| 1. |
- Chen, Deliang, 1961, et al.
(author)
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Summary of a workshop on extreme weather events in a warming world organized by the Royal Swedish Academy of Sciences
- 2020
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In: Tellus Series B-Chemical and Physical Meteorology. - : Stockholm University Press. - 1600-0889 .- 0280-6509. ; 72:1
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Journal article (peer-reviewed)abstract
- Climate change is not only about changes in means of climatic variables such as temperature, precipitation and wind, but also their extreme values which are of critical importance to human society and ecosystems. To inspire the Swedish climate research community and to promote assessments of international research on past and future changes in extreme weather events against the global climate change background, the Earth Science Class of the Royal Swedish Academy of Sciences organized a workshop entitled 'Extreme weather events in a warming world' in 2019. This article summarizes and synthesizes the key points from the presentations and discussions of the workshop on changes in floods, droughts, heat waves, as well as on tropical cyclones and extratropical storms. In addition to reviewing past achievements in these research fields and identifying research gaps with a focus on Sweden, future challenges and opportunities for the Swedish climate research community are highlighted.
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| 2. |
- Karimi, Masoud, et al.
(author)
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A retrospective study of extracolonic, non-endometrial cancer in Swedish Lynch syndrome families 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis 11 Medical and Health Sciences 1117 Public Health and Health Services
- 2018
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In: Hereditary Cancer in Clinical Practice. - : Springer Science and Business Media LLC. - 1731-2302 .- 1897-4287. ; 16:1
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Journal article (peer-reviewed)abstract
- Background: Lynch Syndrome is an autosomal dominant cancer syndrome caused by pathogenic germ-line variants in one of the DNA-mismatch-repair (MMR) genes MLH1, MSH2, MSH6 or PMS2. Carriers are predisposed to colorectal and endometrial cancer, but also other cancer types. The purpose of this retrospective study was to characterize the tumour spectrum of the Swedish Lynch syndrome families. Methods: Data were obtained from genetically verified 235 Lynch families from five of the six health care regions in Sweden. The material was stratified for gender, primary cancer, age and mutated gene and the relative proportions of specific cancer types were compared to those in the general population. Results: A total of 1053 family members had 1493 cancer diagnoses of which 1011 were colorectal or endometrial cancer. Individuals with pathogenic variants in MLH1 and MSH2 comprised 78% of the cohort. Among the 482 non-colorectal/non-endometrial cancer diagnoses, MSH2 carriers demonstrated a significantly increased proportion of urinary tract, gastric, small bowel, ovarian and non-melanoma skin cancer compared to the normal population. MLH1 carriers had an elevated proportion of gastrointestinal cancers (gastric, small bowel, pancreas), while MSH6 carriers had more ovarian cancer than expected. Gastric cancer was predominantly noted in older generations. Conclusion: Lynch syndrome confers an increased risk for multiple cancers other than colorectal and endometrial cancer. The proportions of other cancers vary between different MMR genes, with highest frequency in MSH2-carriers. Gender and age also affect the tumour spectrum, demonstrating the importance of additional environmental and constitutional parameters in determining the predisposition for different cancer types.
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| 5. |
- Avallin, Therese, et al.
(author)
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Person-centred pain management for the patient with acute abdominal pain : An ethnography informed by the Fundamentals of Care framework
- 2018
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 74:11, s. 2596-2609
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Journal article (peer-reviewed)abstract
- Aims: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contributes to or detract from successful pain management for the patient with acute abdominal pain (AAP) across the acute care pathway.Background: Although pain management is a recognized human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance.Design: Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework.Methods: Participant observation and informal interviews (92hr) were performed at one emergency department (ED) and two surgical wards at a University Hospital during April-November 2015. Data include 261 interactions between patients, aged 18years seeking care for AAP at the ED and admitted to a surgical ward (N=31; aged 20-90years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N=198).Results: The observations revealed an organizational culture with considerable impact on how well pain was managed. Well-managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics.Conclusions: Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management.
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| 6. |
- Björck, Erik
(author)
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Genetic studies of follicular and mantle cell lymphoma
- 2005
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Doctoral thesis (other academic/artistic)abstract
- Non-Hodgkin lymphoma is a malignancy derived from lymphoid tissues. In Sweden, non-Hodgkin lymphoma constituted 3% of all cancers recorded in 2003. Follicular and mantle cell lymphoma are the two types of non-Hodgkin lymphomas studied in this thesis. The treatment modalities of these lymphomas vary, and the reasons why some patients have a good response to therapy while other fail to respond are largely unknown. To address this problem we compared the gene expression of follicular lymphomas that had good response to therapy with follicular lymphomas that did not respond. The investigated treatment was combination chemotherapy with CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone). With high-density oligonucleotide arrays we could show that 14 genes involved in the G2/M transition of the cell cycle were up-regulated in the responders compared with the non-responders. Six out of these 14 genes were correlated with survival in a cohort of 57 patients with follicular lymphoma. Furthermore, one of these genes was also investigated with immunohistochemistry and there was a good correlation between mRNA expression and protein expression of this gene (Paper I). The gene expression measured with high-density oligonucleotide arrays was correlated with survival in two independent cohorts of follicular lymphoma. A total of 21 genes were associated with a prolonged survival in both cohorts. This association was independent of the international prognostic index. Genes of particular interest in this study were ERCC1, PTAFR, C4A, RPL23A, BCLAF and ABCC5 (Paper II). The gene expression in mantle cell lymphoma was also studied with high-density oligonucleotide arrays. Differences in genetic profiles were shown between tumors with a high and a low proliferation rate and also between primary and relapsed tumors (Paper III). In mantle cell lymphoma the prevalence of mutated V H-genes was investigated. In a cohort of 110, 17% of the tumors had somatic mutations. This implies that a subgroup of mantle cell lymphomas has a post germinal center origin. It was further demonstrated that there was a preferential V H3-21 usage in 19% of the tumors, and that patients with tumor usage of this V H-gene had a longer survival compared with the rest of the patients (Paper IV) .
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| 7. |
- Björck, Inger, et al.
(author)
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Cereal grains for nutrition and health benefits: Overview of results from in vitro, animal and human studies in the HEALTHGRAIN project
- 2012
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In: Trends in Food Science & Technology. - : Elsevier BV. - 1879-3053 .- 0924-2244. ; 25:2, s. 87-100
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Journal article (peer-reviewed)abstract
- Epidemiological studies have linked whole grain intake to the prevention of the metabolic syndrome, obesity and associated chronic diseases such as CVD and T2D. The Nutrition module within the HEALTHGRAIN project, included 10 partners and undertook in vitro, animal and humanin vivo studies with the overall aims of elucidating the components and mechanisms underlying the health benefits of cereal grains. This review summarises the major outcomes of these studies, including yet unpublished findings.
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| 8. |
- Bolander Laksov, Klara, 1973-, et al.
(author)
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Developing clinical education based on medical education research - findings from a faculty development program
- 2018
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In: Amee 2018: Educating the Future Healthcare Professional and the Roles of the Teacher. ; , s. 52-52
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Conference paper (peer-reviewed)abstract
- BackgroundStudents in health and medical education spend a great deal of their education in clinical learning environments. There is today a growing knowledge of how learning in the clinical education environment can be facilitated, as well as about existing barriers to the implementation of these skills. By studying how clinical teachers engaged in educational development work, we wanted to better understand the conditions and systems required for successful implementation. This project aimed at examining the conditions for the successful use of medical-educational research results to stimulate learning in clinical education. Summary of workBased on knowledge generated from educational research, a faculty development program was designed to enable five teams of clinical teachers from three university hospitals to participate in a faculty development program aiming to develop, implement and evaluate an educational 'tool' together. The five teams that participated in the program were interviewed in focus groups at the start and end of the program. Observational and document data were collected throughout the process.Summary of resultsAll teams managed to develop a tool aimed at students or clinical teachers, implement and evaluate it. The faculty development program and its structure as a year-long scaffolding of driving and legitimising change processes in the clinical environment was acknowledged as facilitating the implementation of the educational tools. One year after the end of the program, four of the five teams had presented their work at medical education conferences, three teams are currently working to publish their work.Discussion & ConclusionThe design of the program around building capacity for change together with workshops focusing different aspects of Mayer and Stensaker's Change process prescriptors was identified as a successful framework for successful implementation and use of medical education research in the clinical education environment.Take-home messageThe invitation of teams to faculty development program, together with a design building on scaffolding educational change and leadership enabled participants to translate medical education research into their clinical teaching practice.
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| 9. |
- Bolander Laksov, Klara, 1973-, et al.
(author)
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Från engagerad individ till fungerande systemperspektiv på pedagogisk utveckling i klinisk utbildningsmiljö
- 2018
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Conference paper (peer-reviewed)abstract
- Detta 10-åriga forskningsprojekt har titeln ’Från engagerad individ till fungerande systemperspektiv’. Projektet, som påbörjades 2010 tar sin utgångspunkt i problemet med att det trots att det återkommande tas goda initiativ till att förändra och utveckla den pedagogiska miljön, i detta fall inom den kliniska utbildningen, tycks vara svårt att etablera pedagogisk utveckling som är hållbar över tid. Syftet med projektet är att undersöka både hur studenter interagerar med utbildningsmiljön för att lära, och vilka förutsättningar som finns för lärares möjligheter att bedriva pedagogisk utveckling i sådan miljö, samt pröva en modell för pedagogisk utveckling och undersöka vad resultatet av detta blev. Vi har i projektet sökt oss till systemteori (Senge, Engeström, Billet) som ett sätt att bättre fö rstå den komplexa miljö som den kliniska utbildningsmiljön ugör. Olika teoretiska perspektiv har guidat olika stadier i projektet. Den övergripande forskningsfrågan bottnar i Peter Senges arbete och idén om den lärande organisationen (2006). Genom att förstå den kliniska utbildningsmiljön som en lärande organisation, som ett intrikat system där olika delar interagerar och skapar förutsättningar för lärande, hoppades vi kunna belysa skillnader mellan olika kliniska utbildningsmiljöer i en jämförande fallstudie. I utforskandet av studenters lärande i den kliniska utbildningsmiljön har Stephen Billets (2001; 2004; 2008) arbete, med lärande som ett resultat av relationen mellan praktikens/ arbetsplatsens erbjudande i fråga om deltagande och individens engagemang, utgjort en viktig utgångspunkt i studierna för att bättre förstå sjuksköterske- och läkarstudenters interaktion och lärande med den kliniska utbildningsmiljön. Vad gäller förutsättningarna för kliniska lärare att arbeta med pedagogiskt förändringsarbete i den kliniska miljön vände vi oss till Yrjö Engeströms arbete (1999; 2010; 2011). Engeströms syn på mänsklig aktivitet som sammanhängande i ett aktivitetssystem som påverkar varandra fungerar som utgångspunkt för en serie studier där vi undersöker lärares drivkrafter till att ägna sig åt pedagogiskt förändringsarbete och förutsättningarna för att bedriva utvecklingsprocesser samt dess resultat. De metodologiska utgångspunkterna för projektet har bottnat i ett sociokonstruktivistiskt perspektiv, och utgår från ett flertal olika sätt att samla data för att fokusera på olika aspekter i den kliniska utbildningsmiljön och de ledare, lärare och studenter som verkar i den. Det är dock huvudsakligen intervjuer, både individuella intervjuer (27) och fokusgruppintervjuer (6), men också ett stort antal observationer (200h), som utgjort underlag för våra studier. Resultaten av projektet som helhet visar på flera centrala aspekter för möjligheterna till lärande i den kliniska utbildningsmiljön. Studiernas visar att engagemanget och utgångspunkterna hos de individer, både studenter, kliniker som lärare, och ledare, som deltar i miljön är mycket centralt (Elmberger et al., inskickad). I våra studier identifierade vi systemför den kliniska utbildningsmiljön som har sin utgångspunkt i väldigt olika organisationsrationaliteter (Laksov et al, 2015). Dessa olikheter kunde ibland upplevas av studenter som motsägelsefulla (Liljedahl et al, 2015). Den kliniska utbildningsmiljön är komplex, men genom att lärare och pedagogiska ledare tar ett perspektiv på studenter som deltagare snarare än konsumenter, finns möjlighet att underlätta för studenters insocialisering i både sin profession, och i vad det innebär att vara student i den kliniska miljö n (Liljedahl et al 2016; 2017). Som deltagare lär sig studenterna att förhålla sig till de normer, värderingar och praktiker som förekommer i de olika miljöerna. Genom deltagandet i den kliniska miljön får de också möjlighet att lära sig vikten av att balansera mellan att anpassa sig, och att vara flexibel, och därmed utveckla sin professionella identitet (Liljedahl et al 2016; 2017). Förhållanden som framstår som särskilt utmanande i den kliniska utbildningsmiljön är de spä nningar som olika aktivitetssystem skapar i relation till utbildningsverksamheten och man kan ifrågasätta om och på vilket sätt olika aktörer som är involverade i högre utbildning tar ett sådant helhetsperspektiv, och om detta är möjligt? Seminariet läggs upp som en introduktion (15min) följt av en diskussion med utgångspunkt i följande frågor: Vilka styrkor och svagheter finns i ett systemperspektiv på pedagogisk utveckling? Med bas i vår och andras forskning, vad innebär hållbarhet i utvecklingen av pedagogisk verksamhet? Hur ser möjliga modeller ut för att implementera högskolepedagogisk forskning i olika utbildningsmiljöer? Vilken bäring har våra resultat i andra utbildningsmiljöer?
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| 10. |
- Bolander Laksov, Klara, et al.
(author)
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Shifting to team-based faculty development: a programme designed to facilitate change in medical education
- 2022
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In: Higher Education Research and Development. - : Informa UK Limited. - 0729-4360 .- 1469-8366. ; 41:2, s. 269-283
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Journal article (peer-reviewed)abstract
- The value of traditional faculty development programmes has been questioned regarding its effectiveness in transforming clinical education. Rather than training faculty separately from their colleagues, the faculty development programme described in this paper presented an opportunity for teams of faculty to improve clinical education by developing tools grounded in medical education research. The five participating teams were interviewed in focus groups at the end of the programme and followed up with emails and phone calls three years after the end of the programme. The interview data were analysed according to conventional content analysis. Immediately after completion of the programme, all teams had managed to implement their tools, and three years later, four were still in use. The study demonstrates that critical success factors for faculty development to transform change in practice included a design focused on a stepwise, longitudinal programme; coaching of teams; management and peer engagement, and programme days that created space for reflection, development, and discussion.
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