| 1. |
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| 2. |
- Oussi, Ninos, et al.
(author)
-
Trainee Performance After Laparoscopic Simulator Training Using a Blackbox versus LapMentor
- 2020
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In: Journal of Surgical Research. - : Elsevier BV. - 0022-4804 .- 1095-8673. ; 250, s. 1-11
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Journal article (peer-reviewed)abstract
- BACKGROUND: Training using laparoscopic high-fidelity simulators (LHFSs) to proficiency levels improves laparoscopic cholecystectomy skills. However, high-cost simulators and their limited availability could negatively impact residents' laparoscopic training opportunities. We aimed to assess whether motivation and surgical skill performance differ after basic skills training (BST) using a low-cost (Blackbox) versus LHFS (LapMentor) among medical students.MATERIALS AND METHODS: Sixty-three medical students from Karolinska Institutet volunteered, completing written informed consent, questionnaire regarding expectations of the simulation training, and a visuospatial ability test. They were randomized into two groups that received BST using Blackbox (n = 32) or LapMentor (n = 31). However, seven students absence resulted in 56 participants, followed by another 9 dropouts. Subsequently, after training, 47 students took up three consecutive tests using the minimally invasive surgical trainer-virtual reality (MIST-VR) simulator, finalizing a questionnaire.RESULTS: More Blackbox group participants completed all MIST-VR tests (29/31 versus 18/25). Students anticipated mastering LapMentor would be more difficult than Blackbox (P = 0.04). In those completing the simulation training, a trend toward an increase was noted in how well participants in the Blackbox group liked the simulator training (P = 0.07). Subgroup analysis of motivation and difficulty in liking the training regardless of simulator was found only in women (Blackbox [P = 0.02]; LapMentor [P = 0.06]). In the Blackbox group, the perceived difficulty of training, facilitation, and liking the Blackbox training (significant only in women) were significantly correlated with the students' performance in the MIST-simulator. No such correlations were found in the LapMentor group.CONCLUSIONS: Results indicate an important role for low-tech/low-cost Blackbox laparoscopic BST of students in an otherwise high-tech surrounding. Furthermore, experience of Blackbox BST procedures correlate with students' performance in the MIST-VR simulator, with some gender-specific differences.
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| 3. |
- Oussi, Ninos, et al.
(author)
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Video analysis in basic skills training : a way to expand the value and use of BlackBox training?
- 2018
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In: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 32:1, s. 87-95
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Journal article (peer-reviewed)abstract
- BackgroundBasic skills training in laparoscopic high-fidelity simulators (LHFS) improves laparoscopic skills. However, since LHFS are expensive, their availability is limited. The aim of this study was to assess whether automated video analysis of low-cost BlackBox laparoscopic training could provide an alternative to LHFS in basic skills training.MethodsMedical students volunteered to participate during their surgical semester at the Karolinska University Hospital. After written informed consent, they performed two laparoscopic tasks (PEG-transfer and precision-cutting) on a BlackBox trainer. All tasks were videotaped and sent to MPLSC for automated video analysis, generating two parameters (Pl and Prtcl_tot) that assess the total motion activity. The students then carried out final tests on the MIST-VR simulator. This study was a European collaboration among two simulation centers, located in Sweden and Greece, within the framework of ACS-AEI.Results31 students (19 females and 12 males), mean age of 26.2 ± 0.8 years, participated in the study. However, since two of the students completed only one of the three MIST-VR tasks, they were excluded. The three MIST-VR scores showed significant positive correlations to both the Pl variable in the automated video analysis of the PEG-transfer (RSquare 0.48, P < 0.0001; 0.34, P = 0.0009; 0.45, P < 0.0001, respectively) as well as to the Prtcl_tot variable in that same exercise (RSquare 0.42, P = 0.0002; 0.29, P = 0.0024; 0.45, P < 0.0001). However, the correlations were exclusively shown in the group with less PC gaming experience as well as in the female group.ConclusionsAutomated video analysis provides accurate results in line with those of the validated MIST-VR. We believe that a more frequent use of automated video analysis could provide an extended value to cost-efficient laparoscopic BlackBox training. However, since there are gender-specific as well as PC gaming experience differences, this should be taken in account regarding the value of automated video analysis.
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| 4. |
- Schlickum, Marcus, et al.
(author)
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Surgical Simulation Tasks Challenge Visual Working Memory and Visual-Spatial Ability Differently
- 2011
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 35:4, s. 710-715
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Journal article (peer-reviewed)abstract
- Background New strategies for selection and training of physicians are emerging. Previous studies have demonstrated a correlation between visual-spatial ability and visual working memory with surgical simulator performance. The aim of this study was to perform a detailed analysis on how these abilities are associated with metrics in simulator performance with different task content. The hypothesis is that the importance of visual-spatial ability and visual working memory varies with different task contents.Methods Twenty-five medical students participated in the study that involved testing visual-spatial ability using the MRT-A test and visual working memory using the RoboMemo computer program. Subjects were also trained and tested for performance in three different surgical simulators. The scores from the psychometric tests and the performance metrics were then correlated using multivariate analysis.Results MRT-A score correlated significantly with the performance metrics Efficiency of screening (p = 0.006) and Total time (p = 0.01) in the GI Mentor II task and Total score (p = 0.02) in the MIST-VR simulator task. In the Uro Mentor task, both the MRT-A score and the visual working memory 3-D cube test score as presented in the RoboMemo program (p = 0.02) correlated with Total score (p = 0.004).Conclusions In this study we have shown that some differences exist regarding the impact of visual abilities and task content on simulator performance. When designing future cognitive training programs and testing regimes, one might have to consider that the design must be adjusted in accordance with the specific surgical task to be trained in mind.
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| 5. |
- Bergmark, Karin, et al.
(author)
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Patient-rating of distressful symptoms after treatment for early cervical cancer.
- 2002
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In: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 81:5, s. 443-450
-
Journal article (peer-reviewed)abstract
- BACKGROUND: More refined information on sources of symptom-induced distress in a patient population can improve the quality of pretreatment information, make follow-up visits more efficient and guide research priorities in the efforts to modify treatments.METHODS: In a population-based epidemiological study covering all of Sweden, data were collected 1996-97 by means of an anonymous postal questionnaire. We attempted to enroll all 332 patients with stage IB-IIA cervical cancer registered in 1991-92 at the seven departments of gynecological oncology in Sweden.RESULTS: A total of 256 cases (77%) completed the questionnaire. After surgery, alone or in combination with intracavitary radiotherapy, several symptoms related to sexual dysfunction are the primary sources of symptom-induced distress (reduced orgasm frequency: much distress 23% (surgery alone) and 23% (intracavitary radiotherapy and surgery), respectively, overall intercourse dysfunction: much distress 17% and 20%, respectively, followed by lymphedema (much distress 14% and 14%, respectively). Dyspareunia (much distress 24%) and defecation urgency (much distress 22%) are two leading causes of distress after surgery and external radiotherapy. After treatment with radiotherapy alone, loose stool and dyspareunia were the two most distressful symptoms (much distress 19% each). When a symptom occurs, fecal leakage and reduced orgasm frequency are the two most distressful ones (measured as much distress, 38% each).CONCLUSIONS: The observed symptoms are distressful and should, if one focuses on patient satisfaction, be given priority.
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| 6. |
- Bergmark, Karin, et al.
(author)
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Vaginal changes and sexuality in women with a history of cervical cancer.
- 1999
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In: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 340:18, s. 1383-1389
-
Journal article (peer-reviewed)abstract
- BACKGROUND: In women with cervical cancer, treatment causes changes in vaginal anatomy and function. The effect of these changes on sexual function and the extent, if any, to which they distress women are not known.METHODS: In 1996 and 1997, we attempted to contact 332 women with a history of early-stage cervical cancer (age range, 26 to 80 years) who had been treated in 1991 and 1992 at the seven departments of gynecological oncology in Sweden and 489 women without a history of cancer (controls) to ask them to answer an anonymous questionnaire about vaginal changes and sexual function.RESULTS: We received completed questionnaires from 256 of the women with a history of cervical cancer and 350 of the controls. A total of 167 of 247 women with a history of cancer (68 percent) and 236 of 330 controls (72 percent) reported that they had regular vaginal intercourse. Twenty-six percent of the women who had cancer and 11 percent of the controls reported insufficient vaginal lubrication for sexual intercourse, 26 percent of the women who had cancer and 3 percent of the controls reported a short vagina, and 23 percent of the women who had cancer and 4 percent of the controls reported an insufficiently elastic vagina. Twenty-six percent of the women who had cancer reported moderate or much distress due to vaginal changes, as compared with 8 percent of the women in the control group. Dyspareunia was also more common among the women who had cervical cancer. The frequency of orgasms and orgasmic pleasure was similar in the two groups. Among the women who had cervical cancer, the type of treatment received had little if any effect on the prevalence of specific vaginal changes.CONCLUSIONS: Women who have been treated for cervical cancer have persistent vaginal changes that compromise sexual activity and result in considerable distress.
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| 7. |
- Cui, Yanhua, et al.
(author)
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Prior exposure to alkylating agents negatively impacts testicular organoid formation in cells obtained from childhood cancer patients
- 2024
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In: HUMAN REPRODUCTION OPEN. - : OXFORD UNIV PRESS. - 2399-3529. ; 2024:3
-
Journal article (peer-reviewed)abstract
- STUDY QUESTION Can human pre- and peri-pubertal testicular cells obtained from childhood cancer patients, previously treated with chemotherapy, form testicular organoids (TOs)?SUMMARY ANSWER Organoid formation from testicular tissue collected from childhood cancer patients positively correlates with SRY-Box transcription factor 9 (SOX9) expression in Sertoli cells, which in turn negatively correlates with previous exposure to alkylating chemotherapy.WHAT IS KNOWN ALREADY Pre- and peri-pubertal boys exposed to highly gonadotoxic therapies can only safeguard their fertility potential through testicular tissue cryopreservation. Today, there is no established clinical tool to restore fertility using these testicular samples. Organoids hold promise in providing fundamental early insights in creating such platforms. However, the generation of TOs that closely resemble the innate testis, to enable a thorough monitoring of the necessary steps for germ cell differentiation and somatic functionalities, remains a challenge.STUDY DESIGN, SIZE, DURATION We used a Matrigel-based three-layer gradient culture system to generate human TOs and to reveal whether chemotherapy exposure affects TO formation capacity and the functionality of pre- and peri-pubertal testicular somatic cells. Testicular cells of 11 boys (aged 7.7 +/- 4.1 (mean +/- SD) years) were assessed for TO formation in relation to previous chemotherapy exposure and SOX9 expression in histological sections of paraffin-embedded testicular tissue samples collected on the day of biopsy and compared with testicular tissue samples obtained from 28 consecutive patients (aged 6.9 +/- 3.8 (mean +/- SD) years). All 39 patients were part of the fertility preservation project NORDFERTIL; an additional 10 samples (from boys aged 5.5 +/- 3.5 (mean +/- SD) years, without an underlying pathology) in an internal biobank collection were used as controls.PARTICIPANTS/MATERIALS, SETTING, METHODS We obtained 49 testicular tissue samples from boys aged 0.8-13.4 years. Fresh samples (n = 11) were dissociated into single-cell suspensions and applied to a three-layer gradient culture system for organoid formation. Histological sections of another 28 samples obtained as part of the fertility preservation project NORDFERTIL, and 10 samples from a sample collection of a pathology biobank were used to evaluate the effects of prior exposure to alkylating agents on testicular samples. Testicular organoid formation was defined based on morphological features, such as compartmentalized structures showing cord formation, and protein expression of testicular cell-specific markers for germ and somatic cells was evaluated via immunohistochemical staining. Hormone secretion was analysed by specific enzyme-linked immunosorbent assays for testosterone and anti-M & uuml;llerian hormone (AMH) production.MAIN RESULTS AND THE ROLE OF CHANCE Our results revealed that 4 out of 11 prepubertal testicular samples formed TOs that showed compartmentalized cord-like structures surrounded by interstitial-like areas and increasing levels of both testosterone as well as AMH over a 7-day culture period. We observed that SOX9 expression was correlated positively with TO formation. Moreover, exposure to alkylating agents before biopsy was inversely correlated with SOX9 expression (P = 0.006).LARGE SCALE DATA N/A.LIMITATIONS, REASONS FOR CAUTION Due to the limited amount of material available, only 11 out of the 39 pre- and peri-pubertal testicular tissue samples could be used for the organoid formation experiments. The testicular tissue samples obtained from a sample collection of the internal biobank of Department of Pathology, Karolinska University Hospital were considered normal and included in the study if no testicular pathology was reported. However, detailed information regarding previous medical treatments and/or testicular volumes of the patients included in this biobank was not available.WIDER IMPLICATIONS OF THE FINDINGS Our observations suggest that SOX9 expression may serve as a putative indicator of TO formation, indicating a critical role of Sertoli cells in promoting organoid formation, seminiferous tubule integrity, and testicular function in pre- and peri-pubertal testicular tissue.STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from the Swedish Childhood Cancer Foundation (PR2019-0123; PR2022-0115; TJ2020-0023) (J.-B.S.), Finnish Cancer Society (K.J.), Finnish Foundation for Paediatric Research (K.J.), Swedish Research Council (2018-03094; 2021-02107) (J.-B.S.), and Birgitta and Carl-Axel Rydbeck's Research Grant for Paediatric Research (2020-00348; 2020-00335; 2021-00073; 2022-00317) (J.-B.S. and K.J.). Y.C. and Y.Y. received a scholarship from the Chinese Scholarship Council. J.P.A-L. was supported by a Starting Grant in Medicine and Health (2022-01467) from the Swedish Research Council. R.T.M. was supported by a UKRI Future Leaders Fellowship (MR/S017151/1). The MRC Centre for Reproductive Health was supported by an MRC Centre Grant (MR/N022556/1). The authors declare no competing interests.
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| 8. |
- Cui, Yanhua, et al.
(author)
-
Prior exposure to alkylating agents negatively impacts testicular organoid formation in cells obtained from childhood cancer patients
- 2024
-
In: Human Reproduction Open. - : Oxford University Press. - 2399-3529. ; 2024:3
-
Journal article (peer-reviewed)abstract
- STUDY QUESTION: Can human pre- and peri-pubertal testicular cells obtained from childhood cancer patients, previously treated with chemotherapy, form testicular organoids (TOs)?SUMMARY ANSWER: Organoid formation from testicular tissue collected from childhood cancer patients positively correlates with SRY-Box transcription factor 9 (SOX9) expression in Sertoli cells, which in turn negatively correlates with previous exposure to alkylating chemotherapy.WHAT IS KNOWN ALREADY: Pre- and peri-pubertal boys exposed to highly gonadotoxic therapies can only safeguard their fertility potential through testicular tissue cryopreservation. Today, there is no established clinical tool to restore fertility using these testicular samples. Organoids hold promise in providing fundamental early insights in creating such platforms. However, the generation of TOs that closely resemble the innate testis, to enable a thorough monitoring of the necessary steps for germ cell differentiation and somatic functionalities, remains a challenge.STUDY DESIGN, SIZE, DURATION: We used a Matrigel-based three-layer gradient culture system to generate human TOs and to reveal whether chemotherapy exposure affects TO formation capacity and the functionality of pre- and peri-pubertal testicular somatic cells. Testicular cells of 11 boys (aged 7.7 ± 4.1 (mean ± SD) years) were assessed for TO formation in relation to previous chemotherapy exposure and SOX9 expression in histological sections of paraffin-embedded testicular tissue samples collected on the day of biopsy and compared with testicular tissue samples obtained from 28 consecutive patients (aged 6.9 ± 3.8 (mean ± SD) years). All 39 patients were part of the fertility preservation project NORDFERTIL; an additional 10 samples (from boys aged 5.5 ± 3.5 (mean ± SD) years, without an underlying pathology) in an internal biobank collection were used as controls.PARTICIPANTS/MATERIALS, SETTING, METHODS: We obtained 49 testicular tissue samples from boys aged 0.8-13.4 years. Fresh samples (n = 11) were dissociated into single-cell suspensions and applied to a three-layer gradient culture system for organoid formation. Histological sections of another 28 samples obtained as part of the fertility preservation project NORDFERTIL, and 10 samples from a sample collection of a pathology biobank were used to evaluate the effects of prior exposure to alkylating agents on testicular samples. Testicular organoid formation was defined based on morphological features, such as compartmentalized structures showing cord formation, and protein expression of testicular cell-specific markers for germ and somatic cells was evaluated via immunohistochemical staining. Hormone secretion was analysed by specific enzyme-linked immunosorbent assays for testosterone and anti-Müllerian hormone (AMH) production.MAIN RESULTS AND THE ROLE OF CHANCE: Our results revealed that 4 out of 11 prepubertal testicular samples formed TOs that showed compartmentalized cord-like structures surrounded by interstitial-like areas and increasing levels of both testosterone as well as AMH over a 7-day culture period. We observed that SOX9 expression was correlated positively with TO formation. Moreover, exposure to alkylating agents before biopsy was inversely correlated with SOX9 expression (P = 0.006).LARGE SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: Due to the limited amount of material available, only 11 out of the 39 pre- and peri-pubertal testicular tissue samples could be used for the organoid formation experiments. The testicular tissue samples obtained from a sample collection of the internal biobank of Department of Pathology, Karolinska University Hospital were considered normal and included in the study if no testicular pathology was reported. However, detailed information regarding previous medical treatments and/or testicular volumes of the patients included in this biobank was not available.WIDER IMPLICATIONS OF THE FINDINGS: Our observations suggest that SOX9 expression may serve as a putative indicator of TO formation, indicating a critical role of Sertoli cells in promoting organoid formation, seminiferous tubule integrity, and testicular function in pre- and peri-pubertal testicular tissue.STUDY FUNDING/COMPETING INTEREST(S): This study was supported by grants from the Swedish Childhood Cancer Foundation (PR2019-0123; PR2022-0115; TJ2020-0023) (J.-B.S.), Finnish Cancer Society (K.J.), Finnish Foundation for Paediatric Research (K.J.), Swedish Research Council (2018-03094; 2021-02107) (J.-B.S.), and Birgitta and Carl-Axel Rydbeck's Research Grant for Paediatric Research (2020-00348; 2020-00335; 2021-00073; 2022-00317) (J.-B.S. and K.J.). Y.C. and Y.Y. received a scholarship from the Chinese Scholarship Council. J.P.A-L. was supported by a Starting Grant in Medicine and Health (2022-01467) from the Swedish Research Council. R.T.M. was supported by a UKRI Future Leaders Fellowship (MR/S017151/1). The MRC Centre for Reproductive Health was supported by an MRC Centre Grant (MR/N022556/1). The authors declare no competing interests.
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| 9. |
- Dunberger, Gail, et al.
(author)
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Cancer survivors' perception of participation in a long-term follow-up study.
- 2013
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In: Journal of medical ethics. - : BMJ. - 1473-4257 .- 0306-6800. ; 39:1, s. 41-5
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Journal article (peer-reviewed)abstract
- Every year medical researchers make contact with a large number of cancer survivors with the aim of evaluating cancer treatment. For this reason we decided to investigate how Swedish cancer survivors perceived their participation in research studies focusing on the long-term consequences of being a survivor of gynaecological or urinary bladder cancer. Data were collected by means of two study-specific postal questionnaires, both consisting of questions covering physical symptoms, well-being and the experience of being a cancer survivor. Both questionnaires also included questions evaluating the participants' experience of being research subjects. The questionnaires were developed in close co-operation with cancer survivors. The study population consisted of 1068 cancer survivors. Of these, 95% (n=1003) reported that they thought the study was valuable and 54% (n=559) that they had been positively affected by participating. Four per cent (n=39) expressed that they had been negatively affected by their participation in the study. The vast majority of the cancer survivors thought that participating in their particular study was valuable.
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| 10. |
- Engström, Gabriella
(author)
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Lower Urinary Tract Symptoms in Swedish Male Population : Prevalence, Distress and Quality of Life
- 2006
-
Doctoral thesis (other academic/artistic)abstract
- The aim the thesis was to investigate, the prevalence of Lower Urinary Tract Symptoms (LUTS). Moreover, we examine symptom severity and different levels of distress and describe how different symptoms from the lower urinary tract affect the self-assessed health, sadness, happiness and the quality of life in men. The studies are based on two data collections. In the first data collection, all men aged 40 – 80 years (n=2571) living in the Swedish community received a postal questionnaire. Twelve months later, 504 men who had earlier reported LUTS and 504 who had not reported symptoms were asked to complete the DAN-PSS and the SF-36 questionnaires. The overall prevalence of LUTS was 24%. Post-micturition dribbling (21%) was the most frequent symptom, and stress incontinence (2%) was the least frequent symptom. Urge incontinence, stress incontinence and “other” incontinence cause a high level of distress, even if the symptoms do not occur very often. Men experiencing mild, moderate or severe urge, stress or “other incontinence” had lower mean scores for all of the eight dimensions measured by the SF-36 than men without the same symptoms. Men experiencing a moderate/severe degree of weak stream or nocturia reported a poorer quality of life in all dimensions compared to men with a mild level of the same symptoms. The total burden of moderate/severe LUTS is related to self-assessed health, sadness and happiness. For each of the 12 specific LUTS, men with mild, moderate or severe symptoms had lower scores for self-assessed health and happiness, and higher scores for self-assessed sadness, than men without the same symptoms. In conclusions, one of every four men reports LUTS. Urinary incontinence causes high level of distress even to men who experience this symptom rarely. LUTS have a negative impact on quality of life, health, sadness and happiness.
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| 11. |
- Engström, Gabriella, et al.
(author)
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The impact on quality of life of different symptoms from the lower urinary tract in men measured by the SF-36 questionnaire
- 2006
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In: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 40:6, s. 485-494
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Journal article (peer-reviewed)abstract
- Objective. To describe how different lower urinary tract symptoms (LUTS) affect the quality of life (QOL) in men. Material and methods. The study included 1008 men aged 40-80 years living in the community of Surahammar, Sweden who had answered a questionnaire concerning stress incontinence, urgency and post-micturition dribbling 12 months earlier. The occurrence and severity/frequency of 12 specific LUTS were assessed using the Danish Prostatic Symptom Score questionnaire. QOL was evaluated using the Short Form 36 (SF-36) questionnaire. Results. Post-micturition dribbling was the most frequently reported symptom (71%) and stress incontinence the least common (11%). Men who experienced urge, stress or "other incontinence'' had lower mean scores for all of the eight dimensions measured by the SF-36 than men without such symptoms. Furthermore, men who experienced a moderate/severe degree of weak stream or nocturia reported a poorer QOL for all dimensions compared to men with a mild level of the same symptoms. QOL was found to decrease with increasing age. Men aged 66-80 years with "other incontinence'' reported lower mean SF-36 scores for physical functioning, role physical, role emotional, social functioning and body pain than 40-65-year-old men. Conclusions. LUTS in men affect QOL dimensions differently. Storage symptoms appear to reduce QOL more than voiding and post-micturition symptoms. Urinary incontinence affected all eight of the dimensions evaluated. Elderly men with LUTS reported a lower QOL than younger men.
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| 12. |
- Fredholm, Angelica, et al.
(author)
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The practice of thresholds : Autonomy in clinical education explored through variation theory and the threshold concepts framework
- 2020
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In: Teaching in Higher Education. - : Taylor & Francis. - 1356-2517 .- 1470-1294. ; 25:3, s. 305-320
-
Journal article (peer-reviewed)abstract
- This paper demonstrates a practical dimension to the discussion about threshold concepts. Threshold concepts have thus far mostly been acknowledged to elucidate learning processes mainly connected to theoretical concepts. By exploring situations that prompted experiences of autonomy and authenticity in clinical learning, findings showed how a practical experience could have the same power to transform thinking and identity as theoretical thresholds and serve as a trigger for transformational learning, therefore making the discussion about ‘practical thresholds' or thresholds in practice possible. The present study explores situations that prompted autonomy and authenticity, and offers context for and substance to these situations by adopting variation theory and the threshold concept framework. In order to learn more about situations that prompt experiences of autonomy and authenticity, and create prerequisites for such experiences, this paper examines how students discern and interpret these situations by analysing them through variation theory and the threshold concept framework.
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| 13. |
- Henningsohn, Lars
(author)
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Improving the situation of urinary bladder cancer survivors treated with radical surgery or radical radiotherapy
- 2002
-
Doctoral thesis (other academic/artistic)abstract
- In this thesis we investigated whether the situation of urinary bladder cancer survivors can be improved. To do this, it is necessary to acquire a more specific knowledge of longterm distressing symptoms, symptom characteristics (nature, occurrence, intensity and duration), and of the corresponding symptom-induced distress, as well as the effect on wellbeing and the quality of life (VI). This more exact information can also be used in the pretherapeutic situation to "tailor", as far as possible, the method of treatment for the individual. Well-being is statistically significantly lower in patients having undergone cystectomy and urostomy, both non-continent and continent, as compared to a matched control population (I). Patients treated with radical radiotherapy for urinary bladder cancer report the same lowered level of well-being (II) in contrast to patients treated with cystectomy and an orthotopic neobladder connected to the urethra; they reported well-being and a subjective quality of life as good as that of the matched control population (M). One reason for the discordance might be the feeling of reduced attractiveness in urostomy patients, a 5-fold increase in feeling unattractive being reported among them (I) as compared to no increase at all in cystectomised patients with a neobladder (III). The 6-fold increase of the feeling of reduced attractiveness in the irradiated patients as compared to matched controls might be an effect due to the increased risk for bowel symptoms. A 9-fold increased risk for defecation urgency and an 11-fold increased risk for faecal leakage was reported by the irradiated patients as compared to the matched controls (II). The risk of being affected by these symptoms was also increased in cystectomised patients with a urostomy, and a 7-fold increase of defecation urgency and faecal leakage was seen compared to matched controls (I). The risk of symptomatic urinary tract infections was increased 3-fold among the operated patients with a urostomy, i.e. 25% had at least one urinary tract infection requiring treatment during the past year (I). Virtually all men operated on were affected by sexual dysfunction, particularly erectile dysfunction, a symptom causing much distress among the affected (I+III, IV). A lower prevalence of erectile dysfunction was seen among the irradiated patients, i.e. 75% (II). Symptoms of sexual dysfunction were the most distressing kinds of symptom among urinary bladder cancer patients (IV). The prevalence of distressing symptoms was lowest for surgical patients with orthotopic neobladder substitution. The occurrence of distressing symptoms does not increase with follow-up time, but an increased symptom burden was strongly correlated with decreased well-being (V). A majority of urinary bladder cancer patients give priority to optimal survival over a reduced symptom burden (I- III). If we refine the surgical technique during radical cystectomy and preserve (autonomic?) nerves in the pelvis, possibly the distressful bowel symptoms and the faecal leakage seen in patients operated in Sweden but not among those operated at Herlev University Hospital in Copenhagen can be eliminated. The high incidence of urinary tract infections in bladder cancer survivors possibly can be diminished by preventive measures. An orthotopic neobladder substitution and preservation of erectile nerves during surgery are further means to improve quality of life in urinary bladder cancer survivors. For those giving high priority to preserved sexual function, radical radiotherapy can be an option. During radiotherapy, diminishing the dose to the anal sphincter and rectum probably can increase quality of life in the patients that are cured. Our studies have identified additional factors that may improve the situation for urinary bladder cancer survivors, and 1 conclude that quality of life of urinary bladder cancer survivors probably can be improved considerably.
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| 14. |
- Henningsohn, Lars, et al.
(author)
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Risk of relationship separation in men with Peyronie's disease in a matched Swedish cohort
- 2024
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In: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 14:1
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Journal article (peer-reviewed)abstract
- Peyronie's disease (PD) has detrimental effects on the quality of life, mental health, sexual functioning and several other aspects that increase the risk of relationship problems. However, no study to date has assessed the risk of relationship separation in med with PD. Herein, we utilized data from Swedish national registers to examine the risk of relationship separation in men with PD. We conducted a matched cohort study on men born 1933-1992, followed from 1997 to 2013. PD was defined as a physician-assigned diagnosis according to the International Classification of Diseases, Tenth version. Each man with PD (n = 8020) was matched with 10 comparison men. We defined relationship separation as (1) ever separated, and (2) separation rate. We used log-linear regression to estimate the risk ratio, and rate ratio of relationship separation. We adjusted for matching variables (birth year and country of birth), and an indicator of each follow-up year. We found that men with PD had a 13% increased risk of relationship separation (risk ratio 1.13, 95% confidence interval [CI] 1.08-1.17). The rate of relationship separation events, measured on a yearly basis, was increased by 18% (rate ratio 1.18, CI 1.12-1.24), and remained similar when adjusting for follow-up year and socio-economic status.
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| 15. |
- Kuja-Halkola, Ralf, et al.
(author)
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Mental Disorders in Peyronie's Disease : A Swedish Cohort Study of 3.5 Million Men
- 2021
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In: Journal of Urology. - : American Urological Association, Inc.. - 0022-5347 .- 1527-3792. ; 205:3, s. 864-869
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Journal article (peer-reviewed)abstract
- PURPOSE: Studies have shown that men with Peyronie's disease often suffer from psychological problems, but the psychiatric burden of this disorder remains largely unknown. We assessed risks of a range of psychiatric outcomes in a population-based, Swedish cohort comprising 3.5 million men.MATERIALS AND METHODS: We conducted a longitudinal cohort study based on Swedish national registers. A total of 8,105 men diagnosed with Peyronie's disease and 3.5 million comparison subjects from the general Swedish population were selected, and followed-up for diagnosed psychiatric outcomes, including substance use disorder, alcohol misuse, anxiety disorder, depression, and self-injurious behaviors. Risks of psychiatric outcomes were estimated with Cox regressions, and additionally adjusted for birth year.RESULTS: Men with Peyronie's disease had increased risks of being diagnosed with substance use disorder; hazard ratio (HR) 1.4, 95% confidence interval (CI) 1.1-1.9, no excess risk of alcohol misuse; HR 0.9, CI 0.8-1.1, but elevated risks of anxiety disorder; HR 1.9, CI 1.6-2.2, depression; HR 1.7, CI 1.5-2.0, self-injurious behaviors; HR 2.0, 95% CI 1.7-2.3, as well as any psychiatric outcomes; HR 1.4, 95% CI 1.2-1.5. The risk estimates were slightly decreased when adjusted for birth year. A limitation of the study was that we had no information about Peyronie's disease diagnoses assigned before year 1997.CONCLUSIONS: Men with Peyronie's disease are at increased risk of being diagnosed with adverse psychiatric outcomes. Health care providers should ensure that men with Peyronie's disease have a documented mental health status assessment.
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| 16. |
- Kurek, Magdalena, et al.
(author)
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Spermatogonia Loss Correlates with LAMA 1 Expression in Human Prepubertal Testes Stored for Fertility Preservation
- 2021
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In: Cells. - : MDPI AG. - 2073-4409. ; 10:2
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Journal article (peer-reviewed)abstract
- Fertility preservation for male childhood cancer survivors not yet capable of producing mature spermatozoa, relies on experimental approaches such as testicular explant culture. Although the first steps in somatic maturation can be observed in human testicular explant cultures, germ cell depletion is a common obstacle. Hence, understanding the spermatogonial stem cell (SSC) niche environment and in particular, specific components such as the seminiferous basement membrane (BM) will allow progression of testicular explant cultures. Here, we revealed that the seminiferous BM is established from 6 weeks post conception with the expression of laminin alpha 1 (LAMA 1) and type IV collagen, which persist as key components throughout development. With prepubertal testicular explant culture we found that seminiferous LAMA 1 expression is disrupted and depleted with culture time correlating with germ cell loss. These findings highlight the importance of LAMA 1 for the human SSC niche and its sensitivity to culture conditions.
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| 17. |
- Lauritzen, Märta, et al.
(author)
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Intermittent self-dilatation after internal urethrotomy for primary urethral strictures : a case-control study
- 2009
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In: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 43:3, s. 220-5
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To retrospectively evaluate the effects of intermittent self-dilatation (ISD) on the natural course of urethral strictures after an internal urethrotomy. MATERIAL AND METHODS: A retrospective case-control analysis of all males who had undergone a first time internal urethrotomy due to a urethral stricture in 1998-2000 at 15 urological departments in Sweden. Out of 217 included patients 162 were treated with internal urethrotomy only and 55 with internal urethrotomy followed by postoperative ISD. Demographic data including stricture localization, stricture aetiology and reoperation dates, as well as postoperative indwelling catheter and antibiotic treatment, were collected from the medical records. Factors concerning the ISD were also gathered: postoperative starting time, dilatation catheter size, dilatation frequency and time for retreatment. All patients' medical records were followed for 3-6 years until 2003. RESULTS: The median time until recurrence (surgical reoperation) was 732 days in the ISD group and 167 days in the non-ISD group (p<0.0001). The frequency of recurrence after internal urethrotomy was 9% (5/55) in the ISD group and 31% in the non-ISD group (51/162) during the observational follow-up period (p=0.0007). There was a higher risk of recurrence among those with a traumatic aetiology (39/104) compared with those with unknown aetiology (14/89) (p=0.0005). Patients with a postoperative catheter had a lower risk of recurrence (40/172) than those without one (16/45) (p=0.01). CONCLUSIONS: Postoperative ISD of a urethral stricture, primarily treated by internal urethrotomy, significantly reduces the stricture recurrence rate as well as delaying the time until recurrence.
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| 18. |
- Norström, Melissa M., et al.
(author)
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Progression of benign prostatic hyperplasia is associated with pro-inflammatory mediators and chronic activation of prostate-infiltrating lymphocytes
- 2016
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In: Oncotarget. - : Impact Journals LLC. - 1949-2553. ; 7:17, s. 23581-23593
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Journal article (peer-reviewed)abstract
- Benign prostatic hyperplasia (BPH) is a common chronic non-malignant condition whose prevalence substantially increases with age. Immune cell infiltration and pro-inflammatory mediators have been implicated in the pathogenesis. Here, we characterized 21 extracellular markers on prostate-infiltrating lymphocytes (PILs) and analyzed expression of 26 soluble proteins in prostate tissue obtained from BPH patients (n = 31). These data were correlated with clinical parameters and compared with peripheral blood mononuclear cells (PBMCs) (n = 10). Increased frequencies of T cells expressing co-inhibitory receptors LAG-3, PD-1, TIM-3 or CTLA-4, and co-stimulatory receptors CD28, OX40 or 4-1BB were observed in BPH tissue compared to PBMCs. These findings are consistent with chronic activation and possible functional exhaustion of PILs that may be further augmented by several identified pro-inflammatory factors, such as IL-8 and MCP-1, promoting inflammation and chemotaxis of immune cells to the prostate. Prostate size and plasma prostate-specific antigen levels positively correlated with IL-8 and MCP-1 concentrations, and frequencies of T cells expressing CTLA-4 and TIM-3. It remains to be established whether the link between inflammation and BPH progression supported by our findings reflects a progressive failure of the immune system leading to decreased immune surveillance and development of prostate cancer.
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| 19. |
- Onelöv, Erik, et al.
(author)
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Measuring anxiety and depression in the oncology setting using visual-digital scales.
- 2007
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In: Acta oncologica (Stockholm, Sweden). - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 46:6, s. 810-6
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Journal article (peer-reviewed)abstract
- We investigated the feasibility of using single-item visual-digital scales for measuring anxiety and depression for research purposes within the oncology and palliative care setting. Data were retrieved from five nationwide postal questionnaires comprising 3030 individuals (response rate 76%): cancer patients, widows/parents who had lost their husband/child to cancer and population controls. All questionnaires contained the Center for Epidemiological Studies Depression scale (CES-D) and Spielberger's State-Trait Anxiety Inventory (STAI-T) as well as seven-point Visual-Digital Scales (VDS) assessing anxiety and depression. Each stepwise increased score on the VDS-depression provided a statistically significant increase in the mean score on CES-D (Spearman's r=0.582). The VDS-anxiety correlated with mean scores on STAI-T (Spearman's r=0.493), however, not all stepwise increased scores on the VDS-anxiety gave a statistically significant increase on the STAI-T. Positive- and negative predictive values were 51% and 91% for VDS-depression and 64% and 80% for VDS-anxiety. Missing data for STAI-T were 7% and 9% for CES-D; the corresponding figures were 2% for the VDS-depression and 3% for VDS-anxiety. With low attrition and agreement with psychometric scales, the Visual-Digital Scales are a feasible alternative for research in the oncology setting. However, the high negative predictive value and the low positive predictive value suggest that the visual- digital scales mainly detect the absence of the symptoms.
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| 20. |
- Porserud, Andrea, et al.
(author)
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Effects of an exercise intervention in primary care after robot-assisted radical cystectomy for urinary bladder cancer : A randomised controlled trial
- 2024
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In: BMC Cancer. - 1471-2407. ; 24
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Journal article (peer-reviewed)abstract
- INTRODUCTION: After radical cystectomy physical activity is important to reduce risk of complications, but patients with urinary bladder cancer have difficulties in achieving general recommendations on physical activity and exercise. The aim of this randomised controlled trial was therefore to evaluate the effects of a physical exercise programme in primary care, following discharge from hospital after robot-assisted radical cystectomy for urinary bladder cancer.MATERIALS AND METHODS: Patients with urinary bladder cancer scheduled for robot-assisted radical cystectomy at Karolinska University Hospital, Sweden between September 2019 and October 2022 were invited to join the study. At discharge, they were randomised to intervention or active control group. The intervention group was planned to start exercise with physiotherapist in primary care during the third week; the programme included aerobic and strengthening exercises, twice a week for 12 weeks, and daily walks. The control group received unsupervised home-based exercise with daily walks and a sit-to-stand exercise. Assessments were conducted before surgery, at discharge and after four months regarding the primary outcome physical function (Six-minute walk test), and secondary outcomes physical activity, pain, health-related quality of life, fatigue, and psychological wellbeing.RESULTS: Ninety patients were included, mean (sd) age 71.5 (8.5) years. An intention-to-treat analysis showed no intervention effect on the primary outcome physical function, or on pain or psychological wellbeing, but effect on physical activity with a difference from discharge to four months with a median (IQR) of 4790 (3000) and 2670 (4340) daily steps in the intervention and control group, respectively (p = 0.046), and for fatigue, and health-related quality of life, in favour of the intervention group.CONCLUSION: Both the intervention and control groups improved physical function, but the patients who exercised in primary care experienced additional positive effects on physical activity, fatigue, and health-related quality of life. Hence, exercise in primary care after discharge from hospital could be a promising method after radical cystectomy for urinary bladder cancer.TRIAL REGISTRATION: The study was registered in Clinical Trials with registration number NCT03998579, 20,190,607.
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| 21. |
- Schlickum, Marcus, et al.
(author)
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Endourological simulator performance in female but not male medical students predicts written examination results in basic surgery
- 2013
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In: Scandinavian Journal of Urology. - : Informa Healthcare. - 2168-1805 .- 2168-1813. ; 47:1, s. 38-42
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Journal article (peer-reviewed)abstract
- Objective. The objective of this study was to examine the correlation between endourological simulator performance and demonstrated theoretical knowledge in the basic surgical sciences. Material and methods. In total, 158 fourth year medical students participated in the study, 83 females and 75 males, all surgical novices. All students performed the flexible endoscopic task Hall of Fame in the urological simulator URO Mentor (TM). Later during the same semester all students took the final theoretical examination in surgery. Results. In female medical students a significant correlation was found between surgical simulator performance and the examination results (r = -0.22, p = 0.04). There was no statistically significant correlation when looking at the total study population (r = -0.04, p = 0.58) or when looking at male medical students (r = 0.01, p = 0.9). Conclusion. Female medical students completing an endourological simulator task more efficiently passed the theoretical examination in the basic surgical sciences with significantly higher scores than females with low efficiency in the urological simulator. There are likely to be several explanations for this correlation, such as motivation and a lower amount of current video gaming experience.
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| 22. |
- Stathakarou, Natalia, et al.
(author)
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MOOC Learners' Engagement with Two Variants of Virtual Patients : A Randomised Trial
- 2018
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In: Education Sciences. - : MDPI AG. - 2227-7102. ; 8:2
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Journal article (peer-reviewed)abstract
- Introduction: Massive Open Online Courses (MOOCs) are an increasingly popular form of education in health professional education. VPs have been introduced in MOOCs to increase interactivity. There is a lack of research in understanding the reasons behind high dropout rates in MOOCs. We explored how learners interact with VPs and compared the significance of different VP designs on dropout rates. Methods: RCT of 378 participants split into two groups to interact with two VPs using different design: branching and linear. Data on node progression and VP attempts was analysed using descriptive and quantitative analysis. Results: Eight groups of learner interaction patterns were identified. The majority of learners completed the VP in a linear path in one attempt. A significant number either completed the case in a loop path in one attempt, completed in a linear path in multiple attempts or dropped out without attempting the case. VP design has a significant effect on dropout rates of learners. There is a higher dropout rate from a branched VP compared to linear VP. Discussion: Prior research showed that branched VPs are more engaging and promote greater learning compared to linear VPs. However, our results indicate that branched VPs had greater dropout compared to VPs that require less time to be solved. Conclusions: We conclude that branching had a negative effect on completion of the VP activity in the MOOC. Moreover, we believe that more complex VPs require more effort on task and this might not be a design that facilitates the interaction in a MOOC audience, where the participants might wish to acquire the basic medical knowledge offered by the course.
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| 23. |
- Thulin, Helena, et al.
(author)
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Defecation disturbances after cystectomy for urinary bladder cancer
- 2011
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In: BJU International. - : Blackwell Publishing Ltd. - 1464-4096 .- 1464-410X. ; 108:2, s. 196-203
-
Journal article (peer-reviewed)abstract
- What’s known on the subject? and What does the study add?Functional gastrointestinal symptoms and problems are common after radical cystectomy with urinary diversion. This study adds new important epidemiological data on this group of symptoms. OBJECTIVE: To describe and compare long-term defecation disturbances in patients who had undergone a cystectomy due to urinary bladder cancer with non-continent urostomies, continent reservoirs and orthotopic neobladder urinary diversions. PATIENTS AND METHODS: During their follow-up we attempted to contact all men and women aged 30–80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. During a qualitative phase we identified defecation disturbances as a distressful symptom and included this item in a study-specific questionnaire together with free-hand comments. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results are presented as relative risks with 95% confidence interval. RESULTS: The questionnaire was returned from 452 (92%) of 491 identified patients. Up to 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). A sense of decreased straining capacity was reported by 20% of the men and women with non-continent urostomy and 14% and 8% of those with continent reservoirs and orthotopic neobladders, respectively. CONCLUSIONS: Of the cystectomized individuals 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). Those wanting to improve the situation for bladder cancer survivors may consider communicating before surgery the possibility of stool-emptying problems, and asking about them after surgery.
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| 24. |
- Thulin, Helena, et al.
(author)
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Hygiene and urinary tract infections after cystectomy in 452 Swedish survivors of bladder cancer.
- 2009
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In: BJU International. - 1464-4096 .- 1464-410X.
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Journal article (peer-reviewed)abstract
- OBJECTIVES To determine whether or not an improved hygiene can lessen the incidence of symptomatic urinary tract infections (UTIs) in patients treated by cystectomy for urinary bladder cancer. PATIENTS AND METHODS We attempted to contact during their follow-up all men and women aged 30-80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. During a qualitative phase we identified hygienic measures and included them in a study-specific questionnaire. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results presented as relative risks (RR) with 95% confidence interval. RESULTS We received the questionnaire from 452 (92%) of 491 identified patients. The proportion of patients who had a symptomatic UTI in the previous year was 22% for orthotopic neobladder and cutaneous continent reservoir, and 23% for non-continent urostomy diversion. The RR for a UTI was 1.1 (0.5-2.5) for 'never washing hands' before handling with catheters or ostomy material. Patients with diabetes mellitus had a RR of 2.1 (1.4-3.2) for having a symptomatic UTI. CONCLUSIONS We could not confirm lack of hygiene measures as a cause of UTI for men and women who had a cystectomy with urinary diversion. Patients with diabetes mellitus have a greater risk of contracting a UTI.
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| 25. |
- Thulin, Helena, et al.
(author)
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Sleep disturbances decrease self-assessed quality of life in individuals who have undergone cystectomy.
- 2010
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In: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 184:1, s. 198-202
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Journal article (peer-reviewed)abstract
- The best possible urinary diversion after cystectomy, if any, is yet to be defined to our knowledge. Therefore, we investigated nocturnal urinary disturbances and quality of life in individuals who have undergone cystectomy with urinary diversion for bladder cancer.
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| 26. |
- Ugge, Henrik, 1987-
(author)
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Inflammation and prostate carcinogenesis : influence of immune characteristics and early-adulthood exposure to inflammatory conditions on prostate cancer risk
- 2019
-
Doctoral thesis (other academic/artistic)abstract
- Chronic inflammation has been implicated in the development of several types of cancer, and evidence from observational and animal studies suggests that it may play a role also in prostate carcinogenesis. Recent observations have brought Cutibacterium acnes (C. acnes) forward as a possible causative agent in pro-oncogenic prostatic inflammation. However, evidence also suggest that underlying immune characteristics contribute to prostate cancer risk. The overall aim of this thesis was to explore potential mechanisms underlying the proposed link between inflammation and prostate cancer, by evaluating associations between inflammatory conditions during early adulthood, circulating inflammation markers, and prostate cancer. Due to the suggested role of C. acnes in both diseases, we aimed to investigate whether acne vulgaris is a determinant of prostate cancer. Using prospectively collected data from Swedish national registers, we observed that presence of acne during early adulthood conferred an increased risk of prostate cancer later in life. Similarly, we found that appendicitis before late adolescence – a proposed marker of individual immune characteristics – to be positively associated with subsequent prostate cancer. We further evaluated whether prostatic C. acnes infection is linked with elevated systemic levels of IL6 and CXCL8, two inflammation markers previously associated with prostate cancer. No association was observed, however, potentially explained by the subclinical low-grade infection typically caused by C. acnes. Finally, we evaluated 52 circulating inflammation markers as determinants for prostate cancer in a population-based case-control study. In this hypothesis-generating study, we identified CX3CL1, CCL21, PDGF-BB, CCL11 and IL10 as candidate markers for evaluation in prospective studies. If confirmed, these markers may hint at targetable molecular pathways involved in prostate carcinogenesis.
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