| 1. |
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| 2. |
- Ahlström, Gerd, et al.
(author)
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Breaking up and a new beginning when one’s partner goes into a nursing home : An interview study
- 2021
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In: Healthcare. - : MDPI AG. - 2227-9032. ; 9:6
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Journal article (peer-reviewed)abstract
- In aging societies worldwide, spouses take on great responsibility for care when their partner continues to live at home. Nursing home placement occurs when the partner becomes too frail due to multimorbidity, and this will cause a change in the spouse’s life. This study aimed to explore the spouse’s experience of their partner’s move to a nursing home. Two interviews were conducted at 9-month intervals within the project entitled “Implementation of Knowledge-Based Palliative Care in Nursing Homes”. Thirteen spouses from both urban and rural areas were included, with an age-range of 60–86 years (median 72). Qualitative content analysis was performed. The main findings were captured in two themes: Breaking up of close coexistence and Towards a new form of daily life. The first encompassed processing loneliness, separation and grief, exhaustion, increased burden, and a sense of guilt. The second encompassed a sense of freedom, relief, acceptance, support and comfort. Professionals in both home care and nursing home care need to develop and provide a support programme conveying knowledge of the transition process to prevent poor quality of life and depression among the spouses. Such a programme should be adaptable to individual needs and should ideally be drawn up in consultation with both partners.
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| 3. |
- Ahlström, Gerd, et al.
(author)
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Quality of Life among Next of Kin of Frail Older People in Nursing Homes : An Interview Study after an Educational Intervention concerning Palliative Care
- 2022
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In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:5
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Journal article (peer-reviewed)abstract
- One cornerstone of palliative care is improving the family’s quality of life (QoL). The principles of palliative care have not been sufficiently applied in nursing homes. The aim of this study was to investigate the experiences of QoL of next of kin of frail older persons in nursing homes after an educational intervention concerning palliative care. This qualitative interview study with 37 next of kin used an abductive design with deductive and inductive content analysis. The deductive analysis confirmed the three themes of QoL from the study before the implementation: (1) orientation to the new life-situation, (2) challenges in the relationship, and (3) the significance of the quality of care in the nursing home. The inductive analysis resulted in the sub-theme “Unspoken palliative care”. Being the next of kin of an older person living in a nursing home can be distressing despite round-the-clock care, so staff need to apply a more explicitly palliative care perspective. Future research needs to evaluate the influence of meaning-focused coping on next of kin’s QoL and integrate this knowledge in psychosocial interventions. Clinical Trial Database for Clinical Research: KUPA project NCT02708498.
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| 4. |
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| 5. |
- Bolin, Sara, 1988-, et al.
(author)
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Dormant SOX9-positive cells behind MYC-driven medulloblastoma recurrence
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Journal article (peer-reviewed)abstract
- Tumor recurrence is a slow biological process involving therapy resistance, immune escape, and metastasis and is the leading cause of death in medulloblastoma, the most frequent malignant pediatric brain tumor. By studying paired primary-recurrent patient samples and patient-derived xenografts we identified a significant accumulation of SOX9-positive cells in relapses and metastases. They exist as rare, quiescent cells in Group 3 and Group 4 patients that constitute two-thirds of medulloblastoma. To follow relapse at the single-cell level we developed an inducible dual Tet model of MYC-driven MB, where MYC can be directed from treatment-sensitive bulk cells to resistant, dormant SOX9-positive cells by doxycycline. SOX9 promoted immune es-cape, DNA repair suppression and was essential for recurrence. Tumor cell dormancy was non-hierarchical, migratory, and depended on MYC suppression by SOX9 to promote relapse. By using computational modeling and treatment we further showed how doxorubicin and MGMT inhibitors are specifically targeting relapsing cells.
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| 6. |
- Borgenvik, Anna, 1987-, et al.
(author)
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Dormant SOX9-Positive Cells Facilitate MYC-Driven Recurrence of Medulloblastoma
- 2022
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In: Cancer Research. - : AMER ASSOC CANCER RESEARCH. - 0008-5472 .- 1538-7445. ; 82:24, s. 4586-4603
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Journal article (peer-reviewed)abstract
- Relapse is the leading cause of death in patients with medulloblas-toma, the most common malignant pediatric brain tumor. A better understanding of the mechanisms underlying recurrence could lead to more effective therapies for targeting tumor relapses. Here, we observed that SOX9, a transcription factor and stem cell/glial fate marker, is limited to rare, quiescent cells in high-risk medulloblastoma with MYC amplification. In paired primary-recurrent patient samples, SOX9-positive cells accumulated in medulloblastoma relapses. SOX9 expression anti-correlated with MYC expression in murine and human medulloblastoma cells. However, SOX9-positive cells were plastic and could give rise to a MYC high state. To follow relapse at the single-cell level, an inducible dual Tet model of medulloblastoma was developed, in which MYC expression was redirected in vivo from treatment-sensitive bulk cells to dormant SOX9-positive cells using doxycycline treatment. SOX9 was essential for relapse initiation and depended on suppression of MYC activity to promote therapy resistance, epithelial-mesenchymal transition, and immune escape. p53 and DNA repair pathways were downregulated in recurrent tumors, whereas MGMT was upregulated. Recurrent tumor cells were found to be sensitive to treatment with an MGMT inhibitor and doxorubicin. These findings suggest that recurrence-specific targeting coupled with DNA repair inhibition comprises a potential therapeutic strategy in patients affected by medulloblastoma relapse.Significance: SOX9 facilitates therapy escape and recurrence in medulloblastoma via temporal inhibition of MYC/MYCN genes, revealing a strategy to specifically target SOX9-positive cells to prevent tumor relapse.
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| 7. |
- Claeson, Magdalena, 1976, et al.
(author)
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Incidence of cutaneous melanoma in Western Sweden, 1970-2007.
- 2012
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In: Melanoma research. - 1473-5636. ; 22:5, s. 392-8
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Journal article (peer-reviewed)abstract
- The aim of this study was to describe the increasing incidence of cutaneous malignant melanoma (CMM) in Western Sweden during the period 1970-2007. A secondary aim was to show a geographical variation in incidence between coastal and inland areas, considering the effects of the local average duration of sunshine, and the sun exposure-related behavior in the populations. The Swedish Cancer Registry provided data on invasive melanomas during 1970-2007. Meteorological maps showed the annual average duration of sunshine during 1961-1990. A survey from 2007 with 2871 participants, carried out by the National Board of Health and Welfare, provided data on self-reported sun exposure. During the period studied, the age-standardized incidence for men in Western Sweden more than quadrupled to 31.1/100 000 inhabitants, whereas it tripled for women to 27.1/100 000. Coastal areas, including Gothenburg city, had a high average duration of sunshine (1701-1900 h of sun/year), whereas inland areas had lower average duration of sunshine (≤1700 h). The incidence of CMM was higher in coastal areas and in Gothenburg city, compared with inland areas. This may be linked to ultraviolet radiation, a consequence of the higher average duration of sunshine. The sun exposure survey showed additional factors, which possibly led to the increased incidence, for example high sun exposure on holidays abroad. The alarming increase in the incidence of CMM in Western Sweden, during the period 1970-2007, shows the need for additional primary preventive measures, for example sun protection programs targeted at populations in this area.
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| 8. |
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| 9. |
- 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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| 10. |
- 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.
-
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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| 11. |
- 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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| 12. |
- Drevenhorn, Eva, et al.
(author)
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Possibilities for patients with elevated blood pressure to achieve blood pressure control without affecting quality of life (the PEQ-study) – a study protocol.
- 2017
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In: International journal of cardiovascular research. - : OMICS Publishing Group. - 2324-8602. ; 6:1
-
Journal article (peer-reviewed)abstract
- Several interventions on adherence have been tested in hypertension care but still the number of patients with well controlled blood pressure is not increasing. The aim is to get a deeper understanding of the patients’ reasons for not following their treatment as a base for in collaboration with the patients, developing effective interventions. A mixed methods design is to be used. Patients with hypertension who have considered changing lifestyle will be interviewed individually about their reasons for changing or not changing lifestyle and for taking or not taking medicines. Other patients, both those who do and those who do not have well-controlled blood pressure, treated at health centres and hospital clinics, will be asked to fill in instruments. The Exercise of Self Care Agency instrument gives information about the patients’ ability to perform self-care (change lifestyle) and the SF-36 is about health-related quality of life. Finally, patients will be asked to participate in focus-group interviews about how they want to be treated and what would be of help for them to achieve blood pressure control. From the findings we will create intervention/interventions without negative impact on quality of life together with the patients. These interventions are to be carried out and evaluated in real practice with patients with hypertension and other significant persons or health care personnel that may be involved.
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| 13. |
- Edsfeldt, Andreas, et al.
(author)
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Validation of a New Method for 2D Fusion Imaging Registration in a System Prepared Only for 3D
- 2020
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In: Journal of Endovascular Therapy. - : SAGE Publications. - 1526-6028 .- 1545-1550. ; 27:3, s. 468-472
-
Journal article (peer-reviewed)abstract
- Purpose: To validate a new 2D-3D registration method of fusion imaging during aortic repair in a system prepared only for 3D-3D registration and to compare radiation doses and accuracy. Materials and Methods: The study involved 189 patients, including 94 patients (median age 70 years; 85 men) who underwent abdominal endovascular aneurysm repair (EVAR) with 2D-3D fusion on an Artis zee imaging system and 95 EVAR patients (median age 70 years; 81 men) from a prior study who had 3D-3D registration done using cone beam computed tomography (CBCT). For the 2D-3D registration, an offline CBCT of the empty operating table was imported into the intraoperative dataset and superimposed on the preoperative computed tomography angiogram (CTA). Then 2 intraoperative single-frame 2D images of the skeleton were aligned with the patient’s skeleton on the preoperative CTA to complete the registration process. A digital subtraction angiogram was done to correct any misalignment of the aortic CTA volume. Values are given as the median [interquartile range (IQR) Q1, Q3]. Results: The 2D-3D registration had an accuracy of 4.0 mm (IQR 3.0, 5.0) after bone matching compared with the final correction with DSA (78% within 5 mm). By applying the 2D-3D protocol the radiation exposure (dose area product) from the registration of the fusion image was significantly reduced compared with the 3D-3D registration [1.12 Gy∙cm2 (IQR 0.41, 2.14) vs 43.4 Gy∙cm2 (IQR 37.1, 49.0), respectively; p<0.001). Conclusion: The new 2D-3D registration protocol based on 2 single-frame images avoids an intraoperative CBCT and can be used for fusion imaging registration in a system originally designed for 3D-3D only. This 2D-3D registration protocol is accurate and leads to a significant reduction in radiation exposure.
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| 14. |
- Gonzalez, Helena, 1971, et al.
(author)
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Photostability of commercial sunscreens upon sun exposure and irradiation by ultraviolet lamps
- 2007
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In: BMC Dermatol. - 1471-5945. ; 7
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Journal article (peer-reviewed)abstract
- BACKGROUND: Sunscreens are being widely used to reduce exposure to harmful ultraviolet (UV) radiation. The fact that some sunscreens are photounstable has been known for many years. Since the UV-absorbing ingredients of sunscreens may be photounstable, especially in the long wavelength region, it is of great interest to determine their degradation during exposure to UV radiation. Our aim was to investigate the photostability of seven commercial sunscreen products after natural UV exposure (UVnat) and artificial UV exposure (UVart). METHODS: Seven commercial sunscreens were studied with absorption spectroscopy. Sunscreen product, 0.5 mg/cm2, was placed between plates of silica. The area under the curve (AUC) in the spectrum was calculated for UVA (320-400 nm), UVA1 (340-400 nm), UVA2 (320-340 nm) and UVB (290-320 nm) before (AUCbefore) and after (AUCafter) UVart (980 kJ/m2 UVA and 12 kJ/m2 of UVB) and before and after UVnat. If theAUC Index (AUCI), defined as AUCI = AUCafter/AUCbefore, was > 0.80, the sunscreen was considered photostable. RESULTS: Three sunscreens were unstable after 90 min of UVnat; in the UVA range the AUCI was between 0.41 and 0.76. In the UVB range one of these sunscreens was unstable with an AUCI of 0.75 after 90 min. Three sunscreens were photostable after 120 min of UVnat; in the UVA range the AUCI was between 0.85 and 0.99 and in the UVB range between 0.92 and 1.0. One sunscreen showed in the UVA range an AUCI of 0.87 after UVnat but an AUCI of 0.72 after UVart. Five of the sunscreens were stable in the UVB region. CONCLUSION: The present study shows that several sunscreens are photounstable in the UVA range after UVnat and UVart. There is a need for a standardized method to measure photostability, and the photostability should be marked on the sunscreen product.
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| 15. |
- Gudnadottir, Gunnhildur, et al.
(author)
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The effect of telephone counseling and internet-based support on pain and recovery after tonsil surgery in children – a systematic review
- 2021
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In: International Journal of Nursing Studies Advances. - : Elsevier BV. - 2666-142X. ; 3
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Journal article (peer-reviewed)abstract
- Objectives: The recovery after tonsil surgery is often troublesome for children and caregivers often feel insecure regarding optimal post-operative care for their children at home. The aim was to study what the current literature reports regarding the effect of post-operative telephone counselling and Internet support on pain and recovery after paediatric tonsil surgery. Method: A systematic literature review was conducted where only randomised clinical trials were included. Outcome measures: Primary outcome measure was pain after surgery. Secondary outcomes also included nausea, anxiety, children's knowledge, use of analgesics, fluid intake and health care service use. Results: Only four studies fulfilled the inclusion criteria. The studies were heterogeneous, rendering a meta-analysis impossible. The results of the included studies showed a possible positive effect on postoperative pain, as well as level of anxiety, use of analgesics, fluid intake and health care service use. However, the studies were few with few included participants. Conclusion: There were indications, but no definitive evidence supporting the positive effect of telephone counselling or Internet-based support on pain and recovery after tonsil surgery in children. More research is needed to further examine these effects. ClinicalTrials.gov 12/03/2017 (NCT03292068). © 2021 The Author(s)
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| 16. |
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| 17. |
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| 18. |
- 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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| 19. |
- Hedvall, Johan, et al.
(author)
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Perspectives on Challenge-Driven Engineering Education for a Sustainable Future
- 2021
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Conference paper (peer-reviewed)abstract
- Engineering education has changed and evolved over decades in harmony with societies challenges. Today, sustainable development is of greatest importance and one way of equipping future engineers with the competencies to tackle this challenge is through Challenge Driven Education (CDE). This study takes on an exploratory approach when studying the implementation of CDE as it is formed at two different universities, one in Sweden, and one in Tanzania. By interviewing key-actors such as teachers and stakeholders who are in one way or another engaged or are about to become involved in CDE, an investigation has been conducted in order to understand how these key-actors view CDE as a successful pedagogical approach for educating engineers of the future. First, a question was asked on which competencies for sustainability could be considered important in future engineers. Second, the participants were encouraged to tell how CDE could develop from their perspective. Results show that the depiction of key competencies for sustainability correlates well with the participants views of what is important for future engineers, although it is evident that good communication between stakeholders and students/teachers about what is expected to train during a CDE course is paramount. The study also shows the importance of stakeholders trusting each other and having a common picture of what a CDE collaboration should lead to in order to achieve the best possible results of such training.
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| 20. |
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| 21. |
- Johansson, AnnaKarin, et al.
(author)
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Parents' experiences of participating in an intervention on tobacco prevention in Child Health Care
- 2014
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In: BMC Pediatrics. - : BioMed Central. - 1471-2431. ; 14:69
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Journal article (peer-reviewed)abstract
- BackgroundChild health care is an important arena for tobacco prevention in Sweden. The aim of this study was to describe parents’ experiences from participating in a nursebased tobacco prevention intervention. MethodsEleven parents were interviewed using semi-structured interviews. The material was analysed in a qualitative content analysis process. ResultsThe analysis emerged four categories; Receiving support, Respectful treatment, Influence on smoking habits and Receiving information. The parents described how the CHC nurses treated them with support and respect. They described the importance of being treated with respect for their autonomy in their decisions about smoking. They also claimed that they had received little or no information about health consequences for children exposed to environmental tobacco smoke (ETS). The findings also indicate that both the questionnaire used and the urine-cotinine test had influenced parents’ smoking. ConclusionThe clinical implication is that CHC is an important arena for preventive work aiming to minimize children’s tobacco smoke exposure. CHC nurses can play an important role in tobacco prevention but should be more explicit in their communication with parents about tobacco issues. The SiCET was referred to as an eye-opener and can be useful in the MI dialogues nurses perform in order to support parents in their efforts to protect their children from ETS.
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| 22. |
- Lundequist, Anders, et al.
(author)
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Differential regulation of Nr4a subfamily nuclear receptors following mast cell activation
- 2011
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In: Molecular Immunology. - : Elsevier BV. - 0161-5890 .- 1872-9142. ; 48, s. 1753-1761
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Journal article (peer-reviewed)abstract
- The biological function of the Nr4a subfamily of nuclear receptors is only partially understood. Here we show for the fist time that mast cell (MC) activation processes involve the regulation of Nr4a factors. Exposure of murine bone marrow-derived MCs (BMMCs) to live bacteria causes a robust and selective upregulation of all Nr4a members (Nr4a1-Nr4a3). In response to purified LPS, strong upregulation of Nr4a3, but not of Nr4a1 or Nr4a2 was seen. Nr4a3 expression was also induced after the activation of BMMCs by IgE receptor cross-linking. Moreover, Nr4a expression was induced in activated human MCs. As shown by Western blot analysis, Nr4a phosphorylation was induced by IgE receptor cross-linking and calcium ionophore stimulation of BMMCs and LAD2 cells, respectively. By using various inhibitors of signaling pathways, Nr4a3 induction in BMMCs was shown to be strongly dependent on Go6976-sensitive kinases and partially dependent on the nuclear factor of activated T-cells (NFAT) pathway, while nuclear factor kappa-light-chain-enhancer of activated B cells (NFKB) inhibition failed to inhibit Nr4a3 expression in BMMCs. Together, these data reveal selective induction of Nr4a family members in activated MCs and implicate Nr4a family nuclear receptors in the regulation of MC function. (C) 2011 Elsevier Ltd. All rights reserved.
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| 23. |
- Neikter, Susanna Allgurin, et al.
(author)
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Toward a new information infrastructure in health technology assessment : communication, design, process, and results
- 2009
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In: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 0266-4623 .- 1471-6348. ; 25:Suppl 2, s. 92-98
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Journal article (peer-reviewed)abstract
- Objectives: The aim of this study was to facilitate effective internal and external communication of an international network and to explore how to support communication and work processes in health technology assessment (HTA).Structure and Methods: European network for Health Technology Assessment (EUnetHTA) connected sixty-four HTA Partner organizations from thirty-three countries. User needs in the different steps of the HTA process were the starting point for developing an information system. A step-wise, interdisciplinary, creative approach was used in developing practical tools.Results: An Information Platform facilitated the exchange of scientific information between Partners and with external target groups. More than 200 virtual meetings were set up during the project using an e-meeting tool. A Clearinghouse prototype was developed with the intent to offering a single point of access to HTA relevant information. This evolved into a next step not planned from the outset: Developing a running HTA Information System including several Web-based tools to support communication and daily HTA processes. A communication strategy guided the communication effort, focusing on practical tools, creating added value, involving stakeholders, and avoiding duplication of effort.Conclusions: Modern technology enables a new information infrastructure for HTA. The potential of information and communication technology was used as a strategic tool. Several target groups were represented among the Partners, which supported collaboration and made it easier to identify user needs. A distinctive visual identity made it easier to gain and maintain visibility on a limited budget.
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| 24. |
- Nguyen, Thanh N, et al.
(author)
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Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: A 1-Year Follow-up.
- 2023
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In: Neurology. - 1526-632X. ; 100:4
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Journal article (peer-reviewed)abstract
- Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020).We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1-6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1-4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4-5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6-0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31-1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82-2.97], 5,656/195,539) of all stroke hospitalizations.There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.This study is registered under NCT04934020.
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| 25. |
- Norrman, Jenny, 1971, et al.
(author)
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Enriching social and economic aspects in sustainability assessments of remediation strategies – Methods and implementation
- 2020
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In: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 707
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Journal article (peer-reviewed)abstract
- Over the last decade, there has been rapid development in promoting and implementing sustainable remediation. It is now common to include at least some sustainability considerations in remediation projects. Specific challenges that have been highlighted often relate to economic and social aspects not receiving enough attention: broadening the social aspects, community and meaningful stakeholder engagement, understanding stakeholders' risk perception, and a need for better estimates of site-specific economic costs and benefits. This study presents an application of the Sustainable Choice of REmediation (SCORE) framework with special focus on (1) demonstrating the working process for a broad sustainability assessment and (2) sharing the lessons learned from its application. Specific objectives are to describe (a) the types of stakeholders involved in the assessment, (b) the methods for collection of social and economic sustainability data, (c) residents' perception of risks, (d) the use of the sustainability assessment results in the decision-making process, and (5) possibilities for improving the methods and working process. SCORE was applied and evaluated with input from, and together with, stakeholders at the BT Kemi industrial site in the village of Teckomatorp, south Sweden, a former pesticide production site associated with the most infamous Swedish environmental scandal. A questionnaire (n = 78) was used to collect input from residents regarding local acceptance and economic externalities of the remediation alternatives. Alternatives with a high degree of removal of contaminants received a high ranking in the assessment, primarily due to social and economic effects. The working process can be improved, specifically regarding workshop preparation and workshop structure. A broad representation of stakeholders and early establishment of communication channels to residents is key for robust assessment of social aspects. The information from the sustainability assessment was used in the decision-making process, not least for revising remediation options.
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| 26. |
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| 27. |
- Prentice, Honor C, et al.
(author)
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Changes in allozyme frequencies in Festuca ovina populations after a 9-year nutrient/water experiment
- 2000
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In: Journal of Ecology. - : Wiley. - 0022-0477 .- 1365-2745. ; 88:2, s. 331-347
-
Journal article (peer-reviewed)abstract
- 1 The grass Festuca ovina is an important constituent of the species-rich 'alvar' grasslands on the Baltic island of Oland. Levels of allozyme polymorphism are high and variation is known to be correlated with habitat variation (soil moisture, pH and depth). 2 A 9-year field experiment on species diversity provided replicate plots (in three sites) that had been subjected to six different experimental treatments (control; N + P + K; P + K; N + K; K; water). 3 Samples of F. ovina were collected and analyses of deviance were used to investigate associations between allele frequencies, at each of four polymorphic loci, and the nutrient/water treatments. We also used the models to estimate predicted values for the alleles in different nutrient/water treatments and in interactions involving the nutrient/water treatments and additional explanatory variables (vegetation height and clipping). 4 There were significant allozyme frequency differences between samples of F. ovina from the six different nutrient/water treatments in the grassland experiment. Frequencies in the fertilized or watered plots had diverged from those in the control plots. There were also significant allele-habitat associations (after the removal of site effects), especially at the Pgi-2 locus. 5 Soil moisture was the only variable that was common to this study and an earlier study of variation in F. ovina in natural habitats. In natural populations, the Pgi-2-2 allele was significantly associated with soil moisture and was more common in dry habitats. Our findings that the frequency of the Pgi-2-2 allele was significantly affected by the nutrient/water treatments, and that it was rarest in the treatment that involved the addition of extra water, were therefore as predicted. 6 The study supports the conclusion, from an earlier study of populations in unmanipulated grassland habitats, that selection is contributing to the fine-scale patterning of genetic variation in the alvar populations of F. ovina.
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| 28. |
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| 29. |
- Rantala, Andreas, et al.
(author)
-
Quality is in the eye of the beholder : a focus group study from the perspective of ambulance clinicians, physicians, and managers
- 2019
-
In: Healthcare (Basel, Switzerland). - 2227-9032. ; 7:1
-
Journal article (peer-reviewed)abstract
- Quality within all areas of healthcare should be systemically monitored and ensured. However, the definition of quality is complex and diverse. In the ambulance service (AS), quality has traditionally been defined as response time, but this measurement eliminates the possibility of addressing other characteristics of quality, such as the care provided. This study aimed to explore what constitutes quality in the context of the ambulance service as experienced by ambulance clinicians, physicians, and managers. A focus group study was conducted with 18 participants. The three focus groups were analyzed with the focus group method developed by Kreuger and Casey. The participants highlighted patient involvement, information and care, as well as adherence to policies, regulations, and their own standards as representing quality in the AS. This study demonstrates that quality is in the eye of the beholder. As quality seems to be viewed similarly by patients and ambulance clinicians, physicians, and managers, stakeholders should aim for a paradigm shift where patients' experience of the care is just as important as various time measures.
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| 30. |
- Rantala, Andreas, et al.
(author)
-
Quality Is in the Eye of the Beholder - A Focus Group Study from the Perspective of Ambulance Clinicians, Physicians, and Managers
- 2019
-
In: Healthcare. - : MDPI. - 2227-9032. ; 7:1
-
Journal article (peer-reviewed)abstract
- Quality within all areas of healthcare should be systemically monitored and ensured. However, the definition of quality is complex and diverse. In the ambulance service (AS), quality has traditionally been defined as response time, but this measurement eliminates the possibility of addressing other characteristics of quality, such as the care provided. This study aimed to explore what constitutes quality in the context of the ambulance service as experienced by ambulance clinicians, physicians, and managers. A focus group study was conducted with 18 participants. The three focus groups were analyzed with the focus group method developed by Kreuger and Casey. The participants highlighted patient involvement, information and care, as well as adherence to policies, regulations, and their own standards as representing quality in the AS. This study demonstrates that quality is in the eye of the beholder. As quality seems to be viewed similarly by patients and ambulance clinicians, physicians, and managers, stakeholders should aim for a paradigm shift where patients' experience of the care is just as important as various time measures.
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| 31. |
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| 32. |
- Rosen, Astrid von, 1964, et al.
(author)
-
Debating Diversity - a panel on multiple performing arts histories in a digital age
- 2020
-
In: ANTS, Scan-Aesthetics, Association of Nordic Theatre Scholars Conference 2020.
-
Conference paper (other academic/artistic)abstract
- Panel 7: Theatre Ecology in Gothenburg. Chair: Rikard Hoogland Mikael Strömberg: Entertainment as infrastructure. Sandra Grehn: Theatre for young audiences played by independent theatre groups in Gothenburg 1980-1985. Fia Adler Sandblad: Physical theatre in Gothenburg. A performance lecture. Helena Holgersson: Where the expansion was made possible: On the importance of municipal cultural and community centers. Astrid von Rosen: Debating Diversity - Developing a dig where you stand database Abstract: Debating Diversity - a panel on multiple performing arts histories in a digital age. Joint panel organized by the research project: Expansion and Diversity: Digitally mapping and exploring independent performance in Gothenburg 1965-2000, funded by the Swedish Research Council. Expansion and Diversity connects extensive digital explorations of newspapers with place and historiographical analysis in order to take on the urgent challenge of accounting for diversity in late 20th century performing arts history. The project is the first in Scandinavia to bring together historiographical criticism with new information technologies and digital methods in order to find novel ways of countering previous theatre historiography's denouncing of a multiple independent performing arts heritage. The joint panel will briefly introduce the project, offer some current challenges, and present initial results.
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| 33. |
- Rosen, Astrid von, 1964, et al.
(author)
-
Expansion och mångfald - en relationell forskningsdatabas : Expansion and Diversity - a relational research database
- 2021
-
In: Expansion och mångfald: Digital kartläggning och analys av den utominstitutionella scenkonsten i Göteborg 1965-2000.
-
Other publication (other academic/artistic)abstract
- I svenska teaterhistorier ses perioden 1965–2000 som en tid för framväxt och etablering av en utominstitutionell scenkonst. Fältet expanderande kraftigt när institutionsteatrarna utmanades av ”fria” grupper och en ny mycket varierad scenkonstkultur växte fram. Denna nya scenkonst ifrågasatte hierarkier, sökte sig ut från de traditionella scenerna, överskred genregränser, experimenterade konstnärligt och mötte en ny publik. En mångfald angelägna föreställningar för barn, migranter, arbetare, queera personer, studenter och många andra skapades av människor med olika kulturella bakgrunder och kompetenser. Historieskrivningen har observerat detta skifte, men endast lyft fram några få grupper, verk och välkända artister. Därmed har en endimensionell bild fått fäste i historieskrivningen, men nu har det blivit dags att utmana tidigare forskning genom att se perioden på ett nytt sätt och bejaka dess mångfald. Det är dags att inkludera de många olika uttrycken och grupperna i en historieskrivning som gör det fria kulturarvet rättvisa. Forskningsprojektet Expansion och mångfald vill använda digitalt material och metoder för att analysera, lyfta fram och tillgängliggöra frikulturen som ett värdefullt kulturarv som angår och engagerar många olika människor. Den viktiga mångfalden av uttryck, grupper, relationer och spelplatser i det expanderade fältet har visat sig vara svår för att hantera för traditionell historieskrivning. Den har genom sin linjära karaktär inte kunnat ge plats för exempelvis karnevalers mångfacetterade uttryck, migranters kulturföreningar, jazzdans som folkrörelse och konstnärlig katalysator, fysisk teater, spex och populärkulturella uttryck, danskonst i offentliga rum, och scenkonst för barn. Med mångfald och skillnader som utmaning för forskningen krävs att arkivmaterial från det expanderade fältet undersöks och görs tillgängligt på nya sätt och att tidigare oanvänt källmaterial görs åtkomligt och tas i anspråk. En grupp bestående av humanistiska och urban-sociologiska forskare med stor erfarenhet av scenkonstforskning och stadsanalyser kommer att tillsammans med experter från digital humaniora undersöka och tillgängliggöra den frikulturella mångfalden.
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| 34. |
- Rosen, Astrid von, 1964, et al.
(author)
-
Re-vitalizing Dig Where You Stand: Place as agent in participatory performance history
- 2020
-
In: ACHS 2020 Futures.
-
Conference paper (other academic/artistic)abstract
- By mobilizing place as a particularly pertinent agent in participatory history making, this paper contributes a Swedish case study, to the ongoing re-vitalization of the dig where you stand realm. Both contributors are leading scholars within the international and Swedish movement to update Sven Lindqvist’s Dig Where You Stand (1978) method and ethos in an increasingly digital world. Within this broader research and activist context, this paper focusses on how place oriented urban-sociological analysis, can contribute to expanding and diversifying our knowledge of downplayed independent performance heritage. First, our focus on Gothenburg, Sweden’s second city, and its suburbs, will help counter previous theatre histories national bias and over-emphasis on source materials from the capital Stockholm. Second, our “local digging” and place analysis will not only charter established venues, but also include previously neglected rehearsal studios and other types of alternative places used by local communities in their performance making. Thus, place orientation enables us to better scrutinize conditions pertinent for independent performance culture, and critically relate them to shifts in urban and cultural policies. Third, as memory strongly connects with place, interviews involving performers and their artistic practices within a diversity of cultural hubs, will contribute new knowledge challenging previous elitist and excluding theatre historiography. The research is conducted within the Swedish research project Expansion and Diversity: Digitally mapping and exploring independent performance in Gothenburg 1965–2000, situated at the University of Gothenburg.
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| 35. |
- Rosén, Helena, et al.
(author)
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‘‘A call for a clear assignment” – A focus group study of the ambulance service in Sweden, as experienced by present and former employees
- 2018
-
In: International Emergency Nursing. - : Elsevier BV. - 1755-599X. ; 36, s. 1-6
-
Journal article (peer-reviewed)abstract
- AimThe aim was to explore the ambulance service as experienced by present and former employees.BackgroundOver the last decade, the number of ambulance assignments has increased annually by about 10%, and as many as 50% of all ambulance assignments are considered non-urgent. This raises questions about which assignments the Ambulance Service (AS) is supposed to deal with.Design/methodData were collected from three focus group interviews with a total of 18 present and former employees of the Swedish AS. An inductive qualitative analysis method developed by Krueger was chosen.ResultsFive themes emerged in the analysis: “Poor guidance for practice”, “An unclear assignment”, “Being a gate keeper”, “From saving lives to self-care” and “Working in no man’s land”, which together constitute the AS.ConclusionPresent and former employees of the AS in Sweden describe their mission as unclear and recognize the lack of consensus and a clearly developed mission statement. Furthermore, expectations and training mainly focus on emergency response, which is contrary to the reality of the ambulance clinicians’ everyday work.
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| 36. |
- Rosén, Helena, et al.
(author)
-
Being the next of kin of an older person living in a nursing home : an interview study about quality of life
- 2019
-
In: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 19:1, s. 1-12
-
Journal article (peer-reviewed)abstract
- Background The length of stay in nursing homes before death in Sweden has significantly decreased, and nearly one-third of people die within 6 weeks of entering a nursing home. Support for the next of kin is one of the cornerstones of palliative care, but the principles are not always adhered to as recommended when caring for the elderly, which can affect the quality of life of their next of kin. The aim of this study was to explore the experiences of quality of life among the next of kin of older persons who live in nursing homes before an educational intervention of palliative care. Methods This is an explorative qualitative interview study with 40 next of kin using qualitative content analysis performed at baseline before the implementation of the principles of palliative care in nursing homes. Results The next of kin's experiences of quality of life were expressed in three themes: Orientation to the new life situation, Challenges in their relationship and the Significance of the quality of care in the nursing home. The next of kin experienced a sense of relief, although the older person was constantly on their minds, and they could feel lonely. The difference in the couple'slife situations was experienced as burdensome by the next of kin. The challenges in the relationship were described as stressful, related to a guilty conscience and the older person's vulnerability. The nursing home could be a context facilitating good relations. The perceptions of quality of care in terms of person-centredness affected the quality of life of the next of kin. Conclusions The findings show that four factors are decisive for the quality of life of next of kin: the relationships within the family, the degree of relief that nursing home care entails as compared to home care, the older person's health status and whether the care is person-centred. Increased knowledge and education regarding palliative care in nursing homes are needed to better meet the needs of next of kin. Implementation of palliative care should take into account the need for support for next of kin.
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| 37. |
- Rosén, Helena, et al.
(author)
-
Challenges of patient-focused care: Nurses’ descriptions and observations before and after intervention
- 2017
-
In: Nordic Journal of Nursing Research. - : SAGE Publications. - 2057-1585 .- 2057-1593. ; 37:1, s. 27-32
-
Journal article (peer-reviewed)abstract
- The concept of patient-focused care aims to provide an environment in which the healthcare team focuses on the individual patient’s needs. In order to increase our understanding of how nurses perceive and conduct patient-focused care, the issue needs to be studied in various contexts. The aims of the study were to explore nurses’ descriptions of their patient-focused care, what took place during observed situations including the time spent, before and after the change of design from a more traditional to a single-bed hospital in Sweden. Non-participant observations with follow-up interviews were carried out. Data were analysed using qualitative content analysis. Three categories emerged from the analysis: Barriers to being close to the patient, Desire to be close to the patient and The influence of environment on caring. The theme Presence or absence was interpreted as the latent meaning. The conclusion was that being present is crucial in nursing when providing compassionate and effective nursing care.
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| 38. |
- Rosén, Helena I., et al.
(author)
-
Patients' experiences and perceived causes of persisting discomfort following day surgery
- 2010
-
In: BMC Nursing. - : BioMed Central. - 1472-6955. ; 9, s. artikelnummer 16-
-
Journal article (peer-reviewed)abstract
- Background: The aim of this study was to describe patients’ experiences and perceived causes of persisting discomfort following day surgery. Earlier research has mainly covered symptoms and signs during a recovery period of up to one month, and not dealt with patients’ perceptions of what causes persisting, longer-term discomfort. Methods: This study is a part from a study carried out during the period May 2006 to May 2007 with a total of 298 day surgery patients. Answers were completed by 118 patients at 48 hours, 110 at seven days and 46 at three months to one open-ended question related to discomfort after day surgery constructed as follows: If you are stillexperiencing discomfort related to the surgery, what is the reason, in your opinion? Data was processed, quantitatively and qualitatively. Descriptive, inferential, correlation and content analyses were performed. Results: The results suggest that patients suffer from remaining discomfort e.g. pain and wound problem, with effects on daily life following day surgery up to three months. Among patients’ perceptions of factors leading to discomfort may be wrongful or suboptimal treatment, type of surgery or insufficient access to provider/information. Conclusions: The results have important implications for preventing and managing discomfort at home followingday surgery, and for nursing interventions to help patients handle the recovery period better.
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| 39. |
- Rosén, Helena I., et al.
(author)
-
Patients´ Experiences of Pain Following Day Surgery - At 48 Hours, Seven Days and Three Months
- 2011
-
In: Open Nursing Journal. - : Bentham Open. - 1874-4346. ; 5, s. 52-59
-
Journal article (peer-reviewed)abstract
- Recent studies indicate that patients experience pain after day surgery for a longer period than previously known. This requires verification. This was a prospective, descriptive correlational study. A convenience sample of 298 day surgery patients undergoing various surgical procedures was asked to report pain intensity and its interference with daily function 48 hours, seven days and three months after day surgery. Correlation and regression analyses were performed. On a NRS, 55% (n=230) reported pain (≥4) 48 hours after surgery, as did 43% (n=213) at seven days. Pain interfered with normal activities at ≥4 NRS at 48 hours and at seven days, after which it decreased.
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| 40. |
- Rosén, Helena I., et al.
(author)
-
The Recovery Process After Day Surgery Within the Symptom Management Theory
- 2014
-
In: Nursing Forum. - : John Wiley & Sons. - 1744-6198 .- 0029-6473. ; 49:2, s. 100-109
-
Journal article (peer-reviewed)abstract
- Purpose: The aim was to illustrate two cases in a postoperative situation following day surgery within the framework of the symptom management theory. Method: Template analysis using the symptom management theory. Result: Neither the woman nor the man was able to return to their normal activities, health status or functional status, within a week. Conclusion: The results illustrate how a postoperative situation may involve personal suffering up to 3 months. Practical Implication: To obtain an outcome following day surgery, as optimal as possible, improving clinical practices and routines, such as discharge criteria, guidelines, and care pathways, is necessary. © 2014 Wiley Periodicals, Inc.
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| 41. |
- Rosén, Helena
(author)
-
Patients' experiences of symptoms, discomfort and their impact on daily living following day surgery
- 2011
-
Doctoral thesis (other academic/artistic)abstract
- The frequency of day surgery continues to increase worldwide. However, knowledge of the patients experiences of symptoms and discomfort beyond the first 72 hours postoperatively remains almost nonexistent. The overall aim of this study was to describe patients' experiences of symptoms and discomforts and their impact on daily living. A prospective design was used to survey 298 patients’ symptoms and discomforts as well as their impact on daily living up to three months after a day surgery in a community hospital in Sweden. A review of previous research, published between 1992 and 2008 was completed (Paper I). The first analysis of data was descriptive and correlational; focusing on patients' perception of pain, return to normal activities and daily function over time (Paper II). The second analysis was descriptive, focusing on patients' experiences and perceived causes of persisting discomfort following day surgery (Paper III). The third analysis was qualitative, using thematic analysis of two cases (Paper IV) to examine symptom experience, components of symptom management strategies and symptom status outcomes as well as influencing factors related to person, health and illness and environment domains. Paper II: On a Numerical rating scale (NRS) (0-10) 55% (n=127) of patients rated their worst pain as >4 at 48 hours, 43% (n=91) at seven days and 34% (n=26) at three months after surgery. Pain interfered at NRS >4 with work at 48 hours and seven days, then subsided, but still reported at three months. Worst pain at 48 hours correlated significantly with return to normal activity within seven days. Paper III: Varying types of discomforts was reported by 118 patients at 48 hours, 110 at seven days and 46 at three months after surgery. Perceived causes of discomfort at three months were: type of surgery, insufficient access to provider or information and incorrect or suboptimal treatment. Paper IV: Contextual domains, Symptom Experiences, Symptom Management strategies and Symptom Status Outcomes, were used to illustrate the postoperative situation following day surgery. Concluding; despite extensive efforts, such as pain management guidelines, people may suffer for a long period after day surgery.
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| 42. |
- Rosén, Helena, et al.
(author)
-
Persons’ experiences of having hypertension – an interview study
- 2022
-
In: International Journal of Nursing Studies Advances. - : Elsevier BV. - 2666-142X. ; 4
-
Journal article (peer-reviewed)abstract
- Backgroundamong the 1–1.5 billion persons with hypertension globally only, 20–30% have controlled blood pressure (BP). The most important problem identified is non-adherence to treatment, i.e., failure to change lifestyle and to take prescribed medication. Knowledge about the reasons for this is limited.ObjectivesThe aim of the study was to explore people's experiences of having hypertension.DesignInductive design based on qualitative interviews.SettingsThe south of Sweden.ParticipantsTwelve adults diagnosed with hypertension and treated in primary care were interviewed.MethodsThe transcribed interviews were analysed using content analysis, which rendered three categories.ResultsThe individuals adapted to their diagnosis in different ways. Collaboration with the staff gave security, but the persons still perceived anxiety and uncertainty.ConclusionsTo meet the needs of people with hypertension, strategies such as person-centred counselling and care, using digital interventions, following national guidelines and starting nurse-led clinics, may be of help. These strategies can give a foundation for increased self-efficacy, which is crucial for persons to be able to change lifestyle and adhere to prescribed medication in order to achieve BP control.
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| 43. |
- Rosén, Helena, et al.
(author)
-
Psychometric properties of the WHOQOL-BREF among next of kin to older persons in nursing homes
- 2020
-
In: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525. ; 18:1
-
Journal article (peer-reviewed)abstract
- Background: The worries of next of kin about their older loved ones in nursing homes can be extensive and can adversely affect their subjective experiences of their own physical, mental and social well-being. It is thus of utmost importance to measure the quality of life of next of kin in a valid and reliable way. Methods: The design is a cross-sectional study with psychometric evaluation based on classical test theory in preparation for a planned educational intervention study on palliative care. An abbreviated version of the World Health Organization's quality-of-life self-assessment instrument WHOQOL, the Swedish WHOQOL-BREF, was completed by 254 next of kin of older persons in 30 nursing homes. Data quality was assessed via the mean, median, item response, missing values, and floor and ceiling effects. Reliability was estimated using Cronbach's alpha and corrected item-total correlations. Construct validity was estimated by Spearman's rank correlation, and model fit was assessed using confirmatory factor analysis. Results: The rate of missing data was low (less than 2%). Ceiling effects ranged from 11 to 43% and were above 20% for 21 of 24 items. The corrected item-total correlations varied between 0.35 and 0.68 and were thus well above the lower limit of 0.30. Cronbach's alpha was 0.83, indicating satisfactory internal consistency. The confirmatory factor analysis indicated a fair to close model fit (comparative fit index 0.93, root mean squared error of approximation 0.06). Conclusions: The findings suggest that the WHOQOL-BREF may constitute a reliable and valid measure of quality of life for use among next of kin to older persons in nursing homes. When interpreting the results, it is important to assess the ceiling effect, as it may restrict the ability of the WHOQOL-BREF to detect true positive changes in quality of life over time. Trial registration: NCT02708498.
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| 44. |
- Rosén, Helena, et al.
(author)
-
Symptoms following day surgery : a review of the literature
- 2009
-
In: Journal of Advanced Perioperative Care. - : Association for Perioperative Practice. - 1470-5664. ; 4:1, s. 7-18
-
Research review (peer-reviewed)abstract
- Aim: The purpose of this paper is to provide a broad-based overview of the current literature regarding patients’ experiences of symptoms following day surgery. Background: The advent of new anaesthetic and anti-emetic agents, advanced surgical techniques and the need for reduced costs for inpatient hospital services, has resulted in about 70% of all surgical procedures being undertaken as day surgery (Mattila et al 2005, Qureshi et al 2006) in many countries such as the United Kingdom (UK) (Aylin et al 2005) and Europe, Australia and North America (Jarrett 2001). As more and more types of surgery, including increasingly complex procedures, are undertaken as day surgery and with the expansion of day surgery for patients who are older, frail or who have multiple co-morbidities, there is a need to expand the knowledge base regarding patients’ symptom experience at home following day surgery. In particular, there is a need to examine the patients’ experience of symptoms longitudinally and to examine the impact of these on the return to activities of daily living (Gudex et al 2006). Method: Nursing and health care papers published in English between 1992 and April 2008 were sought, using the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database. Thirty six papers were selected and critiqued. A checklist was used to review the included studies for their type of method and the way they were designed and implemented (Goodman 1993). Findings: The wide range of studies reviewed provided further understanding of incidence, intensity and duration of symptoms experienced by patients after day surgery. Patients almost invariably report that pain and other symptoms were at their peak up to 24 hours after discharge and frequently persisted for six days or more. However, a clear picture of the symptom experience following day surgery failed to emerge because methodological differences make comparison across studies difficult. While there has been little exploration of the symptom experience longitudinally, those studies that have examined symptoms over time suggest that the patient's experience of them does have a significant impact on their ability to function in their normal social and work roles for a prolonged period of time following day surgery. In the studies reviewed when day surgery patients´ activity levels were reduced postoperatively, return to usual activity was delayed and activities of daily living were reported as difficult to manage. Conclusion: This review demonstrates that patients' experience of symptoms in the recovery period at home following day surgery is more profound than clinicians expect, lasts for a longer period and interferes with the ability to return to normal activities. However there are still gaps in knowledge particularly concerning the extent to which patients continue to experience symptoms after six days and beyond. Further research needs to explore multidimensional perspectives on symptoms together with an additional and more thorough evaluation of the impact of symptoms on daily living. Recommendations: Further research regarding these gaps in knowledge is necessary in order to develop a deeper understanding of patients’ symptom experience following day surgery and to develop appropriate assessment and intervention strategies for this population. The perioperative nurse with his or her specialised knowledge is well suited to face these challenges.
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| 45. |
- Svanström, Rune, et al.
(author)
-
Moving from theory to practice : Experience of implementing a learning supporting model designed to increase patient involvement and autonomy in care
- 2016
-
In: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 9:1
-
Journal article (peer-reviewed)abstract
- Background: In implementing new programs of care, such as person-centered care, there is a risk that the focus will be at an organizational level, instead of a level that describes what happens in the personal development among staff. The aim of this study was to describe experiences of the implementation process of a learning supporting model designed to increase patient involvement and autonomy in care. The project, which lasted 2 years, involved training sessions, supervision and reflective meetings. Over the period, the staff who participated focused on developing their dialogues with patients to make the patients aware of their own capabilities and to encourage them to be fully involved in the treatment. A reflective lifeworld approach was used. Data were collected through interviews, notes and written stories, and analyzed using hermeneutic analysis with a focus on meanings. Results: At the beginning of the project, the participants perceived the model as abstract and difficult to understand but supervision and reflection sessions enabled understanding and changed the participants' approach to caring. The participants described the model as an approach used in challenging patients to become involved in their care and to take charge of their lives when living with a chronic life-threatening disease. The participants' experience of implementing the model has not been easy but has led to increased self-confidence and feelings of improved competence in dialogue with patients. Conclusions: Using the PARISH model when critically examining the results shows that in the implementation process there were some difficulties, e.g. the context was supportive and facilitating but there was no appointed facilitator. By making participation in improvement work voluntary, the impact of such work becomes less efficient, less cost-effective and probably less sustainable. Furthermore, implementation needs encouragement since changing approaches takes time and requires patience. Group supervision sessions seem an appropriate way to translate research into practice; systematic scheduled and mandatory group supervision sessions would, therefore, probably make implementation more robust and sustainable. In addition, a well-trained facilitator would be able to motivate staff to undertake daily reflection and participate in group supervision sessions. Reflection seems to be a key component in the personal learning necessary to change work routines and approaches.
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| 46. |
- Tjörnstrand, Axel, et al.
(author)
-
The incidence rate of pituitary adenomas in western Sweden for the period 2001-2011
- 2014
-
In: European Journal of Endocrinology. - 0804-4643 .- 1479-683X. ; 171:4, s. 519-526
-
Journal article (peer-reviewed)abstract
- © 2014 European Society of Endocrinology. Objective: The number of studies on the incidence of pituitary adenomas (PAs) is limited. The aim of this study was to evaluate the standardised incidence rate (SIR) of PAs in western Sweden.Design, subjects and methods: Data from adult patients diagnosed with PAs in 2001-2011, living in the Vä stra Götaland County, were collected from the Swedish Pituitary Registry (SPR). In addition, medical records on all patients diagnosed with PAs at the six hospitals in the region were reviewed. In total, 592 patients were included in the study.Age-SIR, given as rate/100 000 inhabitants (95% CI), was calculated using the WHO 2000 standard population as a reference.Results: The total SIRfor PAswas 3.9/100 000 (3.6-4.3); 3.3/100 000 (2.9-3.7) formen and 4.7/100 000 (4.1-5.3) forwomen. Inmen, SIR increasedwith age, while inwomen SIR peaked at 25-34 years, mainly due to prolactinomas. Non-functioning PA (NFPA)was the most common PA (54%, 1.8/100 000 (1.6-2.0)) followed by prolactinomas (32%, 1.6/100 000 (1.3-1.9)), acromegaly (9%, 0.35/100 000 (0.25-0.45)), Cushing'sdisease (4%, 0.18/100 000 (0.11-0.25)) andTSH-producingPA(0.7%, 0.03/100 000 (0.00-0.05)). The proportion of macroadenomas for NFPA was 82%, prolactinomas 37%, GH-producing PA 77%, ACTH-producing PA 28% and TSH-producing PA 100%. The lifetime risk for PAs was 0.27% (0.24-0.31) in men and 0.29% (0.26-0.33) in women.Conclusion: This study provides a reliable estimate on the overall incidence of PAs and confirms an increased incidence of PAs compared with studies conducted in the pre-magnetic resonance imaging era. The lower proportion of prolactinomas compared with previous studies is probably explained by the different criteria used.
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| 47. |
- Wang, Li-San, et al.
(author)
-
Rarity of the Alzheimer Disease-Protective APP A673T Variant in the United States.
- 2015
-
In: JAMA neurology. - : American Medical Association (AMA). - 2168-6157 .- 2168-6149. ; 72:2
-
Journal article (peer-reviewed)abstract
- Recently, a rare variant in the amyloid precursor protein gene (APP) was described in a population from Iceland. This variant, in which alanine is replaced by threonine at position 673 (A673T), appears to protect against late-onset Alzheimer disease (AD). We evaluated the frequency of this variant in AD cases and cognitively normal controls to determine whether this variant will significantly contribute to risk assessment in individuals in the United States.
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| 48. |
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| 49. |
- Wensman, Helena, et al.
(author)
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Tumor-mast cell interactions: Induction of pro-tumorigenic genes and anti-tumorigenic 4-1BB in MCs in response to Lewis Lung Carcinoma
- 2012
-
In: Molecular Immunology. - : Elsevier BV. - 0161-5890 .- 1872-9142. ; 50, s. 210-219
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Journal article (peer-reviewed)abstract
- Mast cells (MCs) can have either detrimental or beneficial effects on malignant processes but the underlying mechanisms are poorly understood. Here we addressed this issue by examining the interaction between Lewis Lung Carcinoma (LLC) cells and MCs. In vivo, LLC tumors caused a profound accumulation of MCs, suggesting that LLC tumors have the capacity to attract MCs. Indeed, transwell migration assays showed that LLC-conditioned medium had chemotactic activity towards MCs, which was blocked by an antibody towards stem cell factor. In order to gain insight into the molecular mechanisms operative in tumor-MC interactions, the effect of LLC on the MC gene expression pattern was examined. As judged by gene array analysis, conditioned medium from LLC cells caused significant upregulation of numerous cell surface receptors and a pro-angiogenic Runx2/VEGF/Dusp5 axis in MCs, the latter in line with a role for MCs in promoting tumor angiogenesis. Among the genes showing the highest extent of upregulation was Tnfrsf9, encoding the anti-tumorigenic protein 4-1BB. suggesting that also anti-tumorigenic factors are induced. Quantitative RT-PCR analysis showed that 4-1BB was upregulated in a transient manner, and it was also shown that tumor cells induce 4-1BB in human MCs. Immunohistochemical analysis showed that LLC-conditioned medium induced 4-1BB also at the protein level. Together, this study provides novel insight into the molecular events associated with MC-tumor interactions and suggests that tumor cells induce both pro- and anti-tumorigenic responses in MCs. (C) 2012 Elsevier Ltd. All rights reserved.
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