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  • 1.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Factors affecting in-hospital sleep-wake pattern in octogenarians during the early postoperative phase after transcutaneous aortic valve replacement2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S53-S53Article in journal (Refereed)
    Abstract [en]

    Background: Octogenarian patients are an increasing group admitted for advanced cardiac treatment. Little is known about factors disturbing their sleep-wake pattern in the early postoperative phase after transcutaneous aortic valve replacement (TAVI), as current knowledge is based upon studies on younger age groups treated for surgical aortic valve replacement.

    Aim: To determine factors affecting the in-hospital sleep wake pattern in octogenarian patients after TAVI.

    Methods: This is a prospective cohort study in a tertiary university hospital. Inclusion criteria were age > 80 years with severe aortic stenosis accepted for TAVI. Actigraphy was used to identify sleep-wake pattern (sleep time night and sleep time day), and the Minimal Insomnia Symptom Scale (MISS) to measure self-reported insomnia daily during the first five postoperative days. Charlson`s comorbidity index was used as a measure of comorbidities and the Visual Analog Scale (VAS) to rate pain severity. Information regarding duration of anesthesia, blood transfusion and parenteral administration of morphine equivalents were derived from the patients’ medical journals. Multiple regression analysis was used to test associations between variables.

    Results: In all, 65 patients (41 women) were included. Mean age was 85 years (SD 2.8). No significant associations were found between age, comorbidities, blood transfusion and morphine equivalents and sleep. Gender was significantly associated with sleep time night and sleep efficiency as men had shortest duration of sleep from the third to the fifth postoperative night (p < .001, and adjusted R2=.230 to .283). Duration of anesthesia had a significant association with sleep time night and sleep efficiency from the third to the fifth postoperative night (p=.013 to p < .001, and adjusted R2=.230 to .283), where longer duration gave less total sleep and lower sleep efficiency. VAS score correlated with wake time night the third night, where a higher VAS score gave more wake time (p=.006 and adjusted R2 .236).

    Conclusion: Male gender, longer duration of perioperative anesthesia and postoperative pain were associated with disturbances in the postoperative sleep-wake pattern in octogenarian patients in the early postoperative phase after TAVI. This knowledge is important and relevant and should have implications in improving patient care.

  • 2.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Faculty of Health and Social Science, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway .
    Factors associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after surgical aortic valve replacement2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S63-S64Article in journal (Refereed)
    Abstract [en]

    Background: Disturbances of the sleep-wake pattern are known phenomenon in the postoperative phase after aortic valve replacement (SAVR) that have negative impact on the morbidity, quality of life and mortality. Octogenarian patients are an increasing group admitted for cardiac surgery, however knowledge is based on younger patients.

    Aims: To determine factors associated with disturbances in postoperative sleep-wake pattern in octogenarian patients after SAVR.

    Methods: A prospective cohort study of octogenarian patients in a single center university hospital. Inclusion criteria were age > 80 years, severe aortic stenosis, accepted for SAVR. Actigraphy was used to identify the sleep-wake pattern (sleep-time, sleep efficiency and wake time night and sleep- and wake-time day) for the five first postoperative days, and the sleep questionnaires Minimal Insomnia Symptom scale (MISS) to measure the selfreported insomnia at baseline and daily for the five first postoperative days. 

    Charlsons comorbidity index was used to score comorbidities and the Visual Analog Scale (VAS), was used to rate pain severity. The patients’ medical journals were used to record duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusions and parenteral administration of morphine equivalents. Multiple regression analysis was used to test associations between variables.

    Results: In all, 78 patients were included (40 women). Mean age was 82 years (SD 2.0). For the sleep-wake pattern first to fifth postoperative night, mean sleep-time night was 330-370 minutes (SD 32-124). Mean sleep efficiency was 68-77% (SD 21-26). Mean sleep-time day was 545-712 minutes (SD 146-169). Mean insomnia score was 1,8-5,3 (SD 2,6-3,8). On the first postoperative night the pain VAS score correlated with wake time night, where a higher VAS indicated more wake time (p=.014, adjusted R2=.213). No other variable; age, gender, duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusion or morphine equivalents showed significant association with the sleep-wake pattern or insomnia.

    Conclusion: Postoperative pain was associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after SAVR. This indicates that pain management may be inadequate for patients after SAVR. More research on this issue is needed to establish data needed to improve treatment and care.

  • 3.
    Bergman, Annika
    et al.
    Lundberg Laboratory for Cancer Research, Department of Pathology, The Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden.
    Sahlin, Pelle
    Department of Plastic Surgery, The Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden.
    Emanuelsson, Monica
    Oncology Center, Umeå University Hospital, Umeå, Sweden.
    Carén, Helena
    Department of Clinical Genetics, The Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden.
    Tarnow, Peter
    Department of Plastic Surgery, The Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden.
    Martinsson, Tommy
    Department of Clinical Genetics, The Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden.
    Grönberg, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Stenman, Göran
    Lundberg Laboratory for Cancer Research, Department of Pathology, The Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden.
    Germline mutation screening of the Saethre-Chotzen-associated genes TWIST1 and FGFR3 in families with BRCA1/2-negative breast cancer2009In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 0284-4311, E-ISSN 1651-2073, Vol. 43, no 5, p. 251-255Article in journal (Refereed)
    Abstract [en]

    Saethre-Chotzen syndrome is one of the most common craniosynostosis syndromes. It is an autosomal dominantly inherited disorder with variable expression that is caused by germline mutations in the TWIST1 gene or more rarely in the FGFR2 or FGFR3 genes. We have previously reported that patients with Saethre-Chotzen syndrome have an increased risk of developing breast cancer. Here we have analysed a cohort of 26 women with BRCA1/2-negative hereditary breast cancer to study whether a proportion of these families might have mutations in Saethre-Chotzen-associated genes. DNA sequence analysis of TWIST1 showed no pathogenic mutations in the coding sequence in any of the 26 patients. MLPA (multiplex ligation-dependent probe amplification)-analysis also showed no alterations in copy numbers in any of the craniofacial disorder genes MSX2, ALX4, RUNX2, EFNB1, TWIST1, FGFR1, FGFR2,FGFR3, or FGFR4. Taken together, our findings indicate that mutations in Saethre-Chotzen-associated genes are uncommon or absent in BRCA1/2-negative patients with hereditary breast cancer.

  • 4.
    Cardell, K.
    et al.
    Dep. of Infectious Diseases, University Hospital, Linköping, Sweden.
    Widell, A.
    Dep. of Medical Microbiology (Malmö), Lund University, Sweden.
    Frydén, A.
    Dep. of Infectious Diseases, University Hospital, Linköping, Sweden.
    Åkerlind, B.
    Dep. of Virology, University Hospital, Linköping, Sweden.
    Månsson, A-S.
    Dep. of Medical Microbiology (Malmö), Lund University, Sweden.
    Franzén, S.
    Dep. of Thoracic Surgery, University Hospital. Linköping, Sweden.
    Lymer, U-B.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Isaksson, B.
    Dep. of Infection Control, University Hospital. Linköping, Sweden.
    Nosocomial hepatitis C in a thoracic surgery unit: retrospective findings generating a prospective study2008In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 68, no 4, p. 322-328Article in journal (Refereed)
  • 5.
    Darwich, George
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Johansson, Linda
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Livskvalitet efter en prostatektomi: - En litteraturöversikt2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Prostate cancer is the most common cancer in Sweden and can be treated with a prostatectomy where the prostate is surgically removed. This operation entails risks for side effects which may affect the man's quality of life. There are several different instruments to measure quality of life. The aim was to describe the factors that can affect quality of life in men with prostate cancer who have undergone prostatectomy. The method was a literature study based on a quantitative approach. Fourteen articles for the study were found using the Cinahl database. All included articles had some sort of ethical stance. Categories that were created were: physical factors, psychological factors and social factors. The results indicate that the physical, psychological and social factors diminish after a prostatectomy, and thus affect the quality of life. The conclusions were that mainly the urinary function and the sexual ability declines at a prostatectomy. The study provides knowledge to nursing staff about how a prostatectomy may affect the patient's quality of life to be able to give a better treatment to this population. Nursing staff should educate and inform the patient of likely side-impact a prostatectomy can cause before beginning treatment.

  • 6.
    Jarl, Gustav
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Accuracy and precision of a technique to assess residual limb volume with a measuring-tape2003Independent thesis Basic level (professional degree), 10 points / 15 hpStudent thesis
    Abstract [en]

    Transtibial stump volume can change dramatically postoperatively and jeopardise prosthetic fitting. Differences between individuals make it hard to give general recommendations of when to fit with a definitive prosthesis. Measuring the stump volume on every patient could solve this, but most methods for volume assessments are too complicated for clinical use.

    The aim of this study was to evaluate accuracy and intra- and interrater precision of a method to estimate stump volume from circumferential measurements. The method approximates the stump as a number of cut cones and the tip as a sphere segment.

    Accuracy was evaluated theoretically on six scanned stump models in CAPOD software and manually on six stump models. Precision was evaluated by comparing measurements made by four CPOs on eight stumps. Measuring devices were a wooden rule and a metal circumference rule. The errors were estimated with intraclass correlation coefficient (ICC), where 0,85 was considered acceptable, and a clinical criterion that a volume error of ±5% was acceptable (5% corresponds to one stocking).

    The method was accurate on all models in theory but accurate on only four models in reality. The ICC was 0,95-1,00 for intrarater precision but only 0,76 for interrater precision. Intra- and interrater precision was unsatisfying when using clinical criteria. Variations between estimated tip heights and circumferences were causing the errors.

    The method needs to be developed and is not suitable for stumps with narrow ends. Using a longer rule (about 30 cm) with a set square end to assess tip heights is recommended to improve precision. Using a flexible measuring-tape (possible to disinfect) with a spring-loaded handle could improve precision of the circumferential measurements.

  • 7. Johannesson, Anton
    et al.
    Larsson, Gert-Uno
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Turkiewicz, Aleksandra
    Wiréhn, Ann-Britt
    Atroshi, Isam
    Incidence of Lower Limb Amputation in the Diabetic and Nondiabetic General Population: A 10-year population-based cohort study of initial unilateral and contralateral amputations and reamputations2009In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 32, no 2, p. 275-280Article in journal (Refereed)
    Abstract [en]

    Objective: To compare the incidence of vascular lower limb amputation (LLA) in the diabetic and nondiabetic general population. Research design & methods: A population-based cohort study was conducted in a representative Swedish region. All vascular LLA (at or proximal to transmetatarsal level) performed from 1997 through 2006 were consecutively registered and classified into initial unilateral amputation, contralateral amputation or re-amputation. The incidence rates were estimated in the diabetic and nondiabetic general population aged 45 years or older. Results: During the 10-year period, LLA was performed on 62 women and 71 men with diabetes and on 79 women and 78 men without diabetes. The incidence of initial unilateral amputation per 100,000 person-years (95% CI) was for diabetic women 192 (145-241) and for diabetic men 197 (152-244) and for nondiabetic women 22 (17-26) and for nondiabetic men 24 (19-29). The incidence increased from the age of 75 years. 74% of all amputations were transtibial. The incidence of contralateral amputation and of re-amputation per 100 amputee-years (95% CI) in diabetic women amputees was 15 (7-27) and 16 (8-28) and in diabetic men 18 (10-29) and 21 (12-32), respectively, and in nondiabetic women amputees were 14 (7-24) and 18 (10-28) and in men 13 (6-22) and 24 (15-35), respectively. Conclusions: In the general population aged 45 years or older the incidence of vascular lower limb amputation at or proximal to transmetatarsal level is 8 times higher in diabetic than in nondiabetic persons. One in four amputees may require contralateral amputation and/or re-amputation.

  • 8.
    Lundgren, L.
    et al.
    Department of Surgery, County Council of Östergötland and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Muszynska, C.
    Department of Surgery, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden.
    Ros, Axel
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Persson, G.
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Gimm, O.
    Department of Surgery, County Council of Östergötland and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Andersson, B.
    Department of Surgery, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden.
    Sandström, P.
    Department of Surgery, County Council of Östergötland and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Management of incidental gallbladder cancer in a national cohort2019In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, no 9, p. 1216-1227Article in journal (Refereed)
    Abstract [en]

    Background: Incidental gallbladder cancer is a rare event, and its prognosis is largely affected by the tumour stage and treatment. The aim of this study was to analyse the management, treatment and survival of patients with incidental gallbladder cancer in a national cohort over a decade.

    Methods: Patients were identified through the Swedish Registry of Gallstone Surgery (GallRiks). Data were cross-linked to the national registry for liver surgery (SweLiv) and the Cancer Registry. Medical records were collected if registry data were missing. Survival was measured as disease-specific survival. The study was divided into two intervals (2007–2011 and 2012–2016) to evaluate changes over time.

    Results: In total, 249 patients were identified with incidental gallbladder cancer, of whom 92 (36·9 per cent) underwent re-resection with curative intent. For patients with pT2 and pT3 disease, median disease-specific survival improved after re-resection (12·4 versus 44·1 months for pT2, and 9·7 versus 23·0 months for pT3). Residual disease was present in 53 per cent of patients with pT2 tumours who underwent re-resection; these patients had a median disease-specific survival of 32·2 months, whereas the median was not reached in patients without residual disease. Median survival increased by 11 months for all patients between the early and late periods (P = 0·030).

    Conclusion: Re-resection of pT2 and pT3 incidental gallbladder cancer was associated with improved survival, but survival was impaired when residual disease was present. A higher re-resection rate and more R0 resections in the later time period may have been associated with improved survival. 

  • 9.
    Pakpour, Amir H.
    et al.
    Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Kumar, Santhosh
    Population Social Health Research Program, Griffith Health Institute, School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia.
    Scheerman, Janneke F. M.
    Academic Centre of Dentistry Amsterdam, Department of Preventive Dentistry, ACTA University, Amsterdam, Netherlands.
    Lin, Chung-Ying
    Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health.
    Oral health-related quality of life in Iranian patients with spinal cord injury: A case-control study2016In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 47, no 6, p. 1345-1352Article in journal (Refereed)
    Abstract [en]

    Introduction: The study aimed to compare the oral health variables, general, and oral health-related quality of life (QoL), depression, and anxiety between spinal cord injury (SCI) patients and healthy controls and also to determine the key factors related to the oral health-related quality of life (OHRQoL) in the SCI patients.

    Methods: A total of 203 SCI patients and 203 healthy controls were enrolled. Patients and healthy adults were invited to attend a dental clinic to complete the study measures and undergo oral clinical examinations. OHRQoL was assessed by the 14-item Oral Health Impact Profile (OHIP-14), and the general health-related quality of life (GHRQoL) was evaluated by SF-36. In SCI patients, depression and anxiety were recorded using the Hospital Anxiety and Depression Scale (HADS), while Functional Assessment Measure (FAM) was used to assess dependence and disability. All the subjects were examined for caries which was quantified using the decayed, missing, and filled Teeth (DMFT) index, gingival bleeding index (GI), plaque index, and periodontal status by community periodontal index (CPI).

    Results: The analysis of covariance (ANCOVA) revealed significant differences between the two groups in terms of oral health expressed in DMFT, oral hygiene, and periodontal status, controlled for age, gender, family income, and occupational status (p < 0.001). Using the hierarchical linear regression analyses, in the final model, which accounted for 18% of the total variance (F(126.7), p < 0.01), significant predictors of OHRQoL were irregular tooth brushing (β = 1.23; 95% CI = 1.06; 1.41), smoking (β = 0.82; 95% CI = 0.66; 0.97), dry mouth (β = 0.37; 95% CI = -0.65 to 0.10) functional and motor functioning (β = 0.32; 95% CI = -0.45 to 0.17), DMFT (β = 0.06; 95% CI = 0.02; 0.09), CPI (β = 0.22; 95% CI = 0.04; 0.04), physical component measure of GHRQoL (β = -0.275; 95% CI = -0.42 to 0.13), lesion level at the lumbar-sacral (β = -0.18; 95% CI = -0.29 to -0.06) and thoracic level (β = -0.09; 95% CI = -0.11 to -0.06).

    Conclusion: SCI patients had poor oral hygiene practices, greater levels of plaque, gingival bleeding, and caries experience than the healthy controls. In addition, more number of SCI patients had periodontal pockets and dry mouth than the comparative group. SCI patients experienced more depression and anxiety, poor GHRQoL, and OHRQoL than the healthy control group. The factors that influenced OHRQoL in SCI patients were age, toothbrushing frequency, smoking, oral clinical status, depression, physical component of GHRQoL, and level of lesion.

  • 10.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    A comparison of foot placement strategies of transtibial amputees and able-bodies subjects during stair ambulation2009In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 33, no 4, p. 348-355Article in journal (Refereed)
    Abstract [en]

    Ambulation on stairs presents a significant challenge for lower extremity amputees and increases the risk of falling and sustaining a serious injury. This study aimed to compare foot placement and foot clearance during stair ambulation in a group of transtibial amputees and a group of able-bodied subjects Three-dimensional motion analysis was used to determine foot positioning and to calculate temporospatial parameters during stair ascent and descent of 10 transtibial amputees (mean age = 56) and a control group consisting of 10 healthy able-bodied individuals (mean age = 26 7) No significant difference was observed in foot positioning and foot clearance between the amputee and control groups Temporospatial data revealed a number of significant differences between the groups, particularly during stair ascent Amputees were observed to walk with a slower velocity and cadence (p < 0 01), to increase the time spent in stance phase and double support (p < 0 01) and to increase their step width during both stair ascent and descent (p < 0.01) Results suggest that foot placement and clearance are not factors that would contribute to a stumble or fall on stairs in established amputees but that balance related issues, such as relative motion of the centre of mass, require further investigation.

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