| 1. |
- Lökk, Johan, et al.
(author)
-
Shifts in B12 opinions in primary health care of Sweden.
- 2001
-
In: Scandinavian Journal of Public Health. - 1403-4948 .- 1651-1905. ; 29:2, s. 122-128
-
Journal article (peer-reviewed)abstract
- AIMS: The diagnosis and management of vitamin B12 deficiency varies between countries and within countries. The aim of the study was to map current attitudes and values behind clinical decision-making in Swedish primary health care, which has a unique B12 tradition: two patients out of three are treated with oral high-dose cyanocobalamin. Most patients with B12-associated problems are managed in primary health care by general practitioners (GPs). METHODS: The study was designed to elucidate possible opinion shifts among GPs during the period 1996-1998. GPs (n=499), stratified and randomized, received a questionnaire with 24 statements on B12-associated clinical and laboratory problems, to be evaluated by a visuo-analogue scale. RESULTS: The majority of GPs in primary health care in Sweden accepted homocysteine and methylmalonic acid (MMA) as markers for functional deficiency of vitamin B12. The evaluation of classical markers of B12 deficiency was wary and balanced. There was a consensus of the need for B12 therapy to risk groups such as patients with atrophic gastritis or previous gastric surgery. The answers also appeared to reflect an improvement of professional knowledge and competence concerning B12-associated problems among Swedish GPs between 1996 and 1998. CONCLUSIONS: The overriding conclusion was that B12-associated opinions of Swedish GPs were stable within the period studied, with marginal improvements of knowledge and competence.
|
|
| 2. |
- Lökk, Johan, et al.
(author)
-
Vitamin B12 in primary health care and geriatrics - attitudes, knowledge, competence.
- 2001
-
In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 16:10, s. 987-992
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: The objective of the study was to test attitudes, knowledge and competence of Swedish general practitioners and geriatricians concerning B12-associated problems in 1998. METHODS: Postal questionnaires were sent to a random sample of 485 GPs and a total sample of 613 geriatricians. The response rates were 70% in the GP group and 69% in the geriatrician group. The questionnaire contained 24 statements to be evaluated by a visuo-analogue scale. RESULTS: There were small numerical differences between the two physician groups. The geriatricians were more aware of risk groups for B12 deficiency. GPs were less categorical concerning low hit rate in the laboratory testing of clinical conclusions. There were statistical differences in both directions for statements on pitfalls in laboratory diagnostics. GPs were somewhat less prone to give risk groups prophylactic B12 therapy. CONCLUSIONS: GPs and geriatricians appeared to be familiar with the current debate on B12-associated problems, suggesting that health care quality will be unaffected by patient transfer from hospital care to primary health care. Copyright 2001 John Wiley & Sons, Ltd.
|
|
| 3. |
- Nilsson, Mats, et al.
(author)
-
Medical intelligence in Sweden. Vitamin B12 : oral compared with parenteral?
- 2005
-
In: Postgraduate medical journal. - : Oxford University Press (OUP). - 0032-5473 .- 1469-0756. ; 81:953, s. 191-193
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Sweden is the only country in which oral high dose vitamin B12 has gained widespread use in the treatment of deficiency states. OBJECTIVE: The aim of the study was to describe prescribing patterns and sales statistics of vitamin B12 tablets and injections in Sweden 1990-2000.Design, setting, and sources: Official statistics of cobalamin prescriptions and sales were used. RESULTS: The use of vitamin B12 increased in Sweden 1990-2000, mainly because of an increase in the use of oral high dose vitamin B12 therapy. The experience, in statistical terms a "total investigation", comprised 1,000,000 patient years for tablets and 750,000 patient years for injections. During 2000, 13% of residents aged 70 and over were treated with vitamin B12, two of three with the tablet preparation. Most patients in Sweden requiring vitamin B12 therapy have transferred from parenteral to oral high dose vitamin B12 since 1964, when the oral preparation was introduced. CONCLUSION: The findings suggest that many patients in other post-industrial societies may also be suitable for oral vitamin B12 treatment.
|
|
| 4. |
- Nilsson, Mats, et al.
(author)
-
Sex differences in cobalamin (vitamin B12) opinions of Swedish physicians.
- 2002
-
In: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 56:4, s. 299-303
-
Journal article (peer-reviewed)abstract
- The aim of the study was to elucidate possible sex differences in knowledge, competence and attitudes behind decision-making on cobalamin-associated problems (vitamin B(12)). The study was conducted by postal questionnaires to Swedish physicians in 1996-98. The participants were recruited by random sampling of general practitioners (1996, 1998), and a total sampling of geriatricians (1998). The overall response rate was 71%. The study group comprised 480 female physicians and 526 male physicians. The responses to 24 statements in the questionnaire were measured by means of visual analogue scales. Group differences were evaluated by medians and shapes of distributions. The female doctors appeared to value patient-related symptoms and signs more than male doctors. Conversely, male doctors relied on laboratory tests more than female doctors. As reflected by questionnaire answers, female doctors appeared to be more informed than male doctors on cobalamin-associated clinical problems. Group differences between the sexes were marginal from a numerical point of view. It is suggested that the statistical differences observed should be regarded as negligible until confirmed by further studies.
|
|
| 5. |
- Skogar, Örjan, et al.
(author)
-
National surveys : a way to manage treatment strategies in Parkinson's disease? Pharmaceutical prescribing patterns and patient experiences of symptom control and their impact on disease
- 2013
-
In: Journal of Multidisciplinary Healthcare. - Stockholm : Karolinska Institutet, Dept of Neurobiology, Care Sciences and Society. - 1178-2390.
-
Journal article (peer-reviewed)abstract
- BACKGROUND: The purpose of this study was to draw conclusions from patient-reported experiences in two national surveys from Scandinavia with the intention of comparing treatment strategies and increasing our knowledge of factors that affect the experiences of patients with Parkinson's disease (PD). METHODS: A total of 2000 individuals in Sweden and 1300 in Norway were invited to complete postal surveys covering PD-related issues. Patient experiences of diagnostic procedures, symptom control, and follow-up in PD and the effects on symptom-related quality of life were collected. Pharmaceutical prescription data on anti-PD drugs and administrative data were collected from national registries. RESULTS: The surveys were completed by 1553 (78%) of the Swedish cohort and 1244 (96%) of the Norwegian cohort. Only small differences were seen in disease duration and age distribution. Statistically as well as clinically significant differences in symptom control, diagnostic, and follow-up procedures, as well as in pharmacological treatment and impact on quality of life, were found between the national cohorts independent of disease duration. CONCLUSION: Information from separate national surveys has the potential to increase our knowledge of patient experiences in PD and can be used to compare, evaluate, educate, and guide health care staff and administrators in optimizing health care for patients with the disease.
|
|
| 6. |
- Skogar, Örjan, et al.
(author)
-
Parkinson’s disease patients’ subjective descriptions of characteristics of chronic pain, sleeping patterns and health-related quality of life
- 2012
-
In: Neuropsychiatric Disease and Treatment. - 1176-6328 .- 1178-2021. ; 8, s. 435-442
-
Journal article (peer-reviewed)abstract
- Objective: Nonmotor symptoms are common in Parkinson’s disease (PD). Health-related quality of life (HRQoL) is negatively affected by different factors, of which pain and sleep disturbances are important contributors. This study was performed to evaluate and describe subjective experiences of pain, sleeping patterns, and HRQoL in a cohort of PD patients with chronic pain.Methods: A total of 45 participants with established PD for more than 2 years, and PD-related pain for the preceding three months, were recruited from three sites in Sweden. Data regarding time point for onset, duration and degree of pain parameters, body localization of pain, external influences, and treatments were obtained. HRQoL was evaluated with the Short Form-36® Health Survey, and sleeping patterns were registered with the Parkinson’s disease Sleep Scale, both completed along with a questionnaire.Results: In one-third of participants, pain preceded the PD diagnosis. Median pain score measured with a visual analog scale was 6.6 and 5.9 (for females and males, respectively) the week before the study. In almost half of the participants, pain was present during all their waking hours. Significantly more females described their pain as troublesome, while more males described their pain as irritating. Feelings of numbness and creeping sensations at night were strongly associated with the maximal visual analog scale scores. Polypharmacy was common; 89% used medication for anxiety/insomnia, and 18% used antidepressants. Only one-third of patients who reported pain relief with analgesics had these prescribed on their drug lists. Sleep was characterized by frequent awakenings. Urinary urgency and restless legs were frequently reported as troublesome. Patients rated HRQoL as significantly worse in all items compared with a healthy reference population matched for age and sex.Conclusions: Experiences of chronic PD-related pain are complex; there is substantial sleep fragmentation and negative impact on HRQoL.
|
|
| 7. |
- Törnhage, Carl-Johan, et al.
(author)
-
Short- and long-term effects of tactile massage on salivary cortisol concentrations in Parkinsons disease : a randomised controlled pilot study
- 2013
-
In: BMC Complementary and Alternative Medicine. - : BioMed Central (BMC). - 1472-6882. ; 13:357
-
Journal article (peer-reviewed)abstract
- BACKGROUND:Parkinson's disease (PD) is a chronic neurodegenerative disorder with limited knowledge about the normal function and effects of non-pharmacological therapies on the hypothalamic-pituitary-adrenal (HPA) axis. The aim of the study was to analyse the basal diurnal and total secretion of salivary cortisol in short- and long-term aspects of tactile massage (TM).METHODS:Design: Prospective, Controlled and Randomised Multicentre Trial.Setting and interventions: Forty-five women and men, aged 50-79 years, were recruited. Twenty-nine of them were blindly randomised to tactile massage (TM) and 16 of them to the control group, rest to music (RTM). Ten interventions were given during 8 weeks followed by a 26 weeks of follow up. Salivary cortisol was collected at 8 am, 1 pm, 8 pm, and 8 am the next day, on five occasions. With the first and eighth interventions, it was collected immediately before and after intervention.Main outcome measures: The primary aim was to assess and compare cortisol concentrations before and immediately after intervention and also during the follow-up period. The secondary aim was to assess the impact of age, gender, body mass index (BMI), duration and severity of PD, effects of interventional time-point of the day, and levodopa doses on cortisol concentration.RESULTS:The median cortisol concentrations for all participants were 16.0, 5.8, 2.8, and 14.0 nmol/L at baseline, later reproduced four times without significant differences. Cortisol concentrations decreased significantly after TM intervention but no change in diurnal salivary cortisol pattern was found. The findings of reduced salivary cortisol concentrations immediately after the interventions are in agreement with previous studies. However, there was no significant difference between the TM and control groups. There were no significant correlations between cortisol concentrations and age, gender, BMI, time-point for intervention, time interval between anti-parkinson pharmacy intake and sampling, levodopa doses, duration, or severity of PD.CONCLUSIONS:Diurnal salivary cortisol rhythm was normal. Salivary cortisol concentrations were significantly reduced after the TM intervention and after RTM, but there were no significant differences between the groups and no sustained long-term effect. No associations were seen between salivary cortisol concentration and clinical and/or pharmacological characteristics.
|
|
| 8. |
- Arnetz, Bengt B, et al.
(author)
-
Spiritual values and practices in the workplace and employee stress and mental well-being
- 2013
-
In: Journal of Management, Spirituality and Religion. - : International Association of Management Spirituality & Religion. - 1476-6086 .- 1942-258X. ; 10:3, s. 271-281
-
Journal article (peer-reviewed)abstract
- Objective:To determine whether employees’ spiritual values and practicesin the workplace attenuate occupational stress and work-related exhaustion,and promote mental well-being.Methods:Participants (N = 649) completedvalidated measures of mental well-being, occupational stress, and workrelatedexhaustion, as well as two newly developed measures of individualspiritual values and practices in the workplace.Results:Factor analysis confirmedthat spirituality items belonged to two separate constructs. In logisticregression models, the Spiritual Values in the Workplace scale was positivelyassociated with mental well-being and low occupational stress. Thespiritual practices at work scale was positively associated with low workrelatedexhaustion.Conclusions: Employee spiritual values and practices, aswell as workplace acceptance of such practices, appear to promote mentalwell-being and attenuate stress.
|
|
| 9. |
- Cho, Karl, et al.
(author)
-
Calcium intake in elderly patients with hip fractures
- 2008
-
In: Food & nutrition research. - : SNF Swedish Nutrition Foundation. - 1654-6628 .- 1654-661X. ; 52, s. 1654-
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Dietary calcium intake is assumed important in the prevention and treatment of osteoporosis. However, people in countries with a high calcium intake from commodities such as milk and milk products have a high incidence of hip fracture. The effect and influence of calcium intake in the prevention of osteoporotic fracture vary from different studies. OBJECTIVE: To investigate premorbid daily calcium intake in patients with low energy hip fractures during four consecutive years. DESIGN: In total 120 patients (mean age 78+/-8.5 (SD) years) were included between 2002 and 2005. The patients answered a structured food frequency questionnaire (FFQ) and interviews on patients' daily calcium intake from food and supplements took place during a 6-month period before the fracture. Dual energy X-ray absorptiometry (DEXA) was performed in a subgroup of 15 patients. RESULTS: The mean daily calcium intake from food and supplementation was 970+/-500 mg. However, 38% of patients had an intake below the recommended 800 mg/day. There was no significant relationship between calcium intake and age, gender, bone mineral density, serum calcium or albumin, type of fracture or body mass index. The mean free plasma calcium concentration was 2.3+/-0.1, i.e. within the reference limit. In 2005, 80% of the patients who underwent DEXA had manifest osteoporosis. There was a trend towards decreased calcium intake over the observation period, with a mean calcium intake below 800 mg/day in 2005. CONCLUSIONS: Hip fracture patients had a mean calcium intake above the recommended daily intake, as assessed by a FFQ. However, more than one-third of patients had an intake below the recommended 800 mg/day. The intake appeared to decrease over the investigated years. The relationship between calcium intake and fracture susceptibility is complex.
|
|
| 10. |
- Egenvall, Monika, et al.
(author)
-
Management of colon cancer in the elderly : a population-based study
- 2014
-
In: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 16:6, s. 433-441
-
Journal article (peer-reviewed)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.
|
|
| 11. |
- Flodin, Lena, et al.
(author)
-
Increased 1-year survival and discharge to independent living in overweight hip fracture patients
- 2016
-
In: Acta Orthopaedica. - : Informa UK Limited. - 1745-3674 .- 1745-3682. ; 87:2, s. 146-151
-
Journal article (peer-reviewed)abstract
- Background and purpose - Hip fracture patients usually have low body mass index (BMI), and suffer further postoperative catabolism. How BMI relates to outcome in relatively healthy hip fracture patients is not well investigated. We investigated the association between BMI, survival, and independent living 1 year postoperatively.Patients and methods - This prospective multicenter study involved 843 patients with a hip fracture (mean age 82 (SD 7) years, 73% women), without severe cognitive impairment and living independently before admission. We investigated the relationship between BMI and both 1-year mortality and ability to return to independent living.Results - Patients with BMI > 26 had a lower mortality rate than those with BMI < 22 and those with BMI 22-26 (6%, 16%, and 18% respectively; p = 0.006). The odds ratio (OR) for 1-year survival in the group with BMI > 26 was 2.6 (95% CI: 1.2-5.5) after adjustment for age, sex, and physical status. Patients with BMI > 26 were also more likely to return to independent living after the hip fracture (OR = 2.6, 95% CI: 1.4-5.0). Patients with BMI < 22 had similar mortality and a similar likelihood of independent living to those with BMI 22-26.Interpretation - In this selected group of patients with hip fracture, the overweight and obese patients (BMI > 26) had a higher survival rate at 1 year, and returned to independent living to a higher degree than those of normal (healthy) weight. The obesity paradox and the recommendations for optimal BMI need further consideration in patients with hip fracture.
|
|
| 12. |
|
|
| 13. |
- Kivipelto, M, et al.
(author)
-
Homocysteine and holo-transcobalamin and the risk of dementia and Alzheimers disease : a prospective study.
- 2009
-
In: European journal of neurology : the official journal of the European Federation of Neurological Societies. - : Wiley. - 1468-1331 .- 1351-5101. ; 16:7, s. 808-813
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Elevated total homocysteine (tHcy) levels may be caused by vitamin B12 deficiency and are linked to Alzheimers disease (AD) in some studies, although the evidence is mixed. Another marker of vitamin B12 deficiency, holo-transcobalamin (holo-TC), has not been studied in a prospective setting. OBJECTIVE: To investigate the association between tHcy and holo-TC and the subsequent development of dementia and AD in a prospective study. METHODS: A sub-sample of 228 non-demented subjects was taken from the Kungsholmen Project, a population-based longitudinal study amongst persons 75+ years. tHcy and holo-TC were analysed at baseline. RESULTS: Increasing tHcy levels were related to an increased risk of dementia (n = 83) and AD (n = 61) after a mean follow-up time of 6.7 years. Persons with high tHcy (the fourth quartile) had more than twice as high a risk of developing AD than persons with low tHcy, even after adjusting for confounding or mediating factors. The third quartile of holo-TC was associated with a reduced risk of AD, after adjusting for Hcy and other confounders. CONCLUSIONS: These results suggest that Hcy is involved in the development of dementia and AD. The role of holo-TC was less clear and this marker needs to be studied further.
|
|
| 14. |
- Lökk, Johan, et al.
(author)
-
Controversies around vitamin B12 in Sweden. : Attitudes and values behind clinical decision-making in primary health care 1996
- 1997
-
In: Hematology. - 1024-5332 .- 1607-8454. ; 2:4, s. 341-350
-
Journal article (peer-reviewed)abstract
- Over a five-year period, 1991-1995, the vitamin B12 market in Sweden increased three-fold, from approximatelyy 2 million U.S. dollars to approximately 6 million U.S. dollars. Most prescriptions, approximately 60%, originated from primary health care. The attitudes, values and knowledge of the family physicians/general practitioners were elucidated by a questionnaire study with visuo-analogue opinion scales, evaluating 24 basic statements on problems associated with the management of vitamin B12 deficiency. The questionnaire was sent to a representative sample of 506 family physicians/general practitioners. Response rate was 74%. Dropout analysis supported the view that responders provided a representative sample of Swedish FP/GPs. Analysis of the answers was compatible with the hypothesis that the mentioned increase in Swedish B12 market reflected increased awareness in primary health care about the biochemical, pathophysiological and social problems associated with vitamin B12 deficiency.
|
|
| 15. |
- Lökk, Johan, et al.
(author)
-
Willingness to pay for a new drug delivery in Parkinson patients.
- 2014
-
In: Journal of Multidisciplinary Healthcare. - 1178-2390. ; 7, s. 431-440
-
Journal article (peer-reviewed)abstract
- The Swedish reimbursement system operates a system where prices are set based on the expected value to the consumer. This value can be measured using willingness to pay (WTP).
|
|
| 16. |
- Nilsson, Mats, 1954-
(author)
-
Cobalamin communication in Sweden 1990 – 2000 : views, knowledge and practice among Swedish physicians
- 2005
-
Doctoral thesis (other academic/artistic)abstract
- Cobalamin (vitamin B12) is one of several essential micronutrients needed by the human organism. Other important micronutritients, which interplay with vitamin B12, are folate and iron. During the last ten years, the attention has been drawn to different forms of neurological disorders supposed to be caused by vitamin B12 deficiency. Vitamin B12 deficiency states are common among elderly patients in primary health care and sometimes in hospital care, especially in geriatric practice. This is a study to define the cobalamin treatment traditions, among Swedish physicians in the period 1990 – 2000. The period was distinguished by an intense debate on the issue by the physicians, an increase of cobalamin consumption, and a shift from parenteral therapy towards oral high-dose therapy. It had been known that symptoms of cobalamin deficiency could start in the nervous system. This knowledge was reinforced by the application of homocysteine and methyl-malonic acid (MMA) in deficiency diagnosis. Introduction of homocysteine and MMA in deficiency diagnosis changed the view on deficiency prevalence, by identifying persons at risk to develop B12 deficiency prior to established symptoms. In this study, Swedish physicians are regarded mainly as receivers of communication about the markers homocysteine and MMA, and deficiency states of cobalamin and folate. The main senders were scientists from North America, Norway, Denmark, and Sweden. This study sets the senders and the receivers of cobalamin communication on a collegial level and quantifies and evaluates the feed-back from the receivers. The receivers, gen¬eral practitioners and geriatricians, appeared to be familiar with old knowledge and frontier concepts in the field. Thus, it is suggested that the increase of B12 prescriptions in Sweden 1990 – 2000 reflected an increased awareness of B12-associated clinical problems among the physicians managing the majority of deficiency patients, although a possible overconsumption of pharmaceutical drugs must be kept in mind.
|
|
| 17. |
- Quell, Robin, et al.
(author)
-
Using tactile stimulation in a dementia care facility with plasma prolactine as an outcome measure : a pilot study
- 2008
-
In: Archives: the international journal of medicine. - 1791-4000. ; I:3, s. 123-129
-
Journal article (peer-reviewed)abstract
- BackgroundThere is poor scientific documentation supporting tactile stimulations’ benefit as a nursing intervention. It has been theorized that older adults with dementia experience high anxiety and stress levels. High prolactin levels are associated with psychosomatic reactions and have been used to measure stress levels in adults.AimTo evaluate tactile stimulation’s effectiveness on anxiety and stress in older adults, with dementia diagnosis or signs of dementia and living in a dementia care facility, as manifested by plasma prolactin levels.Materials and MethodsTactile stimulation was given weekly by trained staff members to half the residents of a Swedish dementia care facility.The subjects were randomly selected (n=20) and were tracked in the study for a minimum of 28 weeks. The remaining half elders made up the control team (n=20). Diagnostic groups were formed according the severity of dementia. Plasma prolactin levels were drawn at baseline and post intervention. Medications caused the exclusion of 12 residents and seven dropped out due to other causes. ResultsThere was no difference in plasma prolactin levels between the intervention (n=11) and control (n=12) group. A significant main effect between the diagnostic groups was found as well as a trend towards a positive correlation between age and plasma prolactin levels. There was no gender difference in plasma prolactin levels.ConclusionsOur hypothesis that reduced plasma prolactin levels could be detected in elders treated with tactile stimulation, indicating alleviated stress, was not supported by the preliminary results of the present study. Further evaluation of tactile stimulation with larger study groups and a better understanding of prolactin’s sensitivity, complexity and interaction with medications could contribute to the outcome and problems of the study. The use of neuropsychological assessment could enrich the research data and help the evaluation.
|
|
| 18. |
- Samuelsson, Katja Schubert, et al.
(author)
-
Preoperative geriatric assessment and follow-up of patients older than 75 years undergoing elective surgery for suspected colorectal cancer
- 2019
-
In: Journal of Geriatric Oncology. - : Elsevier. - 1879-4068 .- 1879-4076. ; 10:5, s. 709-715
-
Journal article (peer-reviewed)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.
|
|
| 19. |
- Samuelsson, Katja Schubert, et al.
(author)
-
The older patient's experience of the healthcare chain and information when undergoing colorectal cancer surgery according to the ERAS concept
- 2018
-
In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:7-8, s. e1580-e1588
-
Journal article (peer-reviewed)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.
|
|
| 20. |
|
|
