Individualised care for patients with breast or prostate cancer aided by an interactive app : a frame of process evaluation

Background: Patients receiving outpatient cancer treatment often experience distressing symptoms and unmet needs. Collecting patient-reported outcomes via apps (ePROs) facilitates patient-clinician communication regarding symptoms and is recommended in clinical guidelines. Previous studies of an interactive app (Interaktor) for individualised symptom management show reduced symptom burden for patients undergoing breast and prostate cancer treatment. Aim: To contribute to the knowledge of the value of implementing ePRO in clinical practice by studies framed as a process evaluation of an intervention for individualised symptom management assisted by Interaktor. Methods: Following the Medical Research Council framework for process evaluation of complex interventions, qualitative and quantitative data were collected along two randomised controlled trials (RCTs). Patients receiving neoadjuvant chemotherapy for breast cancer (N=149), and radiotherapy for prostate cancer (N=150) were randomised to standard care with or without intervention. Intervention group patients reported symptoms and concerns daily by questionnaire and free text. The app included selfcare advice and symptom history graphs. Oncology nurses responded to alerts triggered by severe symptoms. Study I investigates which and how patients engaged, by analysing adherence and usage predictors from logged data and telephone interviews with patients. Study II analyses the effects on patients' perceptions of individualised care and health literacy by questionnaires. Study III assesses if the intervention is cost-effective according to the Swedish National Board of Health and Welfare. Cost-effectiveness analyses (CEA) estimate gains in Quality-adjusted lifeyears (QALYs), intervention costs, and the patient's healthcare utilisation as obtained from the Stockholm Council database. Acute healthcare use is also explored. Results: Study I shows that adherence to daily symptom reporting was 83 %; most patients used the self-care advice and free text. Patients regarded the app easy to use and helpful for self-management. Marital status, age, education level, and comorbidity were associated with usage variations. Study II shows no between-group differences in individualised care or health literacy among patients with breast cancer. Intervention group patients with prostate cancer rated their support for decision control as more individualised than their control group, and their ability to seek, understand and communicate health information improved. Study III shows the intervention produced significantly more QALYs, although the effect was small. The weekly intervention cost per patient was low. The cost-effectiveness depended on the type of healthcare costs studied. The intervention was cost-effective for patients with breast cancer if non-acute healthcare costs were excluded, and for patients with prostate cancer, considering all healthcare costs. Healthcare costs varied greatly. Patients with breast cancer who used the app had more acute visits for fever. Patients with prostate cancer who used the app had fewer acute visits for urinary problems. Conclusions: Patients used and valued Interaktor as promoting assurance and participation in care. Using the app can positively affect care individualisation and health literacy for patients with prostate cancer during radiotherapy. It may be beneficial to increase the individualisation of features and settings for patients with breast cancer. The intervention may be cost-effective, but to show if healthcare savings can be achieved requires a larger study

African swine fever in Uganda

The objective of this study was to investigate the attitude towards African swine fever (ASF) primarily among smallholder pig farmers but also among other actors along the pork value chain in Gulu district, Uganda. More specifically, the study aimed to investigate the specific challenges facing both farmers and other members of the pork value chain using participatory epidemiology (PE). ASF is a feared viral disease of pigs associated with high mortality, which is endemic in many parts of Africa. The recent history of Gulu district in Northern Uganda can be described as turbulent and the human population has suffered during decades of war and civil unrest. Pig keeping is considered a potential opportunity for business as well as a way of providing more animal protein in the diet. However, this is threatened by ASF as farmers can lose entire herds due to the disease. This study can confirm some previously known factors and risk activities such as the free range system of pigs and movement of pigs and pork during ongoing outbreaks, which make disease control difficult. ASF has severe socio-economic implications for the pig owners and society as a whole. The study demonstrates that the local participants have relatively good knowledge about ASF and how to prevent disease although this knowledge was not always turned into practice. Many of the participants in the study showed a great willingness to change the current systems and establish new ways of keeping pigs to reduce outbreaks of ASF and improve pig production.Målet med studien var att undersöka attityder och erfarenheter av Afrikansk svinpest (ASF) inom småskalig grisproduktion i Gulu distriktet, norra Uganda. Studien ämnade beskriva specifika problem som grisbönder såväl som andra aktörer i värdekedjan mötte. För att samla in data och åsikter användes verktyg från fältet deltagande epidemiologi (PE). ASF är en fruktad virussjukdom hos gris med hög dödlighet och är endemisk i stora delar av Afrika. Gulu distriktet i Uganda anses vara ett utsatt område och populationen har lidit under årtionden av krig och oroligheter. Grisproduktion anses vara en möjlighet för småskaligt företagande och erbjuder en källa till animaliskt protein i kosten. ASF utgör en hög riskfaktor i verksamheten då bönder kan förlora hela gruppen grisar vid ett utbrott av sjukdomen. Denna studie kan dra slutsatser som visar på en komplex situation. En mängd riskaktiviteter såsom hållning av lösgående grisar, förflyttning av grisar och fläsk under pågående sjukdomasutbrott försvårar sjukdomskontroll. ASF har betydande socio-ekonomiska implikationer för individer såväl som för samhället som helhet. Studien visar att en hög andel av de småskaliga bönderna har god kännedom om kliniska symtom på ASF och gott om förslag på preventiva åtgärder vilket ger hopp om framtida sjukdomsprevention. Det fanns också en uttalad vilja att förändra gällande praxis inom grishållningen för att minska utbrott av ASF

Upphandling för en cirkulär ekonomi - En studie om kommunala upphandlingar av datorer

The aim of this study was to analyze how municipalities can promote circular economy (CE) in the public procurement, focusing on procurement of computers. Furthermore, the aim was to identify opportunities and barriers for the integration of the CE within municipal procurement and analyze where the market is heading. The methods used in this study consisted of a literature study and semi-structured interviews. The conclusions of the study are that the municipalities can promote CE, especially through five steps. (1) By sending the old computers to remanufacturers(2) Conduct market surveys and enter into dialogues with relevant actors when planning future procurements (3) Analyze the feasibility to buy re-manufactured computers (4) Analyze the possibility to claim recycling materials and environmental certification (5) Verify the requirements. Furthermore the biggest barriers for the municipalites to promote CE in public procurement of computers are organizational, informational/ knowledge and social barriers and the study shows that the main soloutions are to educate and inform people about CE and increase peoples awareness of computers environmental impact. Finally the study indicates that requirements focusing on the environment and social requirements will most likely be more common in the future; especially requirements focusing on re- manufactured computers and environmental certifications.Hur kan kommuner ställa flerhållbarhetskrav i den offentliga upphandlingen? Datorer används idag i de flesta arbeten inom kommuner. Det många människor inte är medvetna om är datorers negativa påverkan på vår planet. Kommuner har ett ansvar att styra samhället mot en hållbar utveckling, det vill säga ett samhälle som värnar om vår jord. Ett sätt att göra det är genom att börja ställa mer hållbarhetskrav på de datorer som kommunen köper in. Användningen av datorer har ökat otroligt mycket under de senaste 15 åren och i dagens samhälle hade det varit svårt för kommuner att utföra sitt arbete utan dem. När kommuner köper in datorer sker det genom den så kallade offentliga upphandlingen. Offentlig upphandling innebär att kommuner skickar ut dokument med krav som datorerna behöver uppfylla och sedan får leverantörer och tillverkare lämna in anbud på vad de har för datorer som kommuner kan köpa. I de flesta fall köper kommuner de datorer som är billigast och samtidigt uppfyller deras krav. Denna studie undersöker hur kommuner kan ställa fler miljökrav och sociala krav på datorerna som de köper. Miljökrav är krav kopplade till exempelvis hur mycket el en dator förbrukar och dess kemikalieinnehåll. Sociala krav är kopplat till exempelvis vilka rättigheter arbetstagarna som tillverkar datorerna har. Det är av stor vikt att kommuner börjar ställa fler hållbarhetskrav, eftersom detta bidrar till att datorernas miljöpåverkan minskar samt att de människor som tillverkar dem får det bättre.Denna studie bygger på en litteraturgenomgång samt elva intervjuer med företag, kommuner och myndigheter. En övergripande slutsats är att kommuner kan göra framförallt fem saker för att inkludera hållbarhetskrav i den offentliga upphandlingen. (1) Skicka gamla datorer till ett företag som reparera och fixar till dem och sedan säljer dem på nytt, det vill säga främjar återtillverkning. (2) Göra marknadsundersökningar och hålla dialoger med leverantörer och tillverkare innan de nya datorerna köps in. Detta för att undersöka vilka datorer som finns på marknaden och vilken hållbarhetsprestanda de har. (3) Undersöka möjligheten till att köpa in återtillverkade datorer, det vill säga renoverade och begagnade datorer. (4) Undersöka möjligheten till att ställa krav på att datorerna ska vara gjorda av återvunnet material samt vara miljöcertifierade. (5) Kontrollera att leverantören och tillverkaren uppfyller kraven och att de håller vad de lovat vid anbudsgivningen. Problemet för kommuner är att människor, både privatpersoner och kommunalanställda inte alltid är medvetna om varför dessa krav bör ställas. Därför är det viktigt att kommuner utbildar och informerar sina anställda om kommunens miljö- och sociala ansvar

A new model for in vitro testing of vitreous substitute candidates

Purpose: To describe a new model for in vitro assessment of novel vitreous substitute candidates. Methods: The biological impact of three vitreous substitute candidates was explored in a retinal explant culture model; a polyalkylimide hydrogel (Bio-Alcamid®), a two component hydrogel of 20 wt.% poly (ethylene glycol) in phosphate buffered saline (PEG) and a cross-linked sodium hyaluronic acid hydrogel (Healaflow®). The gels where applied to explanted adult rat retinas and then kept in culture for 2, 5 and 10 days. Gel-exposed explants were compared with explants incubated under standard tissue culture conditions. Cryosections of the specimens were stained with hematoxylin and eosin, immunohistochemical markers (GFAP, Vimentin, Neurofilament 160, PKC, Rhodopsin) and TUNEL. Results: Explants kept under standard conditions as well as PEG-exposed explants displayed disruption of retinal layers with moderate pyknosis of all neurons. They also displayed moderate labeling of apoptotic cells. Bio-Alcamid®-exposed explants displayed severe thinning and disruption of retinal layers with massive cell death. Healaflow®-treated explants displayed normal retinal lamination with significantly better preservation of retinal neurons compared with control specimens, and almost no signs of apoptosis. Retinas exposed to Healaflow® and retinas kept under standard conditions showed variable labeling of GFAP with generally low expression and some areas of upregulation. PEG-exposed retinas showed increased GFAP labeling and Bio-Alcamid®-exposed retinas showed sparse labeling of GFAP. Conclusions Research into novel vitreous substitutes has important implications for both medical and surgical vitreoretinal disease. The in vitro model presented here provides a method of biocompatibility testing prior to more costly and cumbersome in vivo experiments. The explant culture system imposes reactions within the retina including disruption of layers, cell death and gliosis, and the progression of these reactions can be used for comparison of vitreous substitute candidates. Bio-Alcamid® had strong adverse effects on the retina which is consistent with results of prior in vivo trials. PEG gel elicits reactions similar to the control retinas whereas Healaflow® shows protection from culture-induced trauma indicating favorable biocompatibility.Swedish Research CouncilUniversity of Lund. Medical FacultyPrincess Margaret's Foundation for Blind ChildrenKnut and Alice Wallenberg FoundationGeneral Sir John Monash Foundation (Scholarship)In Vivo Therapeutics Corporatio

Effects on the maternofetal unit of the rabbit model after substitution of the amniotic fluid with perfluorocarbons

Objectives: Exchanging amniotic fluid (AF) with perfluorocarbon (PFC) may serve as a medium for fetoscopic surgery. This study evaluates the distribution and physiologic effects of intraamniotic PFC as a medium for fetoscopy. Methods: Fetuses of 17 pregnant rabbits underwent either exchange of the AF with PFC, electrolyte solution (ES), or control. The quality of vision during fetoscopy was assessed in AF and PFC. After 6 h, we determined the distribution of PFC in the maternofetal unit. Results: Quality of vision during fetoscopy was better in PFC than with AF. There was no difference in fetal survival between the study groups. PFC was demonstrated on X-ray in the pharynx of 4 fetuses, and the esophagus in 1. Conclusions: PFC provided an ideal medium for fetoscopy without fetal compromise. Copyright (c) 2005 S. Karger AG, Basel

Laparoscopic sacrohysteropexy and myomectomy for uterine prolapse: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>A large number of hysterectomies are carried out for uterine prolapse, menorrhagia and other symptomatic but benign gynaecological conditions, which has increased interest in new approaches to treat these disorders. These new procedures are less invasive and offer reduced risk and faster recovery.</p> <p>Case presentation</p> <p>Sacrohysteropexy can be carried out instead of vaginal hysterectomy in the treatment of uterine prolapse. It involves using a synthetic mesh to suspend the uterus to the sacrum; this maintains durable anatomic restoration, normal vaginal axis and sexual function. A laparoscopic approach has major advantages over the abdominal route including shorter recovery time and less adhesion formation. We describe a laparoscopic sacrohysteropexy in a 55-year-old Caucasian British woman that was technically difficult. An intramural uterine fibroid was encroaching just above the uterosacral ligament making mesh positioning impossible. This was removed and the procedure completed successfully.</p> <p>Conclusion</p> <p>Posterior wall fibroid is not a contraindication for laparoscopic sacrohysteropexy. This procedure has increasingly become an effective treatment of uterine prolapse in women who have no indication for hysterectomy.</p

Risk Factors for Periacetabular Osteolysis and Wear in Asymptomatic Patients with Uncemented Total Hip Arthroplasties

Osteolysis is a silent disease leading to aseptic loosening. This has not been studied in a cohort of asymptomatic patients. The aim of this study was to detect factors that might be associated with the development of periacetabular osteolysis and wear around an uncemented cup. We assessed 206 patients with an uncemented cup, measuring wear and periacetabular osteolysis using computed tomography with a median follow-up of 10 years after surgery (range 7-14 years). EQ5D, pain from the hip, and satisfaction were assessed. The association between periacetabular osteolysis and wear, age, gender, activity, BMI, cup type, cup age, positioning of the cup, and surface coating was investigated with a proportional odds model. Wear and male gender were associated with an increased risk for periacetabular osteolysis. There was no association with periacetabular osteolysis for time from operation, patient age, UCLA Activity Score, liner thickness at time of operation, BMI, cup positioning, and type of implant. A thin liner at time of operation is correlated to increased wear. Linear wear rate was 0.18 mm/year and 46 of 206 patients had large periacetabular osteolysis. Asymptomatic patients with these implants should be followed up on a regular basis with a sensitive method such as CT in order to detect complications early