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- Heap, Graham A., et al.
(författare)
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HLA-DQA1-HLA-DRB1 variants confer susceptibility to pancreatitis induced by thiopurine immunosuppressants
- 2014
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Ingår i: Nature Genetics. - : Nature Publishing Group. - 1061-4036 .- 1546-1718. ; 46:10, s. 1131-1134
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Tidskriftsartikel (refereegranskat)abstract
- Pancreatitis occurs in approximately 4% of patients treated with the thiopurines azathioprine or mercaptopurine. Its development is unpredictable and almost always leads to drug withdrawal. We identified patients with inflammatory bowel disease (IBD) who had developed pancreatitis within 3 months of starting these drugs from 168 sites around the world. After detailed case adjudication, we performed a genome-wide association study on 172 cases and 2,035 controls with IBD. We identified strong evidence of association within the class II HLA region, with the most significant association identified at rs2647087 (odds ratio 2.59, 95% confidence interval 2.07-3.26, P = 2 x 10(-16)). We replicated these findings in an independent set of 78 cases and 472 controls with IBD matched for drug exposure. Fine mapping of the H LA region identified association with the HLA-DQA1*02:01-HLA-DRB1*07:01 haplotype. Patients heterozygous at rs2647087 have a 9% risk of developing pancreatitis after administration of a thiopurine, whereas homozygotes have a 17% risk.
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| 7. |
- Brännmark, Mikael, et al.
(författare)
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Packages of participation : Swedish employees´experience of Lean depends on how they are involved
- 2013
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Ingår i: IIE Transactions on Occupational Ergonomics and Human Factors. - : Informa UK Limited. - 2157-7323 .- 2157-7331. ; 1:2, s. 93-108
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Tidskriftsartikel (refereegranskat)abstract
- Background: Lean production is a dominant approach in Swedish and global manufacturing and service industries. Studies of Lean’s employee effects are few and contradictory. Purpose: Employee effects from Lean are likely not uniform. This article investigates the effect of employees’ participation on their experiences of Lean. Method: This study investigated how different packages of employee participation in Lean affected manufacturing workers’ experiences of Lean. During 2008–2011, qualitative and quantitative data were collected from Swedish manufacturing companies participating in the national Swedish Lean production program Produktionslyftet. Data from 129 surveys (28 companies), 39 semi-structured interviews, and 30 reports were analyzed. In the main analysis, comparisons were made of the survey-reported Lean experiences of employees in three groups: temporary group employees (N = 36), who participated in Lean mostly through intermittent projects; continuous group employees (N = 69), who participated through standing improvement groups; and combined group employees (N = 24), who participated in both ways. Results: Continuous group employees had the most positive experience of Lean, followed by the combined group. Temporary group employees had the least positive experiences, being less likely than their counterparts to report that Lean improved teamwork; occupational safety; and change-related learning, decision making, and authority. Conclusions: These findings support the importance of continuous, structured opportunities for participation but raise the possibility that more participation may result in greater workload and role overload, mitigating some benefits of employee involvement. Consequently, companies should consider involving employees in change efforts but should attend to the specific design of participation activities.
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| 8. |
- Dellve, Lotta, et al.
(författare)
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Health care clinicians' engagement in organizational redesign of care processes : Health care clinicians' engagement in organizational redesign of care processes
- 2018
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Ingår i: Applied Ergonomics. - : Elsevier. - 0003-6870 .- 1872-9126. ; 68, s. 249-257
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Tidskriftsartikel (refereegranskat)abstract
- The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production. The results show that kinds of engagement are interlinked and contribute to clinical engagement behaviour in quality of care and patient safety. Increased work resources have importance for engagements in organizational improvements, especially in top-down implementations. An extended work engagement model during organizational improvements in health care was supported. The model contributes to knowledge about how and when clinicians are mobilized to engage in organizational changes.
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| 9. |
- Dellve, Lotta, et al.
(författare)
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Health care clinicians’ engagement in organizational redesign of care processes : Health care clinicians’ engagement in organizational redesign of care processes
- 2018
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Ingår i: Applied Ergonomics. - : Elsevier BV. - 0003-6870. ; 68, s. 249-257
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Tidskriftsartikel (refereegranskat)abstract
- The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production. The results show that kinds of engagement are interlinked and contribute to clinical engagement behaviour in quality of care and patient safety. Increased work resources have importance for engagements in organizational improvements, especially in top-down implementations. An extended work engagement model during organizational improvements in health care was supported. The model contributes to knowledge about how and when clinicians are mobilized to engage in organizational changes.
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| 10. |
- Dellve, Lotta, et al.
(författare)
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Lean implementation approaches at different levels in Swedish hospitals : the impor¬tance for working conditions, worker engagement, health and performance.
- 2014
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Konferensbidrag (refereegranskat)abstract
- This paper reports result from one-year follow up in a research program with the overall aim to investigate how implementations of lean in health care affect working conditions, health, and performance of employees at five Swedish hospitals. This paper summarizes the implementation approaches, and their importance at short-term follow up for performance (with regard to active work with improvements), perceived working conditions and stress-related health among the healthcare workers. The implementation strategies and pace varied between the hospitals and between the strategic and operative levels. This short-term follow up showed that physical stress-related symptoms had increased overall but the cognitive stress had increased only in hospitals implementing lean. In hospitals with high implementation pace, there were more improvement work among the employees, but higher quantitative demands and lower job satisfaction.
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