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  • 1.
    Larsson, Lina
    Linköping University, Department of Science and Technology. Linköping University, The Institute of Technology.
    Kliniskt datainsamlingssystem med beslutsstöd - Användarutredning och gränssnitt för Sahlgrenskas akutintag2005Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

     Extra high requirements are made on all systems in health care that they are functional and usable,´something, however, that is not always the case. At Emergency Admissions at Sahlgrenska University´Hospital many systems are in use at the same time and it happens that much overhead is caused by having to fill in the same information in different places. In addition, data that is gathered is to a large extent saved in free text format, which means that it cannot be used in a larger context such as research, quality control or for decision support. Data is saved in the patient file only for the treatment process of the individual patient.

    A data collecting system with decision support functionality could be a first step towards reducing Emergency Admissions’ costs and patients’ waiting times by providing a structured method of data collection. It is also possible that it could contribute to safer care for patients as the system could warn the staff on occasions where there may be a risk of a patient suffering from a serious, acute illness that might be difficult to diagnose.

    An analysis has been performed at Emergency Admissions at Sahlgrenska to distinguish possible users of a new system for collecting data with decision support. The results showed that the nurses in reception were the most suitable target group.

    A prototype of a user interface for gathering initial patient data at reception has been made at Emergency Admissions at Sahlgrenska. This prototype has decision support functionality for ranking the most probable diagnoses as well as providing advice on suitable tests and examinations to perform. The focus has been on usability and on adapting the system to the needs of the users.

    It is highly important that future users, the staff at Emergency Admissions, continue to participate in the future further development of the data gathering system so that their needs and requirements are not overshadowed by the new technology.

  • 2.
    Weström, Sarah
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Örneholm, Isabelle
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Interaktion och intervention: En undersökning av kommunikativa behov hos personer med afasi och dysartri i vardagliga och kliniska samtal2012Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    In speech and language intervention, the ability to interact is seldom evaluated; rather intervention is evaluated in terms of improved testresults.  If goal-setting in intervention also is based on everyday communicative needs, the relevance of the treatment may be increased and intervention outcome may be implemented in the patient’s natural environment.

    The present study, as part of a research-project, is based on analyses of interaction and interviews to examine everyday conversations and speech and language intervention. The aim was to explore if there is a relation between everyday communication needs and goal-setting in speech and language intervention for people with aphasia. A further aim was to investigate if there are everyday communicative needs that may form goals for speech and language intervention.

    Two individuals with aphasia and one individual with both dysarhtria and aphasia participated in the study. Three speech and language pathologists and two relatives also participated in the study. Everyday interaction and intervention sessions were recorded and transcribed according to Conversation Analysis principles and analysed from an interactional perspective. Interviews regarding intervention and everyday communication were carried out with all participants. Recordings were presented and discussed with all participants, in so called retrospections.

    Four phenomena that illustrate communication needs of the participating patients were identified: repair, alternative and augmentative communication, co-construction and feedback. Analysis, interviews and retrospections have revealed that communication needs can form the basis of goal-setting in speech and language intervention. It is also demonstrated that intervention mainly is based on the everyday communication needs of the patient. Retrospections were also shown to be useful in order to observe communication needs in everyday life and in order to evaluate speech and language intervention. The retrospections were found to be beneficial to an open dialogue between speech and language pathologist, patient and relatives regarding the content and aim of the intervention.

     

  • 3.
    Ståhl, Sally
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Strokekedjan från början till slut: En etnografisk studie om farlighet och tid i en akut vårdkedja2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    30 000 people in Sweden get a stroke every year. This leads to large personal adaptions as well as high costs for the society. The most efficient treatment, thrombolysis, must be given as soon as possible to have a good effect. At the same time it is very important to find out if the patient has any differential diagnosis that can make the treatment hazardous.

    This study investigates how the course ov events around acute stroke patients take place and important factors for the decision making. The studiy is based on ethnographic field studys on four swedish hospitals. The material is analysed with methods from joint cognitive systems and goal-oriented design. The results show that in spite of different organisation of the course  of events around acute stroke patients are the processes and direct communication most successful for effective spread of information between the processes. The neurologist on call is an important roll who, as well as the rest of the participants in the course of events, balances the decision making between efficiency and thoroughness. The combination of analysis gives results on both system- and individual levels. Possibilites for improvents are given in three categories: logistic, technological and organizational.

  • 4.
    Åman, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Joakim, Behrendtz
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Anestesipersonalens peri-operativa omvårdnad av överviktiga och obesa barn2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Children are a group of patients that require special knowledge from the anesthesia staff, both general and specific. Theoretical knowledge and practical experience is necessary to adequately care for the child as it anatomically, physiologically and mentally may differ from adult patients.

    A growing problem in the pediatric population is overweight and obesity. From a stagnation in the early 2000s the prevalence of overweight and obesity among children in the world are again increasing.The purpose of this study was to examine peri-operative care of overweight and obese children.

    Systematic searches were done in PubMed, CINAHL and Scopus. After the quality audit according to SBU, twelve articles were included for analysis.

    Results suggest that overweight and obese children have a higher risk of respiratory peri-operative complications. The risk of hospital admission after outpatient surgery was also greater in this group as well as higher costs for health care.

    Overweight and obese children are complex subjects with more frequent peri-operative risk factors than normal-weight children. This group requires special knowledge of the anesthesia staff. More studies are required to secure evidence in anesthetic care for overweight and obese children.

  • 5.
    Pettersson, Olivia
    et al.
    Linköping University, Department of Medical and Health Sciences.
    Wennfalk, Martina
    Linköping University, Department of Medical and Health Sciences.
    Patient education and adherence to tuberculosis treatment: - Indonesian nurses share their experiences2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim

    The aim of this qualitative study was to explore Indonesian nurses’ experiences of patient education and patients’ adherence to TB treatment.

    Background

    Tuberculosis (TB) is an infectious disease that 9.6 million people in the world suffer from. Indonesia is one of the world’s 22 high-burden countries with over 320.000 cases of TB in 2014. The UN’s (United Nation) goal is to have ended the TB epidemics by the year 2030. Nurses play a central role in accomplishing adherence to treatment and prevention of TB.

    Method

    To fulfil the aim a qualitative method using semi-structured interviews was used. The interviews were recorded and transcribed. The transcribed data was analysed by using a qualitative content analysis with a manifest approach.

    Findings

    The findings, based on the result of nine interviews, showed four themes: “Strategies for patient education”, “Factors affecting patient education and adherence to treatment”, ”Outcomes of patient education” and ”Feelings and opinions about patient education”.

    Conclusion

    This study showed that the nurses use different strategies when practicing patient education. It was also shown that the nurses are well aware about patient-related factors and how they affect patient education and adherence to TB treatment.

    Keywords

    Tuberculosis, nursing care, patient education, adherence 

  • 6.
    Neggers, Sebastian J C M M
    et al.
    Department of Endocrinology Erasmus Medical Center, Rotterdam, Netherlands et al .
    Pronin, Vyacheslav
    1Department of Endocrinology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
    Balcere, Inga
    Department of Endocrinology, Pauls Stradins Clinical University Hospital, Riga, Latvia.
    Lee, Moon-Kyu
    Division of Endocrinology and Metabolism, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea.
    Rozhinskaya, Liudmila
    Department of Neuroendocrinology and Bone Diseases, National Endocrinology Research Centre, Moscow, Russian Federation.
    Bronstein, Marcello D
    Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
    Gadelha, Mônica R
    Endocrine Section, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
    Maisonobe, Pascal
    Boulogne-Billancourt, Ipsen, Boulogne-Billancourt, France.
    Sert, Caroline
    Boulogne-Billancourt, Ipsen, Boulogne-Billancourt, France.
    van der Lely, Aart Jan
    Department of Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands.
    Lanreotide Autogel 120 mg at extended dosing intervals in patients with acromegaly biochemically controlled with octreotide LAR: the LEAD study2015In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 173, no 3Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate extended dosing intervals (EDIs) with lanreotide Autogel 120 mg in patients with acromegaly previously biochemically controlled with octreotide LAR 10 or 20 mg.

    DESIGN AND METHODS: Patients with acromegaly had received octreotide LAR 10 or 20 mg/4 weeks for ≥ 6 months and had normal IGF1 levels. Lanreotide Autogel 120 mg was administered every 6 weeks for 24 weeks (phase 1); depending on week-24 IGF1 levels, treatment was then administered every 4, 6 or 8 weeks for a further 24 weeks (phase 2). Hormone levels, patient-reported outcomes and adverse events were assessed.

    PRIMARY ENDPOINT: proportion of patients on 6- or 8-week EDIs with normal IGF1 levels at week 48 (study end).

    RESULTS: 107/124 patients completed the study (15 withdrew from phase 1 and two from phase 2). Of 124 patients enrolled, 77.4% were allocated to 6- or 8-week EDIs in phase 2 and 75.8% (95% CI: 68.3-83.3) had normal IGF1 levels at week 48 with the EDI (primary analysis). A total of 88.7% (83.1-94.3) had normal IGF1 levels after 24 weeks with 6-weekly dosing. GH levels were ≤ 2.5 μg/l in > 90% of patients after 24 and 48 weeks. Patient preferences for lanreotide Autogel 120 mg every 4, 6 or 8 weeks over octreotide LAR every 4 weeks were high.

    CONCLUSIONS: Patients with acromegaly achieving biochemical control with octreotide LAR 10 or 20 mg/4 weeks are possible candidates for lanreotide Autogel 120 mg EDIs. EDIs are effective and well received among such patients.

  • 7.
    Gheorghiade, Mihai
    et al.
    Northwestern University Feinberg School of Medicine, Chicago, USA.
    Greene, Stephen J
    Duke University Medical Center, Durham, North Carolina, USA.
    Butler, Javed
    Stony Brook University, Stony Brook, New York, USA.
    Filippatos, Gerasimos
    Athens University Hospital Attikon and Kapodistrian University of Athens, Athens, Greece.
    Lam, Carolyn S P
    National Health Center, Singapore and Duke, National University of Singapore, Singapore.
    Maggioni, Aldo P
    Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy.
    Ponikowski, Piotr
    Medical University, Wroclaw, Poland.
    Shah, Sanjiv J
    Northwestern University Feinberg School of Medicine, Chicago, USA.
    Solomon, Scott D
    Brigham and Women's Hospital Boston, Massachusetts, USA.
    Kraigher-Krainer, Elisabeth
    Charite University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany.
    Samano, Eliana T
    Bayer, Sao Paulo, Brazil.
    Müller, Katharina
    Bauer Pharma, Wuppertal, Germany.
    Roessig, Lothar
    Bauer Pharma, Wuppertal, Germany.
    Burkert, Pieske
    Charité University Medicine Berlin–Campus Virchow Klinikum and German Heart Center Berlin, Germany.
    Effect of Vericiguat, a Soluble Guanylate Cyclase Stimulator, on Natriuretic Peptide Levels in Patients With Worsening Chronic Heart Failure and Reduced Ejection Fraction: The SOCRATES-REDUCED Randomized Trial.2015In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 314, no 21, 2251-2262 p.Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Worsening chronic heart failure (HF) is a major public health problem.

    OBJECTIVE: To determine the optimal dose and tolerability of vericiguat, a soluble guanylate cyclase stimulator, in patients with worsening chronic HF and reduced left ventricular ejection fraction (LVEF).

    DESIGN, SETTING, AND PARTICIPANTS: Dose-finding phase 2 study that randomized 456 patients across Europe, North America, and Asia between November 2013 and January 2015, with follow-up ending June 2015. Patients were clinically stable with LVEF less than 45% within 4 weeks of a worsening chronic HF event, defined as worsening signs and symptoms of congestion and elevated natriuretic peptide level requiring hospitalization or outpatient intravenous diuretic.

    INTERVENTIONS: Placebo (n = 92) or 1 of 4 daily target doses of oral vericiguat (1.25 mg [n = 91], 2.5 mg [n = 91], 5 mg [n = 91], 10 mg [n = 91]) for 12 weeks.

    MAIN OUTCOMES AND MEASURES: The primary end point was change from baseline to week 12 in log-transformed level of N-terminal pro-B-type natriuretic peptide (NT-proBNP). The primary analysis specified pooled comparison of the 3 highest-dose vericiguat groups with placebo, and secondary analysis evaluated a dose-response relationship with vericiguat and the primary end point.

    RESULTS: Overall, 351 patients (77.0%) completed treatment with the study drug with valid 12-week NT-proBNP levels and no major protocol deviation and were eligible for primary end point evaluation. In primary analysis, change in log-transformed NT-proBNP levels from baseline to week 12 was not significantly different between the pooled vericiguat group (log-transformed: baseline, 7.969; 12 weeks, 7.567; difference, -0.402; geometric means: baseline, 2890 pg/mL; 12 weeks, 1932 pg/mL) and placebo (log-transformed: baseline, 8.283; 12 weeks, 8.002; difference, -0.280; geometric means: baseline, 3955 pg/mL; 12 weeks, 2988 pg/mL) (difference of means, -0.122; 90% CI, -0.32 to 0.07; ratio of geometric means, 0.885, 90% CI, 0.73-1.08; P = .15). The exploratory secondary analysis suggested a dose-response relationship whereby higher vericiguat doses were associated with greater reductions in NT-proBNP level (P < .02). Rates of any adverse event were 77.2% and 71.4% among the placebo and 10-mg vericiguat groups, respectively.

    CONCLUSIONS AND RELEVANCE: Among patients with worsening chronic HF and reduced LVEF, compared with placebo, vericiguat did not have a statistically significant effect on change in NT-proBNP level at 12 weeks but was well-tolerated. Further clinical trials of vericiguat based on the dose-response relationship in this study are needed to determine the potential role of this drug for patients with worsening chronic HF.

    TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01951625.

  • 8.
    Galiè, Nazzareno
    et al.
    University of Bologna, Italy.
    Barberà, Joan A
    University of Barcelona and Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain.
    Frost, Adaani E
    Baylor College of Medicine, Houston, USA.
    Ghofrani, Hossein-Ardeschir
    University of Giessen and Marbury Lung Center, Giessen, Germany.
    Hoeper, Marius M
    Hanover Medical School and German Center of Lung Research, Hanover, Germany.
    McLaughlin, Vallerie V
    University of Michigan, USA.
    Peacock, Andrew J
    Regional Heart and Lung Center, Glasgow, Scotland.
    Simonneau, Gérald
    University Paris-Sud, Paris, France.
    Vachiery, Jean-Luc
    Hospital Erasme, Brussels, Belgium.
    Grünig, Ekkehard
    University Hospital Heidelberg, Heidelberg, Germany.
    Oudiz, Ronald J
    UCLA Medical Center, Torrance,USA.
    Vonk-Noordegraaf, Anton
    University Medical Center, Amsterdam, Netherlands.
    White, R James
    University of Rochester, NY, USA.
    Blair, Christiana
    Gilead Sciences, Foster City.
    Gillies, Hunter
    Gilead Sciences, Foster City.
    Miller, Karen L
    Gilead Sciences, Foster City.
    Harris, Julia H N
    GlaxoSmith Kline, Uxbridge, UK.
    Langley, Jonathan
    GlaxoSmith Kline, Uxbridge, UK.
    Rubin, Lewis J
    University of California at San Diego, USA.
    Initial Use of Ambrisentan plus Tadalafil in Pulmonary Arterial Hypertension2015In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 373, no 9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Data on the effect of initial combination therapy with ambrisentan and tadalafil on long-term outcomes in patients with pulmonary arterial hypertension are scarce.

    METHODS: In this event-driven, double-blind study, we randomly assigned, in a 2:1:1 ratio, participants with World Health Organization functional class II or III symptoms of pulmonary arterial hypertension who had not previously received treatment to receive initial combination therapy with 10 mg of ambrisentan plus 40 mg of tadalafil (combination-therapy group), 10 mg of ambrisentan plus placebo (ambrisentan-monotherapy group), or 40 mg of tadalafil plus placebo (tadalafil-monotherapy group), all administered once daily. The primary end point in a time-to-event analysis was the first event of clinical failure, which was defined as the first occurrence of a composite of death, hospitalization for worsening pulmonary arterial hypertension, disease progression, or unsatisfactory long-term clinical response.

    RESULTS: The primary analysis included 500 participants; 253 were assigned to the combination-therapy group, 126 to the ambrisentan-monotherapy group, and 121 to the tadalafil-monotherapy group. A primary end-point event occurred in 18%, 34%, and 28% of the participants in these groups, respectively, and in 31% of the pooled-monotherapy group (the two monotherapy groups combined). The hazard ratio for the primary end point in the combination-therapy group versus the pooled-monotherapy group was 0.50 (95% confidence interval [CI], 0.35 to 0.72; P<0.001). At week 24, the combination-therapy group had greater reductions from baseline in N-terminal pro-brain natriuretic peptide levels than did the pooled-monotherapy group (mean change, -67.2% vs. -50.4%; P<0.001), as well as a higher percentage of patients with a satisfactory clinical response (39% vs. 29%; odds ratio, 1.56 [95% CI, 1.05 to 2.32]; P=0.03) and a greater improvement in the 6-minute walk distance (median change from baseline, 48.98 m vs. 23.80 m; P<0.001). The adverse events that occurred more frequently in the combination-therapy group than in either monotherapy group included peripheral edema, headache, nasal congestion, and anemia.

    CONCLUSIONS: Among participants with pulmonary arterial hypertension who had not received previous treatment, initial combination therapy with ambrisentan and tadalafil resulted in a significantly lower risk of clinical-failure events than the risk with ambrisentan or tadalafil monotherapy. (Funded by Gilead Sciences and GlaxoSmithKline; AMBITION ClinicalTrials.gov number, NCT01178073.).

  • 9.
    Mounagurusamy, Purani
    Linköping University, Department of Computer and Information Science, Database and information techniques.
    Parsing AQL Queries into SQL Queries using ANTLR2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    An Electronic Health Record is a collection of each patient’s health information which is stored electronically or in digital format. openEHR is an open standard specification for electronic health record data. openEHR has a method for querying a set of clinical data using the Archetype Query Language (AQL). 

    The EHR data is in XML format and this format is a tree like structure. Since XML databases were considerably slower, AQL needs to be translated to another query language. Researchers have already investigated translating AQL to XQuery and tested the performance. Since the performance was not satisfactory, we now investigate translating AQL to SQL.

    AQL queries are translated to SQL queries using the ANTLR tool. The translation is implemented in Java language. The AQL queries which are translated into SQL queries are also tested in this thesis work. Finally, the result is to get the corresponding SQL query for any given AQL query.

  • 10.
    Tardif, Jean-Claude
    et al.
    Université de Montréal Beaulieu-Saucier Pharmacogenomics, Centre Montreal, Quebec, Canada.
    Rhéaume, Eric
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Lemieux Perreault, Louis-Philippe
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Grégoire, Jean C
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Feroz Zada, Yassamin
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Asselin, Géraldine
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Provost, Sylvie
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Barhdadi, Amina
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Rhainds, David
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    L'Allier, Philippe L
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Ibrahim, Reda
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Upmanyu, Ruchi
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Niesor, Eric J
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Benghozi, Renée
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Suchankova, Gabriela
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Laghrissi-Thode, Fouzia
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Guertin, Marie-Claude
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Olsson, Anders G
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Mongrain, Ian
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Schwartz, Gregory G
    University of Colorado, Denver, USA and F. Hoffmann-La Roche, Basel, Switzerland.
    Dubé, Marie-Pierre
    Université de Montréal Beaulieu-Saucier Pharmacogenomics, Centre Montreal, Quebec, Canada.
    Pharmacogenomic determinants of the cardiovascular effects of dalcetrapib.2015In: Circulation: Cardiovascular Genetics, ISSN 1942-325X, E-ISSN 1942-3268, Vol. 8, no 2, 372-382 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dalcetrapib did not improve clinical outcomes, despite increasing high-density lipoprotein cholesterol by 30%. These results differ from other evidence supporting high-density lipoprotein as a therapeutic target. Responses to dalcetrapib may vary according to patients' genetic profile.

    METHODS AND RESULTS: We conducted a pharmacogenomic evaluation using a genome-wide approach in the dal-OUTCOMES study (discovery cohort, n=5749) and a targeted genotyping panel in the dal-PLAQUE-2 imaging trial (support cohort, n=386). The primary endpoint for the discovery cohort was a composite of cardiovascular events. The change from baseline in carotid intima-media thickness on ultrasonography at 6 and 12 months was evaluated as supporting evidence. A single-nucleotide polymorphism was found to be associated with cardiovascular events in the dalcetrapib arm, identifying the ADCY9 gene on chromosome 16 (rs1967309; P=2.41×10(-8)), with 8 polymorphisms providing P<10(-6) in this gene. Considering patients with genotype AA at rs1967309, there was a 39% reduction in the composite cardiovascular endpoint with dalcetrapib compared with placebo (hazard ratio, 0.61; 95% confidence interval, 0.41-0.92). In patients with genotype GG, there was a 27% increase in events with dalcetrapib versus placebo. Ten single-nucleotide polymorphism in the ADCY9 gene, the majority in linkage disequilibrium with rs1967309, were associated with the effect of dalcetrapib on intima-media thickness (P<0.05). Marker rs2238448 in ADCY9, in linkage disequilibrium with rs1967309 (r(2)=0.8), was associated with both the effects of dalcetrapib on intima-media thickness in dal-PLAQUE-2 (P=0.009) and events in dal-OUTCOMES (P=8.88×10(-8); hazard ratio, 0.67; 95% confidence interval, 0.58-0.78).

    CONCLUSIONS: The effects of dalcetrapib on atherosclerotic outcomes are determined by correlated polymorphisms in the ADCY9 gene.

    CLINICAL TRIAL INFORMATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00658515 and NCT01059682.

  • 11.
    Hägg, Mary
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Hudiksvall, Uppsala University/County Council of Gävleborg, Gävle, Uppsala, Sweden.
    Tibbling, Lita
    Hudiksvall, Uppsala University/County Council of Gävleborg, Gävle, Uppsala, Sweden.
    Effect of oral IQoro(R) and palatal plate training in post-stroke, four-quadrant facial dysfunction and dysphagia: A comparison study2015In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 135, no 9, 962-968 p.Article in journal (Refereed)
    Abstract [en]

    Conclusion: Training with either a palatal plate (PP) or an oral IQoro(R) screen (IQS) in patients with longstanding facial dysfunction and dysphagia after stroke can significantly improve facial activity (FA) in all four facial quadrants as well as swallowing capacity (SC). Improvements remained at late follow-up. The training modalities did not significantly differ in ameliorating facial dysfunction and dysphagia in these patients. However, IQS training has practical and economic advantages over PP training. Objectives: This study compared PP and oral IQS training in terms of (i) effect on four-quadrant facial dysfunction and dysphagia after a first-ever stroke, and (ii) whether the training effect persisted at late follow-up. Methods: Patients were included during two periods; 13 patients in 2005-2008 trained with a PP, while 18 patients in 2009-2012 trained with an IQS. Four-quadrant facial dysfunction was assessed with an FA test and swallowing dysfunction with a SC test: before and after a 3-month training period and at late follow-up. FA and SC significantly improved (p less than 0.001) in both groups. FA test scores after training and at late follow-up did not differ significantly between the groups, irrespective of whether the interval between stroke incidence and the start of training was long or short.

  • 12. Klompstra, Leonie
    et al.
    Jaarsma, TinyStrömberg, Anna
    Playing exergames by heart failure patients.2013Conference proceedings (editor) (Refereed)
    Abstract [en]

    Purpose: Regular daily exercise is recognized as important in patients with heart failure (HF), but adherence to exercise recommendations is low. It is important to search for alternative approaches to motivate patients with HF to be more active. The use of exergames (games to improve physical exercise) might be an encouragement for HF patients, especially for people who may be reluctant to engage in more traditional forms of exercise, such as going to the gym or take a walk outside. The aim of this study is to assess the self-reported time playing on the Wii exergame platform when patients get access to the Wii at home for 12 weeks and the factors related to the time playing.

    Methods: As part of a feasibility study, the Wii was installed in the home of HF patients for a period of 12 weeks and patients were instructed to exergame 20 minutes a day (e.g. virtual bowling or tennis). Patients completed a diary which contained questions about the amount of minutes exergaming, heart failure symptoms and perceived exertion. At baseline and 12 weeks the physical capacity was assessed by 6minute walking test. We compared patients who played more than the median amount of minutes on the Wii with patients who played less than the median time.

    Results:  Thirty-two HF patients (age 64 ± 14, 10 female) were included. The mean time exergaming was 28 (±13) minutes a day (median of 27 minutes). Two patients stopped exergaming during the study. Men played more minutes a day on the Wii (31 minutes) than women (20 minutes), (t =2.243, p <.033) which could not be explained by age. Both male and female patients decreased in time exergaming, comparing the first 6 weeks access to the Wii with the last 6 weeks, but no differences were found in the amount of minutes decrease in exergaming (-5±9) between man and women. Patients who played more than the median time were significant lower educated, had a lower NYHA class and had more often grandchildren than patients who exergamed less than the median time.  No association could be found between the groups in exercise capacity, motivation, self-efficacy, symptoms experience, perceived exertion with time exergaming.

    Conclusion: Patients with HF played a considerable time active games on the Wii during 12 months of access to the Wii. Although women exergamed less than men, they did not decrease more in playing then men during the study. Patients who increased more than the median amount of minutes exergaming had a lower educational level, lower NYHA class, and more patients had grandchildren than patients who exergamed less. Access to exergames seem to be a promising to keep HF patients motivated to be active and to provide social facilitation with grandchildren. 

  • 13. Klompstra, Leonie
    et al.
    Jaarsma, TinyStrömberg, Anna
    Gender differences in participation motives for exercise and exergaming in heart failure patients.2014Conference proceedings (editor) (Refereed)
    Abstract [en]

    Purpose: Regular daily exercise is recognized as important in patients with heart failure (HF). The use of exergames (games to improve physical exercise) might be an encouragement for HF patients, especially for people who may be reluctant to engage in more traditional forms of exercise. It is known that participation motives are important factors in able to become more physical active. Therefore the purpose of this study is to examine gender differences in participation motives before access to an exergame computer and the exercise motives after access to an exergame computer at home.

    Methods: The Wii was installed in the home of HF patients for a period of 12 weeks and patients were instructed to exergame 20 minutes a day (e.g. virtual bowling or tennis). Patients completed a questionnaire on baseline and 12 weeks which included the exercise motivation index (EMI), which measured participation motives. The EMI consists of 15 statements; each statement is followed by a five-point verbal rating from 0 (not important) to 4 (extremely important). Chi-square test was performed to look in gender in participation motives of the EMI and the ESE. P-values<.05 was considered significant.

    Results:  Thirty-two HF patients (age 64 ± 14, 10 female) were included. The exercise motives which scored important or extremely important on baseline were: ‘I want to be in better shape so that my clothes sit better’, ‘I want the ageing process to slow down and feel younger’, ‘Exercise increases my overall well-being’ and ‘I want to be healthier and live longer’. After 12 weeks access to the Nintendo Wii only the participation motive: ‘I want to be healthier and perhaps life longer’ scored important or extremely inportant. Gender differences were found in participation motives at baseline. Female patients significant agreed more on 6 participation motives compared to men: I want to be in better shape so my clothes fit better (3 vs 1), I am proud of myself when I exercise regularly (3 vs 1), I want to look good (2 vs. 1), I want to be as active as my family and my friends (2 vs 1), I feel successful when I am on better shape (3 vs 1) and I want to feel less physical vulnerable (3 vs 1). At 12 weeks there were fewer differences in participation motives. Difference were found where women agreed more on 2 participation motives than men: I want to be as active as my family and my friends (2 vs 1) and People who are in good shape will be admired, I want to be admired too (2 vs 1).

    Conclusion: This study shows gender differences in the participation motives in becoming physical active and exergaming. Women have more participation motives than men. After 12 weeks access to the Nintendo Wii we found less difference in the participation motives between men and women. Gender differences in participation motives in exergaming were due to social facilitation and I want to be admired, where women agreed more than men. 

  • 14.
    Back, Lovisa
    et al.
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Johannisson, Emma
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Ransoneringar på policy- och individnivå i hälso- och sjukvården - Ett beteendeekonomiskt experiment: Health Care Rationing at Policy and Bedside Level - A behavioral economic experiment2015Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Scarce health care resources fail to supply the increasing demand. In order to allocate the economic resources as efficiently as possibly the capacity to ration, to deny patients health care, is essential. Rationing decisions can be considered as moral dilemmas where the decision maker is required to choose between two conflicting ethical principles. However, the conditions under which policymakers and physicians make decisions are different. Many policies are not applicable at the bedside level since they are based on a group perspective and tend to ignore a patient's individual needs.Aim: The aim of this study is to conduct a behavioural economic experiment and examine how the context of the decision-maker influences the outcome of their decision in health care rationing situations.Method: Medical students and students from other graduate programmes receive a questionnaire where they each make decisions in rationing scenarios where utilitarian and deontological principles are in conflict. Each survey is framed as a decision presented in one of two decision-making contexts, policy or bedside level. At policy level, the subjects assume the perspective of a head of department and make decisions regarding a patient based upon a group statistic. At bedside level, the subjects take the perspective of a physician and make decisions regarding an identified patient.Results: Subjects are more utilitarian and ration to a higher degree at policy level than at bedside level. The difference in the rate of utilitarian answers at policy level in comparison to bedside level is largest for medical students and in life saving scenarios. Students from other graduate programmes, however, are more likely to ration at policy level. In life enhancing scenarios, the effect of the decision-making context differs and the rate of utilitarian responses is in some cases lower at policy level than at the individual level.Conclusion: This study shows that decisions at the policy and the bedside level are not necessarily the same, even though the available information of the treatments and costs remains unchanged. This result encourages further studies on the impact of the decision-making context on rationing decisions in health care.

  • 15.
    Karlsson, Louise
    et al.
    Linköping University, Faculty of Medicine and Health Sciences, Faculty of Health Sciences, Medical Programme.
    Olofsson, John
    Linköping University, Faculty of Medicine and Health Sciences, Faculty of Health Sciences, Medical Programme.
    Tidseffektivitet vid ljumskbråcksoperationer: - Jämförelse mellan privat- och offentlig vårdgivare2015Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background:

    Inguinal hernia surgery is one of the most common surgeries within general surgery, with approximately 20 000 surgeries per year in Sweden. There are three places in Östergötland County where inguinal hernias are executed within outpatient surgery; at Aleris Specialistvård in Motala (ASM), Närsjukvården in Finspång (NiF) and at Medicinskt Centrum in Linköping (MCL).

    There is a theory that private health care providers are more time-efficient than public health care providers. The private health care providers are considered to perform more operations over a given time though no studies has been done on time efficiency.

    This study was performed to detect if there is a difference in time in the various steps during the surgery between the clinics, what causes these differences and if the patients differ.

     

    Methods:

    The study includes 70 patients distributed on three outpatient surgery clinics; ASM, MCL and NiF. The inguinal hernia operations were divided into shorter steps measured with a digital watch.  Furthermore, data were noted about the patients’ age, ASA-score, BMI and who were present in the operating room. Statistical analyses were performed with the Kruskal-Wallis one-way analysis of variance. The software used was SPSS version 22.

     

    Results:

    The study found no significant difference in BMI, ASA-score and age between the health care providers (p > 0,05). However, regarding the time efficiency, there were significant differences between the clinics.

     

    Conclusions:

    The study concludes that there are big differences in time, within the various steps in the inguinal hernia surgeries, between the clinics. The private health care providers were always faster than the public health care provider. Since no earlier studies have been made in this area, it would be interesting to see if there are similar differences in other types of surgeries.

  • 16.
    John, M. T.
    et al.
    University of Minnesota, USA.
    Feuerstahler, L.
    University of Minnesota, USA.
    Waller, N.
    University of Minnesota, MN 55455 USA.
    Baba, K.
    Showa University, Japan.
    Larsson, Pernilla
    Centre of Oral Rehabilitation, Prosthetic Dentistry,Norrköping .
    Celebic, A.
    University of Zagreb, Croatia.
    Kende, D.
    University of Pecs, Hungary.
    Rener-Sitar, K.
    University of Ljubljana, Slovenia.
    Reissmann, D. R.
    University of Medical Centre Hamburg Eppendorf, Germany.
    Confirmatory factor analysis of the Oral Health Impact Profile2014In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 41, no 9, 644-652 p.Article in journal (Refereed)
    Abstract [en]

    Previous exploratory analyses suggest that the Oral Health Impact Profile (OHIP) consists of four correlated dimensions and that individual differences in OHIP total scores reflect an underlying higher-order factor. The aim of this report is to corroborate these findings in the Dimensions of Oral Health-Related Quality of Life (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the projects Validation Sample (n = 5022), we conducted confirmatory factor analyses in a sample of 4993 subjects with sufficiently complete data. In particular, we compared the psychometric performance of three models: a unidimensional model, a four-factor model and a bifactor model that included one general factor and four group factors. Using model-fit criteria and factor interpretability as guides, the four-factor model was deemed best in terms of strong item loadings, model fit (RMSEA = 0.05, CFI = 0.99) and interpretability. These results corroborate our previous findings that four highly correlated factors - which we have named Oral Function, Orofacial Pain, Oro-facial Appearance and Psychosocial Impact - can be reliably extracted from the OHIP item pool. However, the good fit of the unidimensional model and the high interfactor correlations in the four-factor solution suggest that OHRQoL can also be sufficiently described with one score.

  • 17.
    John, Mike T.
    et al.
    University of Minnesota, USA.
    Reissmann, Daniel R.
    University of Medical Centre Hamburg Eppendorf, Germany.
    Feuerstahler, Leah
    University of Minnesota, USA.
    Waller, Niels
    University of Minnesota, USA.
    Baba, Kazuyoshi
    Showa University, Japan.
    Larsson, Pernilla
    Centre of Oral Rehabilitation, Prosthetic Dentistry, Norrköping, Sweden.
    Celebic, Asja
    University of Zagreb, Croatia.
    Szabo, Gyula
    University of Pecs, Hungary.
    Rener-Sitar, Ksenija
    University of Ljubljana, Slovenia.
    Factor analyses of the Oral Health Impact Profile - Overview and studied population2014In: Journal of Prosthodontic Research, ISSN 1883-1958, Vol. 58, no 1, 26-34 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: A desideratum of oral health-related quality of life (OHRQoL) instruments such as the Oral Health Impact Profile (OHIP) is that they accurately reflect the structure of the measured construct(s). With this goal in mind, the Dimensions of Oral Health-Related Quality of Life (DOQ) Project was proposed to investigate the number and nature of OHRQoL dimensions measured by OHIP. In this report, we describe our aggregate data set for the factor analyses in the project, which consists of responses to the 49-item OHIP from general population subjects and prosthodontics patients from 6 countries, including a large age range of adult subjects and both genders. Materials and methods: The DOQ Projects aggregate data set combines data from 35 individual studies conducted in Croatia, Germany, Hungary, Japan, Slovenia, and Sweden. Results: The combined data set includes 10778 OHIPs from 9348 individuals (N = 6349 general population subjects, N = 2999 prosthodontic patients). To elucidate the OHIP latent structure, the aggregated data were split into a Learning Sample (N = 5173) for exploratory analyses and a Validation Sample (N = 5022) for confirmatory analyses. Additional data (N = 583) were assigned to a third data set. Conclusion: The Dimensions of Oral Health-Related Quality of Life Project contains a large amount of international data and is representative of populations where OHIP is intended to be used. It is well-suited to assess the dimensionality of the questionnaire. (C) 2013 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.

  • 18.
    Magnusson, Karolina
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Mechanical heart rate detection using cardiogenic impedance - a morphology approach2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The objective of this thesis is to examine the possibility to determine the mechanical heart rate using intracardiac impedance in the time domain. Deducing the mechanical heartrate from the impedance could help improve the performance of implanted devices that today depend on the measurement of the heart’s electrical activity. Cardiogenic – also known as intracardiac – impedance is based on the difference in conductivity between heart muscle tissue and blood, making the impedance vary as the heart is filled and emptied. The data used in this thesis was acquired from three previous studies performed by St Jude Medical, two clinical and one preclinical. Two impedance measurement configurations were chosen from these studies, one bipolar and one quadropolar. To deduce the heart rate from the intracardiac impedance six algorithms were evaluated. Three using continuous peak detection and three evaluating small frames of the impedance signal.The peak detection algorithms were peak detection on the impedance signal itself, on its derivative  and on its integral. The three others were an Auto Correlation Function (ACF), an Average Magnutide Difference Function (AMDF) and an Average Wave Comparison Function (AWCF). In order to assess the heart rates deduced from the intracardiac impedance by the algorithms, these rates were compared to both the IEGM or the ECG (depending on which study was at hand) and the blood pressure.

    Several issues affected the performance of the algorithms. Impedance morphology can vary between patients. Some display so called “double peaks”, making it hard to decide whether a patient has for example a pulse of 80 bpm or of 160 bpm. The impedance morphology was also affected by amplitude modulation with the respiration frequency which in some patients cause difficulties to analyze the impedance signal. The results show that the two impedance measurement configurations perform equally well and that the ACF method was the overall best performing algorithm. They also show that individual patient impedance morphology has a large influence on the results and for future studies it should therefore be interesting to calibrate the algorithms for each patient, as this should improve performance.

  • 19.
    Neffati, Hammadi
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Översättning och anpassning av Kortfattad Afasiprövning till arabiska: Jämförelse med arabiska Bilingual Aphasia Test och självskattad språkförmåga2015Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    With the growing amount of citizens with another mother tongue than Swedish, the need for assessment instruments in other languages than Swedish within the Swedish health care increases. To enable this, the knowledge of multilingualism and adequate assessments are required. The aim is to develop a modern Arabic version of a screening material that is comparable to what is used in the Swedish clinic in the assessment of people diagnosed with aphasia. In the present study, Short Aphasia Examination (Kortfattad Afasiprövning), which is one of the few screening material is available in Swedish and among the ten most frequently used assessment materials (Blom Johansson, Carlsson & Sonnander, 2011). Translation and adaptation was made to the Standard Arabic (KAPARABISKA) and Arabic dialect of Hadari (KAPHADARI). The results were also compared with the participants' self-rated language abilities. The study is also implementing a comparison between KAP and the Hadari Arabic screening version of the Bilingual Aphasia Test (BAT). The translated assessment materials were tested on six participants, where five had Arabic as their mother tongue and one participant had Arabic and Swedish as mother tongues. The result indicates that the Arabic versions of KAP and BAT are assessing the language ability of the participants almost equally, but that KAP is assessing reading and writing abilities on a higher difficulty. The KAP assessments were conducted during half as long time as BAT. Both the KAP assessments and the BAT assessment identified participants with limited literacy skills, which indicates the importance of inquiring the patient’s education level to avoid false interpretation of the results.

  • 20.
    Romanos, J.
    et al.
    Department of Genetics, University of of Groningen, University of Medical Centre Groningen, PO Box 30001, Groningen 9700 RB, Netherlands; School of Medicine, Lebanese American University, Beirut, Lebanon.
    Rosen, A.
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden; Department of Medical Biosciences, Medical and Clinical Genetics, Umeå University, Umeå, Sweden.
    Kumar, V.
    Department of Genetics, University of of Groningen, University of Medical Centre Groningen, Netherlands.
    Trynka, G.
    Department of Genetics, University of of Groningen, University of Medical Centre Groningen, PO Box 30001, Groningen 9700 RB, Netherlands; Division of Genetics and Division of Rheumatology, Harvard Medical School, Brigham and Womens Hospital, Boston, MA, United States.
    Franke, L.
    Department of Genetics, University of of Groningen, University of Medical Centre Groningen, Netherlands.
    Szperl, A.
    Department of Genetics, University of of Groningen, University of Medical Centre Groningen, Netherlands.
    Gutierrez-Achury, J.
    Department of Genetics, University of of Groningen, University of Medical Centre Groningen, Netherlands.
    Van, Diemen C.C.
    Department of Genetics, University of of Groningen, University of Medical Centre Groningen, Netherlands.
    Kanninga, R.
    Department of Genetics, University of of Groningen, University of Medical Centre Groningen, Netherlands.
    Jankipersadsing, S.A.
    Department of Genetics, University of of Groningen, University of Medical Centre Groningen, Netherlands.
    Steck, A.
    Barbara Davis Centre for Childhood Diabetes, University of of Colorado Denver, Aurora, CO, United States.
    Eisenbarth, G.
    Barbara Davis Centre for Childhood Diabetes, University of of Colorado Denver, Aurora, CO, United States.
    Van, Heel D.A.
    Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, United Kingdom.
    Cukrowska, B.
    Department of Pathology, Childrens Memorial Health Institute, Warsaw, Poland.
    Bruno, V.
    European Laboratory for Food-Induced Disease, University of of Naples Federico II, Naples, Italy.
    Mazzilli, M.C.
    Department of Molecular Medicine, Sapienza University of of Rome, Rome, Italy.
    Nunez, C.
    Clinical Immunology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos IdISSC, Madrid, Spain.
    Bilbao, J.R.
    Immunogenetics Research Laboratory, Hospital de Cruces, Bizkaia, Spain.
    Mearin, M.L.
    Department of Paediatrics, Leiden University of Medical Centre, Leiden, Netherlands.
    Barisani, D.
    Department of Experimental Medicine, Faculty of Medicine, University of of Milano- Bicocca, Monza, Italy.
    Rewers, M.
    Barbara Davis Centre for Childhood Diabetes, University of of Colorado Denver, Aurora, CO, United States.
    Norris, J.M.
    Epidemiology Department, Colorado School of Public Health, Aurora, United States.
    Ivarsson, A.
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
    Boezen, H.M.
    Department of Epidemiology, University of of Groningen, University of Medical Centre Groningen, Groningen, Netherlands.
    Liu, E.
    Barbara Davis Centre for Childhood Diabetes, University of of Colorado Denver, Aurora, CO, United States.
    Wijmenga, C.
    Department of Genetics, University of of Groningen, University of Medical Centre Groningen, PO Box 30001, Groningen 9700 RB, Netherlands.
    Improving coeliac disease risk prediction by testing non-HLA variants additional to HLA variants2014In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 63, no 3, 415-422 p.Article in journal (Refereed)
    Abstract [en]

    Background The majority of coeliac disease (CD) patients are not being properly diagnosed and therefore remain untreated, leading to a greater risk of developing CD-associated complications. The major genetic risk heterodimer, HLA-DQ2 and DQ8, is already used clinically to help exclude disease. However, approximately 40% of the population carry these alleles and the majority never develop CD. Objective We explored whether CD risk prediction can be improved by adding non-HLA-susceptible variants to common HLA testing. Design We developed an average weighted genetic risk score with 10, 26 and 57 single nucleotide polymorphisms (SNP) in 2675 cases and 2815 controls and assessed the improvement in risk prediction provided by the non-HLA SNP. Moreover, we assessed the transferability of the genetic risk model with 26 non-HLA variants to a nested case-control population (n=1709) and a prospective cohort (n=1245) and then tested how well this model predicted CD outcome for 985 independent individuals. Results Adding 57 non-HLA variants to HLA testing showed a statistically significant improvement compared to scores from models based on HLA only, HLA plus 10 SNP and HLA plus 26 SNP. With 57 non-HLA variants, the area under the receiver operator characteristic curve reached 0.854 compared to 0.823 for HLA only, and 11.1% of individuals were reclassified to a more accurate risk group. We show that the risk model with HLA plus 26 SNP is useful in independent populations. Conclusions Predicting risk with 57 additional non-HLA variants improved the identification of potential CD patients. This demonstrates a possible role for combined HLA and non-HLA genetic testing in diagnostic work for CD.

  • 21.
    Johansson, Inga-Lena
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Emotionell prosodi efter högersidig cerebral stroke: Akustisk analys samt skattning av röstens uttrycksfullhet2014Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Important aspects of communication, including emotional prosody, are regulated from the right hemisphere. However, the research in the area of emotional prosody has so far been rather limited. One of the aspects that have not been examined yet is the comparison of the participant’s own rating of voice expression with ratings by listeners. The aim of the study was to assess expressive emotional prosody after right-hemisphere stroke. Participants were three patients with right-hemisphere stroke and three controls without neurological conditions or problems regarding speech or voice. The groups of participants with stroke and the controls were matched regarding sex, age, dialect and level of education. Emotional prosody was examined using multiple methods: acoustic analysis of variation in fundamental frequency and the participants’ own as well as listeners’ rating of voice expression. The results show tendencies that indicate a difference between the participants with right-hemisphere stroke and the controls. The participants with stroke showed smaller variations in fundamental frequency and lower ratings of voice expression. Due to the small sample size in the present study, results should be treated with caution. However, the tendencies shown in the results regarding differences between subjects and controls would justify further studies.

  • 22. Varelogianni, Georgia
    et al.
    Hussain, Rashida
    Strid, Hilja
    Oliynyk, Igor
    Roomans, Godfried M
    Johannesson, Marie
    The effect of ambroxol on chloride transport, CFTR and ENaC in cystic fibrosis airway epithelial cells.2013In: Cell Biology International, ISSN 1065-6995, E-ISSN 1095-8355, Vol. 37, no 11, 1149-1156 p.Article in journal (Refereed)
    Abstract [en]

    Ambroxol, a mucokinetic anti-inflammatory drug, has been used for treatment of cystic fibrosis (CF). The respiratory epithelium is covered by the airway surface liquid (ASL), the thickness and composition of which is determined by Cl(-) efflux via the cystic fibrosis transmembrane conductance regulator (CFTR) and Na(+) influx via the epithelial Na(+) channel (ENaC). In cells expressing wt-CFTR, ambroxol increased the Cl(-) conductance, but not the bicarbonate conductance of the CFTR channels. We investigated whether treatment with ambroxol enhances chloride transport and/or CFTR and ENaC expression in CF airway epithelial cells (CFBE) cells. CFBE cells were treated with 100 µM ambroxol for 2, 4 or 8 h. mRNA expression for CFTR and ENaC subunits was analysed by real-time polymerase chain reaction (RT-PCR); protein expression was measured by Western blot. The effect of ambroxol on Cl(-) transport was measured by Cl(-) efflux measurements with a fluorescent chloride probe. Ambroxol significantly stimulated Cl(-) efflux from CFBE cells (a sixfold increase after 8 h treatment), and enhanced the expression of the mRNA of CFTR and α-ENaC, and of the CFTR protein. No significant difference was observed in β-ENaC after exposure to ambroxol, whereas mRNA expression of γ-ENaC was reduced. No significant effects of ambroxol on the ENaC subunits were observed by Western blot. Ambroxol did not significantly affect the intracellular Ca(2+) concentration. Upregulation of CFTR and enhanced Cl(-) efflux after ambroxol treatment should promote transepithelial ion and water transport, which may improve hydration of the mucus, and therefore be beneficial to CF-patients.

  • 23.
    Barsegård Gustavsson, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Familjeterapi inom primärvården. Intervjuer med nio remittenter.2014Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    It is natural for families and couples who have problems to apply to instances other than in primary care, hence the interest to conduct a study in primary care where the purpose was to examine the problems, opportunities, and increase understanding of working with family therapy. The actual study is based on an interview study in which nine individuals with different professions were asked semi-structured questions, where their reflections and assessments, when remitted to family therapy were laying foundation for the study content. The results indicate that it is possible to work with the family system in a health center.

    The conclusion: it is possible to broaden the perspective on various therapies, as well as the opportunities to implement family therapy as a method or expand thinking about the family system when patients with mental illness find their way to a medical center.

  • 24.
    Seki, Satomi
    et al.
    University of Tokyo.
    Kato, Naoko
    University of Tokyo.
    Ito, Naomi
    University of Tokyo.
    Kinugawa, Koichiro
    University of Tokyo.
    Ono, Minoru
    University of Tokyo.
    Motomura, Noboru
    University of Tokyo.
    Yao, Atsushi
    University of Tokyo.
    Watanabe, Masafumi
    University of Tokyo.
    Imai, Yasushi
    University of Tokyo.
    Takeda, Norihiko
    University of Tokyo.
    Inoue, Masashi
    University of Tokyo.
    Hatano, Masaru
    University of Tokyo.
    Kazuma, Kazuma
    University of Tokyo.
    Validity and reliability of Seattle angina questionnaire Japanese version in patients with coronary artery disease2010In: Asian Nurs Res (Korean Soc Nurs Sci), Vol. 4, no 2, 57-63 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to evaluate the validity and reliability of the Seattle Angina Questionnaire, Japanese version (SAQ-J) as a disease-specific health outcome scale in patients with coronary artery disease. METHODS: Patients with coronary artery disease were recruited from a university hospital in Tokyo. The patients completed self-administered questionnaires, and medical information was obtained from the subjects' medical records. Face validity, concurrent validity evaluated using Short Form 36 (SF-36), known group differences, internal consistency, and test-retest reliability were statistically analyzed. RESULTS: A total of 354 patients gave informed consent, and 331 of them responded (93.5%). The concurrent validity was mostly supported by the pattern of association between SAQ-J and SF-36. The patients without chest symptoms showed significantly higher SAQ-J scores than did the patients with chest symptoms in 4 domains. Cronbach's alpha ranged from .51 to .96, meaning that internal consistency was confirmed to a certain extent. The intraclass correlation coefficient of most domains was higher than the recommended value of 0.70. The weighted kappa ranged from .24 to .57, and it was greater than .4 for 14 of the 19 items. CONCLUSIONS: The SAQ-J could be a valid and reliable disease-specific scale in some part for measuring health outcomes in patients with coronary artery disease, and requires cautious use.

  • 25. Kato, Naoko
    et al.
    Kinugawa, Koichiro
    Ito, Naomi
    Yao, Atsushi
    Watanabe, Masafumi
    Imai, Yasushi
    Takeda, Norihiko
    Hatano, Masaru
    Kazuma, Keiko
    Adherence to self-care behavior and factors related to this behavior among patients with heart failure in Japan2009In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 38, no 5, 398-409 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Adherence to self-care behavior is important for patients with heart failure (HF) to prevent exacerbation of HF. The aim of this study was to evaluate adherence, identify associated factors, and clarify the impact of previous HF hospitalizations on adherence in outpatients with HF. METHODS: A total of 116 outpatients completed a questionnaire, including the Japanese version of the European Heart Failure Self-Care Behavior Scale, to assess adherence. RESULTS: Regardless of previous hospitalizations, adherence to seek help if HF worsened was poor. Multivariate analysis adjusted for age and brain natriuretic peptide showed that diabetes mellitus and being employed were independent predictors of poorer adherence to self-care behavior (P = .03, P = .02, respectively), but the experience of previous HF hospitalizations was not a predictor. CONCLUSIONS: Self-care strategies for HF should target patients with diabetes mellitus and employed patients. Further study is necessary to develop effective programs for such patients.

  • 26.
    Strömbom, Johanna
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Carlsson, Malin
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Vad underlättar respektive hindrar fysisk aktivitet hos personer med långvariga smärtor?: En kvalitativ intervjustudie2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Title: FacilitatorsandBarriers toPhysical ActivityamongPeople with Long-term Pain-A Qualitative Study.

    Authors: Malin Carlsson & Johanna Strömbom, Physiotherapy Programme, Faculty of Health Sciences, Linköping University, Sweden.

    Tutor: Britt Larsson, Docent of Occupational Medicine, Lector of Clinical Pain Research, Faculty of Health Sciences, Linköping University, Sweden.

    ABSTRACT

    Introduction: Exercise has been shown to have positive effects on long-term pain. There is, however, reported poor adherence in people with long-term pain. Previous research has demonstrated a number of facilitating and inhibiting factors to exercise for people with long-term pain but lay emphasis on the importance of further research with a broader approach to physical activity.Purpose: The aim of this study was to identify facilitating factors and barriers to physical activity as a treatment for long-term pain.Method: A qualitative study using semi-structured interviews was conducted with ten participants recruited through the Pain -and Rehabilitation Center in Linköping. Collected data was analysed based on a qualitative content analysis.Results: Facilitating factors were reported to be individually tailored, varied and enjoyable training, also support, fellowship, pain relief, motivation, progress, the desire to improve health, availability and knowledge. Pain, timing, lack of energy, difficulty initiating exercise, not having a need to exercise, lack of availability and knowledge, and furthermore embarrassment, laziness, fear, and lack of motivation were reported as being inhibitive.Conclusion: Factors that appeared in the results confirm previous research, this study presented additional factors such as difficulties initiating exercise and not having a need to exercise. Future research should apply presented factors in the design of treatment for patients with pain.Keywords: adherence, pain, physical activity, qualitative research.

  • 27.
    Salgado Willner, Helen
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Huvudhalscancer och livskvalitet: Patientens skattning av livskvalitet innan och efter strålbehandling2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Each year 1200-1300 patients are diagnosed with head neck cancer. Treatment that involves radiotherapy can cause severe side effects for example trismus that affects quality of life.

    Purpose: To study health-related quality of life in patients who have undergone radiation treatment for head and neck cancer and participated in a intervention group who received training intended to prevent trismus or in a control group who received standard treatment.

    Method: This is a prospective study in which data is collected from 66 patients participating in a randomized study aiming to evaluate a training program to prevent trismus. Thirty three participated in the intervention group and thirty three in the control group. Both patient groups assessed health related quality of life (HRQOL) with EORTC QLQ C30 and QLQ-H&N35, at start and end of the radiation treatment, and at 3 and 6-months after completing radiation treatment.

    Results: There is no difference between the intervention and control groups regarding symptoms, functional status and global health, except for intake of nutritional supplements.  For both groups almost all scales measuring HRQOL deteriorated under the radiation treatment. However, 3 and 6 months after end of radiotherapy HRQOL had improved and had returned to the baseline values. The only exceptions were dry mouth, sticky saliva, problems with social eating, senses and physical ability.

    Conclusion: Radiation therapy for head and neck cancer affects patients HRQOL both in the short and long term. Medical staff needs strategies to manage patients ' functional and symptomatic deterioration throughout the treatment period and try to prevent or relieve the symptoms that may still remain several months after radiotherapy.

  • 28.
    Prieto-Velasco, Mario
    et al.
    Complejo Asistencial Universitario de León, León, Spain .
    Isnard Bagnis, Corinne
    Université Pierre et Marie Curie, Paris France .
    Dean, Jessica
    Department of Clinical Health Psychology, Salford Royal Hospital, Salford, UK.
    Goovaerts, Tony
    Cliniques Universitaires St. Luc, Brussels, Belgium .
    Melander, Stefan
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Mooney, Andrew
    St James’s University, Leeds, UK .
    Nilsson, Eva-Lena
    Skåne Universitetssjukhus, Malmö .
    Rutherford, Peter
    Baxter-Gambro Renal, Zurich, Switzerland.
    Trujillo, Carmen
    Hospital Regional Carlos Haya, Malaga, Spain.
    Zambon, Roberto
    Unità Operativa di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo,Vicenza, Italy.
    Crepaldi, Carlo
    Unità Operativa di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo,Vicenza, Italy.
    Predialysis education in practice: a questionnaire survey of centres with established programmes.2014In: BMC research notes, ISSN 1756-0500, Vol. 7, 730- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is growing evidence that renal replacement therapy option education (RRTOE) can result in enhanced quality of life, improved clinical outcomes, and reduced health care costs. However, there is still no detailed guidance on the optimal way to run such programmes. To help address this knowledge gap, an expert meeting was held in March 2013 to formulate a position statement on optimal ways to run RRTOE. Experts were selected from units that had extensive experience in RRTOE or were performing research in this field. Before the meeting, experts completed a pilot questionnaire on RRTOE in their own units. They also prepared feedback on how to modify this questionnaire for a large-scale study.

    METHODS: A pilot, web-based questionnaire was used to obtain information on: the renal unit and patients, the education team, RRTOE processes and content, how quality is assessed, and funding.

    RESULTS: Four nurses, 5 nephrologists and 1 clinical psychologist (9 renal units; 6 EU countries) participated. Nurses were almost always responsible for organising RRTOE. Nephrologists spent 7.5% (median) of their time on RRTOE. Education for the patient and family began several months before dialysis or according to disease progression. Key topics such as the 'impact of the disease' were covered by every unit, but only a few units described all dialysis modalities. Visits to the unit were almost always arranged. Materials came in a wide variety of forms and from a wide range of sources. Group education sessions were used in 3/9 centres. Expectations on the timing of patients' decisions on modality and permanent access differed substantially between centres. Common quality assurance measures were: patient satisfaction, course attendance, updated materials. Only 1 unit had a dedicated budget.

    CONCLUSIONS: There were substantial variations in how RRTOE is run between the units. A modified version of this questionnaire will be used to assess RRTOE at a European level.

  • 29.
    Felekidis, Dimitrios
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, The Institute of Technology.
    Advanced Visualization Techniques for Laparoscopic Liver Surgery2015Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Laparoscopic liver surgery is mainly preferred over the traditional open liver surgery due to its unquestionable benefits. This type of surgery is executed by inserting an endoscope camera and the surgical tools inside the patient’s body through small incisions. The surgeons perform the operation by watching the video transmitted from the endoscope camera to high-resolution monitors. The location of the tumors and cysts is examined before and during the operation by the surgeons from the pre-operative CT scans displayed on a different monitor or on printed copies making the operation more difficult to perform.

    In order to make it easier for the surgeons to locate the tumors and cysts and have an insight for the rest of the inner structures of the liver, the 3D models of the liver’s inner structures are extracted from the preoperative CT scans and are overlaid on to the live video stream transmitted from the endoscope camera during the operation, a technique known as virtual X-ray. In that way the surgeons can virtually look into the liver and locate the tumors and cysts (focus objects) and also have a basic understanding of their spatial relation with other critical structures. The current master thesis focuses on enhancing the depth and spatial perception between the focus objects and their surrounding areas when they are overlaid on to the live endoscope video stream. That is achieved by placing a cone on the position of each focus object facing the camera. The cone creates an intersection surface (cut volume) that cuts the structures that lay in it, visualizing the depth of the cut and the spatial relation between the focus object and the intersected structures. The positioning of the cones is calculated automatically according to the center points of the focus objects but the sizes of the cones are user defined with bigger sizes revealing more of the surrounding area. The rest of the structures that are not part of any cut volume are not discarded but handled in such way that still depict their spatial relation with the rest of the structures. Different rendering results are presented for a laparoscopic liver test surgery in which a plastic liver model was used. The results include different presets of the cut volumes’ characteristics. Additionally, the same technique can be applied on the 3D liver’s surface instead of the live endoscope image and provide depth and spatial information. Results from that case are also presented.

  • 30.
    Goovaerts, Tony
    et al.
    Cliniques Universitaires St Luc, Brussels, Belgium .
    Bagnis Isnard, Corinne
    Université Pierre et Marie Curie, Paris France.
    Crepaldi, Carlo
    Unità Operativa di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italy.
    Dean, Jessica
    Salford Royal Hospital, Salford, UK.
    Melander, Stefan
    Mooney, Andrew
    St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
    Prieto-Velasco, Mario
    Unidad de Nefrología, Complejo Asistencial Universitario de León, León, Spain.
    Trujillo, Carmen
    Unidad clínica de Gestión de Nefrología, Hospital Regional Carlos Haya, Malaga, Spain.
    Zambon, Roberto
    Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italy.
    Nilsson, Eva-Lena
    Skåne University Hospital .
    Continuing education: preparing patients to choose a renal replacement therapy.2015In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686, Vol. 41, no 1, 62-75 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with progressive chronic kidney disease face a series of treatment decisions that will impact the quality of life of themselves and their family. Renal replacement therapy option education (RRTOE), generally provided by nurses, is recommended by international guidelines

    OBJECTIVES: To provide nurses with advice and guidance on running RRTOE.

    DESIGN: A consensus conference.

    PARTICIPANTS: Four nurses, 5 nephrologists and 1 clinical psychologist (9 renal units; 6 European countries) from units that had extensive experience in RRTOE or were performing research in this field.

    APPROACH: Experts brainstormed and discussed quality standards for the education team, processes, content/topics, media/material/funding and quality measurements for RRTOE.

    RESULTS: Conclusions and recommendations from these discussions that are particularly pertinent to nurses are presented in this paper.

    CONCLUSIONS: Through careful planning and smooth interdisciplinary cooperation, it is possible to implement an education and support programme that helps patients choose a form of RRT that is most suited to their needs. This may result in benefits in quality of life and clinical outcomes.

    APPLICATION TO PRACTICE: There are large differences between renal units in terms of resources available and the demographics of the catchment area. Therefore, nurses should carefully consider how best to adapt the advice offered here to their own situation. Throughout this process, it is crucial to keep in mind the ultimate goal - providing patients with the knowledge and skill to make a modality choice that will enhance their quality of life to the greatest degree.

  • 31.
    Prabahar, Jasila
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Localization of Stroke Using Microwave Technology and Inner product Subspace Classifier2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Stroke or “brain attack” occurs when a blood clot carried by the blood vessels from other part of the body blocks the cerebral artery in the brain or when a blood vessel breaks and interrupts the blood flow to parts of the brain. Depending on which part of the brain is being damaged functional abilities controlled by that region of the brain is lost. By interpreting the patient’s symptoms it is possible to make a coarse estimate of the location of the stroke, e.g. if it is on the left or right hemisphere of the brain. The aim of this study was to evaluate if microwave technology can be used to estimate the location of haemorrhagic stroke.

    In the first part of the thesis, CT images of the patients for whom the microwave measurement are taken is analysed and are used as a reference to know the location of bleeding in the brain. The X, Y and Z coordinates are calculated from the target slice (where the bleeding is more prominent). Based on the bleeding coordinated the datasets are divided into classes. Under supervised learning method the ISC algorithm is trained to classify stroke in the left and right hemispheres; stroke in the anterior and posterior part of the brain and the stroke in the inferior and superior region of the brain. The second part of the thesis is to analyse the classification result in order to identify the patients that were being misclassified.

    The classification results to classify the location of bleeding were promising with a high sensitivity and specificity that are indicated by the area under the ROC curve (AUC). AUC of 0.86 was obtained for bleedings in the left and right brain and an AUC of 0.94 was obtained for bleeding in the inferior and superior brain. The main constraint was the small size of the dataset and few availability of dataset with bleeding in the front brain that leads to imbalance between classes. After analysis it was found that bleedings that were close to the skull and few small bleedings that are deep inside the brain are being misclassified. Many factors can be responsible for misclassification like the antenna position, head size, amount of hair etc.

    The overall results indicate that SDD using ISC algorithm has high potential to distinguish bleedings in different locations. It is expected that the results will be more stable with increased patient dataset for training.

  • 32.
    Josefsson, Lena
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Är familjeterapi ett alternativ på vårdcentralen?2014Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Over the last 15 years counselors, psychologists and psychotherapists are the professions hired for counseling in the Swedish primary care centers. Evaluations of the treatments show healthier patients and lower health care costs. Biological, psychological and social functions are central in counseling, since these features affect the description of the problem and the effect based on the level of functioning in relation to the partner and relatives. The primary care facilities are the first-line of caregivers, from maternal - to elderly care. When circumstances change for the patient, the whole family-network surrounding him/her is affected. The purpose of this study was to investigate what patients thought of bringing their relatives into counseling, and with which openness and what experience counselors invited the network to take part? The respondents answered questions in a survey, and the data was analyzed mainly in a quantitative fashion. The results showed that approximately half of the respondents wanted someone from their family-network to participate in the counseling. The other patients did not want their families’ participation, and thought of their own connection to the counselor as essential. The majority of the counselors claimed to offer couples and family counseling. The aim of the couple and family counseling differed between the respondents. The study suggests that the family is invited as resource at any time to get extended information and enhanced understanding of the patient's life situation. Some respondents described the counseling as processing of the interaction between the couple or the family members. A few patients said they had had couple or family counseling. They described it as being helpful and that working with the communication had been a contributing factor to the favorable outcome. 

  • 33.
    Sporre, Pernilla
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Engslätt Jansson, Ingegerd
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Arbetsterapeuters användning av Basal Kroppskännedom TM för att stärka patienters aktivitetsutförande2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Activity as a therapeutic medium has been central to the development of the occupational therapy profession by using meaningful and purposeful activities. Occupational therapy is founded on the commitment of activity as essential for health and wellbeing. Despite this, much of the profession has led to the development of interventions that are not activity-based. Basic Body Awareness Therapy (B-BAT) and occupational therapy have several common basic assumptions. Our clinical experience shows the potential of using the B-BAT-principles in occupational therapy. We wanted to explore other occupational therapists’ perceptions of conditions and the value of working with B-BAT-principles to strengthen patients' occupational performance. Qualitative interviews were conducted with 11 informants, strategically selected. The interview material was analyzed and formed three themes: The occupational therapists’ knowledge and performance, Working with self – the human development process, and The Obstacles and Opportunities in the organization. In relation to ergonomic knowledge, informants expressed the view that B-BAT-principles provide further opportunities to see, understand and comprehend patients and use activities as a part of their treatment. Activities are broken down into stages where simple, rhythmic movements are used to catch the meaningfulness. The patient feels and experiences occupational performance in the body. The results of the study describe the use of self as an instrument as a prerequisite for being both in activity and in contact with the patient. That strengthens the possibility of developing a therapeutic alliance.

  • 34.
    Lennartsson, Emma
    Linköping University, Department of Science and Technology, Communications and Transport Systems. Linköping University, The Institute of Technology.
    Improvements for Waran-patients in Finspång2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Närsjukvården i Finspång har idag 540 patienter som är i behov av, och behandlas med det blodförtunnande läkemedlet Waran. Läkemedlet ges till de som drabbats av blodpropp (bentrombos/lungemboli), förmaksflimmer eller har klaffproteser. Patienterna besöker i stor del den mottagning som finns på Finspångs Lasarett men det finns de som av olika anledningar inte kan ta sig till mottagningen, främst beroende på att de lider av andra sjukdomar som gör att de har svårt att förflytta sig längre sträckor. Därför besöks de i hemmet och där tar DS de prover som behövs. Grunden till projektet Närsjukvården i Finspång-Förbättringsarbete för Waran-patienter i Finspång, är att hitta andra lösningar på hur situation kan förändras och därigenom också förbättras för de patienter där provtagningen måste ske i hemmet. Projektet har resulterat i en analys kring fyra olika scenarier som alla medförde förbättringar både vad gäller kostnader, transporter och tid. För att få en inblick i vilka scenarier som användes beskrivs de nedan. Scenario 1a visar en bild över situationen som den såg ut när fösta kartläggningen skedde i och med det första besöket på Närsjukvården i Finspång. Scenario 1b visar en bild över hur hanteringen av patienterna fungerar vid andra kartläggningen på Närsjukvården i Finspång. Här har vissa patientbesök redan ersatts med att patienterna själva, med hjälp av CoaguChek, genomför kontroll av sitt INR-värde. Scenario 2 liknar scenario 1a men istället för en distriktssköterska (DS) är det en biomedicinsk analytiker (BMA) som besöker patienterna och genomför provtagningen. Scenario 3 ger en bild över hur det ser ut när det är en DS som gör hembesöken men att provtagningen nu sker med hjälp av CoaguChek. Scenarier har därefter analyserats sinsemellan med fördelar och nackdelar och projektet har kommit fram till den lösning som projektet anser vara den bäst lämpade för hanteringen av Waran patienterna.

  • 35.
    Josefsson, Albin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Berggren, Tore
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Rate of change in psychotherapy: A matter of patients: A study contrasting the dose-effect model and the good-enough level model using the CORE-OM in primary care and psychiatric care2013Independent thesis Advanced level (professional degree), 300 HE creditsStudent thesis
    Abstract [en]

    Studies on relations between number of sessions and effect of psychotherapy have usually assumed a constant rate of change across different lengths of therapy, explained by a model called the dose-effect model. This assumption has been challenged by the good-enough level (GEL) model, which makes the prediction that the rate of change will vary as a function of total number of sessions. This study aimed to compare these models. We also assessed the relationship between reliable and clinically significant change (RCSI) and total dose of therapy. Participants were drawn from two datasets in the Swedish primary care (n = 640) and adult psychiatric care (n = 249). The participants made session-wise ratings on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). Multilevel analyses indicated a better fit using the GEL-model, with some reservations concerning RCSI and patterns of change. The results may indicate a general lawful relationship that may have implications for future research, as well as psychotherapy practice and policy making.

  • 36.
    Stupp, Roger
    et al.
    Multidisciplinary Oncology Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
    Mason, Warren P
    van den Bent, Martin J
    Weller, Michael
    Fisher, Barbara
    Taphoorn, Martin J B
    Belanger, Karl
    Brandes, Alba A
    Marosi, Christine
    Bogdahn, Ulrich
    Curschmann, Jürgen
    Janzer, Robert C
    Ludwin, Samuel K
    Gorlia, Thierry
    Allgeier, Anouk
    Lacombe, Denis
    Cairncross, J Gregory
    Eisenhauer, Elizabeth
    Mirimanoff, René O
    Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma2005In: The New England journal of medicine, ISSN 1533-4406, Vol. 352, no 10, 987-996 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Glioblastoma, the most common primary brain tumor in adults, is usually rapidly fatal. The current standard of care for newly diagnosed glioblastoma is surgical resection to the extent feasible, followed by adjuvant radiotherapy. In this trial we compared radiotherapy alone with radiotherapy plus temozolomide, given concomitantly with and after radiotherapy, in terms of efficacy and safety.

    METHODS: Patients with newly diagnosed, histologically confirmed glioblastoma were randomly assigned to receive radiotherapy alone (fractionated focal irradiation in daily fractions of 2 Gy given 5 days per week for 6 weeks, for a total of 60 Gy) or radiotherapy plus continuous daily temozolomide (75 mg per square meter of body-surface area per day, 7 days per week from the first to the last day of radiotherapy), followed by six cycles of adjuvant temozolomide (150 to 200 mg per square meter for 5 days during each 28-day cycle). The primary end point was overall survival.

    RESULTS: A total of 573 patients from 85 centers underwent randomization. The median age was 56 years, and 84 percent of patients had undergone debulking surgery. At a median follow-up of 28 months, the median survival was 14.6 months with radiotherapy plus temozolomide and 12.1 months with radiotherapy alone. The unadjusted hazard ratio for death in the radiotherapy-plus-temozolomide group was 0.63 (95 percent confidence interval, 0.52 to 0.75; P<0.001 by the log-rank test). The two-year survival rate was 26.5 percent with radiotherapy plus temozolomide and 10.4 percent with radiotherapy alone. Concomitant treatment with radiotherapy plus temozolomide resulted in grade 3 or 4 hematologic toxic effects in 7 percent of patients.

    CONCLUSIONS: The addition of temozolomide to radiotherapy for newly diagnosed glioblastoma resulted in a clinically meaningful and statistically significant survival benefit with minimal additional toxicity.

  • 37.
    Ottosson, Marie-Louise
    Linköping University, Faculty of Health Sciences.
    Visualisering av basalcellscancer med Tissue Viability Imaging - ett icke-invasivt diagnostiskt alternativ2014Independent thesis Basic level (degree of Bachelor), 180 HE creditsStudent thesis
    Abstract [en]

    Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer. It can be divided in different subtypes. The most common type is superficial and is most frequently occurring on the trunk and on the face. In severe cases it can be difficult to differentiate basal cell carcinoma from other skin tumors, therefore a skin biopsy is conclusive diagnostic method. In terms of treatment, curettage is a common non-surgical treatment of basal cell carcinoma. However, being superficial, curettage increases the risk of recurrence. Between 30-40 % of most recurrences occur within five years.

    Tissue Viability Imaging or TiVi is a diagnostic method used by the Department of Dermatology at the University Hospital in Linköping. The technology allows the investigator to see through the top layer of the skin (epidermis) and map the skin skin blood circulation in the dermal area.

    The aim of this study was to investigate whether histological features of present basal cell carcinoma, inflammation, stroma and microvessels, correlates with the presence of the tumour visualized by Tissue Viability Imaging technique.

    The hypothesis is, that by visualizing BCC recurrence at the first visit at the clinic by using TiVi technique, we can diagnose BCC and treat patients in one step, thus reducing the amount of discomfort for the patient and also reduce the cost of care.

    In this pilot-study, patient material involving two basal cell carcinomas from one patient were used. The results show that microscopic examination of the tumor and blood vessels correlate with visualizing basal cell carcinoma with TiVi, although furthermore studies of existing basal cell carcinoma and several tumours are required to ensure correlation before TiVi can be used to replace skin biopsy.

  • 38.
    Ekberg, Albin
    et al.
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Holm, Jacob
    Linköping University, Department of Computer and Information Science. Linköping University, The Institute of Technology.
    Effektiv och underhållssäker lagring av medicinsk data2014Independent thesis Basic level (degree of Bachelor), 10,5 credits / 16 HE creditsStudent thesis
    Abstract [en]

    Creating a database to manage medical data is not the easiest. We create a database to be used for a presentation tool that presents medical data about patients that is stored in the database. We examine which of the three databases, MySQL with relational design, MySQL with EAV design and MongoDB that are best suited for storing medical data. The analysis i performed in two steps. The first step handles the database that is most effective to retriev data. The second step examines how easy it is to change the structure of the various databases. The results show that depending on whether efficiency or maintenance is most important, different databases are the best choise. MySQL with relational design proves to be most effective while MongoDB is the easiest to maintain.

  • 39.
    Home, P.D.
    et al.
    Newcastle Diabetes Centre, Newcastle University, Newcastle upon Tyne, United Kingdom.
    Pocock, S.J.
    Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Beck-Nielsen, H.
    Department of Endocrinology and Metabolism, Odense, Denmark.
    Curtis, P.S.
    GlaxoSmithKline Research and Development, Greenford, United Kingdom.
    Gomis, R.
    Hospital Clinic, University of Barcelona, Barcelona, Spain.
    Hanefeld, M.
    Zentrum für Klinische Studien Forschungsbereich Endokrinologie und Stoffwechsel, Dresden, Germany.
    Jones, N.P.
    GlaxoSmithKline Research and Development, Harlow, United Kingdom.
    Komajda, M.
    Université Pierre et Marie Curie Paris 6, Hôpital Pitié-Salpêtrière, Département de Cardiologie, Paris, France.
    McMurray, J.J.
    British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
    Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial2009In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 373, no 9681, 2125-2135 p.Article in journal (Refereed)
    Abstract [en]

    Background: Rosiglitazone is an insulin sensitiser used in combination with metformin, a sulfonylurea, or both, for lowering blood glucose in people with type 2 diabetes. We assessed cardiovascular outcomes after addition of rosiglitazone to either metformin or sulfonylurea compared with the combination of the two over 5-7 years of follow-up. We also assessed comparative safety. Methods: In a multicentre, open-label trial, 4447 patients with type 2 diabetes on metformin or sulfonylurea monotherapy with mean haemoglobin A 1c (HbA 1c) of 7·9% were randomly assigned to addition of rosiglitazone (n=2220) or to a combination of metformin and sulfonylurea (active control group, n=2227). The primary endpoint was cardiovascular hospitalisation or cardiovascular death, with a hazard ratio (HR) non-inferiority margin of 1·20. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00379769. Findings: 321 people in the rosiglitazone group and 323 in the active control group experienced the primary outcome during a mean 5·5-year follow-up, meeting the criterion of non-inferiority (HR 0·99, 95% CI 0·85-1·16). HR was 0·84 (0·59-1·18) for cardiovascular death, 1·14 (0·80-1·63) for myocardial infarction, and 0·72 (0·49-1·06) for stroke. Heart failure causing admission to hospital or death occurred in 61 people in the rosiglitazone group and 29 in the active control group (HR 2·10, 1·35-3·27, risk difference per 1000 person-years 2·6, 1·1-4·1). Upper and distal lower limb fracture rates were increased mainly in women randomly assigned to rosiglitazone. Mean HbA 1c was lower in the rosiglitazone group than in the control group at 5 years. Interpretation: Addition of rosiglitazone to glucose-lowering therapy in people with type 2 diabetes is confirmed to increase the risk of heart failure and of some fractures, mainly in women. Although the data are inconclusive about any possible effect on myocardial infarction, rosiglitazone does not increase the risk of overall cardiovascular morbidity or mortality compared with standard glucose-lowering drugs. Funding: GlaxoSmithKline plc, UK. © 2009 Elsevier Ltd. All rights reserved.

  • 40.
    Strömqvist, Malin
    Linköping University, Department of Physics, Chemistry and Biology, Chemistry. Linköping University, The Institute of Technology.
    Development of quantitative methods for the determination of vemurafenib and its metabolites in human plasma2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Vemurafenib is a potent serine/threonine kinase inhibitor and is registered as Zelboraf® for the treatment of metastatic melanomas harboring BRAFV600E mutations. There is a large individual variation in drug response and the side effects observed among patients treated with Zelboraf® has proven to be severe. 

    LC-MS/MS methods were developed to measure vemurafenib and its metabolites in human plasma for prediction of treatment outcome and side effects in order to individualize treatment with Zelboraf®

    A novel, rapid quantification method was developed for vemurafenib using a stable isotope labeled internal standard. The method was validated according to international guidelines with regard to calibration range, accuracy, precision, carry-over, dilution integrity, selectivity, matrix effects, recovery and stability. All parameters met the set acceptance criteria. 

    The first method suitable for quantifying vemurafenib metabolites in human plasma is presented. Lacking commercially available reference substances, human liver microsomes were used to produce the metabolites. In patient samples at steady-state five previously in vitro identified metabolites were quantified for the first time. 

  • 41.
    Hägg, Mary
    et al.
    Department of Otorhinolaryngology, Speech and Swallowing Centre, Hudiksvall Hospital, Hudiksvall, Sweden, Research and Development Centre, Uppsala University/Gävleborg, Uppsala, Sweden.
    Tibbling, Lita
    Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping. Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Four-quadrant facial function in dysphagic patients after stroke and in healthy controls2014In: Neurology Research International, ISSN 2090-1852, E-ISSN 2090-1860, Vol. 2014, no 672685Article in journal (Refereed)
    Abstract [en]

    This study aims to examine any motility disturbance in any quadrant of the face other than the quadrant innervated by the lower facial nerve contralateral to the cortical lesion after stroke. Thirty-one stroke-afflicted patients with subjective dysphagia, consecutively referred to a swallowing centre, were investigated with a facial activity test (FAT) in all four facial quadrants and with a swallowing capacity test (SCT). Fifteen healthy adult participants served as FAT controls. Sixteen patients were judged to have a central facial palsy (FP) according to the referring physician, but all 31 patients had a pathological FAT in the lower quadrant contralateral to the cortical lesion. Simultaneous pathology in all four quadrants was observed in 52% of stroke-afflicted patients with dysphagia; some pathology in the left or right upper quadrant was observed in 74%. Dysfunction in multiple facial quadrants was independent of the time interval between stroke and study inclusion. All patients except two had a pathological SCT. All the controls had normal activity in all facial quadrants. In summary the majority of poststroke patients with dysphagia have subclinical orofacial motor dysfunction in three or four facial quadrants as assessed with a FAT. However, whether subclinical orofacial motor dysfunction can be present in stroke-afflicted patients without dysphagia is unknown.

  • 42.
    Westergren, Samuel
    Linköping University, Faculty of Health Sciences.
    Nivåer av det lysosomala systemets proteiner i hjärnvävnad från Alzheimerpatienter2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Alzheimer's disease is the most common cause of dementia, and when the population becomes larger and older also the number of patients increase. A cerebral atrophy and microscopic findings of extracellular plaques of β-amyloid, intracellular neurofibrillary of phosphorylated tau and loss of nerve cell protrusions, axons, synapses and dendrites are seen during the disease. One of the early pathological changes is the disruption of the neuronal lysosomal network that plays an important role in the degradation of macromolecules. In a previous study elevated levels of proteins of the lysosomal network in cerebrospinal fluid from Alzheimer’s disease patients was demonstrated. The purpose of this study was to measure levels of the lysosomal network system in the brain. The six proteins EEA1, PICALM, LAMP-1, LAMP -2, LC3 and TFEB were analyzed in human brain tissue from five Alzheimer's disease cases and five control cases by Western blot. The results show a significant increase in the temporal cortex of LAMP-1 and LAMP -2 and a significant decrease of LC3 and EEA1 in patients with Alzheimer's disease. In order to draw proper conclusions about how the increased levels in cerebrospinal fluid reflect the different disease mechanisms in the brain it requires further analysis of more patient samples and from other areas of the brain.

  • 43.
    Norkvist Johansson, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Tollander, Sofie
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Prövning av måttet Läpp-till-Lyft (L-t-L) på vuxna utan sväljsvårigheter2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Context: Lip-to-Lift (L-t-L) is a bedside-method for measuring oral transit time at swallow. It was designed for a swallowing examination of persons on nursing homes where weight loss was noted in people with average L-t-L-time >5 seconds (Sandin, 2005). The measurement was validated and evaluated by Eriksson, Bremer Zerpe (2008).

    Objectives: The study objective was to examine L-t-L on a group of young adults without swallowing disorders and as to examine the inter- and intra-judgereliability of the measure.

    Questions:

    • What is the L-t-L-time for young adults without swallowing disorders?
    • Are there any gender differences regarding L-t-L-time?
    • How high is the inter/intra-judge reliability of L-t-L?

    Method: Examination of L-t-L-time was carried out on 20 young adults, aged 19-27 years, without swallowing disorders after Sandin’s (2005) instructions. Measurements of 20 swallows per person were made.

    Results: The average L-t-L-time of young adults without deglutition-difficulties was 1.13 seconds (sd =.14). No significant gender differences were seen. The intra-judge reliability (.63 and .81) was higher than the inter-judge reliability (.58). A higer inter-judge reliability was found at swallowing 1-10 when compared to swallowing 1-5.

    Conclusion: The fairly good inter-judge reliability suggests that the measure may have some reliability if the measurement is carried out by different examiners. The relatively high intra-judge reliability indicates that the L-t-L-measurement might be  more reliable on follow-ups on patients made by the same examiner.

  • 44.
    Karlsson, Josefin
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Selin, Kathrine
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Patienters bedömning av postoperativ återhämtning efter kolorektal kirurgi2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Postoperativ återhämtning är en viktig del när patienten genomgår ett kirurgiskt ingrepp. Efter operation vårdas patienten för rehabilitering samt för observation och behandling av eventuella anestesiologiska och/eller kirurgiska komplikationer. Som ett resultat av utvecklingen av anestesiologisk och kirurgisk teknik (till exempel minimal invasiv kirurgi och standardisering av operationsmetoder) har den postoperativa vårdtiden på sjukhuset minskat. Genom denna effektivisering så minskar kostnaderna och fler patienter kan opereras inom kortare tid i jämförelse mot tidigare.

    Författarna till den här studien arbetar på en kirurgavdelning där patienter vårdas som bland annat har genomgått kolorektal kirurgi. Uppföljning av patienternas postoperativa återhämtning på avdelningen sker enligt fasta kliniska rutiner genom till exempel kontroll av kroppstemperatur, blodtryck, andning, smärta och magtarmfunktion. Erfarenheten är, att trots regelbundna kontroller av patienterna, så är det svårt att få en uppfattning om deras personliga upplevelse av den postoperativa återhämtningen. Det finns få fullständigt validerade instrument för att undersöka postoperativ återhämtning. Därför valdes nytt validerat instrument som Allvin et al (2009) har utvecklat angående postoperativ återhämtning där patienten gör en självskattning av sina besvär.

  • 45.
    Heed, Cecilia
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Roeger, Maria
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Patienters upplevelser av att vårdas tillsammans, både män och kvinnor, på en akut sjukvårdsavdelning inom nedre kirurgi2011Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Mixed sex-wards, where you mix men and women, occur in hospitals around Sweden and should be recognized by the patient´s perspective when they are in a position of the medical and healthcare environment. Today it is becoming increasingly common for hospitals to have mixed sex-wards, this is usually because the lack of time and space. The study's purpose was to describe patients' experiences of care in a mixed sex-ward on an acute medical department of the lower surgery. The study was qualitative with a phenomenological approach. An interview study with fifthteen patients who had been cared for in a mixed sex-ward was conducted. The result showed that most patients felt positive when cared for in mixed sex ward. It turned out that they experienced a better atmosphere, softer jargon and a calmer ambience. It also emerged that some had not reflected on the mixed sex ward. They argued that there was something quite normal and that all patients towards the same goal, to get well. However, it was a few who felt traumatized by the experience and felt a violation of integrity. In conclusion, the study´s results showed that the mixed sex-wards were seen as a positive experience and something that many patients would consider in the future.

  • 46.
    Sandsveden, Li
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Evaluation of the Robustness of the Brain Parenchymal Fraction for Brain Atrophy Measurements2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    In certain diseases, like Multiple Sklerosis and Alzheimer's disease, the progression of the disease can be measured by whole brain atrophy. A difficulty with this is that all people have very different scull sizes, thus also very different brain sizes. This makes it almost impossible to establish "normal values" for brain size. The spread is very large and the method is not practical to use for individual patients. A method with less spread in healthy persons is to use the ratio of the Brain Parenchymal Fraction (BPF). The use of Brain Parenchymal Fraction has increased steadily since it was first introduced in 1999. 

    BPF = BPV/ICV

    This study was performed to increase the knowledge of what is normal and to evaluate the robustness of the BPF as a measurement for brain atrophy. Among other things, the change in the BPF when calculated from incomplete volumes (parts of the scull missing in the set of MR images) was evaluated. 

    The results show that when parts are missing from the top (superior) of the scull the resulting BPF is strictly higher than the correct PBF and when parts are missing from the lower (inferior) part of teh scull the resulting BPF is stritly lower than teh correct value. 

    Two different methods where tried to compensate for missing parts. The first method was to find a variable factor to compensate with, the size of this factor was depending on how much of the scull that was missing. The second method was to interpolate the ICV and BPV curves and from the new interpolated curves, calculate a new BPF.

    The method of compensating incomplete volumes using a factor calculated as a function of the intercranial volume of the first/last available slice turned out to be the better. 

  • 47.
    Raza, Asim
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, The Institute of Technology.
    SSVEP based EEG Interface for Google Street View Navigation2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Brain-computer interface (BCI) or Brain Machine Interface (BMI) provides direct communication channel between user’s brain and an external device without any requirement of user’s physical movement. Primarily BCI has been employed in medical sciences to facilitate the patients with severe motor, visual and aural impairments. More recently many BCI are also being used as a part of entertainment. BCI differs from Neuroprosthetics, a study within Neuroscience, in terms of its usage; former connects the brain with a computer or external device while the later connects the nervous system to an implanted device. A BCI receives the modulated input from user either invasively or non-invasively. The modulated input, concealed in the huge amount of noise, contains distinct brain patterns based on the type of activity user is performing at that point in time. Primary task of a typical BCI is to find out those distinct brain patterns and translates them to meaningful communication command set. Cursor controllers, Spellers, Wheel Chair and robot Controllers are classic examples of BCI applications. This study aims to investigate an Electroencephalography (EEG) based non-invasive BCI in general and its interaction with a web interface in particular. Different aspects related to BCI are covered in this work including feedback techniques, BCI frameworks, commercial BCI hardware, and different BCI applications. BCI paradigm Steady State Visually Evoked Potentials (SSVEP) is being focused during this study. A hybrid solution is developed during this study, employing a general purpose BCI framework OpenViBE, which comprised of a low-level stimulus management and control module and a web based Google Street View client application. This study shows that a BCI can not only provide a way of communication for the impaired subjects but it can also be a multipurpose tool for a healthy person. During this study, it is being established that the major hurdles that hamper the performance of a BCI system are training protocols, BCI hardware and signal processing techniques. It is also observed that a controlled environment and expert assistance is required to operate a BCI system.

  • 48.
    Franzén, Jerker
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Wijkmark, Hannes
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Rörfonation eller traditionell svensk röstbehandling?: En jämförande studie mellan två olika metoder för röstbehandling2013Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Tube phonation and traditional Swedish voice therapy are two of the most common voice therapy options in Sweden today. As a researcher, it is important to continually evaluate available therapy options to make health care more qualitative and cost effective. Are there differences in treatment effect between these two voice treatments? If so, are the differences so obvious that it is possible to conclude that one treatment should be preferred over the other?

    Analyses of a patient material, before and after treatment, which included acoustic analysis, perceptual analysis by a group of experienced speech-language therapists and patients' selfassessments were made aiming to answer what effect the two treatment options have in these areas.

    The patient material consisted of 28 patients, of whom 23 completed the therapy. Twelve of them received treatment with tube phonation while the remaining eleven patients received traditional Swedish voice therapy. Besides audio recordings, the material consisted of patients' self-assessments pre- and post-therapy, including VHI and Swe-VAPP forms.

    The treatment effect on acoustic parameters was inconclusive. The perceptual parameters aphonia, hyper function, and creaking improved over the entire sample, regardless of the type of voice therapy. Clear improvements were seen in the patients' self-assessments after both therapy methods. Voice therapy thus gives positive results, but no differences in treatment effect between the two different methods of voice therapy were seen.

  • 49.
    Shayeghpour, Omid
    Linköping University, Department of Science and Technology. Linköping University, The Institute of Technology.
    Improving information perception from digital images for users with dichromatic color vision2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Color vision deficiency (CVD) is the inability or limited ability to recognize colors and discriminate between them. A person with this condition perceives a narrower range of colors compared to a person with a normal color vision. A growing number of researchers are striving to improve the quality of life for CVD patients. Finding cure, making rectification equipment, providing simulation tools and applying color transformation methods are among the efforts being made by researchers in this field. In this study we concentrate on recoloring digital images in such a way that users with CVD, especially dichromats, perceive more details from the recolored images compared to the original image. The main focus is to give the CVD user a chance to find information within the picture which they could not perceive before. However, this transformed image might look strange or unnatural to users with normal color vision. During this color transformation process, the goal is to keep the overall contrast of the image constant while adjusting the colors that might cause confusion for the CVD user. First, each pixel in the RGB-image is converted to HSV color space in order to be able to control hue, saturation and intensity for each pixel and then safe and problematic hue ranges need to be found. The method for recognizing these ranges was inspired by a condition called “unilateral dichromacy” in which the patient has normal color vision in one eye and dichromacy in another. A special grid-like color card is designed, having constant saturation and intensity over the entire image, while the hue smoothly changes from one block to another to cover the entire hue range. The next step is to simulate the way this color card is perceived by a dichromatic user and finally to find the colors that are perceived identically from two images and the ones that differ too much. This part makes our method highly customizable and we can apply it to other types of CVD, even personalize it for the color vision of a specific observer. The resulting problematic colors need to be dealt with by shifting the hue or saturation based on some pre-defined rules. The results for the method have been evaluated both objectively and subjectively. First, we simulated a set of images as they would be perceived by a dichromat and compared them with simulated view of our transformed images. The results clearly show that our recolored images can eliminate a lot of confusion from user and convey more details. Moreover, an online questionnaire was created and 39 users with CVD confirmed that the transformed images allow them to perceive more information compared to the original images.

  • 50.
    Varelogianni, Georgia
    et al.
    Uppsala University, Sweden.
    Oliynyk, Igor
    Uppsala University, Sweden.
    Roomans, Godfried M
    Uppsala University, Sweden.
    Johanssesson, Marie
    Uppsala University, Sweden.
    The effect of N-acetylcysteine on chloride efflux from airway epithelial cells2010In: Cell Biology International, ISSN 1065-6995, E-ISSN 1095-8355, Vol. 34, no 3, 245-252 p.Article in journal (Refereed)
    Abstract [en]

    Defective chloride transport in epithelial cells increases mucus viscosity and leads to recurrent infections with high oxidative stress in patients with CF (cystic fibrosis). NAC (N-acetylcysteine) is a well known mucolytic and antioxidant drug, and an indirect precursor of glutathione. Since GSNO (S-nitrosoglutathione) previously has been shown to be able to promote Cl- efflux from CF airway epithelial cells, it was investigated whether NAC also could stimulate Cl- efflux from CF and non-CF epithelial cells and through which mechanisms. CFBE (CF bronchial epithelial cells) and normal bronchial epithelial cells (16HBE) were treated with 1 mM, 5 mM, 10 mM or 15 mM NAC for 4 h at 37 degrees C. The effect of NAC on Cl- transport was measured by Cl- efflux measurements and by X-ray microanalysis. Cl- efflux from CFBE cells was stimulated by NAC in a dose-dependent manner, with 10 mM NAC causing a significant increase in Cl- efflux with nearly 80% in CFBE cells. The intracellular Cl- concentration in CFBE cells was significantly decreased up to 60% after 4 h treatment with 10 mM NAC. Moreover immunocytochemistry and Western blot experiments revealed expression of CFTR channel on CFBE cells after treatment with 10 mM NAC. The stimulation of Cl- efflux by NAC in CF airway epithelial cells may improve hydration of the mucus and thereby be beneficial for CF patients.

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