptom.
|
|
| 2. |
- Eriksdotter-Jönhagen, Maria, et al.
(författare)
-
Encapsulated cell biodelivery of nerve growth factor to the Basal forebrain in patients with Alzheimer's disease.
- 2012
-
Ingår i: Dementia and geriatric cognitive disorders. - : S. Karger AG. - 1421-9824 .- 1420-8008. ; 33:1, s. 18-28
-
Tidskriftsartikel (refereegranskat)abstract
- Degeneration of cholinergic neurons in the basal forebrain correlates with cognitive decline in patients with Alzheimer's disease (AD). Targeted delivery of exogenous nerve growth factor (NGF) has emerged as a potential AD therapy due to its regenerative effects on the basal forebrain cholinergic neurons in AD animal models. Here we report the results of a first-in-man study of encapsulated cell (EC) biodelivery of NGF to the basal forebrain of AD patients with the primary objective to explore safety and tolerability.
|
|
| 3. |
- Janols, Rebecka, et al.
(författare)
-
Användarnas synpunkter på IT-lösningar i vården - Sammanfattande erfarenheter från utvärderingar vid Landstinget i Uppsala län (2008-2012)
- 2013
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det ständigt pågående IT-förändringsarbetet inom vården har potentialen att bidra till ökad vårdkvalitet, effektivitet, patientsäkerhet, patientservice och en förbättrad arbetsmiljö. Om man lyckas med detta är IT-investeringar nyttiga för vården, patienterna och landstinget. Idag finns emellertid en dålig kunskap om vilken nyttan är och det saknas modeller för att beräkna den. All erfarenhet från det hittills genomförda arbetet, liksom från mycket annan tidigare forskning, pekar på att det finns stora problem med utveckling och införande av IT i vården. Problemen består dels i att man inte förmår utnyttja den nyttopotential som finns, dels att såväl IT-system som förändringsprocesserna inte håller nog hög kvalitet, vilket resulterar i negativa reaktioner och effekter hos användarna, dvs. hos vårdpersonalen. Denna rapport presenterar en sammanfattning av användarnas synpunkter på IT lösningar i vården. Innehållet i rapporten är grundat i både kvalitativa och kvantitativa studier genomfört inom ramen for projektet IVAN. Projektet IVAN (Informationssystem i vården Användbarhet och Nytta) är ett samarbetsprojekt mellan Landstinget Uppsala Län (LUL) och forskare vid avdelningen for visuell information och interaktion, Institutionen för informationsteknologi vid Uppsala universitet. Projektet startade med en 6 månaders förstudie på Akademiska sjukhuset hösten 2008 och har mellan jan 2010- dec 2011 fungerat som ett Landstingsprojekt. Projektet var ett IVAN har till stor del fokuserat på kartläggningar och analyser av de system, processer och organisation som finns runt dagens IT-system. Bilden av de problem som finns idag, särskilt när det gäller vårdpersonalens upplevda situation, har klarnat. Många behov av förändringar och förbättringar har framkommit.
|
|
| 4. |
- Janols, Rebecka, et al.
(författare)
-
Evaluation of User Adoption during Three Module Deployments of Region-wide Electronic Patient Record Systems
- 2014
-
Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 83:6, s. 438-449
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:In Sweden there are modular region-wide EPR systems that are implemented at various health organisations in the region. The market is dominated by four IT systems that have been procured and deployed in 18 out of 21 regions.METHODS:In a 2.5-year research study, deployments of three region-wide EPR modules: a patient administration system, eReferral module and eMedication module were followed and evaluated. Health professionals, EPR maintenance organisation, IT and health care managers were observed, interviewed and responded to questionnaires.RESULTS:Although the same deployment process was used during the three deployments, large variations in the units' adoptions were observed. The variations were due to: (1) expectation and attitude, (2) management and steering, (3) end-user involvement, (4) EPR learning, and (5) usability and the possibility of changing and improving the EPR.CONCLUSIONS:If changes in work processes are not considered in development and deployment, the potential benefits will not be achieved. It is therefore crucial that EPR deployment is conceived as organisational development. Users must be supported not just before and during the go-live phase, but also in the post-period. A problem often encountered is that it is difficult to make late changes in a region-wide EPR, and it is an open question whether it is possible to talk about a successful deployment if the usability of the introduced system is low.
|
|
| 5. |
- Lind, Thomas, et al.
(författare)
-
Förstudierapport : Införande av verksamhetsstödjande IT-system. Problem, effekter och nytta
- 2013
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Under hösten 2011 har en förstudie genomförts för att kartlägga och analysera dagens processer för utveckling, anskaffande, införande och utvärdering av administrativa IT-system vid Uppsala universitet (UU). Förstudien, Införande av verksamhetsstödjande IT-system. Problem, effekter och nytta, har genomförts av forskare vid avdelningen för människa-datorinteraktion (MDI) vid institutionen för informationsteknologi, UU. Förstudien har gjorts på uppdrag av universitetsdirektör Ann Fust och kontaktperson har varit Britta Nyberg, enheten för planering, uppföljning och stöd för verksamhetsutveckling.Arbetet har dels bestått av en kartläggning och analys av dagens utvecklings- och införandeprocesser och de problem man upplever i samband med dessa, dels några analyser av hur användare uppfattar de IT-system man idag har.Sammanfattningsvis har kartläggningen och analysen visat att det finns en stor förbättringspotential när det gäller processer för verksamhets- och IT-utveckling samt hur användbarhetsaspekter beaktas i utveckling, anskaffande, införande och utvärdering av IT-system. Kartläggningen av processer som används vid UU visar att det inte finns några enhetliga processer som används generellt inom UU, men att det lokalt finns fungerande sådana. Några exempel är förvaltningen som sedan några år arbetar enligt PM3, och avdelningen för IT och inköp som använder sig av ITIL. I de idag pågående IT-projekten varierar arbetssättet mycket. Det finns inga rekommenderade processer eller arbetssätt utan projektledaren lägger upp arbetet baserat på egna erfarenheter.Inom UU arbetar man generellt inte med användarcentrerade processer, och användbarhetsaspekter är inte prioriterade. Inom vissa projekt och i viss förvaltning förekommer en del arbete med fokus på användbarhet. Referensgrupper används som en form av användarmedverkan, men med olika mål och syften. Införandeprocesser upplevs generellt som problematiska inom UU och här finns påtagliga problem. Den upplevda användbarheten i de administrativa IT-systemen varierar, men generellt anser förstudiens intervjupersoner att det finns stor förbättringspotential.Fallstudien av Raindanceportalen visar att olika användargrupper upplever systemet på helt olika sätt. De som har utbildning i Raindance (ekonomiadministratörer) och använder det i sina kärnuppgifter upplever att systemet i ganska stor utsträckning stöder arbetet. Övriga användare som använder systemet mer sällan och som administrativt stödsystem har klart större problem med systemet.I en avslutande diskussion ger vi en sammanställning av de observerade problemen, ger förslag på vad som fordras för att utveckla kunskaper kring problem och möjligheter och för att införa förbättrade processer, samt för att på sikt få bättre och effektivare administrativa IT-system inom UU.
|
|
| 6. |
- Ahlberg, Alexander, et al.
(författare)
-
ESOPHAGEAL STRICTURE AFTER RADIOTHERAPY IN PATIENTS WITH HEAD AND NECK CANCER : EXPERIENCE OF A SINGLE INSTITUTION OVER 2 TREATMENT PERIODS
- 2010
-
Ingår i: Head and Neck. - : Wiley. - 1043-3074 .- 1097-0347. ; 32:4, s. 452-461
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Risk factors for development of a stricture of the upper esophagus after radiotherapy for head and neck cancer are poorly defined. Methods. This was a retrospective case-control study of patients diagnosed and treated for esophageal stricture after radiotherapy for head and neck cancer. Results. The incidence of esophageal stricture after external beam radiation therapy (EBRT) was 3.3%. Seventy patients with stricture and 66 patients without stricture were identified. A multivariate analysis showed that there was increased risk of stricture in receiving enteral feeding during EBRT or in receiving a mean dose of >45 By to the upper esophagus. Conclusions. Enteral feeding during EBRT is strongly associated with the development of stricture of the esophagus, as is a mean dose of >45 Gy to the upper esophagus. Treatment of the stricture with Savary-Gilliard bougienage or through scope balloon dilatation is safe and successful but often has to be repeated.
|
|
| 7. |
- Alevronta, Eleftheria, et al.
(författare)
-
Dose-response relations for stricture in the proximal oesophagus from head and neck radiotherapy
- 2010
-
Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 97:1, s. 54-59
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Determination of the dose-response relations for oesophageal stricture after radiotherapy of the head and neck. Material and methods: In this study 33 patients who developed oesophageal stricture and 39 patients as controls are included. The patients received radiation therapy for head and neck cancer at Karolinska University Hospital, Stockholm, Sweden. For each patient the 3D dose distribution delivered to the upper 5 cm of the oesophagus was analysed. The analysis was conducted for two periods, 1992-2000 and 2001-2005, due to the different irradiation techniques used. The fitting has been done using the relative seriality model. Results: For the treatment period 1992-2005, the mean doses were 49.8 and 33.4 Gy, respectively, for the cases and the controls. For the period 1992-2000, the mean doses for the cases and the controls were 49.9 and 45.9 Gy and for the period 2001-2005 were 49.8 and 21.4 Gy. For the period 2001-2005 the best estimates of the dose-response parameters are D-50 = 61.5 Gy (52.9-84.9 Gy), gamma = 1.4 (0.8-2.6) and s = 0.1 (0.01-0.3). Conclusions: Radiation-induced strictures were found to have a dose response relation and volume dependence (low relative seriality) for the treatment period 2001-2005. However, no dose response relation was found for the complete material.
|
|
| 8. |
- Andisheh, Bahram, 1967-
(författare)
-
Improving the therapeutic ratio of stereotactic radiosurgery and radiotherapy
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- New methods of high dose delivery, such as intensity modulated radiation therapy (IMRT), stereotactic radiation therapy (SRT) or stereotactic radiosurgery (SRS), hadron therapy, tomotherapy, etc., all make use of a few large fractions. To improve these treatments, there are three main directions: (i) improving physical dose distribution, (ii) optimizing radiosurgery dose-time scheme and (iii) modifying dose response of tumors or normal tissues.Different radiation modalities and systems have been developed to deliver the best possible physical dose to the target while keeping radiation to normal tissue minimum. Although applications of radiobiological findings to clinical practice are still at an early stage, many studies have shown that sublethal radiation damage repair kinetics plays an important role in tissue response to radiation.The purpose of the present thesis is to show how the above-mentioned directions could be used to improve treatment outcomes with special interest in radiation modalities and dose-time scheme, as well as radiobiological modeling. Also for arteriovenous malformations (AVM), the possible impact of AVM network angiostructure in radiation response was studied.
|
|
| 9. |
- Andisheh, Bahram, 1967-, et al.
(författare)
-
Vascular structure and binomial statistics for response modeling in radiosurgery of cerebral arteriovenous malformations
- 2010
-
Ingår i: Physics in Medicine and Biology. - : IOP Publishing. - 0031-9155 .- 1361-6560. ; 55:7, s. 2057-2067
-
Tidskriftsartikel (refereegranskat)abstract
- Radiation treatment of arteriovenous malformations (AVMs) has a slow and progressive vaso-occlusive effect. Some studies suggested the possible role of vascular structure in this process. A detailed biomathematical model has been used, where the morphological, biophysical and hemodynamic characteristics of intracranial AVM vessels are faithfully reproduced. The effect of radiation on plexiform and fistulous AVM nidus vessels was simulated using this theoretical model. The similarities between vascular and electrical networks were used to construct this biomathematical AVM model and provide an accurate rendering of transnidal and intranidal hemodynamics. The response of different vessels to radiation and their obliteration probability as a function of different angiostructures were simulated and total obliteration was defined as the probability of obliteration of all possible vascular pathways. The dose response of the whole AVM is observed to depend on the vascular structure of the intra-nidus AVM. Furthermore, a plexiform AVM appears to be more prone to obliteration compared with an AVM of the same size but having more arteriovenous fistulas. Finally, a binomial model was introduced, which considers the number of crucial vessels and is able to predict the dose response behavior of AVMs with a complex vascular structure.
|
|
| 10. |
- Brahme, Anders, et al.
(författare)
-
A systems biology approach to radiation therapy optimization
- 2010
-
Ingår i: Radiation and Environmental Biophysics. - : Springer Science and Business Media LLC. - 0301-634X .- 1432-2099. ; 49:2, s. 111-124
-
Tidskriftsartikel (refereegranskat)abstract
- During the last 20 years, the field of cellular and not least molecular radiation biology has been developed substantially and can today describe the response of heterogeneous tumors and organized normal tissues to radiation therapy quite well. An increased understanding of the sub-cellular and molecular response is leading to a more general systems biological approach to radiation therapy and treatment optimization. It is interesting that most of the characteristics of the tissue infrastructure, such as the vascular system and the degree of hypoxia, have to be considered to get an accurate description of tumor and normal tissue responses to ionizing radiation. In the limited space available, only a brief description of some of the most important concepts and processes is possible, starting from the key functional genomics pathways of the cell that are not only responsible for tumor development but also responsible for the response of the cells to radiation therapy. The key mechanisms for cellular damage and damage repair are described. It is further more discussed how these processes can be brought to inactivate the tumor without severely damaging surrounding normal tissues using suitable radiation modalities like intensity-modulated radiation therapy (IMRT) or light ions. The use of such methods may lead to a truly scientific approach to radiation therapy optimization, particularly when invivo predictive assays of radiation responsiveness becomes clinically available at a larger scale. Brief examples of the efficiency of IMRT are also given showing how sensitive normal tissues can be spared at the same time as highly curative doses are delivered to a tumor that is often radiation resistant and located near organs at risk. This new approach maximizes the probability to eradicate the tumor, while at the same time, adverse reactions in sensitive normal tissues are as far as possible minimized using IMRT with photons and light ions.
|
|
