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| 2. |
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| 3. |
- Bernhardsson, Susanne, 1958, et al.
(author)
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Implementation of physical activity on prescription for children with obesity in paediatric health care (IMPA): protocol for a feasibility and evaluation study using quantitative and qualitative methods
- 2022
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In: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 8:1
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Journal article (peer-reviewed)abstract
- Background: Physical inactivity is a main cause of childhood obesity which tracks into adulthood obesity, making it important to address early in life. Physical activity on prescription (PAP) is an evidence-based intervention that has shown good effect on physical activity levels in adults, but has not been evaluated in children with obesity. This project aims to evaluate the prerequisites, determinants, and feasibility of implementing PAP adapted to children with obesity and to explore children's, parents', and healthcare providers' experiences of PAP. Methods: In the first phase of the project, healthcare providers and managers from 26 paediatric clinics in Region Vastra Gotaland, Sweden, will be invited to participate in a web-based survey and a subset of this sample for a focus group study. Findings from these two data collections will form the basis for adaptation of PAP to the target group and context. In a second phase, this adapted PAP intervention will be evaluated in a clinical study in a sample of approximately 60 children with obesity (ISO-BMI > 30) between 6 and 12 years of age and one of their parents/legal guardians. Implementation process and clinical outcomes will be assessed pre- and post-intervention and at 8 and 12 months' follow-up. Implementation outcomes are the four core constructs of the Normalization Process Theory; coherence, cognitive participation, collective action, and reflexive monitoring; and appropriateness, acceptability, and feasibility of the PAP intervention. Additional implementation process outcomes are recruitment and attrition rates, intervention fidelity, dose, and adherence. Clinical outcomes are physical activity pattern, BMI, metabolic risk factors, health-related quality of life, sleep, and self-efficacy and motivation for physical activity. Lastly, we will explore the perspectives of children and parents in semi-structured interviews. Design and analysis of the included studies are guided by the Normalization Process Theory. Discussion: This project will provide new knowledge regarding the feasibility of PAP for children with obesity and about whether and how an evidence-based intervention can be fitted and adapted to new contexts and populations. The results may inform a larger scale trial and future implementation and may enhance the role of PAP in the management of obesity in paediatric health care in Sweden.
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| 4. |
- Braekeveldt, Noémie, et al.
(author)
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Patient-derived xenograft models reveal intratumor heterogeneity and temporal stability in neuroblastoma
- 2018
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In: Cancer Research. - 0008-5472. ; 78:20, s. 5958-5969
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Journal article (peer-reviewed)abstract
- Patient-derived xenografts (PDX) and the Avatar, a single PDX mirroring an individual patient, are emerging tools in preclinical cancer research. However, the consequences of intratumor heterogeneity for PDX modeling of biomarkers, target identification, and treatment decisions remain underexplored. In this study, we undertook serial passaging and comprehensive molecular analysis of neuroblastoma orthotopic PDXs, which revealed strong intrinsic genetic, transcriptional, and phenotypic stability for more than 2 years. The PDXs showed preserved neuroblastoma-associated gene signatures that correlated with poor clinical outcome in a large cohort of patients with neuroblastoma. Furthermore, we captured spatial intratumor heterogeneity using ten PDXs from a single high-risk patient tumor. We observed diverse growth rates, transcriptional, proteomic, and phosphoproteomic profiles. PDX-derived transcriptional profiles were associated with diverse clinical characteristics in patients with high-risk neuroblastoma. These data suggest that high-risk neuroblastoma contains elements of both temporal stability and spatial intratumor heterogeneity, the latter of which complicates clinical translation of personalized PDX-Avatar studies into preclinical cancer research.
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| 5. |
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| 6. |
- Båth, Magnus, 1974, et al.
(author)
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Investigation of image components affecting the detection of lung nodules in digital chest radiography
- 2005
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In: Progress in Biomedical Optics and Imaging - Proceedings of SPIE. - : SPIE. - 1605-7422. ; 5749, s. 231-242
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Journal article (other academic/artistic)abstract
- The aim of this work was to investigate and quantify the effects of system noise, nodule location, anatomical noise and anatomical background on the detection of lung nodules in different regions of the chest x-ray. Simulated lung nodules of diameter 10 mm but with varying detail contrast were randomly positioned in four different kinds of images: 1) clinical images collected with a 200 speed CR system, 2) images containing only system noise (including quantum noise) at the same level as the clinical images, 3) clinical images with removed anatomical noise, 4) artificial images with similar power spectrum as the clinical images but random phase spectrum. An ROC study was conducted with 5 observers. The detail contrast needed to obtain an Az of 0.80, C0.8, was used as measure of detectability. Five different regions of the chest x-ray were investigated separately. The C0.8 of the system noise images ranged from only 2% (the hilar regions) to 20% (the lateral pulmonary regions) of those of the clinical images. Compared with the original clinical images, the C0.8 was 16% lower for the de-noised clinical images and 71% higher for the random phase images, respectively, averaged over all five regions. In conclusion, regarding the detection of lung nodules with a diameter of 10 mm, the system noise is of minor importance at clinically relevant dose levels. The removal of anatomical noise and other noise sources uncorrelated from image to image leads to somewhat better detection, but the major component disturbing the detection is the overlapping of recognizable structures, which are, however, the main aspect of an x-ray image.
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| 7. |
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| 8. |
- Båth, Magnus, 1974, et al.
(author)
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Nodule detection in digital chest radiography: effect of anatomical noise.
- 2005
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In: Radiation protection dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 114:1-3, s. 109-13
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Journal article (peer-reviewed)abstract
- The image background resulting from imaged anatomy can be divided into those components that are meaningful to the observers, in the sense that they are recognised as separate structures, and those that are not. These latter components (reffered to as anatomical noise) can be removed using a method developed within the RADIUS group. The aim of the present study was to investigate whether the removal of the anatomical noise results in images where lung nodules with lower contrast can be detected. A receiver operating characteristic (ROC) study was therefore conducted using two types of images: clinical chest images and chest images in which the anatomical noise had been removed. Simulated designer nodules with a full-width-at-fifth-maximum of 10 mm but with varying contrast were added to the images. The contrast needed to obtain an area under the ROC curve of 0.80, C0.8, was used as a measure of detectability (a low value of C0.8 represents a high detectability). Five regions of the chest X ray were investigated and it was found that in all regions the removal of anatomical noise led to images with lower C0.8 than the original images. On average, C0.8 was 20% higher in the original images, ranging from 7% (the lateral pulmonary regions) to 41% (the upper mediastinal regions).
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| 9. |
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| 10. |
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| 11. |
- Båth, Magnus, 1974, et al.
(author)
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Nodule detection in digital chest radiography: introduction to the RADIUS chest trial.
- 2005
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In: Radiation protection dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 114:1-3, s. 85-91
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Journal article (peer-reviewed)abstract
- Most digital radiographic systems of today have wide latitude and are hence able to provide images with a small constraint on dose level. This opens up for an unprejudiced dose optimisation. However, in order to succeed in the optimisation task, good knowledge of the imaging and detection processes is needed. As a part of the European-wide research project 'unification of physical and clinical requirements for medical X-ray imaging'-governed by the Radiological Imaging Unification Strategies (RADIUS) Group-a major image quality trial was conducted by members of the group. The RADIUS chest trial was focused on the detection of lung nodules in digital chest radiography with the aims of determining to what extent (1) the detection of a nodule is dependent on its location, (2) the system noise disturbs the detection of lung nodules, (3) the anatomical noise disturbs the detection of lung nodules and (4) the image background and anatomical background act as pure noise for the detection of lung nodules. The purpose of the present paper is to give an introduction to the trial and describe the framework and set-up of the investigation.
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| 12. |
- Båth, Magnus, 1974, et al.
(author)
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Nodule detection in digital chest radiography: part of image background acting as pure noise.
- 2005
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In: Radiation protection dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 114:1-3, s. 102-8
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Journal article (peer-reviewed)abstract
- There are several factors that influence the radiologist's ability to detect a specific structure/lesion in a radiograph. Three factors that are commonly known to be of major importance are the signal itself, the system noise and the projected anatomy. The aim of this study was to determine to what extent the image background acts as pure noise for the detection of subtle lung nodules in five different regions of the chest. A receiver operating characteristic (ROC) study with five observers was conducted on two different sets of images, clinical chest X-ray images and images with a similar power spectrum as the clinical images but with a random phase spectrum, resulting in an image background containing pure noise. Simulated designer nodules with a full-width-at-fifth-maximum of 10 mm but with varying contrasts were added to the images. As a measure of the part of the image background that acts as pure noise, the ratio between the contrast needed to obtain an area under the ROC curve of 0.80 in the clinical images to that in the random-phase images was used. The ratio ranged from 0.40 (in the lateral pulmonary regions) to 0.83 (in the hilar regions) indicating that there was a large difference between different regions regarding to what extent the image background acted as pure noise; and that in the hilar regions the image background almost completely acted as pure noise for the detection of 10 mm nodules.
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| 13. |
- Bäckman, Malin, et al.
(author)
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A randomized pilot study with daily walking during adjuvant chemotherapy for patients with breast and colorectal cancer
- 2014
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In: Acta Oncologica. - 0284-186X .- 1651-226X. ; 53:4, s. 510-520
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Journal article (peer-reviewed)abstract
- Background. Physical activity during chemotherapy has been shown in several studies to reduce fatigue, improve symptoms and impact positively on health-related quality of life (HRQoL). Challenges associated with intervention studies on physical activity during cancer treatment relate to consistent adherence. The primary objective was to study feasibility and adherence of physical activity intervention among patients with cancer during adjuvant chemotherapy treatment. The secondary objective was to investigate the effects of physical activity on health aspects, including HRQoL, symptoms and surrogate markers for cardiovascular disease. Material and methods. This randomized controlled trial included patients with breast cancer (BRCA) and colorectal cancer (CRC) during adjuvant chemotherapy. The intervention continued for 10 weeks and included daily walks of 10 000 steps and a weekly supervised group walk. Adherence was assessed by a pedometer and the number of participants who reported step counts every week and percentage of participants who achieved the target steps every week. Results. Adherence average reached 91% during the intervention period; in total 74% completed the exercise intervention. The majority of the participants achieved an average of 83% of the target of 10 000 steps per day for 10 weeks. There was a significant increase in daily physical activity (p = 0.016) in the intervention group. Significant differences were also found for some breast cancer-specific symptoms [swelling, mobility and pain (p = 0.045)]. The study showed a relatively small weight gain an average of 0.9 kg in the intervention group and 1.3 kg in the control group. Conclusion. Physical activity in the form of walking is feasible during adjuvant chemotherapy treatment despite increasing symptoms. The physical activity increased in the intervention group during the study time and had a positive impact on breast symptoms and the weight gain was lower in comparison to previous studies.
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| 14. |
- Börjesson, Sara, et al.
(author)
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A software tool for increased efficiency in observer performance studies in radiology.
- 2005
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In: Radiation protection dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 114:1-3, s. 45-52
-
Journal article (peer-reviewed)abstract
- Observer performance studies are time-consuming tasks, both for the participating observers and for the scientists collecting and analysing the data. A possible way to optimise such studies is to perform them in a completely digital environment. A software tool-ViewDEX (Viewer for Digital Evaluation of X-ray images)-has been developed in Java, enabling it to function on almost any computer. ViewDEX is designed to handle several types of studies, such as visual grading analysis (VGA), image criteria scoring (ICS) and receiver operating characteristics (ROC). The results from each observer are saved in a log file, which can be exported for further analysis in, for example, a special software for analysing ROC results. By using ViewDEX for an ROC experiment, an evaluation rate of approximately 200 images per hour can be achieved, compared to approximately 25 images per hour using hard copy evaluation. The results are obtained within minutes of completion of the viewing. The risk of human errors in the process of data collection and analysis is also minimised. The viewer has been used in a major trial containing approximately 2700 images.
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| 15. |
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| 16. |
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| 17. |
- Börjesson, Susanne, 1956-, et al.
(author)
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Colored body images reveal the perceived intensity anddistribution of pain in women with breast cancer treated with adjuvant taxanes: : a prospective multi-method study of pain experience
- 2018
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In: Scandinavian Journal of Pain. - Berlin/Boston : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; , s. 581-591
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Research review (peer-reviewed)abstract
- Background and aims:Breast cancer is the most prevalent adult cancer worldwide. A broader use of screening for early detection and adjuvant systemic therapy with chemotherapy has resulted in improved survival rates. Taxane-containing chemotherapy is one of the cornerstones of the treatment. However, taxane-containing chemotherapy may result in acute chemotherapy-induced nociceptive and neuropathic pain. Since this pain may be an additional burden for the patient both during and after taxane chemotherapy, it is important to rapidly discover and treat it. There is yet no gold standard for assessing taxane-induced pain. In the clinic, applying multiple methods for collecting information on pain may better describe the patients’ pain experiences. The aim was to document the pain during and after taxane through the contribution of different methods for collecting information on taxane-induced pain. Fifty-three women scheduled for adjuvant sequential chemotherapy at doses of ≥75 mg/m2 of docetaxel and epirubicin were enrolled in the study.Methods:Prospective pain assessments were done on a visual analog scale (VAS) before and during each cycle of treatment for about 5 months, and using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire’s (EORTC-QLQ-C30) two pain questions at baseline, 3 months, and 12 months. Participants scoring pain on the VAS >30 and undergoing an interview also colored their pain on a body image during treatment and at 12 months.Results:Surprisingly widespread, intense pain was detected using a multi-method approach. The colored body image showed pain being perceived on 51% of the body surface area during treatment, and on 18% 12 months after inclusion. In general, the pain started and peaked in intensity after the first cycle of taxane. After Cycle 3, most women reported an increase in pain on the VAS. Some women continued to report some pain even during the epirubicin cycles. The VAS scores dropped after the last chemotherapy cycle, but not to the baseline level. At baseline, 3 months and 12 months after inclusion, the women who estimated VAS >30 reported higher levels of pain on the pain questions of the EORTC-QLQ-C30.Conclusions:This study contributes information on how different pain assessment tools offer different information in the assessment of pain. The colored body image brings another dimension to pain diagnostics, providing additional information on the involved body areas and the pain intensities as experienced by the women. A multi-method approach to assessing pain offers many advantages. The timing of the assessment is important to properly assess pain.Implications:Pain relief needs to be included in the chemotherapy treatment, with individual assessment and treatment of pain, in the same way as is done in chemotherapy-triggered nausea. There is a time window whereby the risk of pain development is at its highest within 24–48 h after receiving taxane chemotherapy. Proper attention to pain evaluation and treatment should be in focus during this time window.
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| 18. |
- Börjesson, Susanne, 1957
(author)
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Computer Modelling of the Interaction between Water and Complex Solid Phases
- 1997
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Doctoral thesis (other academic/artistic)abstract
- In this work the program package PASSIPHIC is described. The program has been developed to calculate the equilibrium for an aqueous phase in contact with a complex solid. The complex solid is considered as consisting of pure minerals and /or solid solutions. Cement has been used as an example. Cementitious materials are likely to be present in large quantities in repositories for radioactive waste. The chemistry in the vicinity of such a repository will hence be influenced by the cement. Cement has been shown to serve as an immobiliser of many elements due to its high internal pH (> 12.5), large surface area and the ability of the hydrated phases in the cement matrix to incorporate radionuclides. Thus, the modelling of the evolution of cement-water interaction is an important factor in determining the release rates of radionuclides from a repository for radioactive waste. The PASSIPHIC program has been used to simulate leaching of cement with non-saline groundwater and the result is compared to experimental data. The agreement between experimental and calculated data has been found to be good.
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| 19. |
- Börjesson, Vanja, et al.
(author)
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TC-hunter: identification of the insertion site of a transgenic gene within the host genome
- 2022
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In: Bmc Genomics. - : Springer Science and Business Media LLC. - 1471-2164. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: Transgenic animal models are crucial for the study of gene function and disease, and are widely utilized in basic biological research, agriculture and pharma industries. Since the current methods for generating transgenic animals result in the random integration of the transgene under study, the phenotype may be compromised due to disruption of known genes or regulatory regions. Unfortunately, most of the tools that predict transgene insertion sites from high-throughput data are not publicly available or not properly maintained. Results: We implemented TC-hunter, Transgene-Construct hunter, an open tool that identifies transgene insertion sites and provides simple reports and visualization aids. It relies on common tools used in the analysis of high-throughput data and makes use of chimeric reads and discordant read pairs to identify and support the transgenic insertion site. To demonstrate its applicability, we applied TC-hunter to four transgenic mice samples harboring the human PPM1D gene, a model used in the study of malignant tumor development. We identified the transgenic insertion site in each sample and experimentally validated them with Touchdown-polymerase chain reaction followed by Sanger sequencing. Conclusions: TC-hunter is an accessible bioinformatics tool that can automatically identify transgene insertion sites from DNA sequencing data with high sensitivity (98%) and precision (92.45%). TC-hunter is a valuable tool that can aid in evaluating any potential phenotypic complications due to the random integration of the transgene and can be accessed at https://github.com/bcfgothenburg/SSF.
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| 20. |
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| 21. |
- Forsberg, Håkan, 1981-
(author)
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Kampen om eleverna : Gymnasiefältet och skolmarknadens framväxt i Stockholm, 1987–2011
- 2015
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Doctoral thesis (other academic/artistic)abstract
- The Swedish educational reforms in the beginning of the 1990s, introducing a public-funded voucher system, free school choice and the right to run schools as commercial enterprises, had an important impact on upper secondary education. The Stockholm region, the most populous in Sweden, offered favourable conditions for the growth of a previously non-existent educational market. A massive expansion of independent schools took place, managed primarily by larger companies, along with the extensive marketing of profiled study programmes and the import of management models from the private sector. In 2011 alone, schools competed for 75 000 pupils representing an annual economic value of approximately 8.5 billion SEK.Covering the period 1988 to 2011, this thesis analyses the relationship between the educational market and upper secondary education as a social field structured by the educational strategies of social groups. Building on Bourdieu’s relational sociology, the study combines quantitative and qualitative methods, using correspondence analysis as a major analytical tool.While free school choice and the voucher system established a supply-demand relationship between schools and families and pupils, the analysis shows that the market has submitted to the same forces that structure the field of upper secondary education within which it unfolds, primarily the volume and composition of symbolic and other assets that students, families and schools possess. In fact, the social structure of the field of upper secondary education in Stockholm remains remarkably stable over time, opposing on the one hand female and male dominated education and on the other hand education with high social and scholarly recruitment to that with low. Euclidean clustering analysis unveils a complex social structure reflecting how the increasingly differentiated educational supply has adapted to the needs of various social groups. Elite schools, market-oriented schools and market-exposed schools develop different strategies in the battle over pupils. Competing amongst themselves for pupils rich in inherited and acquired capital, the elite schools withdraw from the openly market-oriented approach that characterises the other type of schools and instead opt for more subtle, long-term strategies for building up trust from their audience, involving investments in staff and other institutional assets.
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| 22. |
- Granstam, Elisabet, et al.
(author)
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Reduced occurrence of severe visual impairment after introduction of anti-Vascular Endothelial Growth Factor in wet age-related macular degeneration : a population- and register-based study from northern Sweden
- 2016
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In: Acta Ophthalmologica. - : Wiley. - 1755-375X .- 1755-3768. ; 94:7, s. 646-651
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Journal article (peer-reviewed)abstract
- PurposeTo study the occurrence of severe visual impairment (SVI) and treatment outcome at 12months in patients treated for wet age-related macular degeneration (AMD) by use of data from the Swedish Macula Register (SMR) and referrals to the regional low vision clinics in five northern counties. MethodsReferrals to low vision clinics during 2005, 2009 and 2013 and treatment outcome at 12months from the SMR database from 2008 until 2013 in patients >65years of age in five northern counties were included in the survey. ResultsThe rate of referral due to AMD was significantly reduced during the time period (-48%; p<0.001). At 12months, a significant slight mean improvement in logMAR visual acuity (VA) was observed (-0.01, SD 0.37; p<0.001) after a mean of 5.02.3 anti-vascular endothelial growth factor (VEGF)-injections were administered. Age and low baseline VA was associated with less favourable visual outcome (p<0.001). ConclusionReferral rate to low vision clinic is a valuable tool for estimating occurrence of SVI and fell between the years 2005 until 2013. Data from the SMR showed improvement in visual acuity on the whole, but also identified patients at high risk for developing SVI during anti-VEGF-treatment.
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| 23. |
- Gustafsson, Johanna, et al.
(author)
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Predictors of the first cardiovascular event in patients with systemic lupus erythematosus : a prospective cohort study
- 2009
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In: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 11:6, s. R186-
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Journal article (peer-reviewed)abstract
- INTRODUCTION :Cardiovascular disease (CVD) is a major cause of premature mortality among Systemic lupus erythematosus (SLE) patients. Many studies have measured and evaluated risk factors for premature subclinical atherosclerosis, but few studies are prospective and few have evaluated risk factors for hard endpoints, i.e. clinically important cardiovascular events (CVE). We investigated the impact of traditional and lupus associated risk factors for the first ever CVE in a longitudinal cohort of SLE patients.METHODS : A total of 182 SLE patients (mean age 43.9 years) selected to be free of CVE were included. Cardiovascular and autoimmune biomarkers were measured on samples collected after overnight fasting at baseline. Clinical information was collected at baseline and at follow up. End point was the first ever CVE (ischemic heart, cerebrovascular or peripheral vascular disease or death due to CVD). Impact of baseline characteristics/biomarkers on the risk of having a first CVE was evaluated with Cox regression.RESULTS :Follow up was 99.5% after a mean time of 8.3 years. Twenty-four patients (13%) had a first CVE. In age-adjusted Cox regression, any positive antiphospholipid antibody (aPL), elevated markers of endothelial activation (von Willebrand factor (vWf), soluble vascular cellular adhesion molecule-1 (sVCAM-1)) and fibrinogen predicted CVEs. Of SLE manifestations, arthritis, pleuritis and previous venous occlusion were positively associated with future CVEs while thrombocytopenia was negatively associated. Among traditional risk factors only age and smoking were significant predictors. In a multivariable Cox regression model age, any positive aPL, vWf and absence of thrombocytopenia were all predictors of the first CVE.CONCLUSIONS : In addition to age, positive aPL, biomarkers indicating increased endothelial cell activity/damage, and absence of thrombocytopenia were independent predictors of CVEs in this prospective study. Our results indicate that activation of the endothelium and the coagulation system are important features in SLE related CVD. Furthermore, we observed that the risk of CVEs seems to differ between subgroups of SLE patients.
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| 24. |
- Hellerstedt Börjesson, Susanne, 1956-
(author)
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Taxane-induced pain : Experiences of women with breast cancer and nurses providing their care
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Breast cancer patients receiving taxane chemotherapy run a substantial risk of develop taxane-induced pain, but little is known about women’s experiences of such pain. The aim of this thesis was to explore women’s acute and longstanding experiences of taxane-induced pain, to evaluate the pain intensity and distribution using different assessment methods, and to study nurses´ perceptions of taxane-induced pain in people with breast cancer.The women experienced pain during chemotherapy with 37– 48% incidence of acute taxane-induced pain. The subjective burden of taxane-induced pain described by the women covered narratives from manageable pain to very difficult and disabling pain with a major impact on their lifeworld (Study I).Longstanding pain in the lifeworld of women with previous breast cancer, was explored through a retrospective reflection after 12 months. The descriptions of pain revealed a time perspective; as pain perceived at that specific time, currently ongoing pain, and pain expectations for the future. This resulted in the women sensing themselves of being somewhere between health and illness gazing into an uncertain future (Study II).A quantitative longitudinal assessment of taxane-induced pain using; the body image, the VAS, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) showed the women’s estimated pain; its intensity, distribution and occurrence - as it appeared during the actual taxane treatment and up to a year afterward. The baseline measurement on the VAS revealed low initial pain, VAS <10, which changed at treatment Cycle 1. The body image revealed intense and widespread pain, and pain after 12 months, as did the EORTC QLQ -C30 (Study III).The nurses’ estimations of taxane-induced pain varied to large extent in both prevalence and intensity. Large parts of the body were expected to be involved in the pain. Nurses lacked local and/or national guidelines reflecting a low level of generalized use of prophylaxis against taxane pain (Study IV).In conclusion, taxane-induced pain is a common debilitating symptom during taxane chemotherapy for women with breast cancer. Pain impacts women´s life during as well as long time after the completion of taxane treatment. Taxane pain can be accurately or successfully estimated using various pain assessment tools. Furthermore, guidelines for dealing with taxane-induced pain are needed.
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| 25. |
- Hellerstedt-Börjesson, Susanne, et al.
(author)
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Women Treated for Breast Cancer Experiences of Chemotherapy-Induced Pain Memories, Any Present Pain, and Future Reflections
- 2016
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In: Cancer Nursing. - 0162-220X .- 1538-9804. ; 39:6, s. 464-472
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Journal article (peer-reviewed)abstract
- Background: Breast cancer survivors make up a growing population facing treatment that poses long-standing adverse effects including chemotherapy-related body function changes and/or pain. There is limited knowledge of patients' lived experiences of chemotherapy-induced pain (CHIP). Objective: The aim of this study was to explore CHIP and any long-standing pain experiences in the lifeworld of breast cancer survivors. Methods: Fifteen women participated in a follow-up interview a year after having experienced CHIP. They were interviewed from a lifeworld perspective; the interviews were analyzed through guided phenomenology reflection. Results: A past perspective: CHIP is often described in metaphors, leads to changes in a patient's lifeworld, and impacts lived time. The women become entirely dependent on others but at the same time feel isolated and alone. Existential pain was experienced as increased vulnerability. Present perspective: Pain engages same parts of the body, but at a lower intensity than during CHIP. The pain creates time awareness. Expected normality in relationships/daily life has not yet been achieved, and a painful existence emerges in-between health and illness. Future perspective: There are expectations of pain continuing, and there is insecurity regarding whom to turn to in such cases. A painful awareness emerges about one's own and others' fragile existence. Conclusions: Experiencing CHIP can impact the lifeworld of women with a history of breast cancer. After CHIP, there are continued experiences of pain that trigger insecurity about whether one is healthy. Implications for Practice: Cancer survivors would likely benefit from communication and information about and evaluation of CHIP.
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| 26. |
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| 27. |
- Hellerstedt-Börjesson, Susanne, et al.
(author)
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Women With Breast Cancer : Experience of Chemotherapy-Induced Pain: Triangulation of Methods
- 2015
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In: Cancer Nursing. - 0162-220X .- 1538-9804. ; 38:1, s. 31-39
-
Journal article (peer-reviewed)abstract
- BACKGROUNDChemotherapy treatment for cancer diseases can cause body pain during adjuvant therapy.OBJECTIVEThe aim was to describe the perceived impact of adjuvant chemotherapy-induced pain (CHIP) on the daily lives of women with newly diagnosed breast cancer, using triangulation.METHODFifty-seven women scheduled for chemotherapy in doses of 75 mg/m2 or greater of epirubicin and/or docetaxel participated. Twenty-two of these women registered pain with values of 4 or more on the visual analog scale on day 10 following chemotherapy. Of these 22, 16 participated in an interview and colored a printed body image. A qualitative thematic stepwise analysis of the interviews was performed.RESULTSChemotherapy-induced pain had a profound impact on daily life. Ten women reported the worst possible pain, with visual analog scale scores of 8 to 10. Three different categories crystallized: perception (A) of manageable pain, which allowed the women to maintain their daily lives; perception (B) of pain beyond imagination, whereby the impact of pain had become more complex; and perception (C) of crippling pain, challenging the women's confidence in survival.CONCLUSIONSThe findings highlight the inability to capture CHIP with 1 method only; it is thus necessary to use complimentary methods to capture pain. We found that pain had a considerable impact on daily life, with surprisingly high scores of perceived pain, findings that to date have been poorly investigated qualitatively.IMPLICATIONS FOR PRACTICENurses need to (1) better identify, understand and treat CHIP, using instruments and protocols; and (2) provide improved communication about pain and pain management.
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| 28. |
- Håkansson, Markus, et al.
(author)
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Nodule detection in digital chest radiography: effect of nodule location.
- 2005
-
In: Radiation protection dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 114:1-3, s. 92-6
-
Journal article (peer-reviewed)abstract
- Most detection studies in chest radiography treat the entire chest image as a single background or divided into the two regions parenchyma and mediastinum. However, the different parts of the lung show great variations in attenuation and structure, leading to different amounts of quantum noise and scattered radiation as well as different complexity. Detailed data on the difference in detectability in the different regions are of importance. The purpose of this study was to quantify the difference in detectability between different regions of a chest image. The chest X ray was divided into six different regions, where each region was considered to be uniform in terms of detectability. Thirty clinical chest images were collected and divided into the different regions. Simulated designer nodules with a full-width-at-fifth-maximum of 10 mm but with varying contrast were added to the images. An equal number of images lacking pathology were included and a receiver operating characteristic (ROC) study was conducted with five observers. Results show that the image contrast needed to obtain a constant value of A(z) (area under an ROC curve) differs by more than a factor of four between different regions.
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| 29. |
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| 30. |
- Håkansson, Markus, et al.
(author)
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Nodule detection in digital chest radiography: effect of system noise.
- 2005
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In: Radiation protection dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 114:1-3, s. 97-101
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Journal article (peer-reviewed)abstract
- Apart from the image content that is the reproduction of anatomy and possible lesions, an X-ray image also contains system noise due to the limited number of photons and other internal noise sources in the system (image plate artefacts, electronic noise, etc.). The aim of this study was to determine the extent to which the system noise influences the detection of subtle lung nodules in five different regions of the chest. This was done by conducting a receiver operating characteristic (ROC) study with five observers on two different sets of images; clinical chest X-ray images and images of a LucAl phantom at similar dose levels found in the different regions of the chest. In both image types, mathematically simulated nodules (with a full-width-at-fifth-maximum of 10 mm) were added to the images at varying contrast levels. As a measure of the influence of system noise on the detection of subtle lung nodules, the ratio between the contrast needed to obtain an area under the ROC curve of 0.80 in the system noise images to that needed in the clinical images was used. The contrast ratio between system noise images and clinical images ranged from approximately 0.02 (in the hilar region) to 0.18 (in the lower mediastinal region). The maximum difference in contrast needed for the corresponding system noise images, collected at the lowest and the highest dose represented in the anatomical image, was a factor of 2. These results indicate that probably no region in a chest X-ray image is limited by the number of quanta to the detector for the detection of 10 mm lung nodules when a radiation dose corresponding to a system with speed class 200 (leading to a detector dose of approximately 9 muGy behind the parenchyma) is used.
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| 33. |
- Håkansson, Markus, et al.
(author)
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Nodule detection in digital chest radiography: summary of the RADIUS chest trial.
- 2005
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In: Radiation protection dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 114:1-3, s. 114-20
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Journal article (peer-reviewed)abstract
- As a part of the Europe-wide research project 'Unification of physical and clinical requirements for medical X-ray imaging'-governed by the Radiological Imaging Unification Strategies (RADIUS) Group-a major image quality trial was conducted by members of the group. The RADIUS chest trial aimed at thoroughly examining various aspects of nodule detection in digital chest radiography, such as the effects of nodule location, system noise, anatomical noise, and anatomical background. The main findings of the RADIUS chest trial concerning the detection of a lung nodule with a size in the order of 10 mm can be summarised as: (1) the detectability of the nodule is largely dependent on its location in the chest, (2) the system noise has a minor impact on the detectability at the dose levels used today, (3) the disturbance of the anatomical noise is larger than that of the system noise but smaller than that of the anatomical background and (4) the anatomical background acts as noise to a large extent and is the major image component affecting the detectability of the nodule.
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| 34. |
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| 35. |
- Lawrence, Akvile, et al.
(author)
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Ethanol, BTEX and microbial community interactions in E-blend contaminated soil slurry
- 2009
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In: INTERNATIONAL BIODETERIORATION and BIODEGRADATION. - : Elsevier BV. - 0964-8305. ; 63:6, s. 654-666
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Journal article (peer-reviewed)abstract
- Degradation of benzene, toluene, ethylbenzene, m-, p- and o-xylenes (BTEX) and microbial community shifts in soil slurries contaminated with ethanol-gasoline blends (E-blends), containing 10, 50 or 90% (v/v) ethanol (E10, E50 and E90) were studied in soil slurries previously uncontaminated, contaminated by E-blends or ethanol. BTEX originating from E50 degraded fastest whereas from E10 slowest. Among the individual compounds, ethylbenzene degraded fastest (max 30% d(-1)), and o-xylene slowest (min 1% d(-1)) during aerobic conditions in previously not contaminated soils. Previous contamination by E-blends increased BTEX degradation significantly (3-19 times) compared with previously uncontaminated soils, whereas previous contamination with ethanol did not show significant difference in BTEX degradation. At least one type of the E-blends during aerobic conditions had a positive effect on total PLFAs (phospholipid fatty acids) and specific PLFAs, i.e. 10Me18:0, 16:1w6 and cy17:0, but had a negative effect on cy19:0 and 18:2w6,9c. The effects on total PLFAs, as well as the individual PLFAs, were particularly strong after repeated contamination. The single most affected PLFA was 16:1w6, which increased 23 times during E10 treatment in soil slurries previously contaminated by E-blends. Altogether, the various E-blends had significantly different effects on BTEX degradation and also on individual PLFAs under aerobic conditions.
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| 36. |
- Milberg, Anna, 1966-, et al.
(author)
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Advanced palliative home care : next-of-kin's perspective
- 2003
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In: Journal of Palliative Medicine. - : Mary Ann Liebert Inc. - 1096-6218 .- 1557-7740. ; 6:5, s. 749-756
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Journal article (peer-reviewed)abstract
- Goals: (1) To describe what aspects are important when next-of-kin evaluate advanced palliative home care (APHC) and (2) to compare the expressed aspects and describe eventual differences among the three settings, which differed in terms of length of services, geographic location, and population size.Subjects and methods: Four to 7 months after the patient's death (87% from cancer), 217 consecutive next-of-kin from three different settings in Sweden responded (response rate 86%) to three open-ended questions via a postal questionnaire. Qualitative content analysis was performed.Main results: Service aspects and comfort emerged as main categories. The staff's competence, attitude and communication, accessibility, and spectrum of services were valued service aspects. Comfort, such as feeling secure, was another important aspect and it concerned the next-of-kin themselves, the patients, and the families. Additionally, comfort was related to interactional issues such as being in the center and sharing caring with the staff. The actual place of care (i.e., being at home) added to the perceived comfort. Of the respondents, 87% described positive aspects of APHC and 28% negative aspects. No major differences were found among the different settings.Conclusions: Next-of-kin incorporate service aspects and aspects relating to the patient's and family's comfort when evaluating APHC. The importance of these aspects is discussed in relation to the content of palliative care and potential goals.
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| 37. |
- Niklasson, Boel, et al.
(author)
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Intraoperative injection of bupivacaine-adrenaline close to the fascia reduces morphine requirements after cesarean section : a randomized controlled trial
- 2012
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:12, s. 1433-1439
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Journal article (peer-reviewed)abstract
- Objective. The purpose of this study was to investigate whether a single injection of bupivacaine with adrenaline close to the fascia could decrease opiate consumption and pain in patients undergoing cesarean section in spinal anesthesia. Design. Randomized double-blind controlled study. Settings. Karolinska University Hospital, Huddinge, Sweden. Population. 260 women scheduled for elective cesarean section were enrolled in the study. Methods. The treatment group (n= 130) received 40 mL bupivacaine (2.5 mg/mL) with adrenaline (5 μg/mL) (Marcain® adrenalin) and the control group (n= 130) received 40 mL saline solution (0.9%), which was, in both groups, injected close to the fascia before closure of the wound. Main outcome measures. Morphine consumption and mean resting pain intensity numerical rating scale at 12 and 24 hours were the primary outcome variables. Other assessments for pain as well as mobilization parameters were considered secondary. Results. Morphine requirements were significantly less in the bupivacaine group, 19.0 mg/woman, compared with 24.0 mg/woman in the placebo group, during the first 12 postoperative hours. During this time period there was also a trend towards a difference between groups in mean pain intensity, but significant only during the first six hours. Over the whole first postoperative 24 hours, there were no differences in either morphine requirement or pain intensity between groups. Conclusions. A single injection of bupivacaine with adrenaline in the surgical wound decreases the need for morphine requirements for the first 12 postoperative hours and contributes to safe and effective pain management in women undergoing cesarean section.
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| 39. |
- Ohlsson-Nevo, Emma, 1960-
(author)
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Colorectal cancer : patients’ and next-of-kin’s experiences and the effects of a psycho-educational program
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Purpose: To test whether a psycho-educational program affects mental wellbeing in persons treated for colorectal cancer and their next-of-kin.Design: A prospective, longitudinal, randomized controlled trial.Setting: Surgical clinic at a university hospital in Sweden.Sample: 105 colorectal cancer patients and 71 next-of-kin were allocated to a psychoeducational program or to standard care.Methods: Mental wellbeing was evaluated with the Mood Adjective Check List and The Hospital Anxiety and Depression Scale at baseline and at 1, 6, and 12 months. The program consisted of seven meetings, including lecture and time for reflection with other patients/nextof-kin.Main Research Variable: Overall mood, activity, calmness, pleasantness, anxiety, and depression.Findings: The psycho-educational program increased overall mood, calmness, and pleasantness among patients after one month but had no effect on activity, anxiety, or depression. The program had no effect on the overall mood, activity, calmness, pleasantness, anxiety, or depression among next-of-kin.Conclusion: The psycho-educational program had a short-term effect on overall patient mood, calmness, and pleasantness but not on next-of-kin. Implications for Nursing: A psycho-educational program including lecture and time for reflection can be used with a colorectal cancer patient population to improve some aspects of their mental wellbeing.
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| 40. |
- Paulrud, Susanne, et al.
(author)
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Förutsättningar för nya biobränsleråvaror. System för småskalig brikettering och pelletering
- 2009
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Reports (other academic/artistic)abstract
- I projektet analyserades vilka biobränsleråvaror som har bäst förutsättningar för vidareförädling till briketter och pellets i mindre produktionsanläggningar (1 000-10 000 årston producerat bränsle) i nära anslutning till råvaran. I studien gjordes dels övergripande analyser kring olika råvarors förutsättningar, dels en fallstudie där en kostnadskalkyl för hela produktionskedjan för brikettering av rörflen på en specifik gård (Låttra gård) har tagits fram.
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| 41. |
- Svensson, Per, 1949, et al.
(author)
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Pleasing everyone?
- 2004
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In: Critical Perspectives on Projects.
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Conference paper (peer-reviewed)
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| 42. |
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