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Biomedical subjects

M Carlsson

Publications and source records attributed to M Carlsson.

At least 37 records · Page 2Linked to original sources
PubMed2001

Classification of procedures in the domain of thoracic surgery--a study of reliability in coding.

This paper relates a study of reliability of coding of surgical procedures in the domain of thoracic surgery. The reliability measured is inter-coder variability in form of agreement. Four classifications were used by four physicians on 100 patient cases. The classifications, having differing granularity and structure, were analyzed using a statistical method (kappa). These results are discussed and related to the differences between the classifications. One of the topics for discussion is how the granularity affects the degree of agreement, coupled to the usefulness of the classification. Also the concept of using formal methods for representing classifications is discussed, how this will affect how classifications are designed and used.

Humans↗
PubMed2001

Indications of change in life perspective among women with breast cancer admitted to complementary care.

In this study, qualitative content analysis was used in order to understand the reported changes of life perspective in interviews with 59 women with breast cancer who were admitted to complementary care. The aim of this research was to study women's perceived consequences as well as perceived causes of breast cancer and to explore aspects of importance to the women. The material was collected in semistructured interviews from women with breast cancer at different stages of the disease. The women received complementary care at an anthroposophic clinic in Sweden. Findings showed that these women's view of their relationships with others grew more valuable. Their self-confidence and experience of strength improved, and they regarded life as being more enriched. A change in their disposition towards becoming more fragile and low-spirited was experienced as a hardship by the women. An interesting finding was that the patients described the aetiology of the disease from several interacting perspectives, which also affected their ideas of how to achieve well-being and health. The findings support the view that changes of both benefit and harm are present in the experience of breast cancer.

Adult↗
PubMed2001

A qualitative study of nursing staff members' interpretations of signs of gerotranscendence.

AIMS: This study was conducted in Sweden and investigated whether nursing staff working with old people could recognize signs of gerotranscendence and, if so, how they interpreted such signs. Another aim was to describe how the staff addressed and cared for older people, 65 and older, showing signs of gerotranscendence. BACKGROUND: The theory of gerotranscendence is a theory that, present a new understanding of the ageing process. Gerotranscendence is regarded as a natural developmental process, and the term transcendence implies a shift in an older person's meta-perspective and a new outlook on reality. METHODS: Proceeding from Tornstam's description of signs of gerotranscendence, an interview guide was designed, qualitative interviews performed and the theory of gerotranscendence was used as the basis for the qualitative analysis. FINDINGS: Findings showed that staff working with old people noticed signs of gerotranscendence. However, their interpretations were highly variable; in some cases such signs were interpreted as what might be interpreted as "pathological". This is probably because the staff had no theoretical tools with which to make other interpretations. Some signs were interpreted as common and in some cases as "normal". These could be theoretically understood from either an activity or developmental perspective. CONCLUSIONS: Staffs' need an interpretative framework allowing them to understand the signs they sometimes observe in older people. Having an interpretative framework in which these signs are seen as normal aspects of ageing would enable staff to develop a different attitude towards older people and another approach to caring for them.

Adult↗
PubMed2001

Student nurses' perception of independence of supervision during clinical nursing practice.

The purposes of this longitudinal study were to examine Swedish student nurses' perceptions of independence and to explore to what extent the students had had opportunities to practise different tasks during clinical practice. Data were collected on weekly self-assessment forms during the first and final clinical courses of a 3-year nursing programme for 60 and the remaining 48 students, respectively. The majority of the students rated themselves as being independent of supervision to a great extent both at the beginning and throughout the clinical courses. Some students reported no or few opportunities to practise certain tasks during both courses. Factors that may have influenced the students' perception of independence are discussed, such as preparation before the clinical courses and the importance students gave to certain tasks. Clinical practice should be carefully planned and individualized to facilitat students' opportunities to practise different tasks.

Adult↗
PubMed2001

Risk, prevention and treatment of pressure ulcers--nursing staff knowledge and documentation.

The aims were to investigate (i) registered nurses' and nursing assistants' knowledge of risk, prevention and treatment of pressure ulcer before implementing a system for risk assessment and pressure ulcer classification for patients with hip fracture (ii) interventions documented in the patient's records by registered nurses, and (iii) to what extent reported and documented interventions accord with the Swedish quality guidelines. Nursing staff (n=85) completed a questionnaire, and patient's records (n=55) were audited retrospectively. The majority of the nursing staff reported that they performed risk assessment when caring for a patient with hip fracture. These risk assessments were, however, not comprehensive. The most frequently reported preventive interventions were repositioning, use of lotion, mattresses/overlays and cushions for the heels. These interventions were to some extent documented in the patient's records. Nutritional support, reduction of shear and friction, hygiene and skin moisture, and patient's education were reported to a small extent and not documented at all. The Swedish quality guidelines regarding prevention and treatment of pressure ulcers were not fully implemented in clinical practice. It was concluded that nursing staff's knowledge and documentation of risk, prevention and treatment of pressure ulcers for patients with hip fractures could be improved.

Aged↗
PubMed2001

A method for assembling a collaborative research team from multiple disciplines and academic centers to study the relationships between ECG estimation and MRI measurement of myocardial infarct size.

A method has been developed for establishing a "University Without Walls" for the purpose of studying the relationship between electrocardiographic estimation and magnetic resonance imaging measurements of myocardial infarct size. The research team includes faculty and students from 4 medical centers, with expertise extending from clinical to technical. Weekly interactive videoconferences provide the key research communication method. Study patients are recruited from 2 of the sites, and the correlations between their electrocardiographic and magnetic resonance imaging data are considered by the research team in conference. Outcomes of this program are both scientific publications in international peer-review journals and formal postdoctoral degree attainment by the research trainees.

Academic Medical Centers↗
PubMed2001

Reduced incidence of pressure ulcers in patients with hip fractures: a 2-year follow-up of quality indicators.

OBJECTIVE: The aims of the present study were to (i) investigate the incidence of pressure ulcers in 1997 and 1999 among patients with hip fracture, (ii) study changes of nursing and treatment routines during the same period and (iii) to identify predictors of pressure ulcer development. DESIGN: The present comparative study was based partly on data collected in two prospective, randomized, controlled studies conducted in 1997 and 1999. SETTING: The study was carried out in the Accident & Emergency (A&E) Department and the Department of Orthopaedics at the University Hospital in Uppsala, Sweden. STUDY PARTICIPANTS INCLUSION CRITERIA: patient with hip fracture, > or = 65 years, admitted without pressure ulcers. Forty-five patents were included in 1997 and 101 in 1999. INTERVENTIONS: Risk assessment, pressure ulcer grading, pressure-reducing mattress and educational programme. MAIN OUTCOME MEASURES: Incidence of pressure ulcers. RESULTS: There was a significant reduction of the overall incidence of pressure ulcers from 55% in 1997 to 29% in 1999. The nursing notes had become significantly more informative. Nursing and treatment routines for patients with hip fractures had changed both in the A&E Department and the orthopaedic ward through initiatives developed and implemented by pressure ulcer nurses. CONCLUSION: In the framework of a quality improvement project, where research activities were integrated with practice-based developmental work, the incidence of pressure ulcers was reduced significantly in patients with hip fractures. The best predictor of pressure ulcer development was increased age.

Age Factors↗
PubMed2001

Perceived quality of life and coping for Swedish women with breast cancer who choose complementary medicine.

The aim of the present study, which is part of a major clinical controlled study of the life situation of women with breast cancer, was to compare two groups of women concerning perceived quality of life and coping. The women were treated in two different cancer treatment programs: complementary treatment, which included anthroposophic therapy, and conventional cancer treatment. A total of 120 women were included, 60 women treated with anthroposophic medicine, and 60 individually matched women treated with conventional medicine only. Quality of life was measured by the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Core 30, and the Life Satisfaction Questionnaire. Coping was measured by the Mental Adjustment to Cancer scale. The results showed that the women who chose anthroposophic therapy perceived their quality of life to be lower on admission to the hospital and showed more anxious preoccupation than the women in conventional medicine. It can be concluded that, due to the careful matching procedure, the women in the two groups are comparable in a medical sense but not from the perspective of quality of life and coping.

Adaptation, Psychological↗
PubMed2001

A gene conferring susceptibility to type 2 diabetes in conjunction with obesity is located on chromosome 18p11.

Genome-wide nonparametric linkage analysis of 480 sib-pairs affected with type 2 diabetes revealed linkage to a previously unreported susceptibility locus on chromosome 18p11. This result improved with stringent subphenotyping using age- and sex-adjusted BMI, ultimately reaching a logarithm of odds of 3.82 (allele sharing 0.6654) at a point between markers D18S976 and D18S391 when the most obese 20% of the sample was analyzed. Several genes on chromosome 18 have been suggested as metabolic disease candidates, but none of these colocalize with our linkage result. We conclude that our results provide support for the presence of a currently uncharacterized gene on chromosome 18p, certain alleles of which confer increased susceptibility to type 2 diabetes in conjunction with obesity. We additionally observed moderate evidence for linkage to chromosome 1, near marker D1S3462; chromosome 4, near marker D4S2361; chromosome 5, near marker D5S1505; and chromosome 17, near marker D17S1301.

Adult↗
PubMed2001

Pre-school children with developmental co-ordination disorder: self-perceived competence and group motor skill intervention.

OBJECTIVE: To investigate self-perceived competence in 5- to 6-y-old children with developmental co-ordination disorder. SUBJECTS AND METHODS: Scores in two scales of self-perceived competence were compared between a study group of children with developmental co-ordination disorder (n = 37) and a reference group (n = 60). In addition, effects of group motor skill intervention were evaluated by comparing scores in study group children randomly allocated to an intervention (n = 17) and a control subgroup (n = 20). The intervention subgroup received intervention once weekly for 10 wk. CONCLUSIONS: Pre-school children with developmental co-ordination disorder are similar to peers of the same age regarding self-perception of their own competence in areas concerning school, peer relations and motor skills. The change in score in the perceived motor competence scale was significantly greater in the intervention than in the control subgroup, suggesting that the intervention increased individual awareness of motor competence.

Chi-Square Distribution↗
PubMed2000

Viral dynamics in primary HIV-1 infection. Karolinska Institutet Primary HIV Infection Study Group.

OBJECTIVES: To study the natural course of viremia during primary HIV infection (PHI). METHOD: Eight patients were followed from a median of 5 days from the onset of PHI illness. Plasma HIV-1 RNA levels were measured frequently and the results were fitted to mathematical models. HIV-1 RNA levels were also monitored in nine patients given two reverse transcriptase inhibitors and a protease inhibitor after a median of 7 days from the onset of PHI illness. RESULTS: HIV-1 RNA appeared in the blood during the week preceding onset of PHI illness and increased rapidly during the first viremic phase, reaching a peak at a mean of 7 days after onset of illness. This was followed by a phase of rapidly decreasing levels of HIV-1 RNA to an average of 21 days after onset. Viral density continued to decline thereafter but at a 5- to 50-fold lower rate; a steady-state level was reached at a median of 2 months after onset of PHI. Peak viral density levels correlated significantly with levels measured between days 50 and 600. Initiation of antiretroviral treatment during PHI resulted in rapidly declining levels to below 50 copies/mL. CONCLUSIONS: This study demonstrates the kinetic phases of viremia during PHI and indicates two new contributions to the natural history of HIV-1 infection: PHI peak levels correlate with steady-state levels and HIV-1 RNA declines biphasically; an initial rapid decay is usually followed by a slow decay, which is similar to the initial changes seen with antiviral treatment.

Antiretroviral Therapy, Highly Active↗
PubMed2000

Impact on survival of high-dose therapy with autologous stem cell support in patients younger than 60 years with newly diagnosed multiple myeloma: a population-based study. Nordic Myeloma Study Group.

High-dose therapy has become a common treatment for myeloma. The objectives of this study were to estimate in a prospective, population-based setting the impact on survival of high-dose therapy in newly diagnosed, symptomatic patients less than 60 years old and to compare the results with those of conventionally treated historic controls. The prospective population comprised 348 patients. Of these, 274 were treated according to a specified intensive-therapy protocol (Nordic Myeloma Study Group [NMSG] #5/94) and constituted the intensive-therapy group. The historic population consisted of 313 patients identified from 5 previous population-based Nordic studies. Of these, 274 fulfilled the eligibility criteria for high-dose therapy stated in NMSG #5/94 and constituted the control group. The expected numbers of patients in the prospective population and the historic population were 450 and 410, respectively, estimated from previously established data on the incidence in this population and the population base for each study. Survival was prolonged in the intensive-therapy group compared with the control group (risk ratio for the control group 1.62; 95% confidence interval 1.22-2.15; P =.001). These groups represented more than 60% of the expected number of patients. When survival for all the registered patients in the 2 populations was compared, representing more than 75% of the expected number of patients, the advantage for the prospective population persisted (risk ratio for the historic population 1.46; 95% confidence interval 1.14-1.86; P =. 002). These results indicate that the introduction of high-dose therapy for newly diagnosed myeloma has resulted in prolonged survival for the total patient population aged less than 60 years. (Blood. 2000; 95:7-11)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Cancer patients seeking information from sources outside the health care system.

Most of the information patients receive about cancer and its treatment is probably provided by staff in health care, but if patients do not get sufficient information there is a risk that they might rely on nonmedical sources to satisfy their need. The aim of this study was to survey the degree to which patients seek information from sources outside the health care system. All adult cancer patients visiting or being admitted to the Oncology Department on 1 day were asked to complete a questionnaire. In the course of that day, 192 adult patients visited the Oncology Department, and the response rate was 74%. The patients had used an active information-seeking strategy, i.e., had sought information from the following sources, only to a limited degree: the Internet (6%) medical books (37%), narratives (32%) and telephone helplines (10%). A more passive information-seeking strategy was more common; the patients obtained information from television and radio (82%), newspapers (86%), other patients (46%) and friends (55%). There was a significant correlation between educational level and information-seeking from the Internet, medical books and telephone helplines. Persons with a higher level of formal education had used these sources more than people with less education (P<0.05). Younger patients (<60 years) and those with a higher level of formal education had greater access to the Internet (P<0.0001) and read about cancer in the papers to a greater degree than older ones (P<0.05). Younger patients (P<0.05) and women (P<0.01) had used narratives to a greater degree than older patients and men. The main finding of this study was that the patients actively sought information about cancer only to a limited degree, but the majority of patients take an interest when cancer issues are presented in newspapers and magazines, or on radio and television.

Adult↗
PubMed2000

Coping strategies and health-related quality of life among spouses of continuous ambulatory peritoneal dialysis, haemodialysis, and transplant patients.

In the study reported here 55 spouses of patients living with end-stage renal disease (ESRD) were investigated with respect to coping strategies and health-related quality of life. Findings from the study were compared to two random samples of the Swedish general population (n = 454, and n = 1200). The study design was correlational and comparative. Coping was measured by the Jalowiec Coping Scale, and quality of life (QoL) by the Swedish Health-Related Quality of Life Survey (SWED-QUAL). Data were analysed using a number of statistical tests including Pearson's product moment correlations, Student's t-test and two way ANOVAs. The combined sample of spouses used significantly more optimistic and palliative coping than the general population, but less confrontative, self-reliant, evasive and emotive coping. In the study fatalistic, evasive and emotive coping was associated with low perceived efficiency in handling various aspects of the partners' situation. The male spouses used significantly less optimistic, supportive and palliative coping than did the female spouses. The spouses of transplant patients had better overall quality of life than the continuous ambulatory peritoneal dialysis and haemodialysis spouse groups, most likely due to the lower age of the former group. The study findings suggest that emotive, evasive and fatalistic coping are less than optimal ways to deal with problems occasioned by the partner's treatment.

Adaptation, Psychological↗
PubMed2000

Angiotensin converting enzyme (ACE) gene polymorphism in sarcoidosis in relation to associated autoimmune diseases.

OBJECTIVES: To investigate the significance of ACE gene insertion/deletion (I/D) polymorphism in the frequency of autoimmune manifestations in sarcoidosis. DESIGN: In patients with sarcoidosis the ACE gene I/D polymorphism was detected with PCR on genomic DNA. The patients with sarcoidosis were divided according to the presence (n = 30) or absence (n = 32) of autoimmune manifestations. The former group was subdivided into thyroid autoimmunity (n = 10), gluten immune reactivity (n = 10) and gastric autoimmunity (n = 17). SETTINGS: The patients were recruited at the Department of Pulmonary Medicine, and the study was conducted at the Department of Endocrinology, University of Lund, Malmö University Hospital, Malmö, Sweden. SUBJECTS: Sixty-two patients with documented sarcoidosis (30 females, 32 males, median age/range at diagnosis of sarcoidosis 31.5/19-75 years, median age/range at study 47.5/22-81 years) were examined. A total of 107 healthy unrelated subjects without sarcoidosis (60 females, 47 males, median age/range at study 58/40-82 years) served as controls. RESULTS: S-ACE values were significantly increased in patients compared to controls (P = 0.00001). The same was true in the subgroup of sarcoidosis patients with associated autoimmunity compared with those with isolated sarcoidosis (P = 0.0328). A significant association was seen between ACE gene polymorphism (II, ID, DD genotypes) and S-ACE levels in both patients and controls according to the order II < ID < DD. The observed genotype frequency distributions in the different study groups agreed the Hardy-Weinberg equilibrium without significant differences between the patients and the controls. Within the group with autoimmune manifestations the DD genotype was significantly over-represented in X-ray stage III compared to the other X-ray stages (P = 0.0181) and a significant increase in the DD genotype in X-ray stage III (P = 0.035) in the group with autoimmune manifestations compared to isolated sarcoidosis was detected. CONCLUSION: We confirmed that the S-ACE levels corresponded to the order II < ID < DD in patients with sarcoidosis as well as in healthy controls. S-ACE levels were significantly higher in sarcoidosis patients with autoimmune manifestations. The frequency of the DD genotype was significantly increased in patients with autoimmune manifestations and major granuloma mass (X-ray stage III). The ACE D allele in its homozygous form may confer susceptibility for autoimmune manifestations in sarcoidosis, possibly via the high levels of S-ACE it encodes.

Adult↗
PubMed2000

High levels of nonesterified fatty acids are associated with increased familial risk of cardiovascular disease.

To address the question of whether elevated concentrations of nonesterified fatty acids (NEFAs) are associated with an increased risk of cardiovascular disease, we measured NEFA concentrations in 140 diabetic and 343 nondiabetic unrelated Swedish subjects with a family history of type 2 diabetes and related the findings to history of cardiovascular disease in their parents. Parents of nondiabetic offspring belonging to the quartile of highest NEFA concentrations had a higher risk of myocardial infarction (35% versus 16%, P<0.01) and stroke (45% versus 16%, P<0.0005) than did parents of offspring from the lowest NEFA quartile. In a multiple logistic regression analysis, a high NEFA concentration in offspring was significantly associated with myocardial infarction and stroke in their parents. No such relationship was observed between diabetic offspring and their parents. Assuming that the same relationship between NEFA concentrations and cardiovascular disease is seen in the offspring and their parents, the findings suggest that elevated NEFA concentration is a risk factor for cardiovascular disease and could be pathogenically involved in the atherosclerotic process.

Adult↗