| 1. |
- Angenete, Eva, 1972, et al.
(author)
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Ostomy function after abdominoperineal resection-a clinical and patient evaluation.
- 2012
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In: International journal of colorectal disease. - : Springer Science and Business Media LLC. - 1432-1262 .- 0179-1958. ; 27:10, s. 1267-74
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Journal article (peer-reviewed)abstract
- PURPOSE: Abdominoperineal resection (APR) for rectal cancer results in a permanent colostomy. As a consequence of a recent change in operative technique from standard (S-APR) to extralevator resection (E-APR), the perineal part of the procedure is now performed with the patient in a prone jackknife position. The impact of this change on stoma function is unknown. The aim was to determine stoma-related complications and the individual patient experience of a stoma. METHODS: Consecutive patients with rectal cancer operated on with APR in one institution in 2004 to 2009 were included. Recurrent cancer, palliative procedures, pre-existing stoma and patients not alive at the start of the study were excluded. Data were collected from hospital records and the national colorectal cancer registry. A questionnaire was sent out to patients. The median follow-up was 44months (13-84) after primary surgery. RESULTS: Ninety-six patients were alive in February 2011. Seventy seven agreed to participate. Sixty-nine patients (90%) returned the questionnaire. Stoma necrosis was more common for E-APR, 34% vs. 10%, but bandaging problems and low stoma height were more common for S-APR. There were no differences in the patients' experience of stoma function. In all, 35% of the patients felt dirty and unclean, but 90% felt that they had a full life and could engage in leisure activities of their choice. CONCLUSIONS: This exploratory study indicates no difference in stoma function after 1year between S-APR and E-APR. Over 90% of the patients accept their stoma, but our study indicates that more information and support for patients are warranted.
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| 2. |
- Angenete, Eva, 1972, et al.
(author)
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Self reported experience of sexual function and quality after abdominoperineal excision in a prospective cohort.
- 2014
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In: International journal of surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1743-9191. ; 12:11, s. 1221-1227
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Journal article (peer-reviewed)abstract
- Introduction: Rectal cancer treatment, especially abdominoperineal excision (APE), can cause sexual dysfunction. There are indications that pre-operative information regarding sexual dysfunction is inadequate. The aim of this study was to explore self reported sexual function in a group of patients operated with APE and the patients' remembrance of preoperative information more than one year after their surgical procedure. Methods: Consecutive patients with rectal cancer operated with APE in one institution between 2004 and 2009 were included. Data was collected from hospital records and the Swedish rectal cancer registry. A detailed questionnaire was sent out to the patients 13-84 months post-operatively. Results: One hundred and eight patients were alive in February 2011, 84 agreed to participate and 89% returned the questionnaire. Men and women did not differ regarding age, tumour stage, neoadjuvant treatment or type of surgical procedure. More men were involved in a relationship; men had more thoughts about sex, were less satisfied and were more bothered than women by their sexual dysfunction. A majority of patients did not retain sufficient knowledge from the preoperative information regarding sexual dysfunction. Discussion: This exploratory study shows that although sexual activity was similar between the two genders, men reported more bother by their self-reported sexual dysfunction after an APE than women did. However, both men and women felt that the preoperative information was inadequate. Conclusion: Surgeons should focus more on information about the risk of sexual dysfunction as well as on its treatment at follow-up.
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| 3. |
- Angenete, Eva, 1972, et al.
(author)
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Stenting for colorectal cancer obstruction compared to surgery-a study of consecutive patients in a single institution.
- 2012
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In: International journal of colorectal disease. - : Springer Science and Business Media LLC. - 1432-1262 .- 0179-1958. ; 27:5, s. 665-670
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Journal article (peer-reviewed)abstract
- BACKGROUND: Colonic obstruction is a common complication to colorectal cancer and surgical treatment is associated with high morbidity and mortality. Stenting has emerged as an alternative to surgery. The aim of this study was to compare short-term morbidity, mortality and hospital stay between treatment with self-expandable metallic stent and emergency surgery performed at our department during a 5-year period in a non-randomized setting. METHODS: Patients with colonic obstruction due to rectal or colon cancer referred to the Endoscopic Unit or Surgical Department for insertion of a colonic stent between 1 August 2003 and 1 August 2008 were prospectively registered and followed (n=112). A control group was identified using the hospital records of operations with the International Classification Code-10 (ICD-10) for bowel obstruction and colorectal cancer (n=60). Age, gender, indication, preoperative investigations, surgical procedure, complications and procedure-related mortality were registered. Patients were followed in accordance with local guidelines. RESULTS: The complication rate was similar in the two groups, although there was a trend toward a higher number of severe complications in the surgical group. The hospital stay was significantly lower in the stent group, median of 4 vs. 9days (p<0.0001). The procedure-related mortality was lower in the stent group; 7% vs. 20% (p<0.05). CONCLUSIONS: Stenting can be safely performed with lower or similar complication rate and lower mortality rate compared to surgery and results in significantly shorter hospital stay. The results support stenting as the treatment of choice in patients with acute colonic obstruction, especially in disseminated disease.
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| 4. |
- Asplund, Dan, et al.
(author)
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Outcome of extralevator abdominoperineal excision compared with standard surgery. Results from a single centre.
- 2012
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In: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. - : Wiley. - 1463-1318. ; 14:10, s. 1191-6
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Journal article (peer-reviewed)abstract
- Aim: Extralevator abdominoperineal excision (APE) for low rectal tumours has been introduced to achieve improved local radicality. Fewer positive margins and intraoperative perforations have been reported compared with standard APE. The aim of this retrospective study was to compare short-term complications and results of the two techniques in our institution. Method: Consecutive patients with rectal cancer undergoing abdominoperineal excision between 2004 and 2009 were included. They were divided into two group of 79 patients in extralevator and standard APE. Patients with recurrence and those having a palliative procedure were excluded. Data were collected from hospital records and the colorectal cancer registry. Main endpointgs were wound infection, perineal wound revision, oncologic data and length of hospital stay. Results: CRM positivity did not differ significantly between groups (17%extralevator; 20% standard APE). Intraoperative perforation (13 vs. 10%) or local recurrence (7 in each group) were no different. Perineal wound infection was more common after extralevator APE (46 vs. 28%,p<0.05) as was perineal wound revision (22 vs.8% p<0.05). Hospital stay was longer after extralevator APE (median 12 vs. 11 days,p<0.05). Tumour height (median 4 cm) and pTNM-classification did not differ. Conclusion: The results do not show any advantage for extralevator APE. The oncologic data were no better and postoperative morbidity was increased. Further studies are needed before extralevator APE is widely adopted in clinical practice.
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| 5. |
- Asplund, Dan, et al.
(author)
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Persistent perineal morbidity is common following abdominoperineal excision for rectal cancer.
- 2015
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In: International journal of colorectal disease. - : Springer Science and Business Media LLC. - 1432-1262 .- 0179-1958. ; 30:11, s. 1563-1570
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Journal article (peer-reviewed)abstract
- Short-term complications related to the perineal wound after abdominoperineal excision (APE) are a well-known problem. Perineal morbidity in the longer term is an almost unexplored area. The aim of this cross-sectional study was to investigate the prevalence of perineal symptoms 3years after APE for rectal cancer, to identify potential risk factors and to explore the relationship between perineal morbidity and global quality of life.
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| 6. |
- Asplund, Dan, et al.
(author)
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Pretreatment quality of life in patients with rectal cancer is associated with intrusive thoughts and sense of coherence
- 2017
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In: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 32:11, s. 1639-1647
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Journal article (peer-reviewed)abstract
- Purpose Quality of life may predict survival. In addition to clinical variables, it may be influenced by psychological factors, some of which may be accessible for intervention. The primary objective of this study was to investigate the association of intrusive thoughts and the patients' sense of coherence with pretreatment quality of life in patients with newly diagnosed rectal cancer. Methods Patients were prospectively included in 16 hospitals in Sweden and Denmark. They answered an extensive questionnaire after receiving their treatment plan. Clinical data were retrieved from national quality registries for rectal cancer. Results Of 1248 included patients, a total of 1085 were evaluable. Pretreatment global health-related and overall quality of life was lower in patients planned for palliative compared with curative treatment (median 53 vs. 80 on the EuroQoL visual analogue scale, p < 0.001 and odds ratio 0.56, 95% confidence interval 0.36-0.88, respectively). Quality of life was associated with intrusive thoughts (odds ratio 0.33, 95% confidence interval 0.24-0.45) and sense of coherence (odds ratio 0.44, 95% confidence interval 0.370.52) irrespective of the treatment plan. Conclusions Pretreatment quality of life was influenced by the intent of treatment as well as by intrusive thoughts and the patients' sense of coherence. Interventions could modify these psychological factors, and future studies should focus on initiatives to improve quality of life for this group of patients.
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| 7. |
- Asplund, Dan, et al.
(author)
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Self-reported quality of life and functional outcome in patients with rectal cancer--QoLiRECT.
- 2014
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In: Danish medical journal. - 2245-1919. ; 61:5
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Journal article (peer-reviewed)abstract
- The treatment of rectal cancer has improved, and survival rates today exceed those of colon cancer, but functional impairments and other adverse effects of treatment are common among patients. The impact of treatment on patients' quality of life (QoL) remains unclear. Many of the common QoL instruments are brief and not sufficiently detailed to provide a deeper understanding of the factors that determine QoL. The aim of this study was to explore patients' experiences and long-term QoL in an unselected cohort of patients with rectal cancer.
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| 8. |
- Asplund, Matthias, et al.
(author)
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Inspection of railway turnouts using camera
- 2013
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Conference paper (peer-reviewed)abstract
- The railway turnout is an essential component in a railway system, used to divert traffic along different tracks. A turnout includes a number of different parts, including the switch blade, frog, point machine, switch roller, soleplate, check rail, wing rail, drive rods, control rods and other bars. These parts must be kept in good condition, meeting functional and safety requirements. Failing to comply will result in a reduction of the network’s capacity with economic consequences. Not honouring the safety limits could result in severe accidents, including derailment, causing human casualties. By performing the right type of inspection and/or maintenance at the right time, these unwanted events can be reduced. To determine if and when a maintenance action should be performed, the condition of the turnout must be established, usually by manual inspections or with measurement vehicles. The drawback is the discrete nature of these inspection events. Failure modes with development times shorter than the inspection interval could result in a malfunction of the unit. An on-line measurement system would be able to deal with these failure events and initiate correct maintenance actions at an earlier stage. With an on-line system, remotely located turnouts could be inspected without on-site personnel. Capacity consuming failures of turnouts with a strategic location or with bottleneck characteristics could also be corrected before they affect traffic. This paper describes a feasibility study of a camera based inspection system for turnouts and discusses the effect the method could have on system reliability and capacity.
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| 9. |
- Asplund, Matthias, et al.
(author)
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Slutrapport avseende hjulprofilmätare i Sunderbyn
- 2014
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Reports (other academic/artistic)abstract
- Bakgrunden till projektets genomförande har varit den ökande mängden rälsbyten och mängden trafik med 30 tons axellast på Malmbanan. Spårunderhållet och hjulunderhållet har idag de överlägset högsta underhållskostnaderna av järnvägens olika system. Hjulprofilmätaren sågs som en möjlighet att kunna plocka ut de hjul som närmade sig underhållsgränserna för slitage, och därigenom kunna styra underhållet mer kostnadseffektivt.LKAB och Trafikverket enades därför att sätta upp ett gemensamt projekt där en ny typ av mätutrustning utprovades. För att få stöd med datalagring, bearbetning av data mm anlitades LTU och eMaintenanceLAB. Syftet med projektet har varit att undersöka och verifiera att en utrustning för automatisk hjulprofilmätning kan klara av att registrera och larma vid hjulpassager som avviker från de säkerhetsgränser och underhållsgränser som definieras i projektet med hänsyn till vårt klimat och våra förhållanden på Malmbanan. Den bärande idén i detta projekt har varit att man genom en kontinuerlig mätning av hjulprofiler ska kunna ta ut fordon ur trafik innan den avvikande hjulprofilen ger upphov till ett accelererande hjul- och rälslitage och därigenom sänka underhållskostnaden och öka livslängden på både hjul och räl. Projektet har även lett till en högre säkerhet på spåret då man kan mäta hjul som passerat säkerhetsgränsen för hjulparametrar och plockar bort dem, detta var inte var möjligt tidigare. De slutsatser som kan dras från detta projekt är följande:• Utvecklingsprojekt kan med fördel genomföras gemensamt mellan industri, infrastrukturförvaltare och akademi. • För att säkerställa ett bra resultat är det viktigt att genomföra alla steg i ett projekt från koncept till överlämnande. Som stöd för detta har V-modellen används som representerar livscykeln för systemet enligt EN-50126.• Val av tekniklösning och leverantör har gjorts utifrån tekniknivå, referensanläggningar samt drift- och supportmöjlighet och inte enbart utifrån pris. Ett utvecklingsprojekt likt detta handlar inte primärt om att få en utrustning i drift utan överföring av ”know how” kring vilka möjligheter och begränsningar det finns med denna teknik.• Resursbehovet för test och utvärdering underskattades och gjorde att projektet försenades ett år jämfört med ursprunglig tidplan. • Informationen som genereras från denna utrustning är mycket användbar för alla parter som arbetar med utveckling av underhåll inom järnvägen. • Utmaningen för att tillgodogöra sig nyttan från mätstationen ligger i att kunna förädla och integrera de genererade tillståndsdata till respektive underhållsorganisation.
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| 10. |
- Asplund, Matthias, et al.
(author)
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The wheel profile measurement system at Sunderbyn, Sweden : final report
- 2014
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Reports (other academic/artistic)abstract
- The background to the realisation of this project comprises an increasing number of rail replacements and an increasing volume of traffic with a 30-tonne axle load on the Swedish Iron Ore Line (IOL). When comparing the maintenance costs of all the different systems in the Swedish railway network, the maintenance costs for the track and wheels are by far the highest at present. The wheel profile measurement system (WPMS) was considered to provide the possibility of picking out wheels approaching the maintenance limits for wear and thereby of controlling maintenance in a more cost-effective way. Accordingly, LKAB and Trafikverket (the Swedish Transport Administration) reached an agreement concerning the initiation of a joint project in which a new type of measurement equipment would be tested. To obtain assistance with data storage and processing, etc., Luleå University of Technology (LTU) and its eMaintenance Lab were engaged in the project. The objective of the project has been to investigate and verify whether equipment for automatic wheel profile measurement is capable of registering wheel data and sending alerts concerning the passage of wheels which deviate from the safety and maintenance limits defined in the project, with regard to the climate and conditions prevailing along the Swedish IOL. The fundamental idea behind this project has been that, through continuous measurement of wheel profiles, one should be able to take vehicles out of service before any deviating wheel profiles give rise to accelerating wheel and rail wear, and that one should thereby be able to reduce the maintenance costs and increase the operational life of both wheels and rails. An additional result of the project has been increased safety on the track, since it is possible to measure wheels that have exceeded the safety limit for wheel parameters and remove them, which was impossible previously. The following conclusions can be drawn from this project.• There are benefits to be derived from development projects conducted jointly between industry, infrastructure managers and academia. • In order to ensure good results, it is important to perform all the steps in a project, from the concept phase to the handing-over phase. In support of this, the V-model was used, which represents the life cycle of the system according to EN 50126. • The selection of a technical solution and a supplier was made on the basis of the technology level, reference installations, and operation and support possibilities, and not merely based on the price. A development project of this nature is not primarily a question of putting equipment into operation, but of transferring knowhow concerning the possibilities and limitations associated with the technology in question. • The resource requirement for testing and evaluation was underestimated, which resulted in the project being delayed by one year compared with the original timetable. • The information generated by the equipment installed is very useful for all parties working with the development of railway maintenance. • The challenge with regard to utilising the benefits afforded by the measurement station at Sunderby lies in the ability to process the generated condition data for the maintenance organisations concerned and integrate these data in the operations of these organisations.
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