| 1. |
- Dennersten, Ulrika, et al.
(author)
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Lung function in the aging Swedish cystic fibrosis population.
- 2009
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In: Respiratory medicine. - : Elsevier BV. - 1532-3064 .- 0954-6111. ; 103:7, s. 1076-82
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Journal article (peer-reviewed)abstract
- Swedish Cystic Fibrosis (CF) care follows international guidelines in general. The only difference in our CF care package since 25 years is the physiotherapy regimen. Airway clearance therapy has since the early 1980s, from the day of diagnosis, been based upon daily physical exercise in conjunction with techniques for transporting and evacuating mucus. Postural Drainage+/-percussion and vibration has not been used in any age. The aim of this study was to evaluate our CF care package. Lung function data from the start of the study and with a 3-year interval were collected in the entire Swedish CF population > or =7 years old. Data were analysed for the age groups 7-17 and > or =18 years of age. Change of lung function over the study period was calculated. The impact of chronic Pseudomonas aeruginosa (Pa) colonisation and basal FEV(1)%p was also evaluated in a linear mixed model. Data from 99% of the country-wide CF population were available at inclusion. Mean FEV(1)%p was 90+/-21 vs 73+/-26 in the different age groups and mean VC%p was 94+/-18 vs 91+/-20. Forty percent of the adult group was > or =30 years old. Overall, 41% were chronically Pa colonised. Mean annual FEV(1)%p rate of decline was 0.77 and 0.64 in the different age groups. Lung function among Swedish CF patients is good and annual rate of decline low, even in an old cohort. The large proportion of adult patients emphasises future demands on CF care.
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| 2. |
- Frühling, Petter, et al.
(author)
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The prognostic value of C-reactive protein and albumin in patients undergoing resection of colorectal liver metastases. A retrospective cohort study
- 2021
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In: HPB. - : Elsevier. - 1365-182X .- 1477-2574. ; 23:6, s. 970-978
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Journal article (peer-reviewed)abstract
- BACKGROUND: The systemic inflammation-based Glasgow Prognostic Score (GPS) and modified GPS (mGPS), as measured by preoperative C-reactive protein (CRP) and albumin, correlate with poor survival in several cancers. This study evaluates the prognostic value of these scores in patients with colorectal liver metastases (CRLM).METHODS: This retrospective study assessed the prognostic role of preoperatively measured GPS and mGPS in patients undergoing liver resection because of CRLM. Clinicopathological data were retrieved from local databases. The prognostic value of GPS and mGPS were compared and a Cox regression model was used to find independent predictors of overall survival.RESULTS: In total, 849 consecutive patients between January 2005 and December 2015 were included. Patients with GPS 0 had a median survival of 70 months compared to 49 months in patients with GPS 1, and 27 months in patients with GPS 2. Multivariable analyses showed that GPS 1 (HR = 1.51, 95%CI [1.14-2.01]) and GPS 2 (HR = 2.78, 95%CI [1.79-4.31]), after correction for age >70 years (HR = 1.75 [1.36-2.26]), and extended resection (HR = 2.53, 95%CI[1.79-3.58]), were associated with poor overall survival.CONCLUSION: A preoperative GPS is an independent prognostic factor in patients with CRLM, and appears to be a better prognostic tool than mGPS.
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| 3. |
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| 4. |
- Hellberg, Lena, et al.
(author)
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Ett nationellt sammanhållet system för kunskapsbaserad vård : ett system, många möjligheter
- 2020
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Book (other academic/artistic)abstract
- Utredningens förslag har primärt två syften. Förslagen syftar dels till att öka förutsättningarna för staten att göra de insatser som mest effektivt bidrar till att målen med hälso- och sjukvården nås, dels till att öka förutsättningarna för hälso- och sjukvårdens professioner att arbeta kunskapsbaserat.Hälso- och sjukvården är en komplex verksamhet med många olika aktörer. För att få ihop hälso- och sjukvården till en fungerande helhet behövs strukturer och väl fungerande samarbeten.Utredningens uppdrag handlar i grunden om att utveckla och stärka strukturer, förutsättningar och samarbeten för att nå en god vård. Utredningens samlade förslag, bedömningar och rekommendationer bidrar till bättre förutsättningar för en långsiktig utveckling där staten, regionerna och kommunerna kan arbeta tillsammans mot målen med hälso- och sjukvården och därmed skapa värde för patienten. Detta görs genom att:• underlätta för regeringen att styra mer strategiskt, kunskapsbaserat och långsiktigt hållbart. En förbättrad uppföljning av statliga initiativ och ett mer strukturerat samarbete mellan myndigheterna bidrar till att skapa ett utvecklat underlag för regeringens beslut om nya insatser.• förutsättningar för att arbeta kunskapsbaserat lokalt i regioner och kommuner stärks bl.a. genom att staten fortsätter att utveckla sitt stöd. Mer fokus än i dag läggs på stöd till den kommunala hälso- och sjukvården.• ett nationellt sammanhållet system för kunskapsbaserad vård får långsiktiga förutsättningar att utvecklas genom att en överenskommelse sluts mellan stat, regioner och kommuner. Principer och strukturer för ett långsiktigt samarbete läggs fast där några centrala utgångspunkter är en gemensam målbild samt principer för prioriterings- och arbetsprocesser.
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| 5. |
- Hultcrantz, Monica, et al.
(author)
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From evidence to policy on a national level : supporting the government’s role in a learning healthcare system
- 2020
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In: Cochrane Database of Systematic Reviews. - 1469-493X. ; 9, s. 190-190
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Journal article (peer-reviewed)abstract
- Background: In August 2018, the Swedish government appointed a special investigator to support a national ecosystem for evidence-based healthcare. In November 2019, the inquiry received an additional task now focusing on follow-up to enable a more strategic, evidence-based and long-term sustainable management of health care on a national level. Since healthcare systems around the world face similar challenges, we believe the results of the investigation are highly relevant for a broader audience.Objectives: To analyze how governmental agencies can better support a comprehensive follow-up of health care and thereby create a learning system on a national level. This includes following the effects of the government’s initiatives and reforms and analyzing where future governmental interventions are needed.Methods: The investigator and her team have worked with an expert committee including representatives of governmental agencies, healthcare professions and healthcare providers, as well as a reference group of patient representatives. Additional information has been collected through questionnaires, workshops and meetings with stakeholders and other governmental inquiries working on related topics. Background information was collected from published research, governmental reports, existing regulations etc.Results: Although roughly estimated more than 1000 full-time government employees work with followup in Sweden, the quality, effectiveness and equity in health care is not improving at the anticipated rate. Our findings suggest that a co-ordination of the different initiatives is a prerequisite for creating a learning system on a national level. Key challenges arise in the interface between evidence and policy. At the Colloquium, we will present possible solutions to these challenges using the Swedish healthcare system as an example.Conclusions: Although a lot of efforts are made in conducting and developing methods for evidence generation, implementation and follow-up, it is apparent that the full value for patients is not reached. Facilitators are needed for a learning system on a national level, where the government’s initiatives efficiently contribute to an increased quality, effectiveness and equity in health care. Sharing experiences from national efforts can be one way of increasing the understanding of what these facilitators are. Patient or healthcare consumer involvement: We have received valuable input through regular meetings with a reference group of six representatives from different patient organizations throughout the work. The expert committee linked to the investigation also included a patient representative adding important perspectives to the discussions.
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| 6. |
- Rask, Katarina, 1966, et al.
(author)
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Wnt-signalling pathway in ovarian epithelial tumours: increased expression of beta-catenin and GSK3 beta
- 2003
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In: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 89:7, s. 1298-1304
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Journal article (peer-reviewed)abstract
- Beta-catenin is involved in both cell-cell adhesion and in transcriptional regulation by the Wingless/Wnt signalling pathway. Alterations of components of this pathway have been suggested to play a central role in tumorigenesis. The present study investigated, by immunohistochemistry and immunoblotting, the protein expression and localisation of beta-catenin, adenomatous polyposis coli (APC), glycogen synthase kinase 3beta (GSK3beta) and lymphocyte enhancer factor-1 (Lef-1) in normal human ovaries and in epithelial ovarian tumours in vivo and in vitro. Immortalised human ovarian surface epithelium and ovarian cancer cell cells (OVCAR-3) expressed beta-catenin, APC, GSK3beta and Lef-1. Nuclear staining of beta-catenin and Lef-1 were demonstrated only in OVCAR-3 cells. There were significant increases of beta-catenin and GSK3beta, while APC was reduced in ovarian cancer compared to the normal ovary. Beta-catenin and Lef-1 were coimmunoprecipitated in ovarian tumours, but not in the normal ovary. Nuclear localisation of beta-catenin or Lef-1 could not be demonstrated in the normal ovary or in the ovarian tumours. The absence of nuclear localisation of beta-catenin could be due to an increased binding to the cadherin-alpha-catenin cell adhesion complex. In fact, we have earlier reported an increased expression of E-cadherin in ovarian adenocarcinomas. In summary, this study demonstrates an increase in the expression of components of the Wingless/Wnt pathway in malignant ovarian tumours. The increase suggests a role for this signalling pathway in cell transformation and in tumour progression. However, it remains to be demonstrated whether it is an increased participation of beta-catenin in transcriptional regulation, or in the stabilisation of cellular integrity, or both, that is the crucial event in ovarian tumorigenesis.
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| 8. |
- Valdimarsson, Valentinus T., et al.
(author)
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Repeat procedures for recurrent colorectal liver metastases : Analysis of long-term liver regeneration and outcome
- 2019
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In: Cancer Management and Research. - 1179-1322. ; 11, s. 2617-2622
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Journal article (peer-reviewed)abstract
- Background and aim: Repeat hepatectomy is increasingly performed for the management of recurrent colorectal liver metastases (CRLM). The aim of this study was to evaluate longterm functional liver volume (FLV) after a second hepatic procedure and to measure survival outcome. Methods: In this retrospective cohort study, patients treated for recurrent CRLM in the years 2005-2015 at two liver centers were included. Total FLV was calculated before the first procedure and before and after the second procedure. Overall survival was calculated. Results: Eighty-two patients were identified. The median follow-up was 53 (40-71) months from the first procedure. The median interval between first and second procedure was 13 (8-22) months. The initial FLV was 1584 (1313-1927) mL. The FLV was 1438 (1204-1896) mL after the first procedure and 1470 (1172-1699) mL after the second procedure (P<0.001). After the second procedure, a total of ten patients (12%) had a residual liver volume of less than 75% of the initial liver volume. The 5-year overall survival was 37 (26-54)% after the second procedure. Conclusion: Small changes in FLV were found after two hepatic procedures but with considerable inter-individual variation. Patients selected for a repeated hepatic procedure for recurrent CRLM had an acceptable survival.
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