| 1. |
- Demmelmaier, Ingrid, 1960-, et al.
(författare)
-
Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial
- 2021
-
Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : Wiley. - 0905-7188 .- 1600-0838. ; 31:5, s. 1144-1159
-
Tidskriftsartikel (refereegranskat)abstract
- Exercise during cancer treatment improves cancer-related fatigue (CRF), but the importance of exercise intensity for CRF is unclear. We compared the effects of high- vs low-to-moderate-intensity exercise with or without additional behavior change support (BCS) on CRF in patients undergoing (neo-)adjuvant cancer treatment. This was a multicenter, 2x2 factorial design randomized controlled trial (Clinical Trials NCT02473003) in Sweden. Participants recently diagnosed with breast (n = 457), prostate (n = 97) or colorectal (n = 23) cancer undergoing (neo-)adjuvant treatment were randomized to high intensity (n = 144), low-to-moderate intensity (n = 144), high intensity with BCS (n = 144) or low-to-moderate intensity with BCS (n = 145). The 6-month exercise intervention included supervised resistance training and home-based endurance training. CRF was assessed by Multidimensional Fatigue Inventory (MFI, five subscales score range 4-20), and Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F, score range 0-52). Multiple linear regression for main factorial effects was performed according to intention-to-treat, with post-intervention CRF as primary endpoint. Overall, 577 participants (mean age 58.7 years) were randomized. Participants randomized to high- vs low-to-moderate-intensity exercise had lower physical fatigue (MFI Physical Fatigue subscale; mean difference −1.05 [95% CI: −1.85, −0.25]), but the difference was not clinically important (ie <2). We found no differences in other CRF dimensions and no effect of additional BCS. There were few minor adverse events. For CRF, patients undergoing (neo-)adjuvant treatment for breast, prostate or colorectal cancer can safely exercise at high- or low-to-moderate intensity, according to their own preferences. Additional BCS does not provide extra benefit for CRF in supervised, well-controlled exercise interventions.
|
|
| 2. |
- Fagevik Olsén, Monika, et al.
(författare)
-
First mobilisation after abdominal and cardiothoracic surgery : when is it actually performed? A national, multicentre, cross-sectional study
- 2024
-
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 14:2
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Knowledge of clinical practice regarding mobilisation after surgery is lacking. This study therefore aimed to reveal current mobilisation routines after abdominal and cardiothoracic surgery and to identify factors associated with mobilisation within 6 hours postoperatively. DESIGN: A prospective observational national multicentre study.SETTING: 18 different hospitals in Sweden.PARTICIPANTS: 1492 adult patients undergoing abdominal and cardiothoracic surgery with duration of anaesthesia>2 hours.PRIMARY AND SECONDARY OUTCOMES: Primary outcome was time to first postoperative mobilisation. Secondary outcomes were the type and duration of the first mobilisation. Data were analysed using multivariate logistic regression and general structural equation modelling, and data are presented as ORs with 95% CIs.RESULTS: Among the included patients, 52% were mobilised to at least sitting on the edge of the bed within 6 hours, 70% within 12 hours and 96% within 24 hours. Besides sitting on the edge of the bed, 76% stood up by the bed and 22% were walking away from the bedside the first time they were mobilised. Patients undergoing major upper abdominal surgery required the longest time before mobilisation with an average time of 11 hours post surgery. Factors associated with increased likelihood of mobilisation within 6 hours of surgery were daytime arrival at the postoperative recovery unit (OR: 5.13, 95% CI: 2.16 to 12.18), anaesthesia <4 hours (OR: 1.68, 95% CI: 1.17 to 2.40) and American Society of Anaesthesiologists (ASA) classification 1-2, (OR: 1.63, 95% CI: 1.13 to 2.36).CONCLUSIONS: In total, 96% if the patients were mobilised within 24 hours after surgery and 52% within 6 hours. Daytime arrival at the postoperative recovery unit, low ASA classification and shorter duration of anaesthesia were associated with a shorter time to mobilisation. TRIALREGISTRATION NUMBER: FoU, Forskning och Utveckling in VGR, Vastra Gotaland Region (Id:275357) and Clinical Trials (NCT04729634).
|
|
| 3. |
- Forslund, Marina
(författare)
-
A nutrition intervention in men with prostate cancer : Exploring effects on bowel symptoms from radiotherapy, patient experience, and nutrient intake
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective The main objective of this thesis was to explore the effects of a nutrition intervention on acute and late bowel symptoms in men with localised prostate cancer treated with pelvic radiotherapy (study I), participants’ experiences from receiving the nutrition intervention (study II), and associations with nutrient intakes (study III).Methods A total of 180 men with localised prostate cancer referred to curative radiotherapy targeting the prostate gland and pelvic lymph nodes were recruited to the trial. The participants were randomised to standard care plus a nutrition intervention aiming to modify fibre and lactose intakes (NIG; n=92) or standard care alone (SCG; n=88). Data on bowel symptoms and dietary intake were collected pre-treatment and at seven time points during a 26-month study period. Analyses of the effects of the nutrition intervention on bowel symptoms were conducted for the acute phase (up to 2 months post radiotherapy), and the late phase (7 to 24 months post radiotherapy). Semi-structured interviews were conducted with 15 participants from the NIG to explore experiences of the nutrition intervention.Results The nutrition intervention was associated with statistically significantly, but not clinically significantly, less bother from blood in stools and flatulence during the acute phase. The nutrition intervention was also associated with more bloated abdomen during the late phase (Study I). Social support, contributing to the greater good, prior knowledge, dietary information, and a small need for change facilitated adherence. While feeling limited, wanting to decide for themselves, the timing of the intervention, unmet expectations, and loss of motivation were described as barriers for adherence (Study II). A greater reduction of lactose was associated with decreased intake of calcium at the end of the radiotherapy period. A more modified fibre intake during the radiotherapy period was associated with increased vitamin C, but decreased selenium intake (Study III).Conclusions The effects from the nutrition intervention were small and inconclusive and do not support routine dietary advice aiming to modify fibre and lactose intakes as a mean to substantially reduce adverse effects from pelvic radiotherapy. Tailored nutritional interventions based on individual preferences, prior knowledge, and context, could enhance adherence. There were few associations between modified fibre and lactose intakes and nutrient intakes, thus, no recommendations can be made on whether such dietary advice should continue to be provided to men with prostate cancer undergoing pelvic radiotherapy.
|
|
| 4. |
- Hauffman, Anna, et al.
(författare)
-
Cocreated internet-based stepped care for individuals with cancer and concurrent symptoms of anxiety and depression : Results from the U-CARE AdultCan randomized controlled trial
- 2020
-
Ingår i: Psycho-Oncology. - : John Wiley & Sons. - 1057-9249 .- 1099-1611. ; 29:12, s. 2012-2018
-
Tidskriftsartikel (refereegranskat)abstract
- Objective The aim was to evaluate the effects of cocreated internet-based stepped care (iCAN-DO) on anxiety, depression, posttraumatic stress, and health-related quality of life (HRQoL) in individuals with cancer and self-reported anxiety and/or depression symptoms, compared with standard care.Methods Clinically recruited individuals with breast, colorectal, or prostate cancer underwent online screening with the Hospital Anxiety and Depression Scale (HADS). Those with anxiety and/or depression symptoms (>7 on any of the HADS subscales) were randomized to iCAN-DO or standard care. iCAN-DO comprised psychoeducation and self-care strategies (step 1) and internet-based cognitive behavioral therapy (iCBT, step 2). Data were collected before randomization and at 1, 4, 7, and 10 months and analyzed with intention-to-treat regression analysis and randomization tests.Results Online screening identified 245 (27%) of 909 individuals who reported anxiety and/or depression symptoms. They were randomized to iCAN-DO (n = 124) or standard care (n = 121). Of them 49% completed the 10-month assessment, and in the iCAN-DO group 85% accessed step 1 and 13% underwent iCBT. iCAN-DO decreased the levels of symptoms of depression (−0.54, 95% confidence interval: −1.08 to −0.01, P < .05) and the proportion of individuals with symptoms of depression (P < .01) at 10 months, compared with standard care, according to HADS. There were no significant effects on anxiety, posttraumatic stress, or HRQoL.Conclusion Internet-based stepped care improves symptoms of depression in individuals with cancer. Further studies are needed to gain knowledge on how to optimize and implement internet-based support in oncology care.
|
|
| 5. |
- Montelius, Elin, 1983-
(författare)
-
Att göra det materiella virtuellt : Subjektifiering, moral och motstånd i konstruktionen av den riskfyllda mathållningen
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Den här avhandlingen syftar till att bidra till förståelsen av hur risk konstrueras och förändras i diskussioner om mathållning på nätforum och vilka subjektspositioner som görs möjliga då risk uttrycks i relation till klass och kön. Mat har kommit att få stor uppmärksamhet i samhällsdiskussionen, men i det moderna samhället är det inte bristen på mat som står i fokus, utan snarare de val människor måste göra relaterade till mat. Vad vi äter har kommit att bli en signal om vem vi är och vem vi vill vara, men diskussioner kring mat handlar också om vad som betraktas som riskfyllt eller inte. Därtill har mat länge använts för att göra distinktioner mellan människor baserat på maktstrukturer som klass och kön. Avhandlingen är inspirerad av en feministisk poststrukturalistisk ansats vilken används för att undersöka hur maktrelationer och subjektifieringsprocesser uttrycks i konversationer på nätbaserade diskussionsforum.Genom att ta avstamp i den kritiska riskforskningen samt i genusvetenskaplig forskning visar avhandlingen hur risk konstrueras genom riskperformativ. Riskperformativ, uttryckta i det virtuella rummet, medför att olika ”sanningar” konstrueras runt mathållningar vilket får konsekvenser får vilka subjektspositioner som möjliggörs. Genom riskperformativen konstruerats olika förväntningar om vad som kan och bör sägas för att konstituera sig som ett ansvarsfullt och moraliskt subjekt. Därigenom görs olika riskpositioner, det vill säga klass- och könskodade subjektspositioner som konstitueras i relation till riskkonstruktioner, tillgängliga. Analysen visar också hur utrymme för betydelseförskjutningar och motstånd mot riskkonstruktioner skapas i diskussionerna, vilket sker genom dels bekännelsen som teknik och dels genom en teknik som här kallas en responsibiliserad paternalism varigenom det individualiserade ansvaret för upprätthållandet av självreglering inför risk uttrycks i samverkan med kollektivt upprätthållna klass- och könsnormer. I avhandlingen analyseras därigenom hur kön och klass görs i samverkan med riskkonstruktioner på sätt där dessa förstärker varandra.
|
|
| 6. |
- Nygren, Anna, et al.
(författare)
-
Samtal: Text, bild och berättelse
- 2022
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Panelsamtal om text, bild och berättelse med utgångspunkt i Duane Michals konstnärskap.
|
|
| 7. |
- Svensson-Raskh, Anna, et al.
(författare)
-
Mobilization Started Within 2Hours After Abdominal Surgery Improves Peripheral and Arterial Oxygenation: A Single-Center Randomized Controlled Trial.
- 2021
-
Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 101:5
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate if mobilization out of bed, within 2hours after abdominal surgery, improved participants´ respiratory function and whether breathing exercises had an additional positive effect.Participants were 214 consecutively recruited patients who underwent elective open or robot-assisted laparoscopic gynecological, urological, or endocrinological abdominal surgery with an anesthetic duration of >2hours. They were recruited to a randomized controlled trial. Immediately after surgery, patients were randomly assigned to 1 of 3 groups: mobilization (to sit in a chair) and standardized breathing exercises (n=73), mobilization (to sit in a chair) only (n=76), or control (n=65). The interventions started within 2hours after arrival at the postoperative recovery unit and continued for a maximum of 6hours. The primary outcomes were differences in peripheral oxygenation (oxygen saturation [Spo2], as a percentage) and arterial oxygenation (arterial oxygen pressure [Pao2], in kilopascals) between the groups. Secondary outcomes were arterial carbon dioxide pressure, spirometry, respiratory insufficiency, pneumonia, and length of stay.Based on intention-to-treat analysis (n=214), patients who received mobilization and breathing exercises had significantly improved Spo2 (mean difference [MD]=2.5%; 95% CI=0.4 to 4.6) and Pao2 (MD=1.40kPa; 95% CI=0.64 to 2.17) compared to the controls. For mobilization only, there was an increase in Pao2 (MD=0.97kPa; 95% CI=0.20 to 1.74) compared to the controls. In the per-protocol analysis (n=201), there were significant improvements in Spo2 and Pao2 for both groups receiving mobilization compared to the controls. Secondary outcome measures were not different between groups.Mobilization out of bed, with or without breathing exercises, within 2hours after elective abdominal surgery improved Spo2 and Pao2.The respiratory effect of mobilization (out of bed) immediately after surgery has not been thoroughly evaluated in the literature. This study shows that mobilization out of bed following elective abdominal surgery can improve Spo2 and Pao2.Mobilization within 2hours after elective abdominal surgery, with or without breathing exercises, can improve patients' respiratory function.
|
|
| 8. |
|
|
| 9. |
- Andersson-Watz, Anna, 1980-, et al.
(författare)
-
Introducing Mechanically Assisted Cough for Patients with Progressive Neurological Disease : Patient-Physical Therapist Interaction and Physical Therapist Perspective
- 2024
-
Ingår i: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 104:5
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The goal of this study was to explore patient-physical therapist interaction and the physical therapist's experience of the introductory session for mechanical insufflation-exsufflation (MI-E) device treatment for patients with progressive neurological disease.METHODS: Qualitative content analysis of participant-observation of interaction between patients and physical therapists during 9 MI-E introduction sessions in different clinical care settings and 10 follow-up interviews with 6 physical therapists.RESULTS: The introduction of MI-E emerged as a process of instilling a sense of security in the patient. The process can be described in 4 steps: (1) gain understanding by being responsive to the person's whole life-situation; (2) share knowledge and expectations in a respectful and permissive way; (3) introduce the device in a gentle and reciprocal interactivity; and (4) adapt to home-use in an inclusive dialogue with the patient and their significant others. Physical therapists described a need for assurance to instill a sense of security in the patient, implying a need for confidence, competent peers, guiding yet flexible routines, and emotional support.CONCLUSION: Physical therapists have a need to foster assurance in employing a person-centered approach to make a patient feel secure in the process of introducing MI-E treatment. Multiple modes of professional knowledge were used together with action-based and relational-based ethics to facilitate a person-centered care approach. This seems to be a promising approach for providing good care when introducing MI-E to patients. Further research is needed to explore this from the patient's perspective.IMPACT: This study added to the body of knowledge regarding MI-E treatment in relation to patients. This has direct implication, particularly for inexperienced physical therapists, for informed care for the patient during introduction. Our study also supports that person-centered care should be implemented at all levels of health care to make it possible for physical therapists to practice person-centered care.
|
|
| 10. |
|
|
