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- de Man Lapidoth, Joakim
(författare)
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Binge eating and obesity treatment : prevalence, measurement and long-term outcome
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Eating disorders and binge eating has repeatedly been shown to be common in surgical and behavioural weight loss treatments. Due to methodological variations and shortcomings in previous research, there is insufficient information about how eating disorders and binge eating are associated with outcome in weight loss treatments. There is therefore no consensus on how eating pathology should be adressed in weight loss treatments, which has led to large differences in the clinical practice. The main aim of this thesis was to address the issues of eating disorders and binge eating in weight loss treatments, and to investigate how binge eating is associated with long-term treatment outcome.
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| 3. |
- Sakwe, Amos M., 1962-
(författare)
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The Role of Protein Kinase C in the Extracellular Ca2+-regulated Secretion of Parathyroid Hormone
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Parathyroid hormone (PTH) is the major physiological regulator of the extracellular Ca2+ concentration ([Ca2+]o) in the body. The secretion of this hormone is suppressed at high [Ca2+]o. Previously this was thought to occur by intracellular degradation of the hormone in the secretory pathway of parathyroid (PT) cells but is now believed to result from extracellular Ca2+ stimulus-secretion coupling via the calcium sensing receptor (CaR). In contrast to the stimulation of PTH secretion upon inhibition of mature PTH proteolysis, inhibition of PT proteasomes caused the accumulation of PTH precursors and inhibited secretion of PTH. This suggests that PT proteasomes play a quality control function in the maturation of PTH but they do not directly participate in the [Ca2+]o-regulated secretion of the hormone. Treatment of PT cells with 12-O-tetradecanyolphorbol-13-acetate (TPA) blocks the high [Ca2+]o-induced CaR-mediated suppression of PTH secretion. To delineate the role of DAG-responsive protein kinase C (PKC) isoforms in this process, we complemented pharmacological modulation of PKC activity with physiological activation of the enzyme via the CaR. PKC-α was rapidly activated by high [Ca2+]o and was efficiently down-regulated by prolonged TPA treatment. In CaR-transfected HEK293 cells, TPA and high [Ca2+]o induced the activation of ERK1/2 but the TPA effect was CaR- and Ca2+-independent. The magnitude of neomycin-induced release of Ca2+ from intracellular stores following pharmacological modulation of PKC activity was opposite to that resulting from physiological activation/inhibition of the enzyme via the CaR. Influx of Ca2+ following activation of the receptor occurred by store-operated mechanisms. Over-expression of wt or DN PKC-α or-ε in PT cells using the Tet-On adenovirus gene delivery system revealed that the stimulatory effect of TPA on PTH secretion at high [Ca2+]o was enhanced in cells over-expressing wt PKC-α, but the coupling of the extracellular Ca2+ signal to PTH secretion was not dependent on the physiological activation of this PKC isoform via the CaR.
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| 4. |
- Tegelberg, Alexander, 1974-, et al.
(författare)
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Engagement under difficult conditions : Caring for patients with acute abdominal pain across the acute-care chain: A qualitative study
- 2020
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Ingår i: International Emergency Nursing. - : ELSEVIER SCI LTD. - 1755-599X .- 1878-013X. ; 52
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies report that patients with acute abdominal pain do not always receive optimal care and can experience poor pain management, safety failures, and emotional harm. Deeper understanding of how health professionals experience care delivery is needed to improve care to patients with acute abdominal pain. Aim: To explore, from the perspective of registered nurses and physicians, how care is provided for patients with acute abdominal pain in the acute care chain, and to identify barriers that they describe in the delivery of care. Method: Registered nurses and physicians (n = 19) working in ambulance services, emergency departments, and surgical departments at five hospitals in Sweden were interviewed. A content analysis was performed. Results: Five categories were identified; interaction: a decisive moment, competence and resources: not always available, guidelines: limited use, medical care: a main focus, and feedback and collaboration: limited across acute care chain. Conclusion: This study adds new insights relating to how health professionals reflect on patient needs and obstacles to satisfying them. To deliver high quality care and meet patients' fundamental needs, there is a need of general guidelines and close collaboration in the acute care chain.
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- Tegelberg, Alexander, 1974-
(författare)
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Managers and health professionals in the acute care chain : – A need for a shared understanding in the care of patients with acute abdominal pain
- 2021
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Managers and health professionals, so-called stakeholders, at the system and clinical level in the acute care chain, are responsible for providing safe and high-quality care encompassing both nursing and medical aspects. In patients with acute abdominal pain (AAP), high-quality nursing care has been described as not always being delivered across the entire acute care chain. This patient group frequently seeks care across the acute care chain and the care procedures and quality may differ widely. The quality of nursing care provided to patients can be understood through the framework Fundamentals of Care. The framework is divided into three dimensions: establishing a relationship with the patient, integration of the patient’s fundamental care needs, and context of care. Stakeholders are one important part of the context of care and a prerequisite for delivery of high-quality care. Aim: The overall aim was to explore managers’ and health professionals’ understanding of managing and conducting care of patients with AAP across the acute care chain. Method: Individual interviews with open-ended questions were used in two studies and data were analysed with a conventional qualitative content analysis method. Participants represented ambulance services, emergency departments, and surgical departments. Managers at head nurse level (n=11) and operational level (n=6) at four hospitals were included in Study I. Registered nurses (n=11) and physicians (n=8) at five hospitals were included in Study II.Results: In Study I, managers described the adult patient group as challenging and heterogenous. The managers reflected on themselves as role models. Guidelines were used to organise care, but they often had a medical focus and the managers referred to others as being responsible for the guidelines. Managers who were registered nurses focused on the medical care of patients with AAP, while managers who were physicians underlined the value of nursing care to improve patient outcome. In Study II, health professionals described dedication to applying evidence-based practices. However, they used personal experience over guidelines in care provision. They described organisational barriers to delivering high-quality care, such as varying competence among colleagues, lack of available patient beds, and lack of collaboration across the acute care chain. Conclusion: The stakeholders’ perspectives complemented each other, but their descriptions of managing and conducting care of patients with AAP did not always fit together, which revealed a gap in the everyday clinical practices as well as structural issues at the system level. These empirical descriptions of differing understanding may reveal some of the reasons why patients with AAP do not always experience high-quality care. To optimise patient care across the acute care chain, stakeholders need a shared understanding to meet patients’ fundamental care needs and enable provision of high-quality nursing and medical care.
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| 6. |
- Tegelberg, Alexander, 1974-, et al.
(författare)
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Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain
- 2019
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 28:19-20, s. 3641-3650
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Tidskriftsartikel (refereegranskat)abstract
- Aim and objectives: To describe managers' perspectives on the care of patients with acute abdominal pain and explore how they influence the care.Background: Patients with acute abdominal pain form a common group of patients who often report poor pain management. Managers are key actors in ensuring that patients receive high‐quality care. This stresses the need to deepen the understanding of their perspectives on these patients, in order to provide high‐quality fundamental care across the acute care chain.Design: Qualitative descriptive semi‐structured interview study, with an inductive approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used.Methods: Individual interviews were conducted with managers (n = 17) from ambulance services, emergency departments and surgical departments at four hospitals in Sweden, representing managers at the micro‐ and macrolevels across the acute care chain.Results: The patient group was described as a challenging heterogeneous group, with a focus on medical care, shaped by clinical practice guidelines, for which others were responsible. Managers with a physician background expressed that nursing care was important for the outcome of the care, while managers with a nursing background focused solely on the medical care. Additionally, the managers described that they affected the care by providing resources and serving as role models.Conclusions: The solely medical perspective is worrying. By being a stakeholder, the managers' responsibility should be to highlight the patient perspective in the care and promote and support all health professionals in redesigning the care, where achieving higher quality both in nursing and in medical care for patients with acute abdominal pain becomes a shared goal.Relevance to clinical practice: Managers should use their leadership to bridge the gap between medicine and nursing care by highlighting patients' need for fundamental care, and to support health professionals in providing evidence‐based and high‐quality care.
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