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  • 1. Hjorth, Maria
    et al.
    Sjöberg, Daniel
    Svanberg, Anncarin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Uppsala universitet.
    Kaminsky, Elenor
    Langenskiöld, Sophie
    Rorsman, Fredrik
    Nurse-led clinic for patients with liver cirrhosis-effects on health-related quality of life: study protocol of a pragmatic multicentre randomised controlled trial2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 10, article id e023064Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Liver cirrhosis affects health-related quality of life (HRQoL) even in its early stages. Morbidity is especially high when the disease decompensates and self-care actions become essential. Nurse involvement in secondary prevention in other chronic diseases has contributed to better symptom control, less need of inpatient care and improved HRQoL. In order to evaluate the impact of nurse involvement in the follow-up of patients with liver cirrhosis, we decided to compare structured nurse-led clinics, inspired by Dorothea Orem's nursing theory and motivational strategies, with a group of patients receiving standard care. The primary outcome is HRQoL and the secondary outcomes are quality of care, visits to outpatient clinics or hospitals, disease progress and health literacy.

    METHODS AND ANALYSIS: This is a pragmatic, multicentre randomised controlled study conducted at six Swedish hepatology departments. Eligible patients are adults with diagnosed cirrhosis of the liver (n=500). Participants are randomised into either an intervention with nurse-led follow-up group or into a standard of care group. Recruitment started in November 2016 and is expected to proceed until 2020. Primary outcomes are physical and mental HRQoL measured by RAND-36 at enrolment, after 1 and 2 years.

    ETHICS AND DISSEMINATION: The study is ethically approved by the Regional Ethical Review Board in Uppsala. The results shall be disseminated in international conferences and peer-reviewed articles.

    TRIAL REGISTRATION NUMBER: NCT02957253; Pre-results.

  • 2.
    Kamsvag-Magnusson, Tove
    et al.
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Thorsell-Cederberg, Jenny
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Svanberg, Anncarin
    Uppsala Univ, Dept Med Sci, Uppsala, Sweden.
    von Essen, Louise
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.
    Arvidson, Johan
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Mellgren, Karin
    Univ Gothenburg, Dept Pediat, Inst Clin Sci, Gothenburg, Sweden.
    Toporski, Jacek
    Lund Univ, Dept Clin Sci Pediat Oncol & Hematol, Lund, Sweden.
    Ljungman, Gustaf
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Parents’ and children’s perceptions of distressrelated to oral mucositis during hematopoietic stem cell transplantation2013In: Acta Paediatrica, ISSN 0803-5253, Vol. 103, no 6, p. 630-636Article in journal (Refereed)
    Abstract [en]

    Aim

    Oral mucositis is a common and debilitating side effect of haematopoietic stem cell transplantation. Our study investigated parents' and children's experiences of oral mucositis treatment and whether the parents' perceptions accurately reflected the children's views.

    Methods

    We analysed 71 questionnaires completed by the parents of children who had undergone haematopoietic stem cell transplantation, together with 38 questionnaires completed by children who were 7 years of age or over.

    Results

    The parent proxy and child self-reports showed good to excellent agreement. For example, 86% of the parents and 83% of the children reported oral pain and 44% of the parents and 47% of the children reported difficulty swallowing often or very often. The majority of the parents (61%) were satisfied with the pain treatment that had been given to their child. However, the treatment provided for oral mucositis was not altogether consistent.

    Conclusion

    Oral mucositis affected the majority of the children undergoing haematopoietic stem cell transplantation, causing considerable pain and discomfort. The parent proxy reports proved to be reliable and are an important supplement to child self-reports on symptoms related to oral mucositis. But there is a clear need to establish more evidence-based care for children suffering from oral mucositis.

  • 3.
    Svanberg, Anncarin
    Department of Public Health and Caring Sciences, Uppsala University.
    To be safe at home or at hospital after autologous stemcell transplantation: why readmission to hospital2019In: Journal of Nursing & Care, ISSN 2167-1168, Vol. 8, no 2, article id 482Article in journal (Refereed)
    Abstract [en]

    Background: Chemotherapy in connecting with autologous stem cell transplantation (SCT) is an established treatment for patients diagnosed with myeloma and lymphoma. Chemotherapy has side effects nausea/vomiting, infection, diarrhoea, fatigue and oral mucositis. SCT often requires hospitalization for weeks. Today it is common to treat patients in an outpatient care in combination with visits at the clinic/ward. Despite experience about outpatient care in connection with SCT, it is still a small proportion of patients who are treated on an outpatient basis. Reasons to readmit unplanned from homecare to hospital are mainly incidence of infection.

    Purpose: To investigate in what extend patients undergoing autologous SCT, received an outpatient care or care at a University hospital in Sweden during transplant period and if the treatment at outpatient care was interrupted to study the reason for readmitting to hospital care, also to compare intra venous (iv) treatment with antibiotics or total parenteral nutrition and length of hospital stay.

    Methods: The study was a quantitative, retrospective, descriptive design. A review from medical and nursing records of 88 adult patients who underwent autologous SCT in 2013-2014 and treated at a University Hospital in Sweden.

    Results: Thirty-nine patients were cared for outside hospital at home/home-like environment and 28 of them were readmitted to hospital. Forty-nine was cared for at hospital ward. The results showed that the main reason of readmission to hospital was related to nausea/vomiting, oral mucositis, stomach problem or other reason. No patients treated outside the hospital in the home/home-like environment the entire post-transplant period (n=11) needed total parenteral nutrition in contrast to patients readmitted to hospital (n=28) where 7 patients needed total parenteral nutrition. Among patients cared for at hospital ward during the entire post- transplant period (n=49), 17 patients needed total parenteral nutrition.

    Conclusion: Staying at home during the transplant period leads to less total parenteral nutrition, iv antibiotics and fewer days in the hospital.

  • 4.
    Svanberg, Anncarin
    et al.
    Uppsala universitet.
    Birgegård, Gunnar
    Uppsala universitet.
    Addition of aprepitant (EMEND®) to standard antiemetic care during seven days post chemotherapy before stem cell transplantation provides significant reduction of vomiting2015In: Oncology, ISSN 0030-2414, Vol. 89, no 1Article in journal (Refereed)
    Abstract [en]

    Chemotherapy-induced nausea/vomiting (CINV) is a major problem for patients treated with high-dose chemotherapy (HDCT) conditioning before stem cell transplantation (SCT), both during chemotherapy and afterwards (delayed nausea/vomiting). The standard of care (5-HT3 antagonist and dexamethasone) appears to be ineffective against delayed nausea and vomiting. The objective of this study was to compare standard antiemetic treatment with standard treatment plus prolonged treatment with aprepitant (Emend®) until 7 days after the end of chemotherapy in patients treated with HDCT before autologous SCT. Ninety-six patients were randomized to the experiment (EXP) group receiving Emend in addition to standard antiemetics or to the control (CTR) group receiving placebo. Emend or placebo treatment started 1 h before the first HDCT dose for SCT and ended 7 days after HDCT. Thirty-eight patients in the EXP group experienced complete response (no vomiting) compared to 16 patients in the CTR group. There was a significant difference between the EXP (0.63 ± 2.71) and the CTR (3.72 ± 4.91) group during 10 days after the end of HDCT (p = 0.001) with regard to the number of vomiting episodes. No difference with regard to days of nausea or in the use of antiemetic rescue was noted between the groups. We conclude that standard antiemetic treatment can be improved by addition of aprepitant continued for 7 days after the end of chemotherapy.

  • 5.
    Svanberg, Anncarin
    et al.
    Department of Haematology, Akademiska Hospital, Uppsala.
    Birgegård, Gunnar
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Oral cryotherapy reduces mucositis and opioid use after myeloablative therapy: a randomized control trial2007In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 15, no 10, p. 1155-1161Article in journal (Refereed)
    Abstract [en]

    Introduction. Mucositis is a major complication in myeloablative therapy, which often necessitates advanced pharmacological pain treatment, including i.v. opioids. Attempts to prevent oral mucositis have included oral cryotherapy, which has been shown to reduce mucositis, but there is a lack of knowledge concerning the effect of oral cryotherapy on opioid use by reducing the mucositis for patients treated with myeloablative therapy before bone marrow transplantation (BMT). 

    Aim. The aim of the present study was to evaluate if oral cryotherapy could delay or alleviate the development of mucositis and thereby reduce the number of days with i.v. opioids among patients who receive myeloablative therapy before BMT. 

    Materials and methods. Eighty patients 18 years and older, scheduled for BMT, were included consecutively and randomised to oral cryotherapy or standard oral care. A stratified randomisation was used with regard to type of transplantation. Intensity of pain, severity of mucositis and use of opioids were recorded using pain visual analogue scale (VAS) scores, mucositis index scores and medical and nursing charts. 

    Results. This study showed that patients receiving oral cryotherapy had less pronounced mucositis and significantly fewer days with i.v. opioids than the control group. In the autologous setting, cryotherapy patients also needed significantly lower total dose of opioids. 

    Conclusion. Oral cryotherapy is an effective and well-tolerated therapy to alleviate mucositis and consequently reduce the number of days with i.v. opioids among patients treated with myeloablative therapy before BMT.

  • 6. Svanberg, Anncarin
    et al.
    Birgegård, Gunnar
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Survival rate among patients receiving oral cryotherapy in connection with myeloablative therapy followed by bone marrow transplantation2009In: MASCC/ISOO International Symposium, Rom, 2009Conference paper (Refereed)
    Abstract [en]

    Objectives: Oral cryotherapy has been proven to alleviate symptoms of mucositis, a major complication in myeloablative therapy. In a randomised controlled trial it was shown that patients receiving oral cryotherapy had less mucositis and fewer days with and lower dose of i.v. opioides than a control group receiving routine oral care. It is thus of interest to investigate if oral cryotherapy may be harmful to patients. Objectiv: The objective with the present study was to evaluate if there was a difference in survival rate for patients receiving oral cryotherapy in connection with myeloablative therapy followed by BMT compare to patients receiving routine oral care. Methods: Seventy eight patients (mean age 52.0 (12.9) years, range 19 – 69 years) treated with myeloablative therapy followed by BMT were randomised to oral cryotherapy (n=39) or routine oral care (n=39). Survival data was based on a review of the patient’s medical records after four years. Results: During follow-up, 25 of the patients receiving oral cryotherapy survived while 16 of the patients receiving routine oral care survived (odds ratio 0.39, 95 % CI 0.15-0.97, p<0.05). Conclusions: Oral cryotherapy provides no evidence of harm in patients receiving myeloablative therapy followed by BMT. Further analyses are needed to explore the difference in survival rate.

  • 7. Svanberg, Anncarin
    et al.
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Birgegård, Gunnar
    Caphosol, a calciumphosphate mouthwash, gives no additional protectiion against mucositis inpatients with cryotherapy undergoing stem cell transplantation2012Conference paper (Refereed)
  • 8.
    Svanberg, Anncarin
    et al.
    Uppsala Univ, Fac Med, Inst Med Sci, Uppsala, Sweden.
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Birgegård, Gunnar
    Uppsala Univ, Fac Med, Inst Med Sci, Uppsala, Sweden.
    Five-year follow-up of survival and relapse in patients who received cryotherapy during high-dose chemotherapy for stem cell transplantation shows no safety concerns2012In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 21, no 6, p. 822-828Article in journal (Refereed)
    Abstract [en]

    We have previously published a randomised controlled study of the efficacy of cryotherapy in preventing acute oral mucositis after high-dose chemotherapy for stem cell transplantation. The present study is a 5-year follow-up safety study of survival in these patients. In the previously published study oral cryotherapy (cooling of the oral cavity) during high-dose chemotherapy significantly reduced mucositis grade and opiate use in the treated group. All patients were followed up for at least 5 years with regard to relapse and death rates. Baseline data, transplant complications and mucositis data were compared. Significantly more patients (25/39) who received oral cryotherapy were alive after 5 years compared to 15/39 in the control group (P= 0.025). Relapse rates were similar. The only baseline difference was a lower proportion of patients in complete remission at transplantation in the control group (6 vs. 13, P= 0.047). This 5-year follow-up study gave no support for safety concerns with cryotherapy.

  • 9.
    Svanberg, Anncarin
    et al.
    Uppsala Univ, Fac Med, Inst Med Sci, Uppsala, Sweden.
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Birgegård, Gunnar
    Uppsala Univ, Fac Med, Inst Med Sci, Uppsala, Sweden.
    Oral cryotherapy reduces mucositis and improves nutrition: a randomised controlled trial2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 15-16, p. 2146-2151Article in journal (Refereed)
    Abstract [en]

    Aim and objective. To investigate if oral cryotherapy during myeloablative therapy may influence frequency and severity of mucositis, nutritional status and infection rate after bone marrow transplantation.

    Background. Patients treated with intensive myeloablative treatment before bone marrow transplantation are all at risk to develop mucositis. Oral mucositis causes severe pain and oral dysfunction, which can contribute to local and systemic infections and bleeding; it may even interrupt cancer therapy. Oral mucositis also decreases the oral food intake, which increases the risk for malnutrition and infection. Reduced food intake, loss of fat and muscles, alterations in energy and substrate metabolism leads to malnutrition.

    Design. A randomised controlled trial with a random assignment to experimental or control group.

    Method. A stratified randomisation was used with regard to the type of transplantation. Mucositis was measured on WHO mucositis scale. Number of days of total parenteral nutrition, infection rate, weight, albumin levels and days at hospital was compared. Results. There were significantly fewer patients in the experimental group with mucositis grade 3–4 than in the control group and significantly lower number of days in the hospital (allogeneic patients). Less total parenteral nutrition was needed in the experimental group in both settings, and the S-albumin level was significantly better preserved. No significant difference could be found with regard to infection rate.

    Conclusion. Oral cryotherapy reduced mucositis, number of hospital days, the need for total parenteral nutrition and resulted in a better nutritional status.

    Relevance to clinical practice. Nurses caring for patients treated with myeloablative therapy should place high priority to prevent oral mucositis and hereby reduce its side effects.

  • 10.
    Svanberg, Anncarin
    et al.
    Uppsala University.
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Brostrom, Hans
    Birgegard, Gunnar
    The effect of cryotherapy on oral mucosa: a study in healthy volunteers2012In: Medical Oncology, ISSN 1357-0560, E-ISSN 1559-131X, Vol. 29, no 5, p. 3587-3591Article in journal (Refereed)
    Abstract [en]

    Oral cryotherapy causes local vasoconstriction, which reduces blood flow and reduces the cytotoxic damage to the oral mucosa, has been shown to reduce oral mucositis after intense cytostatic treatment. The main object of this study was to investigate the effect of oral cryotherapy on the temperature in the oral mucosa, the level of proinflammatory cytokine interleukin-6 (IL-6) in saliva and the effect on blood pressure in healthy volunteers, before and after 1 h of cooling the oral cavity with crushed ice. Twelve healthy volunteers [mean age 32.4 (SD 13.2) (20-56) years] were treated with oral cryotherapy in the form of crushed ice. Temperature measurements were performed in the oral mucosa using infrared thermograph following a flowchart protocol. Blood pressure (BP) was measured with a sphygmomanometer. Saliva was analysed for inflammatory cytokine IL-6, using an enzyme-linked immunosorbent assay (ELISA). All participants fulfilled the cooling session. The temperature in the oral cavity decreased significantly (mean 12.9 degrees C, p < .002). The systolic BP was marginally but significantly higher after cooling (similar to 5 mmHg, p = .019). We could not detect any differences in cytokine IL-6 levels before and after oral cooling. We conclude that cryotherapy during 1 h lowers the mucosal temperature as much as similar to 12.9 degrees C, which explains the significant protective effect against mucosal damage by cytostatic drugs. The cooling caused no increase in IL-6 levels. Systemic blood pressure was marginally increased.

  • 11. Walladbegi, Java
    et al.
    Svanberg, Anncarin
    Uppsala University Hospital.
    Gellerstedt, Martin
    Protocol for a randomised controlled trial to study cryoprevention of chemotherapy-induced oral mucositis after autologous stem cell transplantation2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 18, no 8, article id e021993Article in journal (Refereed)
    Abstract [en]

    Introduction A majority of patients who receive myeloablative therapy prior to hematopoetic stem cell transplantation develop oral mucositis (OM). This adverse cytotoxic effect manifests as oral mucosal erythema and ulcerations and frequently necessitates high doses of morphine for pain alleviation. OM may also interfere with food intake and result in parenteral nutrition, weight loss and impaired quality of life. To date, there have been a few studies of evidence-based interventions for prevention of OM. Cooling the oral mucosa using ice chips in conjunction with chemotherapy is known to reduce the severity of OM although clinical application is still limited due to several disadvantages. The primary endpoint of this study is therefore to evaluate the efficacy of an innovative intraoral cooling device (Cooral) compared with ice cooling in reducing the degree of OM, in patients with myeloma or lymphoma.

    Method and analysis A total of 180 patients from four different university hospitals in Sweden will be randomised to ice or Cooral in a proportion of 1:1. The degree of OM will be assessed at eight intraoral locations, in accordance with the Oral Mucositis Assessment Scale and WHO scale. Patients will be registered beginning at admission and will continue until discharge or until day +28. The primary variable is analysed in a multiple linear regression model. The significance level used is 5%.

    Ethics and dissemination The study protocol, questionnaire, diaries and letter of invitation to participants have been reviewed by the local ethical board in Göteborg. The trial results will be published in a peer-reviewed journal and disseminated to participants.

    Trial registration number NCT03203733; Pre-results.

    Protocol version Version 4, 2017-06-05

  • 12.
    Walladbegi, Java
    et al.
    Department of Oral Medicine and Pathology, Institute of Odontology at Sahlgrenska Academy, University of Gothernburg.
    Svanberg, Anncarin
    Uppsala University.
    Jontell, Mats
    Department of Oral Medicine and Pathology, Institute of Odontology at Sahlgrenska Academy, University of Gothernburg.
    Efficacy of a novel intraoral cooling device2015Conference paper (Refereed)
    Abstract [en]

    Background: Oral mucositis (OM) is a common debiliating adverse effect following high dose chemotherapy prior to bone marrow transplantation. OM often interferes with food intake and lead to malnutrition, weight loss and impaired quality of life. These adverse effects may require intravenous morphine for pain alleviation, Although uncomfortable to the patient, oral cryotherapy with ice chips has been shown to reduce the grade and extent of OM. Purpose: The purpose of the present study is to evaluate whether an intraoral cooling device has the same effectiveness as ice chips when it comes to cooling the oral mucosa. Method: Five healthy volunteers (mean age 36.2 years) chewed ice under surveillance for 30 minutes. Before the start of and immediately after the termination of the ice chewing, the intraoral mucosal temperature was measured using a modified thermometer. The same protocol was used to asses the cooling efficacy obtained by the newly developed intraoral device. Results: No statistical significant differences in cooling of teh oral mucosa (p=0.12) were obtained. The mean surface temperature following cooling was 25.7 degrees Celcius with ice chips and 24.7 degrees Celcius with the cooling device. Conclucion: The cooling device is as effective as ice chips in terms of cooling the oral mucosa. The next step in this research is to use the cooling devise to establish the highest surface temperature of the oral mucosa, during infusion of chemotherapy, that will still result in prevention of oral mucositis.

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