| 1. |
- Andersson, Pia, 1955-, et al.
(author)
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Testing an oral assessment guide during chemotherapy treatmen in a Swedish care setting : a pilot study
- 1999
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In: Journal of Clinical Nursing. - 0962-1067 .- 1365-2702. ; 8:2, s. 150-158
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Journal article (peer-reviewed)abstract
- Oral complications are common in patients with haematological malignancies who undergo chemotherapy treatment. A pilot study including 16 haematological patients was carried out to evaluate the oral status using an Oral Assessment Guide (OAG) and to test the reliability of the OAG. The oral assessments were made daily by registered nurses at a Department of Internal Medicine in Sweden. Once a week a dental hygienist made the oral assessments independent of the registered nurses in order to provide data for calculations of inter-rater reliability. All patients had varying degrees of alterations in the oral cavity, especially in the mucous membranes, teeth/dentures and gums. The inter-rater agreement between the nurses and the dental hygienist was good for saliva and swallow, and moderate for voice and gums. Assessments to detect alterations in the oral cavity afford the opportunity for early and individualized interventions and may decrease the risk of oral infections. It is necessary to train the nurses to ensure high levels of reliability in the oral assessments. The OAG seems to be a reliable and clinical useful tool for assessing the oral cavity status and determining changes.
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| 2. |
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| 3. |
- Claeson, Magdalena, 1976, et al.
(author)
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Modelling the Future: System Dynamics in the Cutaneous Malignant Melanoma Care Pathway
- 2016
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In: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 96:2, s. 181-185
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Journal article (peer-reviewed)abstract
- Incidence rates for cutaneous malignant melanoma are increasing worldwide. Estimates of the future number of melanoma cases are important for strategic planning of the care pathway. The aim of this study was to use system dynamics modelling to evaluate the long-term effects of changes in incidence, population growth and preventive interventions. Historical data on invasive melanoma cases in Western Sweden from 1990 to 2006 were obtained. Using computer simulation software, a model estimating the accumulated number of melanoma cases for 2014 to 2023 was developed. Five future scenarios were designed: stable incidence, business-as-usual, 25% reduced patient's delay, 50% reduced doctor's delay, and a combination of the last 2, called improved overall secondary prevention. After 10 years, improved overall secondary prevention would have resulted in a 42% decrease in melanomas >4 mm and a 10% increase in melanomas ≤1 mm, compared with business-as-usual. System dynamics is a valuable tool, which can help policymakers choose the preventive interventions with the greatest impact.
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| 4. |
- Claeson, Magdalena, 1976, et al.
(author)
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Multiple primary melanomas in Western Sweden; 1990-2013
- 2016
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In: 3rd International Conference on UV and Skin Cancer Prevention, Melbourne.
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Conference paper (other academic/artistic)abstract
- IntroductionIn Sweden, the incidence of cutaneous malignant melanoma rises yearly with 5.5% for men and 5.2% for women and has now reached world standard rates of 17.6 for men and 18.8 for women per 100,000 population. Over the past decades, the incidence of melanoma has been higher in Western Sweden than the national average. Previous international studies have shown that melanoma patients have an elevated risk of developing a new separate primary melanoma. This study aimed at describing multiple primary melanomas (MPMs) in Western Sweden with focus on the number of tumours detected, tumour characteristics and the time to diagnosis of a subsequent melanoma.MethodsData was extracted retrospectively from the Swedish Melanoma Registry and provided information on all invasive and in situ melanoma cases in Western Sweden (1.6 million inhabitants) from 1990 to 2013. Results Within the studied period, 12,152 patients developed 13,291 melanomas. 11,254 of the patients developed only a single primary melanoma. In total, 898 patients (7.4% of all melanoma patients) developed 2,037 MPMs. Preliminary results show that the median Breslow thickness for all invasive melanomas was below 1 mm. The median Breslow thickness for the MPMs was slightly thinner for the second and third invasive melanoma as compared to the first invasive melanoma. Further, there was a higher percentage of in situ tumours among the subsequent melanomas. The median time to diagnosis of a subsequent melanoma was approximately 3 years. DiscussionSubsequent primary melanomas in Western Sweden are most commonly diagnosed with a somewhat thinner Breslow thickness than the first primary melanoma. The comparatively high percentage of melanoma survivors developing MPMs and the short median time to diagnosis of a subsequent melanoma stresses the importance of follow-up for melanoma patients, particularly during the first years.
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| 5. |
- Claeson, Magdalena, 1976, et al.
(author)
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MultiplePrimary Melanomas: A Common Occurrencein Western Sweden.
- 2017
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In: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 97:6, s. 715-719
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Journal article (peer-reviewed)abstract
- Patients diagnosed with a single primary cutaneous melanoma are at increased risk of developing multiple primary melanomas. The aim of this study is to describe the epidemiology of multiple primary melanomas (invasive and in situ) in Western Sweden. Data from the Swedish Melanoma Registry from 1990 to 2013 revealed that 898 patients (7.4%) developed 2,037 multiple primary lesions and 11,254 patients developed single lesions. The proportion of subsequent lesions that were melanoma in situ was 47%, compared with 26% of first melanomas (p<0.0001). The median time to diagnosis of a subsequent melanoma was 38 months (95% confidence interval (CI), 53-62 months). In total, 49% of subsequent melanomas were detected within 3 years. Patients and physicians should be aware of the high proportion of multiple primary melanomas in Western Sweden, especially during the first years of follow-up.
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| 6. |
- Hallberg, Stefan, 1955, et al.
(author)
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Developing a simulation model for the patient pathway of cutaneous malignant melanoma
- 2015
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In: Operations Research for Health Care. - : Elsevier BV. - 2211-6923. ; 6, s. 23-30
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Journal article (peer-reviewed)abstract
- In this study, a system dynamic simulation model for a part of the patient pathway of cutaneous malignant melanoma was developed. A model was built that produced quantified out-put of diagnosed patients staged by severity, using System dynamic simulation. Data from the Swedish Melanoma Registry were combined with current scientific results and used in this analytical tool. Solutions to how these results are adapted into a simulation are described. The simulation model has the ability to generate alternative quantitative output of patient health in a population corresponding to realistic interventions in health care programmes as well as population and incidence development.
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| 7. |
- Holmström, Paul, 1948, et al.
(author)
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A System Dynamics 'Flight Simulator‛ for the Evaluation of Policy Interventions in Patient Pathways for Cutaneous Malignant Melanoma
- 2012
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In: Operations Research Society Conference, OR54.
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Conference paper (other academic/artistic)abstract
- A system dynamics simulation model was developed as part of building improved long-time planning and policy evaluation in the patient pathways for Cutaneous Malignant Melanoma. An “incidence generator” was used to create patient output sets dependent on different patient delays in seeking treatment. A “flight simulator” was built to test the scenarios against incidence rates, follow-up programmes etc, assessing the trajectories of healthcare costs over time. It is shown that costs escalate significantly unless patient delays addressed and follow-up programmes reviewed.
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| 8. |
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| 9. |
- Holmström, Paul, 1948, et al.
(author)
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Holmström, P. and S. Hallberg (2010). Att hantera verklighetens komplexitet med systemtänkande och verksamhetssimulering
- 2010
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Reports (other academic/artistic)abstract
- Att modellera dynamikenDet verkligt intressanta är att, baserat på orsak-verkansdiagram, bygga en systemdynamisk modell. I en sådan mo- dell följer man utvecklingen över tid på t ex en klinik, en mottagning, en vårdcentral eller ett sjukhus. Till skillnad från enkla kalkylark är det möjligt att modellera cirkulära samband, vilket underlättar förståelsen av orsaker till pro- blem i en komplex verksamhet. Man använder en sådan tidsindelning att varierande värden synliggörs, som annars skulle ”drunkna” i genomsnittsberäkningar över längre tidsperioder.På de följande sidorna ger vi ett flertal exempel på både simuleringar och systemtänkande från hälso- och sjukvår- den. I simuleringsmodellerna kan man först bekräfta modellens trovärdighet genom att testa om den återspeglar den nuvarande verkligheten. Man kan sedan gå vidare och prova alternativa strategier, policies, metoder etc. för att skapa en bild av hur dessa interventioner kan tänkas påverka verksamheten i olika hänseenden.Vi skapar ett användar- och beslutsfattarvänligt gränssnitt där det finns reglage för variabler, tabeller för basdata och grafer på nyckeltal. På så sätt kan beslutsfattare testa och optimera policies utan att förlora sig i modellens bak- omliggande detaljer.Vi strävar också efter att arbeta med en snabb och interaktiv utvecklingsmetod, som innebär att vi får en ömsesidig lärprocess där kunden successivt förstår modelleringsmetodiken och dess användbarhet. Vi fördjupar oss i verk- samhetens processer och förstår dess reella behov. Arbetsgången kan ses som en lärcykel (PDSA: Plan-Do-Study- Act) där testandet görs i en simulering i lärande nätverk tillsammans med verksamhetens aktörer.
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| 11. |
- Magnusson, Stefan, et al.
(author)
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Biotinylated platelets have an impaired response to agonists as evidenced by in vitro platelet aggregation tests.
- 1998
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In: Thrombosis research. - 0049-3848. ; 89:2, s. 53-8
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Journal article (peer-reviewed)abstract
- Biotinylation of platelets, using a water soluble biotin analogue which reacts with primary amines, has been proposed to be a reliable technique for study of in vivo survival of platelets and their subpopulations. The information about the influence of this technique on platelet function has been limited. In the present work we studied the effect of in vitro biotinylation on platelet function and activation. Washed human platelets, at a concentration of 1 x 10(9)/L, were biotinylated with five different concentrations of sulfo-NHS-biotin or NHS-LC-biotin, ranging from 0 to 5 mM. The degree of platelet activation during and after biotinylation was monitored by measuring the externalization of P-selectin, and the platelet function was evaluated by aggregometry. It was observed that biotinylated platelets, in a dose dependent manner, displayed an impaired aggregation response. A slight increase in platelet membrane P-selectin occurred during the labelling procedure.
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| 12. |
- Magnusson, Stefan, et al.
(author)
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Soluble saccharides block the inhibition of agonist-induced human platelet aggregation observed after in vitro incubation of human platelet-rich plasma with porcine aortic endothelial cells.
- 1998
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In: Transplant international : official journal of the European Society for Organ Transplantation. - 0934-0874. ; 11:5, s. 345-52
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Journal article (peer-reviewed)abstract
- Platelet aggregation is a prominent feature in the hyperacute process of vascularized allografts and xenografts. In a study of extracorporeal connection of pig kidneys to the blood circulation of human volunteers, we observed in one case considerable destruction of human platelets in the pig kidney without signs of hyperacute rejection or microthrombi formation. In the present study, we have investigated the agonist-induced aggregation of human platelets in mixtures with porcine aortic endothelial cells (PAEC). In vitro incubation of human platelet-rich plasma (PRP) with PAEC inhibited platelet aggregation induced by ADP, collagen and arachidonic acid in a time-dependent manner and partially inhibited adrenalin-induced aggregation. Aggregation of the human platelets could not be induced by high concentrations of ADP (20 microM) to overcome the inhibition capacity of the PAEC. The PAEC inhibiting effect could be transferred by the supernatants of PAEC/PRP and PAEC/PPP incubation mixtures. Preincubation of the PAEC with aspirin, but not with NG-methyl-L-Arg, reduced the aggregation inhibitory effect. Control experiments mixing human umbilical vein endothelial cells (HUVEC) and human PRP or mixing porcine PRP and PAEC did not elicit any inhibition of ADP-induced platelet aggregation. The aggregation inhibition effect could partially be blocked by preincubation of PRP with soluble Gal alpha 1-3Gal, Gal alpha 1-3 beta 1-4GlcNAc, lactose, galactose, and glucose, but not by lactosamine, galactosamine, or glucosamine. The Gal alpha 1-3Gal disaccharide was most effective in blocking aggregation inhibition, and to a similar extent as its ability to block the human anti-pig lymphocytotoxicity reaction. In conclusion, the data indicate that PAEC, upon stimulation by human anti-pig xenoantibodies in a nondynamic system, inhibits agonist-induced human platelet aggregation, and that this effect is probably at least partially caused by prostacyclin released from the PAEC.
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