| 1. |
- Vanfleteren, Lowie E G W, et al.
(author)
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Challenges to the Application of Integrated, Personalized Care for Patients with COPD-A Vision for the Role of Clinical Information
- 2020
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In: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 9:5
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Journal article (peer-reviewed)abstract
- Chronic Obstructive Pulmonary Disease (COPD) is a complex disease defined by airflow limitation and characterized by a spectrum of treatable and untreatable pulmonary and extra-pulmonary disease characteristics. Nonpharmacological management related to physical activity, physical capacity, body composition, breathing and energy-saving techniques, coping strategies, and self-management is as important as its pharmacological management. Most patients with COPD carry other chronic diagnoses and this poses a key challenge, as it lowers the quality of life, increases mortality, and impacts healthcare consumption. A personalized, multi-, and interprofessional approach is key. Today, healthcare is poorly organized to meet this complexity with the isolation between care levels, logic silos of the different healthcare professions, and lack of continuity of care along the patient's journey with the healthcare system. In order to meet the criteria for integrated, personalized care for COPD, the structural capabilities of healthcare to support a comprehensive approach and continuity of care needs improvement. COPD is preeminently a disease that requires a transition from a reactive single-specialty approach to a proactive interprofessional approach. In this study, we discuss the issues that need to be addressed when moving from current health care practice to a person-centered model where the care processes and information are aligned to the individual personal needs of the patient.
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| 2. |
- Backman, Helena, et al.
(author)
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Decrease in prevalence of COPD in Sweden after decades of decrease in smoking
- 2018
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In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Journal article (other academic/artistic)abstract
- Background: The smoking prevalence in Sweden has steadily decreased during three decades. The prevalence of COPD in Sweden in the 1990s and around the millennium shift was similar to neighboring European countries, i.e. estimated at 11-17%, and of moderate to severe COPD to 7-11%, in ages over 40y.Aim: Has the prevalence of chronic airway obstruction (CAO) and of COPD in Sweden decreased after decades of decreasing smoking prevalence?Methods: Within two large scale population studies in progress, the West Sweden Asthma Study (WSAS) and the Obstructive Lung Disease in Northern Sweden Studies (OLIN), the prevalence of COPD in ages 41-72y was calculated among randomly selected subjects from the general population in 2009-2012. The following post-bronchodilator definitions were used; CAO: FEV1/FVCResults: The prevalence of CAO based on the FEV1/FVCConclusion: As prevalence of COPD defined as chronic airway obstruction before and around the millennium shift was estimated at 11-17% in ages >40 years, the prevalence of COPD has decreased in Sweden, and the decrease in smoking over decades is probably the main causal factor.
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| 3. |
- Backman, Helena, et al.
(author)
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Decreased COPD prevalence in Sweden after decades of decrease in smoking
- 2020
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In: Respiratory Research. - : Springer Nature. - 1465-9921 .- 1465-993X. ; 21
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Journal article (peer-reviewed)abstract
- BackgroundCOPD has increased in prevalence worldwide over several decades until the first decade after the millennium shift. Evidence from a few recent population studies indicate that the prevalence may be levelling or even decreasing in some areas in Europe. Since the 1970s, a substantial and ongoing decrease in smoking prevalence has been observed in several European countries including Sweden. The aim of the current study was to estimate the prevalence, characteristics and risk factors for COPD in the Swedish general population. A further aim was to estimate the prevalence trend of COPD in Northern Sweden from 1994 to 2009.MethodsTwo large random population samples were invited to spirometry with bronchodilator testing and structured interviews in 2009–2012, one in south-western and one in northern Sweden, n = 1839 participants in total. The results from northern Sweden were compared to a study performed 15 years earlier in the same area and age-span. The diagnosis of COPD required both chronic airway obstruction (CAO) and the presence of respiratory symptoms, in line with the GOLD documents since 2017. CAO was defined as post-bronchodilator FEV1/FVC < 0.70, with sensitivity analyses based on the FEV1/FVC < lower limit of normal (LLN) criterion.ResultsBased on the fixed ratio definition, the prevalence of COPD was 7.0% (men 8.3%; women 5.8%) in 2009–2012. The prevalence of moderate to severe (GOLD ≥ 2) COPD was 3.5%. The LLN based results were about 30% lower. Smoking, occupational exposures, and older age were risk factors for COPD, whereof smoking was the most dominating risk factor. In northern Sweden the prevalence of COPD, particularly moderate to severe COPD, decreased significantly from 1994 to 2009, and the decrease followed a decrease in smoking.ConclusionsThe prevalence of COPD has decreased in Sweden, and the prevalence of moderate to severe COPD was particularly low. The decrease follows a major decrease in smoking prevalence over several decades, but smoking remained the dominating risk factor for COPD.
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| 4. |
- 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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| 5. |
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| 6. |
- Cuzzone, Joshua K., et al.
(author)
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Final deglaciation of the Scandinavian Ice Sheet and implications for the Holocene global sea-level budget
- 2016
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In: Earth and Planetary Science Letters. - : Elsevier BV. - 0012-821X .- 1385-013X. ; 448, s. 34-41
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Journal article (peer-reviewed)abstract
- The last deglaciation of the Scandinavian Ice Sheet (SIS) from similar to 21,000 to 13,000 yr ago is well constrained by several hundred Be-10 and C-14 ages. The subsequent retreat history, however, is established primarily from minimum-limiting C-14 ages and incomplete Baltic-Sea varve records, leaving a substantial fraction of final SIS retreat history poorly constrained. Here we develop a high-resolution chronology for the final deglaciation of the SIS based on 79 Be-10 cosmogenic exposure dates sampled along three transects spanning southern to northern Sweden and Finland. Combining this new chronology with existing Be-10 ages on deglaciation since the Last Glacial Maximum shows that rates of SIS margin retreat were strongly influenced by deglacial millennial-scale climate variability and its effect on surface mass balance, with regional modulation of retreat associated with dynamical controls. Ice-volume estimates constrained by our new chronology suggest that the SIS contributed 8 m sea-level equivalent to global sea-level rise between similar to 14.5 ka and 10 ka. Final deglaciation was largely complete by similar to 10.5 ka, with highest rates of sea-level rise occurring during the Bolling-Allerod, a 50% decrease during the Younger Dryas, and a rapid increase during the early Holocene. Combining our SIS volume estimates with estimated contributions from other remaining Northern Hemisphere ice sheets suggests that the Antarctic Ice Sheet (AIS) contributed 14.4 +/- 5.9 m to global sea-level rise since 13 ka. This new constraint supports those studies that indicate that an ice volume of 15 m or more of equivalent sea-level rise was lost from the AIS during the last deglaciation.
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| 7. |
- Gustavsson, Caroline, 1975-
(author)
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Existentiella konfigurationer : Om hur förståelsen av livet tar gestalt i ett socialt sammanhang
- 2013
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Doctoral thesis (other academic/artistic)abstract
- The thesis contributes to the research field of education, or more specific to the field of religious education. The aim of the thesis is to interpret how young adults of today describe and understand their lives, with a specific focus on existential themes, and furthermore, to develop useful concepts that can help us understand individual meaning-making in a social and cultural context.The meaning-making of young people and how they explore and develop their understanding is, in the thesis, seen both as an individual process and at the same time something socially shared. The theoretical understanding of the social context takes its point of departure in Berger and Luckmann’s theory about the social construction of reality. The methodological approach is empirical and the study is based on 21 deep-interviews with men and women between 19-29 years old. Their statements are analyzed using a hermeneutic - interpretive method.The thesis gives a picture of the young adults’ understanding of death and the meaning of life. But the study also addresses vital existential themes for the young adults around the questions: who am I, what do I want to choose and where am I heading. Still another important theme is insecurity. One important contribution of the thesis is the development of new concepts that describe the young adults’ understanding of their lives, in terms of personal and shared configurations. In the material I have seen three different kinds of shared configurations and I speak of those in terms of: life-views, taken for granted perspectives and institutions. The dynamics that the personal configurations give examples of can be understood both in light of the shared configurations but also in light of the personal agency that the young adults show signs of.
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| 8. |
- Jønland Højsgaard, Trine, 1968-
(author)
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Reframed Identity : Red Cross nurses' identity formation between 1945 and 1977
- 2019
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Doctoral thesis (other academic/artistic)abstract
- The overall aim is to explore the construction of nurse identity at the Red Cross Nursing School (RCNS) in Sweden, between 1945 and 1977, when nursing became part of the system of higher education in Sweden. Occupational identity is understood as a construct both of social learning and of a self-image. The empirical data consist of documents from the Red Cross Archive concerning the training of nurses and of interviews with nurses trained during the studied period. A hermeneutical interpretative method has been used. The result showed that the period studied was divided into two different phases. The first phase between 1945 and the end of the 1960s, is called the post war phase. The following phase, from the 1960s until 1977, is called the reform friendly phase. RCNS was in the post war phase a kind of total institution, based on a particular belonging to a very special and highly respected social community, reinforced by the student nurses being dressed in the same uniform and living under the same strong authority in a quite homogeneous group. The training was an introduction to a life-long membership in the total Red Cross Nurse community. This community was in the reform friendly phase challenged by diverse external changes in society. Within a period of approximately ten years, much came to be questioned, and many previously important customs and habits were abandoned. The total community started to dilute, and the lives of students changed gradually passing to a social arrangement where they slept, lived and worked in different places with different people under different authorities. The total community was impossible to modernise, built as it was on pre-modern values and hierarchies. This led to a breakdown of the traditional Red Cross nurse identity based on honour, where they were first of all Red Cross sisters. While the uniform occupational identity was challenged, more and more nurses combined family and work. This meant that their self-identities became more multidimensional. The key to our understanding of the Red Cross nursing education and the shift that took place in the late 1960s is thus to be found in the transformation of the internal collective, where nurses no longer lived and 2 learnt the traditional Red Cross codes of honour and conduct. Gradually, nurse training was integrated into higher education. This was a major reframing of the occupational identity formation, from specially selected Red Cross nurse students being trained into a total community of experienced Red Cross nurses, to an academic education of professional nurses.
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| 9. |
- Olofson, Jan, 1947, et al.
(author)
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Prediction of COPD and Related Events Improves by Combining Spirometry and the Single Breath Nitrogen Test
- 2018
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In: Copd-Journal of Chronic Obstructive Pulmonary Disease. - : Informa UK Limited. - 1541-2555 .- 1541-2563. ; 15:5, s. 424-431
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Journal article (peer-reviewed)abstract
- Chronic obstructive pulmonary disease (COPD) develops in small airways. Severity of small airway pathology relates to progression and mortality. The present study evaluated the prediction of COPD of a validated test for small airway disease, i.e. a slope of the alveolar plateau of the single breath nitrogen test (N-2-slope). The N-2-slope, spirometry, age, smoking habits, and anthropometric variables at baseline were obtained in a population-based sample (n = 592). The cohort was followed for first COPD events (first hospital admission of COPD or related conditions or death from COPD) during 38 years. During follow-up, 52 subjects (8.8%) had a first COPD event, of which 18 (3.0%) died with a first COPD diagnosis. In the proportional hazard regression analysis adjusted for age and smoking habits, the cumulative COPD event incidence increased from 5% among those with high forced expired volume in one second (FEV1) to 25% among those with low FEV1, while increasing from 4% among those with the lowest N-2-slope to 26% among those with the highest. However, combining the N-2-slope and FEV1 resulted in considerable synergy in the prediction of first COPD event and even more so when taking account of smoking habits. The cumulative COPD event incidence rate was 75% among heavy smokers with the highest N-2-slope and lowest FEV1, and less than 1% among never smokers with the lowest N-2-slope and highest FEV1. Thus, combining the results of the single breath N-2-slope and FEV1 considerably improved the prediction of COPD events as compared to either test alone.
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| 10. |
- Pauwels, Romain A, et al.
(author)
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Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group
- 1997
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In: New England Journal of Medicine. - 0028-4793. ; 337:20, s. 1405-1411
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Journal article (peer-reviewed)abstract
- BACKGROUND: The role of long-acting, inhaled beta2-agonists in treating asthma is uncertain. In a double-blind study, we evaluated the effects of adding inhaled formoterol to both lower and higher doses of the inhaled glucocorticoid budesonide. METHODS: After a four-week run-in period of treatment with budesonide (800 microg twice daily), 852 patients being treated with glucocorticoids were randomly assigned to one of four treatments given twice daily by means of a dry-powder inhaler (Turbuhaler): 100 microg of budesonide plus placebo, 100 microg of budesonide plus 12 microg of formoterol, 400 microg of budesonide plus placebo, or 400 microg of budesonide plus 12 microg of formoterol. Terbutaline was permitted as needed. Treatment continued for one year; we compared the frequency of exacerbations of asthma, symptoms, and lung function in the four groups. A severe exacerbation was defined by the need for oral glucocorticoids or a decrease in the peak flow to more than 30 percent below the base-line value on two consecutive days. RESULTS: The rates of severe and mild exacerbations were reduced by 26 percent and 40 percent, respectively, when formoterol was added to the lower dose of budesonide. The higher dose of budesonide alone reduced the rates of severe and mild exacerbations by 49 percent and 37 percent, respectively. Patients treated with formoterol and the higher dose of budesonide had the greatest reductions -- 63 percent and 62 percent, respectively. Symptoms of asthma and lung function improved with both formoterol and the higher dose of budesonide, but the improvements with formoterol were greater. CONCLUSIONS: In patients who have persistent symptoms of asthma despite treatment with inhaled glucocorticoids, the addition of formoterol to budesonide therapy or the use of a higher dose of budesonide may be beneficial. The addition of formoterol to budesonide therapy improves symptoms and lung function without lessening the control of asthma.
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| 11. |
- Sandborg, Michael, et al.
(author)
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Comparison of clinical and physical measures of image quality in chest and pelvis computed radiography at different tube voltages
- 2006
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In: Medical Physics. - : Wiley. - 0094-2405. ; 33:11, s. 4169-4175
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Journal article (peer-reviewed)abstract
- The aim of this work was to study the dependence of image quality in digital chest and pelvis radiography on tube voltage, and to explore correlations between clinical and physical measures of image quality. The effect on image quality of tube voltage in these two examinations was assessed using two methods. The first method relies on radiologists' observations of images of an anthropomorphic phantom, and the second method was based on computer modeling of the imaging system using an anthropomorphic voxel phantom. The tube voltage was varied within a broad range (50-150 kV), including those values typically used with screen-film radiography. The tube charge was altered so that the same effective dose was achieved for each projection. Two x-ray units were employed using a computed radiography (CR) image detector with standard tube filtration and antiscatter device. Clinical image quality was assessed by a group of radiologists using a visual grading analysis (VGA) technique based on the revised CEC image criteria. Physical image quality was derived from a Monte Carlo computer model in terms of the signal-to-noise ratio, SNR, of anatomical structures corresponding to the image criteria. Both the VGAS (visual grading analysis score) and SNR decrease with increasing tube voltage in both chest PA and pelvis AP examinations, indicating superior performance if lower tube voltages are employed. Hence, a positive correlation between clinical and physical measures of image quality was found. The pros and cons of using lower tube voltages with CR digital radiography than typically used in analog screen-film radiography are discussed, as well as the relevance of using VGAS and quantum-noise SNR as measures of image quality in pelvis and chest radiography.
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| 12. |
- Sütterlin, Robert, 1981-
(author)
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Jet Ventilation for Airway Surgery : The Influence of Mode and Frequency on Ventilation Efficacy
- 2014
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Doctoral thesis (other academic/artistic)abstract
- In surgery for airway obstruction, the anesthetist and the ear-nose-throat surgeon share the approach to the airway and jet ventilation (JV) is a mutually convenient ventilation technique for both parties. As a consequence of the open system jet ventilation is applied in, bedside measurements of lung volumes are cumbersome to perform and thus, there is a lack of studies comparing different modes of JV or investigating the influence of ventilator settings on lung volumes and gas exchange. In this thesis, single frequency jet ventilation and superimposed high frequency jet ventilation (SHFJV) at different frequencies are systematically compared with respect to lung volume changes, underlying airway pressure variations and the resulting gas exchange.We compared three single-frequency JV modalities with SHFJV in patients. Moreover, we performed a systematic investigation of single frequency JV and SHFJV in a porcine model. Single frequency JV and SHFJV were compared frequency-wise in intact airways and in a newly developed model of tracheal obstruction. This model was also used to assess the influence of variable airway diameter on ventilation effectiveness during SHFJV. We measured chest wall volume variations with opto-electronic plethysmography and obtained airway pressures as well as gas exchange parameters.In unobstructed airways, both single-frequency JV and SHFJV provided adequate oxygenation, despite differences in lung volumes. Carbon dioxide removal was most effective using single frequency JV at a frequency of 150 min-1. During SHFJV, for both intact and obstructed airways, the choice of frequency for the high frequency component had little influence on lung volumes, airway pressures and gas exchange. With decreasing airway diameter and SHFJV, we observed air trapping and lower tidal volumes and acceptable oxygenation. Carbon dioxide removal, however, was insufficient at the narrowest airway diameter. In single frequency JV, very high frequencies resulted in negligible tidal volume and inacceptable gas exchange. Airway obstruction potentiated this frequency dependence.In conclusion, in intact airways, single frequency JV at sufficiently low frequencies provided adequate oxygenation and better CO2 removal than SHFJV. With decreasing airway diameter, SHFJV provided better oxygenation and CO2 removal and may therefore be the mode of choice in more complicated cases.
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| 13. |
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| 14. |
- Ullman, Gustav, et al.
(author)
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Comparison of clinical and physical measures of image quality in chest PA and pelvis AP views at varying tube voltages
- 2004
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Reports (other academic/artistic)abstract
- Image quality in digital chest PA and pelvis AP was assessed using two different methods; one based on observations of images of an anthropomorphic phantom, one based on computer modelling using an anthropomorphic voxel phantom. The tube voltage was varied within a broad range (50-150 kV), including those values typically used with screen-film radiography. The tube charge was altered so that approximately the same effective dose was achieved in the modelled patient (anthropomorphic phantom). Two x-ray units were employed using a digital image detector (computed radiography, CR, system) with standard tube filtration and anti-scatter device. Clinical image quality was assessed by a group of radiologists using a visual grading analysis (VGA) technique based on the revised CEC image criteria. Physical image quality was derived from the computer model in terms of the signal-to-noise ratio, SNR for fixed effective dose in the voxel phantom. The computer model uses Monte Carlo simulations of the patient and complete imaging system. Both the VGAS (visual grading analysis score) and SNR increase with decreasing tube voltage in both chest PA and pelvis AP examinations, indicating superior performance if lower tube voltages than used today are employed in digital radiology. A positive correlation between clinical and physical measures of image quality was found. The pros and cons of using lower tube voltages with CR digital radiography than typically used in analogue screen-film radiography are discussed as well as the relevance of using VGAS and quantum noise SNR as measures of image quality.
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