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Liv, Per
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Publications (10 of 14) Show all publications
Magnusson, P. & Liv, P. (2018). Living with a pacemaker: patient-reported outcome of a pacemaker system. BMC Cardiovascular Disorders, 18, Article ID 110.
Open this publication in new window or tab >>Living with a pacemaker: patient-reported outcome of a pacemaker system
2018 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 18, article id 110Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to assess among pacemaker patients their overall satisfaction with the pacemaker system, pain, soreness/discomfort, cosmetic results, restrictions due to impaired movement of the shoulder/arm/chest, related sleep disturbances, and concern about possible device malfunction.

Methods: The seven-item questionnaire was mailed to patients from a single center who had a pacemaker implant or replacement between 2006 and 2016. A higher score indicated worse outcome on a visual analog scale (VAS) of 0-100 mm.

Results: The response rate was 75.5% and 342 questionniares were analyzed. Median age of respondents was 77. 6 years and 57.0% were males. In total, 65 complications requiring surgery (10 pocket corrections (2.9%), 5 in females) occurred during a median follow up of 5.6 years.The distribution of the primary outcome had a median score of 5 while the 75th percentile was 13. Cosmetic appearance was significantly associated with reoperation (but not other variables). Overall scores for men and women were 5 vs. 6, respectively, which achieved significance (p = 0.042). Median ratings of pain, soreness/discomfort, cosmetic appearance, range of motion, sleep, and concern about device malfunction were all <= 5. Females reported worse outcomes for all questions, except for cosmetic results and concern about malfunction.

Conclusions: The vast majority of patients report excellent overall satisfaction with the pacemaker system, and are not affected by pain, soreness/discomfort, or concern about device malfunction. They also reported favourable outcomes with respect to cosmetic results, shoulder movement, and sleep. However, some patients underwent a surgical correction of the pacemaker pocket.

Keywords
Arrhythmia, Complication, Experience, Pacemaker, Pocket
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-357690 (URN)10.1186/s12872-018-0849-6 (DOI)000434188200002 ()29866050 (PubMedID)
Available from: 2018-08-23 Created: 2018-08-23 Last updated: 2018-08-23Bibliographically approved
Magnusson, P., Wennström, L., Kastberg, R. & Liv, P. (2017). Placement Of Cardiac PacemaKEr Trial (POCKET) - rationale and design: a randomized controlled trial. Heart International, 12(1), E8-E11
Open this publication in new window or tab >>Placement Of Cardiac PacemaKEr Trial (POCKET) - rationale and design: a randomized controlled trial
2017 (English)In: Heart International, ISSN 1826-1868, E-ISSN 2036-2579, Vol. 12, no 1, p. E8-E11Article in journal (Refereed) Published
Abstract [en]

Background: A pacemaker system consists of one or two leads connected to a device that is implanted into a pocket formed just below the collarbone. This pocket is typically subcutaneous, that is, located just above the pectoral fascia. Even though the size of pacemakers has decreased markedly, complications due to superficial implants do occur. An alternative technique would be intramuscular placement of the pacemaker device, but there are no randomized controlled trials (RCTs) to support this approach, which is the rationale for the Placement Of Cardiac PacemaKEr Trial (POCKET). The aim is to study if intramuscular is superior to subcutaneous placement of a pacemaker pocket. Methods: In October 2016, we started to enroll 200 consecutive patients with an indication for bradycardia pacemaker implantation. Patients are randomized to random block sizes, stratified by age group (cut-off: 65 years) and sex, and then randomized to either subcutaneous or intramuscular implant. A concealed allocation procedure is employed, using sequentially numbered, sealed envelopes. Pocket site is blinded to the patient and in all subsequent care. The primary endpoint is patient overall satisfaction with the pocket location at 24 months as measured using a visual analog scale (VAS) 0-10. Secondary endpoints are: complications, patient-reported satisfaction at 1, 12, and 24 months (overall satisfaction, pain, discomfort, degree of unsightly appearance, movement problems, and sleep problems due to device). Conclusions: POCKET is a prospective interventional RCT designed to evaluate if intramuscular is superior to subcutaneous placement of a bradycardia pacemaker during a two-year follow-up.

Keywords
Arrhythmia, Complication, Pacemaker, Pocket, Randomized controlled trial
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-340116 (URN)10.5301/heartint.5000235 (DOI)000413045600002 ()29114383 (PubMedID)
Available from: 2018-01-31 Created: 2018-01-31 Last updated: 2018-01-31Bibliographically approved
Holgersson, G., Bergström, S., Hallqvist, A., Liv, P., Nilsson, J., Willen, L., . . . Bergqvist, M. (2017). The prognostic value of pre-treatment thrombocytosis in two cohorts of patients with non-small cell lung cancer treated with curatively intended chemoradiotherapy. Neoplasma (Bratislava), 64(6), 909-915
Open this publication in new window or tab >>The prognostic value of pre-treatment thrombocytosis in two cohorts of patients with non-small cell lung cancer treated with curatively intended chemoradiotherapy
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2017 (English)In: Neoplasma (Bratislava), ISSN 0028-2685, E-ISSN 1338-4317, Vol. 64, no 6, p. 909-915Article in journal (Refereed) Published
Abstract [en]

Chemoradiotherapy is the standard of care for inoperable stage III non-small cell lung cancer (NSCLC). This treatment, however, offers only a small chance of cure and is associated with many side effects. Little research has been made concerning which patients benefit most/least from the treatment. The present study evaluates the prognostic value of anemia, leukocytosis and thrombocytosis at diagnosis in this treatment setting. In the present study, data were collected retrospectively for 222 patients from two different phase II studies conducted between 2002-2007 in Sweden with patients treated with chemoradiotherapy for stage IIIA-IIIB NSCLC. Clinical data and the serum values of hemoglobin (Hgb), White blood cells (WBC) and Platelets (Plt) at enrollment were collected for all patients and studied in relation to overall survival using Kaplan-Meier product-limit estimates and a multivariate Cox proportional hazards regression model.

The results showed that patients with thrombocytosis (Plt > 350 x 109/L) had a shorter median overall survival (14.5 months) than patients with normal Plt at baseline (23.7 months). Patients with leukocytosis (WBC > 9 x 109/L) had a shorter median survival (14.9 months) than patients with a normal WBC at baseline (22.5 months). However, in a multivariate model including all lab parameters and clinical factors, only thrombocytosis and performance status displayed a prognostic significance.

In Conclusion, thrombocytosis showed to be an independent prognostic marker associated with shorter overall survival in stage III NSCLC treated with curatively intended chemoradiotherapy. This knowledge can potentially be used together with established prognostic factors, such as performance status when choosing the optimal therapy for the individual patient in this clinical setting.

Keywords
NSCLC, anemia, leukocytosis, thrombocytosis, prognostic, survival
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-339512 (URN)10.4149/neo_2017_614 (DOI)000418756500013 ()28895417 (PubMedID)
Available from: 2018-01-19 Created: 2018-01-19 Last updated: 2018-01-19Bibliographically approved
Heiden, M., Mathiassen, S. E., Garza, J., Liv, P. & Wahlström, J. (2016). A Comparison of Two Strategies for Building an Exposure Prediction Model. Annals of Occupational Hygiene, 60(1), 74-89
Open this publication in new window or tab >>A Comparison of Two Strategies for Building an Exposure Prediction Model
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2016 (English)In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 60, no 1, p. 74-89Article in journal (Refereed) Published
Abstract [en]

Cost-efficient assessments of job exposures in large populations may be obtained from models in which 'true' exposures assessed by expensive measurement methods are estimated from easily accessible and cheap predictors. Typically, the models are built on the basis of a validation study comprising 'true' exposure data as well as an extensive collection of candidate predictors from questionnaires or company data, which cannot all be included in the models due to restrictions in the degrees of freedom available for modeling. In these situations, predictors need to be selected using procedures that can identify the best possible subset of predictors among the candidates. The present study compares two strategies for selecting a set of predictor variables. One strategy relies on stepwise hypothesis testing of associations between predictors and exposure, while the other uses cluster analysis to reduce the number of predictors without relying on empirical information about the measured exposure. Both strategies were applied to the same dataset on biomechanical exposure and candidate predictors among computer users, and they were compared in terms of identified predictors of exposure as well as the resulting model fit using bootstrapped resamples of the original data. The identified predictors were, to a large part, different between the two strategies, and the initial model fit was better for the stepwise testing strategy than for the clustering approach. Internal validation of the models using bootstrap resampling with fixed predictors revealed an equally reduced model fit in resampled datasets for both strategies. However, when predictor selection was incorporated in the validation procedure for the stepwise testing strategy, the model fit was reduced to the extent that both strategies showed similar model fit. Thus, the two strategies would both be expected to perform poorly with respect to predicting biomechanical exposure in other samples of computer users.

Keywords
bias, optimism, statistical performance, variable selection
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:uu:diva-280906 (URN)10.1093/annhyg/mev072 (DOI)000369997400007 ()26424806 (PubMedID)
Available from: 2016-03-16 Created: 2016-03-16 Last updated: 2018-01-10Bibliographically approved
Magnusson, P., Gadler, F., Liv, P. & Morner, S. (2016). Causes of death and mortality in hypertrophic cardiomyopathy patients with implantable defibrillators in Sweden. Journal of Cardiovascular Medicine, 17(7), 478-484
Open this publication in new window or tab >>Causes of death and mortality in hypertrophic cardiomyopathy patients with implantable defibrillators in Sweden
2016 (English)In: Journal of Cardiovascular Medicine, ISSN 1558-2027, E-ISSN 1558-2035, Vol. 17, no 7, p. 478-484Article in journal (Refereed) Published
Abstract [en]

AimsImplantable defibrillators (ICDs) successfully terminate ventricular arrhythmias in hypertrophic cardiomyopathy (HCM), protect against bradycardia, and monitor atrial arrhythmias. This may alter the natural history and causes of death.MethodsThis nationwide observational longitudinal retrospective study of all HCM patients implanted during 1995-2012 obtained data from the Swedish ICD Registry, the National Patient Register, the Cause of Death Register, and were validated by review of medical records.ResultsOf 342 patients (mean age 51.8 years, 70.8% males), 45 died during a total follow-up of 1847 years (mean 5.4 years). Mean age at death was 68.2 years (range 21-83 years; 12 were 75 years). Mean follow-up time among the deceased was 4.9 years (quartiles 1.4-7.4 years). All-cause mortality was higher in HCM patients compared with the age and sex-matched Swedish general population (standardized mortality ratio 3.4; 95% confidence interval 2.4-4.5; P<0.001). Main cause of death was heart failure (n=27), stroke (n=5), cancer (n=3), myocardial infarction (n=2), sepsis (n=2), and others (n=4). Two patients died suddenly, one after the ICD was turned off because of inappropriate shocks, and one patient whose device system was removed after infection. HCM was the main cause of death in 76% of the cases, mainly because of progressive heart failure.ConclusionFor HCM patients, ICDs almost eliminate premature arrhythmic death and result in a shift to heart failure as the cause of death in the majority of cases. Still, mortality in HCM patients remains elevated and management of heart failure and comorbidities must be improved to increase survival.

Keywords
epidemiology, heart failure, hypertrophic cardiomyopathy, implantable defibrillator, mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-299557 (URN)10.2459/JCM.0000000000000359 (DOI)000377826800004 ()26808417 (PubMedID)
Available from: 2016-07-25 Created: 2016-07-22 Last updated: 2017-11-28Bibliographically approved
Jackson, J. A., Mathiassen, S. E. & Liv, P. (2016). Observer performance in estimating upper arm elevation angles under ideal viewing conditions when assisted by posture matching software. Applied Ergonomics, 55, 208-215
Open this publication in new window or tab >>Observer performance in estimating upper arm elevation angles under ideal viewing conditions when assisted by posture matching software
2016 (English)In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 55, p. 208-215Article in journal (Refereed) Published
Abstract [en]

Selecting a suitable body posture measurement method requires performance indices of candidate tools. Such data are lacking for observational assessments made at a high degree of resolution. The aim of this study was to determine the performance (bias and between- and within-observer variance) of novice observers estimating upper arm elevation postures assisted by posture matching software to the nearest degree from still images taken under ideal conditions. Estimates were minimally biased from true angles: the mean error across observers was less than 2. Variance between observers was minimal. Considerable variance within observers, however, underlined the risk of relying on single observations. Observers were more proficient at estimating 0 and 90 postures, and less proficient at 60. Thus, under ideal visual conditions observers, on average, proved proficient at high resolution posture estimates; further investigation is required to determine how non-optimal image conditions, as would be expected from occupational data, impact proficiency.

Keywords
Measurement error, Working postures, Observation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-300293 (URN)10.1016/j.apergo.2016.01.012 (DOI)000374074600021 ()26995050 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-1761
Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2017-11-28Bibliographically approved
Magnusson, P., Gadler, F., Liv, P. & Mörner, S. (2016). Risk Markers and Appropriate Implantable Defibrillator Therapy in Hypertrophic Cardiomyopathy. Pacing and Clinical Electrophysiology, 39(3), 291-301
Open this publication in new window or tab >>Risk Markers and Appropriate Implantable Defibrillator Therapy in Hypertrophic Cardiomyopathy
2016 (English)In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 39, no 3, p. 291-301Article in journal (Refereed) Published
Abstract [en]

Background: Risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is mainly based on evaluations from patients at highly specialized centers.

Aim: To evaluate risk markers for appropriate implantable cardioverter defibrillator (ICD) therapy in an unselected, nationwide cohort of HCM.

Methods: Patients with an ICD due to HCM were identified from the Swedish ICD Registry since its start in 1995, merged with Patient Register data, and medical records were retrieved. Risk markers for ventricular arrhythmias leading to appropriate ICD therapy were analyzed using Cox proportional hazard ratio (HR).

Results: Of 321 patients (70.1% males), at least one appropriate therapy occurred in 77 (24.0%) during a mean follow-up of 5.4 years (5.3% per year; primary prevention 4.5%, secondary prevention 7.0%). Cumulative incidences at 1 year, 3 years, and 5 years were 8.1%, 15.3%, and 21.3%, respectively. Cardioversion effectively restored rhythm in 52% of the first episode and antitachycardia pacing was sufficient in the remaining. For the whole cohort, ejection fraction (EF) <50% (HR 2.63; P < 0.001) was associated with appropriate ICD therapy. In primary prevention, patients with established risk markers experienced appropriate therapy; atrial fibrillation (AF; HR 2.54; P = 0.010), EF < 50% (HR 2.78; P = 0.004), and nonsustained ventricular tachycardia (HR 1.80; P = 0.109) had the highest HR, and wall thickness 30 mm, syncope, exercise blood pressure response, or family history of SCD had weaker associations.

Conclusion: ICD therapy successfully terminates ventricular arrhythmias in HCM. In addition to conventional risk markers, a history of AF or EF < 50% may be considered in risk stratification.

Keywords
implantable cardioverter defibrillator, hypertrophic cardiomyopathy, sudden death, risk stratification, epidemiology
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-288618 (URN)10.1111/pace.12801 (DOI)000372408200013 ()26681505 (PubMedID)
Available from: 2016-05-04 Created: 2016-04-28 Last updated: 2017-11-30Bibliographically approved
Jackson, J. A., Mathiassen, S. E., Wahlstrom, J., Liv, P. & Forsman, M. (2015). Digging deeper into the assessment of upper arm elevation angles using 0 Cross Mark standard inclinometry [Letter to the editor]. Applied Ergonomics, 51, 102-103
Open this publication in new window or tab >>Digging deeper into the assessment of upper arm elevation angles using 0 Cross Mark standard inclinometry
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2015 (English)In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 51, p. 102-103Article in journal, Letter (Refereed) Published
Keywords
Validity, Bias, Posture assessment
National Category
Medical Ergonomics
Identifiers
urn:nbn:se:uu:diva-261466 (URN)10.1016/j.apergo.2015.04.012 (DOI)000358389100012 ()26154209 (PubMedID)
Available from: 2015-09-01 Created: 2015-09-01 Last updated: 2017-12-04Bibliographically approved
Holgersson, G., Bergström, S., Liv, P., Nilsson, J., Edlund, P., Blomberg, C., . . . Bergqvist, M. (2015). Effect of Increased Radiotoxicity on Survival of Patients with Non-small Cell Lung Cancer Treated with Curatively Intended Radiotherapy. Anticancer Research, 35(10), 5491-5497
Open this publication in new window or tab >>Effect of Increased Radiotoxicity on Survival of Patients with Non-small Cell Lung Cancer Treated with Curatively Intended Radiotherapy
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2015 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 35, no 10, p. 5491-5497Article in journal (Refereed) Published
Abstract [en]

Aim: To elucidate the impact of different forms of radiation toxicities (esophagitis, radiation pneumonitis, mucositis and hoarseness), on the survival of patients treated with curatively intended radiotherapy for non-small cell lung cancer (NSCLC). Patients and Methods: Data were individually collected retrospectively for all patients diagnosed with NSCLC subjected to curatively intended radiotherapy (>= 50 Gy) in Sweden during the time period 1990 to 2000. Results: Esophagitis was the only radiation-induced toxicity with an impact on survival (hazard ratio=0.83, p=0.016). However, in a multivariate model, with clinical-and treatment-related factors taken into consideration, the impact of esophagitis on survival was no longer statistically significant (hazard ratio=0.88, p=0.17). Conclusion: The effect on survival seen in univariate analysis may be related to higher radiation dose and to the higher prevalence of chemotherapy in this group. The results do not suggest that the toxicities examined have any detrimental effect on overall survival.

Keywords
NSCLC, radiotherapy, toxicity, esophagitis, survival
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-265679 (URN)000361823200042 ()26408714 (PubMedID)
Available from: 2015-11-04 Created: 2015-11-02 Last updated: 2017-12-01Bibliographically approved
Magnusson, P., Gadler, F., Liv, P. & Morner, S. (2015). Hypertrophic Cardiomyopathy and Implantable Defibrillators in Sweden: Inappropriate Shocks and Complications Requiring Surgery. Cardiovascular Electrophysiology, 26(10), 1088-1094
Open this publication in new window or tab >>Hypertrophic Cardiomyopathy and Implantable Defibrillators in Sweden: Inappropriate Shocks and Complications Requiring Surgery
2015 (English)In: Cardiovascular Electrophysiology, ISSN 1045-3873, E-ISSN 1540-8167, Vol. 26, no 10, p. 1088-1094Article in journal (Refereed) Published
Abstract [en]

Inappropriate ICD Shocks and Complications in HCM IntroductionThe expanded use of implantable cardioverter-defibrillators (ICDs) to prevent sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) based on risk stratification in individuals without known previous ventricular arrhythmia is justified by an acceptable risk of device-related adverse events. Such complications, leading to surgical procedures or inappropriate electrical shocks, may impact mortality, morbidity, quality of life, and cost-effectiveness. Methods and ResultsFrom the Swedish ICD Registry, implants due to HCM since 1995 until November 2012 in patients aged 18 years were identified and medical records reviewed. Inappropriate ICD shock occurred in 14.3% (46 of 321 patients; mean follow-up 5.4 years) with a recurrent episode in 28.2% of them. In multivariable analysis, hazard ratio (HR) for atrial fibrillation was 3.5 (95% confidence interval 1.8-6.8; P < 0.001) but showed no significant association to male sex (HR = 0.77), age (HR = 0.99), secondary indication (HR = 1.02) or device, ICD-DR/CRTD vs. ICD-VR (HR 1.07). Inappropriate shocks were triggered by atrial fibrillation/flutter or ectopic tachycardia (56.5%), sinus tachycardia (14.5%), lead dysfunction (14.5%), and T-wave oversensing (13.0%). A reintervention, besides elective device replacement, occurred in 92 patients (totally 150 procedures). The majority were lead-related (70.0%) procedures, especially of the ICD lead. Reintervention was associated with female sex (HR = 1.6 P = 0.04). ConclusionInappropriate ICD shock triggered by atrial arrhythmias, lead dysfunction, or complications requiring surgical interventions, is a concern in HCM patients who will be eligible for long-term prevention of sudden death. Efforts to avoid adverse events and provide balanced risk-benefit information are important, especially in primary prevention.

Keywords
complication, hypertrophic cardiomyopathy, implantable defibrillator, inappropriate shock, Sprint Fidelis lead, sudden cardiac death
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-267323 (URN)10.1111/jce.12750 (DOI)000363211600014 ()26178879 (PubMedID)
Available from: 2015-11-24 Created: 2015-11-20 Last updated: 2017-12-01Bibliographically approved
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