| 1. |
- Egenvall, Monika, et al.
(författare)
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Management of colon cancer in the elderly : a population-based study
- 2014
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 16:6, s. 433-441
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Tidskriftsartikel (refereegranskat)abstract
- AIM: although the median age of patients diagnosed with colon cancer is above 70 years, little is known about specific characteristics and management in the elderly. The aim of the study was to define characteristics of colon cancer in elderly patients and compare the quality of preoperative assessment and surgery with that of younger patients undergoing surgery for colon cancer.METHOD: data on 15.255 patients diagnosed with colon cancer between 2007 and 2010 were retrieved from the Swedish National Colon Cancer Register. Of these, 12.959 underwent surgical resection, 6.141 were 75 years or older while 6.818 were younger. The χ(2) test, Mann-Whitney U test and uni- and multivariable logistic regression analyses were used for comparison between groups.RESULTS: older patients were more likely to be female (54% older/48% younger) and have right-sided cancer (60% older/49% younger). Among patients who underwent resection, the elderly were less often evaluated regarding tumour stage prior to surgery (59% older/65% younger) and they were less often evaluated at a multidisciplinary team conference (26% older/34% younger). Elderly patients more frequently underwent emergency surgery (22% older/19% younger) despite having an earlier cancer stage. When adjusted for stage, fewer elderly patients underwent a radical curative procedure (OR for non-curative resection 1.19; 95% CI 1.06-1.33)CONCLUSION: routine management of patients with colon cancer is age-dependent. Patients 75 years and older are less often completely staged and less often evaluated at a multi-disciplinary team conference prior to surgery. Adjusted for stage, fewer elderly patients undergo curative resection.
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| 3. |
- Heiwe, Susanne, et al.
(författare)
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Evidence-based practice : attitudes, knowledge and behaviour among allied health care professionals
- 2011
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 23:2, s. 198-209
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore dieticians', occupational therapists' and physical therapists' attitudes, beliefs, knowledge and behaviour concerning evidence-based practice within a university hospital setting. Design: Cross-sectional survey. Setting. University hospital. Participants: All dieticians, occupational therapists and physical therapists employed at a Swedish university hospital (n = 306) of whom 227 (74%) responded. Main Outcome Measures: Attitudes towards, perceived benefits and limitations of evidence-based practice, use and understanding of clinical practice guidelines, availability of resources to access information and skills in using these resources. Results: Findings showed positive attitudes towards evidence-based practice and the use of evidence to support clinical decision-making. It was seen as necessary. Literature and research findings were perceived as useful in clinical practice. The majority indicated having the necessary skills to be able to interpret and understand the evidence, and that clinical practice guidelines were available and used. Evidence-based practice was not perceived as taking into account the patient preferences. Lack of time was perceived as the major barrier to evidence-based practice. Conclusions: The prerequisites for evidence-based practice were assessed as good, but ways to make evidence-based practice time efficient, easy to access and relevant to clinical practice need to be continuously supported at the management level, so that research evidence becomes linked to work-flow in a way that does not adversely affect productivity and the flow of patients. © The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
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| 4. |
- Samuelsson, Daniel, et al.
(författare)
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Clinical, optical coherence tomography, and fundus autofluorescence findings in patients with intraocular tumors
- 2016
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Ingår i: Clinical Ophthalmology. - 1177-5467. ; 10, s. 1953-1964
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To describe clinical, optical coherence tomography (OCT) and fundus autofluorescence (FAF) findings in patients with intraocular tumors and determine if OCT and FAF could be helpful in the differential diagnosis and management of different choroidal tumors.METHODS: Forty-nine patients with untreated, macular, midperipheral, and extrapapillary intraocular tumors were included. All patients underwent ophthalmic examination: best-corrected visual acuity, slit-lamp biomicroscopy, funduscopy, and standardized B mode, and if possible A mode, ultrasonography, and OCT and FAF imaging of the surface of the intraocular tumors.RESULTS: Of the 49 patients studied, 19 had choroidal nevi, ten had indeterminate choroidal melanocytic lesions (IMLs), ten had malignant melanomas, and ten had other choroidal tumors. The choroidal nevi revealed subretinal fluid (SRF) on OCT in only 11%. FAF detected isoauto-fluorescence in 42%, hypoautofluorescence in 37%, patchy FAF pattern in 16%, and a diffuse FAF pattern in 5%. Seventy percent of patients with IML showed SRF on OCT and 20% showed tumor growth on follow-up, detected only by OCT and FAF imaging. FAF revealed a patchy pattern in 50% and a diffuse pattern in 40% of cases with IML. Ninety percent of the patients with choroidal melanoma had SRF on OCT and FAF revealed a patchy pattern in 60% and a diffuse pattern in 40%. Patients with other choroidal tumors had SRF on OCT in 30% of cases and no characteristic pattern on FAF.CONCLUSION: Both OCT and FAF were helpful in the differential diagnosis of choroidal nevi versus IMLs, choroidal melanomas, and other choroidal tumors. Also, detailed and periodical clinical evaluation of patients with intraocular tumors using OCT and FAF imaging for the detection of both SRF and FAF patterns overlying the tumor can be useful for detection of tumor growth.
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| 5. |
- Samuelsson, Katja Schubert, et al.
(författare)
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Preoperative geriatric assessment and follow-up of patients older than 75 years undergoing elective surgery for suspected colorectal cancer
- 2019
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Ingår i: Journal of Geriatric Oncology. - : Elsevier. - 1879-4068 .- 1879-4076. ; 10:5, s. 709-715
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We investigated the predictive value of specific tools used in a Comprehensive Geriatric Assessment (CGA) with regard to postoperative outcome in patients 75 years and older undergoing elective colorectal cancer (CRC) surgery. Furthermore, recovery was followed over the first postoperative year using the same assessment tools.Material and Methods: Baseline clinical and CGA variables including functional and nutritional status, pressure sore risk, fall risk, cognition, depression, polypharmacy, comorbidity, and health-related quality-of-life (HRQoL) were prospectively recorded. Outcome variables were postoperative complications and length of stay (LOS). Patients were likewise followed up at one, three and twelve months postoperatively.Results: Forty-nine patients underwent surgery (median age 81 years). Forty-three per cent had ASA (American Society of Anesthesiologists) class 2 47% had ASA class 3. Postoperative complications occurred in 32.7%. Median LOS was eight days. In univariate analyses, none of the parameters tested predicted postoperative complication or LOS. During follow-up, all patients recovered to baseline values apart from HRQoL which was still reduced at three and twelve months (p = .017). Nutritional status had improved twelve months after surgery (p = .011).Conclusions: No association could be found in this study between the results of a comprehensive geriatric assessment and prolonged length of stay or postoperative complication rate after elective surgery for colorectal cancer. Patients recovered well during the first year after surgery. Quality of life, however, was still lower than prior to surgery.
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| 6. |
- Samuelsson, Katja Schubert, et al.
(författare)
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The older patient's experience of the healthcare chain and information when undergoing colorectal cancer surgery according to the ERAS concept
- 2018
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:7-8, s. e1580-e1588
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To describe how older patients experience the healthcare chain and information given before, during and after colorectal cancer surgery.BACKGROUND: Most persons with colorectal cancer are older than 70 years and undergo surgery with subsequent enhanced recovery programmes aiming to quickly restore preoperative function. However, adaptation of such programmes to suit the older patient has not been made.DESIGN: Qualitative descriptive study.METHOD: Semi-structured interviews were conducted on 16 patients undergoing colorectal cancer surgery at a Swedish University Hospital. Inductive content analysis was employed.RESULTS: During the period of primary investigation and diagnosis, a paucity of information regarding the disease and management, and lack of help in coping with the diagnosis of cancer and its impact on future life, leads to a feeling of vulnerability. During their stay in hospital, the patient's negative perception of the hospital environment, their need for support, and uncertainty and anxiety about the future are evident. After discharge, rehabilitation is perceived as lacking in structure and individual adaptation, leading to disappointment. Persistent difficulty with nutrition delays recovery, and confusion regarding division of responsibility between primary and specialist care leads to increased anxiety and feelings of vulnerability. Information on self-care is perceived as inadequate. Furthermore, provided information is not always understood and therefore not useful.CONCLUSION: Information before and after surgery must be tailored to meet the needs of older persons, considering the patient's knowledge and ability to understand. Furthermore, individual nutritional requirements and preoperative physical activity and status must be taken into account when planning rehabilitation. This article is protected by copyright. All rights reserved.
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| 7. |
- Samuelsson, Monika
(författare)
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Dynamic mechanical allodynia in peripheral neuropathic pain : psychological observations
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction and aim: Pain due to a light moving mechanical stimulus, dynamic mechanical allodynia, is a protruding symptom/sign in subgroups of patients with peripheral neuropathic pain and frequently as troublesome as spontaneous ongoing pain. The objective of this thesis was to survey psychophysical details of dynamic mechanical allodynia using a novel semi-quantitative method. In addition, the psychophysical characteristics of dynamic mechanical allodynia in the secondary hyperalgesic zone after an intradermal injection of capsaicin were probed with regard to similarities and differences of that phenomenon compared to such allodynia in peripheral neuropathic pain. Methods: Using a semi-quantitative method brush-evoked allodynia was induced in the innervation territory of the lesioned nervous structure in patients by lightly stroking different distances of the skin 2 or 4 times with brushes of different widths or while varying stroking velocity or brushing force. In study III the patients were also examined in the area outside the flare after an intradermal capsaicin injection in the corresponding contralateral site to the area of painful neuropathy, i.e., in the secondary hyperalgesic area. Age- and sex-matched controls injected with identical amounts of capsaicin were examined in a corresponding area. In all studies the intensity and duration of brush-evoked allodynia was recorded using a computerized visual analogue scale. The total brush-evoked pain intensity, including painful aftersensation was calculated as the area under the curve. Following each stimulus, the subjects selected pain descriptors from a validated instrument. In study II the repeatability of brushevoked allodynia was examined within and between days in patients with peripheral neuropathic pain. Results: Significantly increased total brush-evoked pain intensity was demonstrated with increased brushing length and number of strokes, higher brushing force and lower stroking velocity but not while altering brush width. Lack of influence of brush width was further underlined by the finding that brushing of equivalent skin areas resulted in higher total evoked pain intensity if brushing the skin with a thin brush over a longer distance than a thick brush over a shorter distance. A very good repeatability of brush-evoked allodynia within and between days was reported using this semiquantitative method. In patients similarities were found in the relationship between brush-evoked allodynia and temporo-spatial stimulus parameters comparing the capsaicin-induced secondary hyperalgesic area with the area of painful neuropathy. Only 3/9 controls (compared to 8/9 patients) reported brush-evoked pain after capsaicin injection. In all studies the frequency of preferred sensorydiscriminative and affective pain descriptors for the brush-evoked pain indicated some similarities, in particular the choice of affective pain descriptors such as annoying and troublesome. Conclusions: Our findings demonstrated dynamic mechanical allodynia to be a partially graded phenomenon in peripheral neuropathic pain conditions since stimulus parameters such as increased brushing length, increased number of strokes, lower stroking velocity and increased brushing force significantly increased the total brush-evoked pain intensity. However, alterations of the brush width within a limited range did not significantly change the total brush-evoked pain intensity. In addition, dynamic mechanical allodynia in the capsaicin-induced secondary hyperalgesic zone in patients seemingly well reflected perceptual details of such allodynia in the neuropathic condition. In healthy controls, only one-third developed brush-evoked allodynia in the potential secondary hyperalgesic area. Such a low hit frequency calls into question the value of the capsaicin model when aiming at studying dynamic mechanical allodynia. Taken together, these results substantiate the usefulness of this semiquantitative assessment method in studies on dynamic mechanical allodynia, including longitudinal treatment studies.
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