| 1. |
- Backes, Carl, et al.
(författare)
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Outcomes Following a Comprehensive versus a Selective Approach for Infants Born at 22 Weeks of Gestation.
- 2019
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Ingår i: Journal of Perinatology. - : Springer Science and Business Media LLC. - 0743-8346 .- 1476-5543. ; 39:1, s. 39-47
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation.Study design: Retrospective, cohort study (2006–2015). Enrollment was limited to mother–infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother–infant dyads (comprehensive center); the other center (Nationwide Children’s Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated.Result: Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05).Conclusion: Even when mother–infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.
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| 2. |
- Berg, Karl, 1988, et al.
(författare)
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Different Perspectives - An immersive experience using 360° video and Google Cardboard
- 2016
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Ingår i: Proceedings of SIDeR’16 – student interaction design research conference.
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Konferensbidrag (refereegranskat)abstract
- Becoming aware of your own or other people’s behaviour in social situations is hard, you can only see the world through your eyes, your experiences. In order to better share and understand each other we have designed a cheap but effective technology through the use of 360 degree film, binaural audio, and Google Cardboard goggles. Our focus is the school environment, while we initially dealt with bullying, we eventually shifted the issue to ambiguous social situations, to avoid the stigma of concepts such as victim and bully. Through participatory design we managed to implement a mobile application that allows a user equipped with headphones and Google Cardboard to experience the 360° film recorded. This will then be followed by a discussion with her or his peers - preferably with supervision of a professional such as a teacher, hopefully raising awareness of their attitudes and preconceived notions.
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| 3. |
- Pettersson, Fanny L. M., et al.
(författare)
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Educating students in a Swedish regionalized medical program through the use of digital technologies
- 2011
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Ingår i: Education and Technology: Innovation and Research. Proceedings of ICICTE 2011. - Rhodes, Greece : ICICTE 2011. ; , s. 282-293
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Konferensbidrag (refereegranskat)abstract
- In 2011, the first regionalized medical program (RMP) started in Sweden. Digital technologies are used for educational and administrational purposes. This paper explores medical teachers and administrators understanding of faculty preparations, their own preparedness and expectations related to the implementation of the RMP. A survey was distributed to teachers and administrators. Early findings indicate that the use of digital technologies began at a small scale, but there is potential for increased development. It is concluded that although teachers and administrators have a limited experience of distance education, the faculty has been able to create a feeling of being prepared.
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| 4. |
- Pettersson, Fanny L. M., et al.
(författare)
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Medical education through the use of digital technologies : The implementation of a Swedish regionalized medical program
- 2013
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Ingår i: The University of the Fraser Valley Research Review. - : University of the Fraser Valley. - 1715-9849. ; 4:3, s. 16-30
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Tidskriftsartikel (refereegranskat)abstract
- In 2011, the first regionalized medical program (RMP) started in Sweden. The Swedish RMP means that students are distributed in groups while doing their five clinical clerkship semesters. To enable the medical students' theoretical studies when being regionalized, digital technologies are used for educational and administrational purposes. This paper explores medical teachers' and administrators' understanding of faculty preparations, their own preparedness and expectations related to the implementation of the RMP supported by digital technologies. A survey was distributed to teachers and administrators before the first regionalized semester was conducted. Findings indicate that the use of digital technologies began at a small scale, but that there is potential for increased development. It is concluded that although teachers and administrators have limited experience of distance education, the faculty has been able to create a feeling of being prepared.
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| 5. |
- Pettersson, Fanny, 1984-
(författare)
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Learning to be at a distance : structural and educational change in the digitalization of medical education
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As an expression of current challenges faced by contemporary societies, past decades have witnessed heavy demands for higher education to change and transform. One key question here has been the increased digitalization of higher education. Within this wider setting, this thesis deals with an attempt to handle the increasing shortage of physicians in Sweden by way of digitalizing medical education. The aim of this explorative and longitudinal thesis is to describe and analyze structural and educational transformation work in medical education during the digitalization of the program and the transition from face-to-face to distance education. This thesis focuses on teachers, students and management, who are all heavily involved in this transition of the medical program. Two questions guide the research: (1) what are teachers’ and students’ expectations pending the transition, and what are the influences of already established tools and activities on the program and (2) in what ways do conflicts and changes occur over time, and how do teachers, students, and management deal with these as part of the transition? Cultural-historical activity theory (CHAT) serves as the theoretical framework of the thesis. In particular, the concepts of dominant and non-dominant activities, conflicts, transitional actions, and levels of learning inform the analysis. The data are generated by surveys (N = 108), logging of actors’ activity patterns (N = 100 teachers and 100 students), field studies (65 hours), and interviews (N = 62). The data cover teachers’, students’ and management’s roles in the transition. The analysis shows that the way of theoretically understanding the transition – from a dominant face-to-face activity to a new and unproven non-dominant distance activity – have proved to contribute to deeper understanding of the process of digitalizing medical education. The analysis further displays how the transition from face-to-face to distance education creates considerable conflicts that over time force teachers, students and management into structural and educational transformation work. This type of work successively renders new educational design solutions and new flexible ways of organizing distance medical education. This thesis discusses how the structural and educational transformation work forces actors to collectively engage in the transition by experimenting with new suitable methods and designs, as digital technologies and technology-enhanced learning (TEL) could make sense to teachers and students when they are at a distance.
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| 6. |
- Söderström, Fanny, et al.
(författare)
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Active versus restrictive ligation strategy for patent ductus arteriosus : A retrospective two-center study of extremely preterm infants born between 22 + 0 and 25 + 6 weeks of gestational age
- 2024
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Ingår i: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 191
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPatent ductus arteriosus (PDA) in premature infants is associated with adverse clinical outcomes. Mode and timing of treatment are still controversial. Data are limited in the most extremely premature infants <26 weeks of gestational age (GA), where clinical problems are most significant and patients are most vulnerable.AimsTo investigate whether different approaches to surgical closure of PDA in two large Swedish centers has an impact on clinical outcomes including mortality in extremely preterm infants born <26 weeks GA.Study designRetrospective, two-center, cohort study.SubjectsInfants born at 22+0–25+6 weeks GA between 2010 and 2016 at Uppsala University Children's Hospital (UUCH; n = 228) and Queen Silvia Children's Hospital Gothenburg (QSCHG; n = 220).Main outcome measuresSurvival, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP).ResultsSurgical closure of PDA was more common and performed earlier at QSCHG (50 % vs 16 %; median age 11 vs 44 days; p < 0.01). Survival was similar in both centres. There was a higher incidence of severe BPD and longer duration of mechanical ventilation at UUCH (p < 0.01). There was a higher incidence of ROP, IVH and sepsis at QSCH (p < 0.05, p < 0.01 and p < 0.01). A sub-group analysis matching all surgically treated infants at QSCHG with infants at UUCH with the same GA showed similar results as the total cohort.ConclusionEarlier and higher rate of surgical PDA closure in this cohort of extremely preterms born <26 weeks GA did not impact mortality but was associated with lower rates of severe BPD and higher rates of severe ROP.
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| 7. |
- Söderström, Fanny, et al.
(författare)
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Active versus restrictive ligation strategy for patent ductus arteriosus - A retrospective two-center study of extremely preterm infants born between 22+0 and 25+6 weeks of gestational age
- 2024
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Ingår i: EARLY HUMAN DEVELOPMENT. - : Elsevier. - 0378-3782 .- 1872-6232. ; 191
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patent ductus arteriosus (PDA) in premature infants is associated with adverse clinical outcomes. Mode and timing of treatment are still controversial. Data are limited in the most extremely premature infants <26 weeks of gestational age (GA), where clinical problems are most significant and patients are most vulnerable. Aims: To investigate whether different approaches to surgical closure of PDA in two large Swedish centers has an impact on clinical outcomes including mortality in extremely preterm infants born <26 weeks GA. Study design: Retrospective, two-center, cohort study. Subjects: Infants born at 22(+0)-25(+6) weeks GA between 2010 and 2016 at Uppsala University Children's Hospital (UUCH; n = 228) and Queen Silvia Children's Hospital Gothenburg (QSCHG; n = 220). Main outcome measures: Survival, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Results: Surgical closure of PDA was more common and performed earlier at QSCHG (50 % vs 16 %; median age 11 vs 44 days; p < 0.01). Survival was similar in both centres. There was a higher incidence of severe BPD and longer duration of mechanical ventilation at UUCH (p < 0.01). There was a higher incidence of ROP, IVH and sepsis at QSCH (p < 0.05, p < 0.01 and p < 0.01). A sub -group analysis matching all surgically treated infants at QSCHG with infants at UUCH with the same GA showed similar results as the total cohort. Conclusion: Earlier and higher rate of surgical PDA closure in this cohort of extremely preterms born <26 weeks GA did not impact mortality but was associated with lower rates of severe BPD and higher rates of severe ROP.
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| 8. |
- Söderström, Fanny, et al.
(författare)
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Early extubation is associated with shorter duration of mechanical ventilation and lower incidence of bronchopulmonary dysplasia
- 2021
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Ingår i: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 163
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Respiratory care of extremely preterm infants remains a challenge. The majority require invasive mechanical ventilation (MV), which is a contributing factor in developing bronchopulmonary dysplasia (BPD). It is important to keep MV to a minimum but there have been concerns that attempting extubation too early increases the risk for atelectasis, re-intubation, and further lung trauma. The aim of this study was to compare two different approaches to extubation. Methods: Single-center, retrospective cohort study including infants born at 22 + 0-25 + 6 weeks during 2005-2009 and 2011-2015, before and after implementing guidelines recommending delayed extubation. Primary outcomes were BPD, duration of MV and length of hospital stay. Results: Eighty-eight infants in the early era and 102 infants in the late era were included. Infants in the first period were younger at first extubation attempt, and a higher number of infants were extubated within 24 h, 72 h, and one week after birth. The number of infants re-intubated and postnatal age at re-intubation did not differ between the groups. The incidence of severe BPD was 28% in the early period compared to 48% in the later (p < 0.01). Infants in the late period had longer duration of MV (17 vs 27 days, p < 0.01) but similar length of hospital stay (118 vs 123, p = 0.21). Conclusion: After implementing guidelines recommending delayed extubation, the incidence of severe BPD was higher and the duration of MV was longer. This supports the strategy to attempt extubation early even in extremely preterm infants.
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| 9. |
- Söderström, Fanny, et al.
(författare)
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Outcomes of a uniformly active approach to infants born at 22-24 weeks of gestation
- 2021
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Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 106:4, s. 413-417
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo determine survival and outcomes in infants born at 22-24 weeks of gestation in a centre with a uniformly active approach to management of extremely preterm infants.Study designSingle-centre retrospective cohort study including infants born 2006-2015. Short-term morbidities assessed included retinopathy of prematurity, necrotising enterocolitis, patent ductus arteriosus, intraventricular haemorrhage, periventricular malacia and bronchopulmonary dysplasia. Neurodevelopmental outcomes assessed included cerebral palsy, visual impairment, hearing impairment and developmental delay.ResultsTotal survival was 64% (143/222), ranging from 52% at 22 weeks to 70% at 24 weeks. Of 133 (93%) children available for follow-up at 2.5 years corrected age, 34% had neurodevelopmental impairment with 11% classified as moderately to severely impaired. Treatment-requiring retinopathy of prematurity, severe bronchopulmonary dysplasia, visual impairment and developmental delay correlated with lower gestational age.ConclusionsA uniformly active approach to all extremely preterm infants results in survival rates that are not distinctly different across the gestational ages of 22-24 weeks and more than 50% survival even in infants at 22 weeks. The majority were unimpaired at 2.5 years, suggesting that such an approach does not result in higher rates of long-term adverse neurological outcome.
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| 10. |
- Söderström, Fanny, et al.
(författare)
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Reduced rate of retinopathy of prematurity after implementing lower oxygen saturation targets.
- 2019
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Ingår i: Journal of Perinatology. - : Springer Science and Business Media LLC. - 0743-8346 .- 1476-5543. ; 39, s. 409-414
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate an implementation of lower oxygen saturation targets with retinopathy of prematurity (ROP) as primary outcome, in infants at the lowest extreme of prematurity.Study design: Retrospective cohort including infants born at 22-25 weeks of gestation in 2005-2015 (n = 325), comparing high (87-93%) and low (85-90%) targets; infants transferred early were excluded from the main analysis to avoid bias.Results: Overall survival was 76% in high saturation era, and 69% in low saturation era (p = .17). Treatment-requiring ROP was less common in low saturation group (14% vs 28%, p < .05) with the most prominent difference in the most immature infants. Including deceased infants in the analysis, necrotizing enterocolitis was more frequent in low saturation era (21% vs 10%, p < .05).Conclusions: Implementing lower saturation targets resulted in a halved incidence of treatment-requiring ROP; the most immature infants seem to benefit the most. An association between lower oxygenation and necrotizing enterocolitis cannot be excluded.
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