[Show abstract][Hide abstract] ABSTRACT: The work-up process for lung cancer patients consists of several steps from suspicion of malignant disease to start of treatment. Delays between these steps should be minimized. Data in the Swedish National Lung Cancer Register show that the work-up times for lung cancer patients vary greatly between different counties in central Sweden. In order to reduce delays, a trial of implementing patient guides (Sw: patientlotsar) for patients referred to the hospital was conducted. When comparing the work-up times before and after implementation of patient guides the median waiting time from suspicion of lung cancer to start of treatment in the region was reduced from 71 to 45 days. Furthermore, the duration of most of the steps in the work-up process were shortened despite more complex investigation procedures, e.g. increased use of PET/CT in the guided patient group.
[Show abstract][Hide abstract] ABSTRACT: Objective
To describe characteristics and quality-of-life (QOL) and to define factors associated with long-term survival in a subgroup of prostate cancer patients with M1b disease.Methods and patientsThe study was based on 915 patients from a prospective randomised multicentre trial (no.5) by the Scandinavian Prostate Cancer Group, comparing parenteral oestrogen with total androgen blockade (TAB). Long-term survival was defined as patients having an overall survival >10 year, and logistic regression models were constructed to identity clinical predictors of survival. QOL during follow-up was assessed using EROTC-30 ratings. .ResultsForty (4.4%) of the 915 men survived longer than 10 years. Factors significantly associated with increased likelihood of surviving more than ten years in the univariate analyses were: absence of cancer-related pain; performance status < 2; negligible analgesic consumption; T-category 1-2; PSA <231 μg/L; and a Soloway score 1. In the multivariate analyses, performance status < 2, PSA < 231 μg/L, and Soloway score 1, were all independent predictors of long-term survival. All subscales of EORTC-C30 were higher in this group than for patients with short survival, but slowly declined over the decade.ConclusionA subgroup of prostate cancer patients with M1b disease and certain characteristics showed a positive long-term response to ADT with an acceptable QOL over a decade or more. Independent predictors of long-term survival were identified as performance status < 2, limited extent of bone metastases (Soloway score 1), and a PSA level < 231 μg/L at the time of enrolment.This article is protected by copyright. All rights reserved.
BJU International 06/2015; DOI:10.1111/bju.13190 · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Courtship is an important part of the reproductive process, ensuring reproductive compatibility and conveying individual quality. One factor in aquatic environments that has the potential to influence courtship behaviours and mating propensity is the level of dissolved oxygen. Furthermore, hypoxic areas are currently spreading due to anthropogenic disturbance, such as eutrophication. In marine environments, hypoxia often occurs in shallow coastal regions that are particularly important areas for reproduction. Here, we investigated how types of reproductive behaviour were affected by mild hypoxia using the well-studied broad-nosed pipefish, Syngnathus typhle. More precisely, we investigated the impact of acute hypoxia on the reproductive behaviour preceding mating, and on the probability of mating, as well as on the latency until these occurred. We found that the latency period to courting and copulation occurring was prolonged in the low-oxygen environment. However, the total time spent courting as well as the probability of mating was unaffected by hypoxia. Other types of reproductive behaviour found in this species, such as dancing, and the unique male pouch-flap behaviour, were also unaffected by the low-oxygen treatment. We conclude that although latency to courting and copulating was prolonged in the hypoxic environment, most reproductive behaviour investigated was unaffected by hypoxia. Thus, hypoxia commonly occurring in shallow coastal regions has the potential to delay certain components of reproduction, but overall the broad- nosed pipefish shows robustness to hypoxic conditions.
Marine Biology Research 02/2015; 11(7). DOI:10.1080/17451000.2015.1007874 · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The work-up process for lung cancer patients consists of several steps from suspicion of malignant disease to start of treatment. Delays between these steps should be minimized. Data in the Swedish National Lung Cancer Register show that the work-up times for lung cancer patients vary greatly between different counties in central Sweden. In order to reduce delays, a trial of implementing patient guides (Sw: patientlotsar) for patients referred to the hospital was conducted. When comparing the work-up times before and after implementation of patient guides the median waiting timefrom suspicion of lung cancer to start of treatment in the region was reduced from 71 to 45 days. Furthermore, the duration of most of the steps in the work-up process were shortened despite more complex investigation procedures, e.g. increased use of PET/CT in the guided patient group.
[Show abstract][Hide abstract] ABSTRACT: Background and purpose:
To evaluate the long-term effects of dietary intervention on gastrointestinal symptoms after highly dose-escalated radiotherapy for localized prostate cancer, using boost with protons or high-dose-rate brachytherapy.
Materials and methods:
Patients were randomized to an intervention group (n=64) advised to reduce insoluble dietary fiber and lactose intake, or to a standard care group (n=66) advised to continue their usual diet. Gastrointestinal symptoms, other domains of health-related quality of life (HRQOL), and dietary intake were evaluated for ⩽24months post-radiotherapy with the European Organization for Research and Treatment of Cancer quality-of-life questionnaires QLQ-C30 and QLQ-PR25, Gastrointestinal Side Effects Questionnaire, and Food Frequency Questionnaire. The effect of the intervention on gastrointestinal symptoms was evaluated using generalized estimating equations.
Dietary intervention had no obvious effect on long-term gastrointestinal symptoms or HRQOL. The intervention group markedly reduced their dietary fiber and lactose intake during radiotherapy, but adherence tended to decline over time. The vast majority of long-term gastrointestinal symptoms were reported as 'a little', with a noticeable difference from pre-treatment only for unintentional stool leakage, limitations on daily activities, and mucus discharge.
Long-term gastrointestinal symptoms were predominantly mild, and dietary intervention was not superior to a usual diet in preventing these symptoms.
Radiotherapy and Oncology 11/2014; 113(2):240-247. DOI:10.1016/j.radonc.2014.11.025 · 4.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:
To compare sickness absence and disability pension in a population-based cohort of women with breast cancer (n = 463) from 1 year pre-diagnosis until 3 years post-diagnosis with a matched control group (n = 2310), and to investigate predictors of sickness absence during the 2nd and 3rd year post-diagnosis.
Following breast cancer, the proportion of disease-free women with sickness absence decreased post-diagnosis (1st-3rd year; 78%-31%-19%), but did not reach the pre-diagnostic level (14%; P < 0.05). Post-diagnosis, patients were more likely than controls to be sickness absent (1st-3rd year; P < 0.001). No between-group differences were observed for disability pension post-diagnosis (P > 0.05). Among patients, chemotherapy, baseline fatigue and pre-diagnosis sick days predicted sickness absence during the 2nd, 3rd, and 2nd and 3rd year post-diagnosis, respectively (P < 0.05).
Breast cancer is associated with increased sickness absence 3 years post-diagnosis. In a clinical setting, prevention and treatment of side effects are important in reducing long-term consequences.
Breast (Edinburgh, Scotland) 10/2014; 23(6). DOI:10.1016/j.breast.2014.09.007 · 2.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Selection processes are influenced by both biotic and abiotic variables, most of which seasonally fluctuate. Therefore, selection may also vary temporally. Specifically, sexual selection, an integral component of natural selection, will inevitably exhibit temporal varia- tion but the scale at which these changes occur are still not well understood. In this study, performed on a wild population of the sex-role reversed black striped pipe- fish Syngnathus abaster (Risso, 1827), we contrast var- iables such as male reproductive success, mating suc- cess, female investment, mate choice and operational sex ratio between two periods, either near the onset or end of the breeding season. Sexual selection is stronger early in the breeding season. Male reproductive and mating success are significantly affected by male size during the onset of the breeding season but not during the end. Moreover, we found that larger females repro- duce mainly during the onset while smaller females had increased chances of reproducing towards the end. As our sampling was performed in two consecutive years, it could be argued that our results stem primarily from between-year variation. Nevertheless, variation in de- mographic parameters from the onset to the end of the breeding season is similar to that observed in past sam- pling events. Hence, we suggest that the change in mating patterns within the breeding season derives from seasonal fluctuations in several abiotic (e.g., temperature) and biotic variables (e.g., operational sex ratio), ren- dering the expression of selective forces, such as sexual selection, inherently dynamic.
[Show abstract][Hide abstract] ABSTRACT: Aims:
To study whether there is an association between dyadic consensus, depressive symptoms, and parental stress during early parenthood and marital separation 6-8 years after childbirth, among couples in Sweden.
At baseline, 393 couples were included. The couples answered three questionnaires, including: Dyadic consensus at 1 week post-partum, depressive symptoms at 3 months post-partum and parental stress at 18 months post-partum. The parents' addresses were followed up after 6-8 years, to study the marital separation rate.
We found, 6-8 years after childbirth, that 20% of study couples were separated. Separation was associated with less dyadic consensus (mothers p < 0.001; fathers p < 0.001), depressive symptoms (mothers p = 0.022; fathers p = 0.041) and parental stress (mothers p = 0.002; fathers p = 0.040). The hazard ratio (HR) for marital separation was related to dyadic consensus for fathers (HR 0.51; 95% CI 0.28-0.92), depressive symptoms for mothers (HR 1.69; 95% CI 1.01-2.84) and fathers (HR 1.92; 95% CI 1.12-3.28), and the mother's parental stress (HR 2.16; 95% CI 1.14-4.07).
Understanding how dyadic consensus, depressive symptoms and parental stress are associated with marital separation is important for health professionals it could be useful in developing interventions to provide parents with adequate support during pregnancy and early parenthood this knowledge is also important for the public parents should get support in pregnancy and while bringing up children, which may help prevent marital separation and optimize conditions for the children.
Scandinavian Journal of Public Health 07/2014; 42(7). DOI:10.1177/1403494814542262 · 1.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background. Capture rate and representativity of quality registers need to be assessed in order to ensure that register data are generalizable.
Material and methods. In 1998–2009, 103 047 men had been diagnosed with prostate cancer and registered in the Swedish Cancer Register to which registration is mandated by law and of these men, 100 849 men (98%) had also been registered in The National Prostate Cancer Register (NPCR) of Sweden. We compared demographics, cancer treatment, comorbidity, and mortality in men in NPCR, with those who had only been registered in the Cancer Register, by use of data from the Cause of Death Register, the In-Patient Register and the Prescribed Drug Register. In addition, we identified 1929 men who had prostate cancer as underlying cause of death in the Cause of Death Register who had neither been registered in the Cancer Register nor in NPCR.
Results. Compared to men in NPCR, men only registered in the Cancer Register were slightly older, median age 72 versus 71 years, and a lower proportion underwent radical prostatectomy, 15% versus 27%. Ten year prostate cancer mortality was 23% (95% CI 20–25) for men in the Cancer Register only and 24% (95% CI 24–25) in NPCR, while mortality from competing causes was 28% (95% CI 26–31) and 30% (95% CI 30–30), respectively. Men identified with prostate cancer by a death certificate were old and had high comorbidity.
Conclusion. The capture rate of NPCR is very high and there are only modest differences in demographics, cancer treatment, comorbidity, and mortality between the small proportion of men only registered in the Cancer Register and men registered in NPCR, indicating that information in NPCR can be generalized to all men with prostate cancer in Sweden.
[Show abstract][Hide abstract] ABSTRACT: Background:
Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety.
A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions.
At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital.
The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.
BMC Health Services Research 07/2014; 14(1):296. DOI:10.1186/1472-6963-14-296 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Commonly used inhalational hypnotics, such as sevoflurane, are pro-inflammatory, whereas the intravenously administered hypnotic agent propofol is anti-inflammatory and anti-oxidative. A few clinical studies have indicated similar effects in patients. We examined the possible association between patient survival after radical cancer surgery and the use of sevoflurane or propofol anaesthesia.
Patients and methods
Demographic, anaesthetic, and surgical data from 2,838 patients registered for surgery for breast, colon, or rectal cancers were included in a database. This was record-linked to regional clinical quality registers. Cumulative 1- and 5-year overall survival rates were assessed using the Kaplan–Meier method, and estimates were compared between patients given propofol (n = 903) or sevoflurane (n = 1,935). In a second step, Cox proportional hazard models were calculated to assess the risk of death adjusted for potential effect modifiers and confounders.
Differences in overall 1- and 5-year survival rates for all three sites combined were 4.7% (p = 0.004) and 5.6% (p < 0.001), respectively, in favour of propofol. The 1-year survival for patients operated for colon cancer was almost 10% higher after propofol anaesthesia. However, after adjustment for several confounders, the observed differences were not statistically significant.
Propofol anaesthesia might be better in surgery for some cancer types, but the retrospective design of this study, with uneven distributions of several confounders, distorted the picture. These uncertainties emphasize the need for a randomized controlled trial.
Upsala Journal of Medical Sciences 05/2014; 119(3):1-11. DOI:10.3109/03009734.2014.922649 · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mate choice for compatible genes is often based on genes of the major histocompatibility complex (MHC). Although MHC-based mate choice is commonly observed in female choice, male mate choice remains elusive. In particular, if males have intense paternal care and are thus the choosing sex, male choice for females with dissimilar MHC can be expected. Here, we investigated whether male mate choice relies on MHC class I genes in the sex-role reversed pipefish Syngnathus typhle. In a mate choice experiment, we determined the relative importance of visual and olfactory cues by manipulating visibility and olfaction. We found that pipefish males chose females that maximize sequence-based amino acid distance between MHC class I genotypes in the offspring when olfactory cues were present. Under visual cues, large females were chosen, but in the absence of visual cues, the choice pattern was reversed. The use of sex-role reversed species thus revealed that sexual selection can lead to the evolution of male mate choice for MHC class I genes.
[Show abstract][Hide abstract] ABSTRACT: Objective:
In countries with widespread prostate cancer screening there has been strong stage migration, but little is known about changes within clinical risk categories. Such data are important for the proper interpretation of studies that recruited cases in an earlier era. The purpose of this study was to examine stage migration between and within clinical risk categories.
Material and methods:
Using the population-based National Prostate Cancer Register (NPCR) of Sweden, changes in the distribution of prostate-specific antigen (PSA), Gleason score, tumor stage and volume overall between and within clinical risk categories were examined in 120 228 prostate cancer cases diagnosed from 1998 to 2011.
Between 1998 and 2011, there was a two-fold increase in the proportion of low-risk prostate cancer (stage T1/T2, Gleason score 2-6 and PSA <10 ng/ml), from 14% to 28%, and more than a two-fold decrease in the proportion of metastatic disease, from 25% to 11%. The proportion of men in the low-risk category with T1c tumors increased two-fold, from 36% to 71%, and PSA levels between 4 and 6 ng/ml increased from 24% to 38%; T2 tumors decreased from 39% to 20% and PSA between 8 and 10 ng/ml decreased from 24% to 15%. The proportion of men with less than 25% of cores involved with cancer increased from 41% to 52% between 2003-2006 and 2007-2011.
Low-risk cases today have substantially lower tumor volume and PSA levels than low-risk cases diagnosed in 1998, indicating that outcomes in studies that recruited cases in previous decades represent worst case scenarios.
[Show abstract][Hide abstract] ABSTRACT: Oncologic and functional outcomes after radical prostatectomy (RP) can vary between surgeons to a greater extent than is expected by chance. We sought to examine the effects of surgeon variation on functional and oncologic outcomes for patients undergoing RP for prostate cancer in a European center.
The study comprised 1,280 men who underwent open retropubic RP performed by one of nine surgeons at an academic institution in Sweden between 2001 and 2008. Potency and continence outcomes were measured preoperatively and 18 months postoperatively by patient-administered questionnaires. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) value > 0.2 ng/mL with at least one confirmatory rise. Multivariable random effect models were used to evaluate heterogeneity between surgeons, adjusting for case mix (age, PSA, pathological stage, and grade), year of surgery, and surgical experience.
Of 679 men potent at baseline, 647 provided data at 18 months with 122 (19%) reporting potency. We found no evidence for heterogeneity of potency outcomes between surgeons (P = 1). The continence rate for patients at 18 months was 85%, with 836 of the 979 patients who provided data reporting continence. There was statistically significant heterogeneity between surgeons (P = 0.001). We did not find evidence of an association between surgeons' adjusted probabilities of functional recovery and 5-year probability of freedom from BCR.
Our data support previous studies regarding a large heterogeneity among surgeons in continence outcomes for patients undergoing RP. This indicates that some patients are receiving sub-optimal care. Quality assurance measures involving performance feedback, should be considered. When surgeons are aware of their outcomes, they can improve them to provide better care to patients.
[Show abstract][Hide abstract] ABSTRACT: Background:
Few studies to date have described the clinical features of malignant melanoma in young adulthood. Also, little is known about patterns of care in young patients. We examined and compared clinical characteristics, management and survival between young adult (15-39 years) and older adult melanoma patients in Central Sweden.
Material and methods:
Patients diagnosed with invasive malignant melanoma between 1997 and 2011 were identified in the Regional Quality Register of Cutaneous Malignant Melanoma in Central Sweden, a population-based register covering a source population of about two million. Data on clinical characteristics, management and survival were retrieved and compared according to age at diagnosis.
Of 5915 patients included in the study, 584 (9.9%) were between 15 and 39 years of age at diagnosis. Compared with older patients, young adult patients were more likely to be female, with higher proportions of thin, non-ulcerated melanomas, superficial spreading melanoma and melanomas located on the lower extremity. Young adults had shorter waiting times for surgical procedures and a higher proportion received surgical treatment according to guidelines. Overall, young patients had better relative survival than older patients. Age-related survival differences varied by stage of disease at diagnosis, and were most prominent in stage II disease.
The observed differences in clinical characteristics, management and survival between young adult and older melanoma patients call for an improved understanding of not only disease etiology but also factors driving management decisions. A better understanding of these differences may help improve care and prognosis for melanoma patients of all ages.