| 1. |
- Engström, Gunnar, et al.
(författare)
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The Swedish CArdioPulmonary BioImage Study : objectives and design
- 2015
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 278:6, s. 645-659
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Tidskriftsartikel (refereegranskat)abstract
- Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started.
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| 2. |
- Barbu, Mikael, et al.
(författare)
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Dextran- versus crystalloid-based prime in cardiac surgery: A prospective randomized pilot study.
- 2020
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Ingår i: The Annals of thoracic surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 110:5, s. 1541-7
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Tidskriftsartikel (refereegranskat)abstract
- The optimum priming fluid for the cardiopulmonary bypass (CPB) circuit is still debated. We compared a new hyperoncotic priming solution containing dextran 40, which has an electrolyte composition that mimics extracellular fluid, with a standard crystalloid-based prime.Eighty cardiac surgery patients were included in this double-blind randomized single-centre study. The patients were randomized to either a dextran-based prime or a crystalloid prime containing Ringer acetate and mannitol. The primary endpoint was colloid oncotic pressure (COP) in serum during CPB. Secondary endpoints included fluid balance, bleeding and transfusion requirements, pulmonary function, hemolysis, systemic inflammation, and markers of renal, hepatic, myocardial, and brain injury. Blood samples were collected before, during, and after CPB.COP was higher in the dextran group than in the crystalloid prime group on CPB (18.8±2.9 vs. 16.4±2.9 mmHg, p<0.001) and 10 min after CPB (19.2±2.7 vs. 16.8±2.9 mmHg, p<0.001). Patients in the dextran group required less intravenous fluid during CPB (1090±499 vs. 1437±543 ml; p=0.003) and net fluid balance was less positive 12h after surgery (+1,431±741 vs. +1,901±922 ml; p=0.014). Plasma free hemoglobin was significantly lower in the dextran group 2h after CPB (0.18±0.11 vs 0.41±0.33, p=0.001). There were no significant differences in bleeding, transfusion requirements, organ function, systemic inflammation, or brain and myocardial injury markers between the groups at any time point.Our results suggest that a hyperoncotic dextran-based priming solution preserves intraoperative COP compared to crystalloid prime. Larger studies with clinically valid endpoints are necessary to evaluate hyperoncotic prime solutions further.
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| 3. |
- Hansson, D., et al.
(författare)
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Clinical impact of routine sleep assessment by peripheral arterial tonometry in patients with COPD
- 2023
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Ingår i: ERJ Open Research. - : European Respiratory Society (ERS). - 2312-0541. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- Background Coexisting obstructive sleep apnoea (OSA) in patients with COPD, defined as overlap syndrome (OVS), is prevalent and underdiagnosed. Routine assessment of OSA is not common practice in COPD care. Our study assessed the clinical impact of sleep assessment by peripheral arterial tonometry (PAT) in COPD patients. Methods 105 COPD patients (mean age 68.1 +/- 9 years, body mass index (BMI) 28.3 +/- 6.0 kg center dot m(-2), 44% males, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I to IV in 2%, 40%, 42% and 16%, respectively) underwent assessment at an outpatient COPD clinic including anthropometrics, arterial blood gas (ABG) and spirometry in this clinical cohort study. PAT-based sleep studies were performed. Predictors of OVS and ABG were determined. Rapid eye movement (REM) sleep-related OSA (REM-OSA) was analysed in OVS. Results 49 COPD patients (47%) suffered from moderate to severe OSA (OVS group, mean apnoea-hypopnoea index 30.8 +/- 18 events center dot h(-)1, REM-oxygen desaturation index (REM-ODI) 26.9 +/- 17 events center dot h(-)1). OVS was more prevalent in males compared to females (59% and 37%, p=0.029, respectively). Age (70.1 +/- 8 versus 66.3 +/- 10 years), BMI (30.0 +/- 6 versus 26.4 +/- 7 kg center dot m(-2)) and hypertension prevalence (71% versus 45%) were elevated (all p<0.03, respectively), while deep sleep (12.7 +/- 7% and 15.4 +/- 6%, p=0.029) and mean overnight oxygenation (90.6 +/- 3% and 92.3 +/- 2%, p=0.003) were lower in OVS compared to COPD alone. REM-ODI was independently associated with daytime arterial carbon dioxide tension (P-aCO2) (beta=0.022, p<0.001). REM-OSA was associated with an elevated prevalence of atrial fibrillation compared to no REM-OSA (25% and 3%, p=0.022). Conclusions OVS was highly prevalent, specifically in obese males. REM-related OSA showed strong association with elevated daytime P-aCO2 and prevalent cardiovascular disease. PAT was feasible for sleep assessment in COPD.
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| 4. |
- Safavi, Setareh, et al.
(författare)
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HSP90 inhibition blocks ERBB3 and RET phosphorylation in myxoid/round cell liposarcoma and causes massive cell death in vitro and in vivo
- 2016
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Ingår i: OncoTarget. - : Impact Journals, LLC. - 1949-2553. ; 7:1, s. 433-445
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Tidskriftsartikel (refereegranskat)abstract
- Myxoid sarcoma (MLS) is one of the most common types of malignant soft tissue tumors. MLS is characterized by the FUS-DDIT3 or EWSR1-DDIT3 fusion oncogenes that encode abnormal transcription factors. The receptor tyrosine kinase (RTK) encoding RET was previously identified as a putative downstream target gene to FUS-DDIT3 and here we show that cultured MLS cells expressed phosphorylated RET together with its ligand Persephin. Treatment with RET specific kinase inhibitor Vandetanib failed to reduce RET phosphorylation and inhibit cell growth, suggesting that other RTKs may phosphorylate RET. A screening pointed out EGFR and ERBB3 as the strongest expressed phosphorylated RTKs in MLS cells. We show that ERBB3 formed nuclear and cytoplasmic complexes with RET and both RTKs were previously reported to form complexes with EGFR. The formation of RTK hetero complexes could explain the observed Vandetanib resistence in MLS. EGFR and ERBB3 are clients of HSP90 that help complex formation and RTK activation. Treatment of cultured MLS cells with HSP90 inhibitor 17-DMAG, caused loss of RET and ERBB3 phosphorylation and lead to rapid cell death. Treatment of MLS xenograft carrying Nude mice resulted in massive necrosis, rupture of capillaries and hemorrhages in tumor tissues. We conclude that complex formation between RET and other RTKs may cause RTK inhibitor resistance. HSP90 inhibitors can overcome this resistance and are thus promising drugs for treatment of MLS/RCLS.
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| 5. |
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| 6. |
- Andrén, Lennart, 1946, et al.
(författare)
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Ketanserin in hypertension. Early clinical evaluation and dose finding study of a new 5-HT2 receptor antagonist.
- 1983
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Ingår i: Acta medica Scandinavica. - 0001-6101. ; 214:2, s. 125-30
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Tidskriftsartikel (refereegranskat)abstract
- Ketanserin, a new 5-hydroxy-tryptamine antagonist, was given at three different dosage levels (double-blind, randomized) in a dose finding study for 2 months to 31 patients with mild to moderately severe essential hypertension. Treatment with ketanserin was then continued until 9 months had been completed. A significant antihypertensive effect was demonstrated at daily dosages of 20 mg t.i.d. or 40 mg t.i.d. The antihypertensive effect was similar to that of previous multiple drug treatment with conventional drugs. However, 60 mg t.i.d. was not acceptable, at least not as initial dosage. At this dose level, 8 out of 10 patients had to be withdrawn from the study during the initial phase due to unwanted effects. It is conceivable that alpha 1-adrenoceptor blockade may have played a role at this dose level, since postural reactions were observed which was otherwise not the case during this study. Ketanserin is a new and interesting alternative in the treatment of hypertension. At the same time it offers a tool by which the role of 5-hydroxy-tryptamine in the regulation of arterial pressure can be investigated.
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| 7. |
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| 8. |
- Belfrage, B., et al.
(författare)
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Performance and interpretation of spirometry among Swedish hospitals
- 2016
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Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 10:5, s. 567-573
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: It is unclear to what extent spirometric performance and interpretation is standardized in Sweden. The aim of this study was to find out how spirometry is performed and interpreted in large Swedish hospitals. Methods: In telephone interviews, technicians and physicians working with lung function measurements at 21 large Swedish hospitals were interviewed about routines for spirometry. Results: Answers were obtained from 37 of the 42 departments contacted revealing differences in the spirometric routines. Some departments lack a written method description, and three different prediction equations were used among the departments. Different ways of calculating the forced expiratory volume in 1 s (FEV1)/vital capacity (VC) ratio (FEV%) were found and also differences in performance and interpretation of the reversibility test. When diagnosing chronic obstructive pulmonary disease, none of the departments reported using an individualized diagnostic limit of FEV1/VC based on age, sex and height. Conclusion: There is a need for standardization of performance and interpretation of the spirometry test in Sweden and probably also in other countries. © 2014 John Wiley & Sons Ltd
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| 9. |
- Bokolamulla, Dhammika, 1973, et al.
(författare)
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Low-complexity iterative detection based on limited bi-directional search
- 2006
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Ingår i: IEE Proceedings Communications. - 1359-7019. ; 153:6
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Tidskriftsartikel (refereegranskat)abstract
- A new reduced-complexity iterative decoding algorithm is introduced. The algorithm approximates a posteriori probabilities by using a set of highly sequences, found in a limited bi-directional search. To assess the performance, numerical results for serially concatenated convolutional codes, transmitted over an intersymbol interference channel, disturbed by additive white Gaussian noise are presented. A substantial reduction in complexity is achieved with a performance degradation around 0.25 dB, as demonstrated by bit error rate performance and convergence behaviour.
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| 10. |
- Breimer, Michael, 1951, et al.
(författare)
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Glycosphingolipid composition of epithelial cells isolated along the villus axis of small intestine of a single human individual
- 2012
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Ingår i: Glycobiology. - : Oxford University Press (OUP). - 1460-2423 .- 0959-6658. ; 22:12, s. 1721-1730
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Tidskriftsartikel (refereegranskat)abstract
- A 6-cm fresh proximal ileum surgical specimen from a blood group A(1)Le(a-b+) secretor individual was used for stepwise isolation of epithelial cells from villus tip to crypt bottom by gentle washing with ethylenediaminetetraacetic acid-containing buffer. Acid and non-acid sphingolipids were prepared from the epithelial cell fractions and the non-epithelial intestinal residue. Molecular information on the sphingolipid composition was obtained without further isolation of individual species by applying thin-layer chromatography using chemical and biological (monoclonal antibodies, cholera toxin, Escherichia coli) detection reagents, mass spectrometry and proton NMR spectroscopy of derivatized glycolipids. In this way, the structure of major and minor saccharides, ceramide components and their relative amounts were obtained. Epithelial cells and non-epithelial residue were distinctly different in their sphingolipid composition. Sphingomyelin was the major single component in both compartments. Characteristic for epithelial cells was the dominance of monoglycosylceramides, sulphatides and blood group fucolipids (mainly Le(b) hexaglycosylceramides and ALe(b) heptaglycosylceramides). The non-epithelial residue had about five times less glycolipids mainly mono-, di-, tri- and tetra-glycosylceramides and gangliosides, including the GM1 ganglioside. The ceramides were more hydroxylated (1-2 additional hydroxyls) in epithelial cell glycolipids compared with the non-epithelial residue. Combined with a separate detailed study on the glycoproteins of the same epithelial cell preparation, this human intestinal sample is the only epithelial cell preparation where both protein- and lipid-linked saccharides are characterized in detail.
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| 11. |
- Brodersen, John, et al.
(författare)
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Consequences of screening in abdominal aortic aneurysm : development and dimensionality of a questionnaire
- 2018
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Ingår i: Journal of Patient-Reported Outcomes. - : Springer. - 2509-8020. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Background: In interview studies, men under surveillance for screening-detected abdominal aortic aneurysms have reported ambivalence towards this diagnosis: the knowledge was welcomed together with worries, feelings of anxiety and existential thoughts about life's fragility and mortality due to the diagnosis. Previous surveys about health-related quality of life aspects among men under surveillance for screening-detected aneurysm have all used generic patient-reported outcomes. Therefore, the aim of this study was to extend the core-questionnaire Consequences of Screening for use in abdominal aortic aneurysm screening by testing for comprehension, content coverage, dimensionality, and reliability.Methods: In interviews, the suitability, content coverage, and relevance of the core-questionnaire Consequences of Screening were tested on men under surveillance for a screeningdetected abdominal aortic aneurysm. The results were thematically analysed to identify the key consequences of abnormal screening results. Item Response Theory and Classical Test Theory were used to analyse data. Dimensionality, differential item functioning, local response dependency and reliability were established by item analysis, examining the fit between item responses and Rasch models.Results: The core-questionnaire Consequences of Screening was found to be relevant for men offered regular follow-up of an asymptomatic screening-detected abdominal aortic aneurysm.Fourteen themes especially relevant for men diagnosed with a screening-detected abdominal aortic aneurysm were extracted from the interviews: 'Uncertainty about the result of the ultra sound examination', 'Change in body perception', 'Guilt', 'Fear and powerlessness', 'Negative experiences from the examination', 'Emotional reactions', 'Change in lifestyle', 'Better not knowing', 'Fear of rupture', 'Sexuality', 'Information', 'Stigmatised', 'Self-blame for smoking', 'Still regretful smoking'. Altogether, 55 new items were generated: 3 were single items and 13 were only relevant for former or current smokers. 51 of the 52 items belonging to a theme were confirmed to fit Rasch models measuring fourteen different constructs. No differential item functioning and only minor local dependency was revealed between some of the 51 items.Conclusions: The reliability and the dimensionality of a condition-specific measure with high content validity for men under surveillance for a screening-detected abdominal aortic aneurysm have been demonstrated. This new questionnaire called COS-AAA covers in two parts the psychosocial experience in abdominal aortic aneurysm screening.
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| 12. |
- Dahlöf, Björn, 1953, et al.
(författare)
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Addition of the calcium antagonist PN 200-110 to pindolol markedly augments the antihypertensive effect in essential hypertension.
- 1987
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Ingår i: Journal of cardiovascular pharmacology. - 0160-2446. ; 10 Suppl 10
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Tidskriftsartikel (refereegranskat)abstract
- Several large-scale studies have recently drawn attention to the fact that arterial hypertension frequently is inadequately controlled and that therapeutic alternatives other than the commonly employed stepped-care treatment may be needed in order to obtain normotension. For this reason PN 200-110, a new dihydropyridine calcium antagonist--at two different dose levels (average 3.8 mg b.i.d. or 5.7 mg b.i.d.)--or placebo was added in a double-blind cross-over trial to pindolol, 10 mg per day, in 20 patients with essential hypertension, after an initial 3-week placebo period. Ionized calcium in serum was determined repeatedly during the study. From an initial level of 157/100 mm Hg, PN 200-110 at the first dose level reduced blood pressure by 14/11 mm Hg (p less than 0.01/0.001) and at the second dose level reduced blood pressure by 22/18 mm Hg (p less than 0.001/0.001). The reduction in mean arterial pressure was significantly correlated to age (=0.050, p less than 0.05). There was no significant increase in heart rate, nor were there any significant correlations between ionized calcium and the effect of PN 200-110 nor between the changes in ionized calcium and the changes in blood pressure. Adverse effects were few and mild. One patient had to be withdrawn because of side effects, probably not related to the investigated drugs. Thus, addition of PN 200-110 to hypertensive patients treated with pindolol caused highly significant and clinically relevant further reductions in arterial pressure. The results show that a combination of this kind offers the possibility of good blood pressure control.
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| 13. |
- Dahlöf, Björn, 1953, et al.
(författare)
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Potentiation of the antihypertensive effect of enalapril by randomized addition of different doses of hydrochlorothiazide.
- 1985
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Ingår i: Journal of hypertension. Supplement : official journal of the International Society of Hypertension. - 0952-1178. ; 3:3
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to evaluate the potentiating effect of hydrochlorothiazide (HCTZ) 12.5 or 25 mg once daily when added in a placebo-controlled double-blind randomized study of patients with essential hypertension, whose diastolic blood pressure (DBP) was not adequately controlled (DBP > 90 mmHg) following 6 weeks of single-blind treatment with the angiotensin converting enzyme (ACE) inhibitor enalapril, 20 mg once daily. Forty-eight patients started the first period with enalapril after 4 weeks on placebo. In 13 patients DBP fell to < or = 90 mmHg after enalapril for 6 weeks. In this group supine mean arterial pressure (MAP) was reduced by 13% (P < 0.01). In the patients whose DBP was > 90 mmHg after 6 weeks on enalapril (n = 32) the average supine MAP fell by 9% (P < 0.001). After 3 weeks there was no further drop in blood pressure (BP). Addition of HCTZ to the 32 patients with DBP > 90 mmHg caused a significant further drop in supine BP by 13/7 mmHg with 12.5 mg and by 15/7 mmHg with 25 mg. Seven patients discontinued the study, none due to side effects on enalapril alone. Well-being, assessed with a special questionnaire, was significantly better with enalapril as monotherapy compared with previous treatment, but not different from well-being during the placebo periods. It is concluded that 20 mg enalapril once daily lowered BP effectively and was well tolerated. The maximum BP lowering effect was seen within 3 weeks. Addition of HCTZ caused a significant, and clinically relevant, further drop in BP.(ABSTRACT TRUNCATED AT 250 WORDS)
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| 14. |
- Dahlöf, Björn, 1953, et al.
(författare)
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The long-term effect of isradipine in pindolol-treated patients.
- 1987
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Ingår i: Journal of hypertension. Supplement : official journal of the International Society of Hypertension. - 0952-1178. ; 5:5
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Tidskriftsartikel (refereegranskat)abstract
- The long-term efficacy of isradipine, a new dihydropyridine calcium antagonist with marked vascular selectivity, was evaluated in 17 patients with essential hypertension. All had a supine diastolic blood pressure of greater than 95 mmHg with 10 mg pindolol once daily. After a short-term, double-blind, dose-finding, crossover comparison with addition of isradipine or placebo twice daily, they continued on pindolol and their optimal dose of isradipine in a single-blind, long-term follow-up study. Eighteen patients were recruited but one male patient discontinued treatment after 2 weeks due to ankle oedema and will not be accounted for in the overall evaluation. There were 11 males and six females with a mean age of 56 +/- 10 years. In the short-term study on the optimal dose of isradipine (5.1 mg twice daily) blood pressure was lowered by 24/18 mmHg (P less than 0.001). No change in heart rate was seen despite the substantial drop in blood pressure. In the long-term study the patients were seen for a mean follow-up time of 12.5 months (range 4-17 months). After the longest follow-up time mean arterial pressure was 107.0 +/- 7.4 compared with 120.1 +/- 8.2 mmHg after placebo baseline [delta = 13 mmHg (11%), P less than 0.001, n = 17]. The heart rate was unchanged (delta = 0.2 beats/min, 95% confidence limits -3, +3), and so was ankle circumference (delta = 0.12 cm, 95% confidence interval, -1, +1). On the other hand, mean weight was reduced by 2 kg from 90 kg (P less than 0.05, n = 17).(ABSTRACT TRUNCATED AT 250 WORDS)
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| 15. |
- Damhus, C. S., et al.
(författare)
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Psychosocial consequences of screening-detected abdominal aortic aneurisms: a cross-sectional study
- 2021
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 39:4, s. 459-465
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Tidskriftsartikel (refereegranskat)abstract
- Objective In Sweden, an abdominal aortic aneurysm (AAA) screening programme was gradually implemented from 2009 to reduce the incidence of rupture and thereby mortality. AAA screening introduces a variety of unintended, but generally unavoidable, harms, e.g. stress and worry. Such psychosocial consequences have previously only been investigated with generic measures. Therefore, the aim of this study was to describe and compare the psychosocial consequences in men with a screening detected AAA to men with a normal screening result after they participated in the Swedish national AAA-screening programme using a validated psychometric instrument. Material and methods This study was a cross-sectional survey. Data were originally collected to validate the COS-AAA and has previously been published in details. The Consequences of Screening in Abdominal Aortic Aneurysm (COS-AAA) questionnaire was sent to 250 men with a screening detected AAA and 500 with a normal screening result who were randomly selected from a Swedish population-based screening register. Results In total, 158 (63%) men with a screening detected AAA and 275 (55%) men with a normal screening result completed the COS-AAA. We found that men with a screening detected AAA reported negative psychosocial consequences to a greater extent in 10 of 13 COS-AAA Part 1 scales, all statistically significant except three (behaviour, sleep and negative experiences from examination). For COS-AAA Part 2, there was a statistically significant difference between groups in four of five scales. Conclusions Men diagnosed with a screening detected AAA, reported more negative psychosocial consequences compared to men with a normal result. Screening for abdominal aorta aneurism (AAA) introduces intended benefits and unintended harms. Adequate measures are necessary to determine the balance between them.
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| 16. |
- Ekelin, E., et al.
(författare)
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The dilemma of repeat weak opioid prescriptions - experiences from swedish GPs
- 2018
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 36:2, s. 180-188
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore general practitioners' (GP) experiences of dealing with requests for the renewal of weak opioid prescriptions for chronic non-cancer pain conditions. Design: Qualitative focus group interviews. Systematic text condensation analysis. Setting and subjects: 15 GPs, 4 GP residents and 2 interns at two rural and two urban health centres in central Sweden. Main outcome measures: Strategies for handling the dilemma of prescribing weak opioids without seeing the patient. Results: After analysing four focus group interviews we found that requests for prescription renewals for weak opioids provoked adverse feelings in the GP regarding the patient, colleagues or the GP's inner self and were experienced as a dilemma. To deal with this, the GP could use passive as well as active strategies. Active strategies, like discussing the dilemma with colleagues and creating common routines regarding the renewal of weak opioids, may improve prescription habits and support physicians who want to do what is medically correct. Conclusion: Many GPs feel umcomfortable when prescribing weak opioids without seeing the patient. This qualitative study has identified strategic approaches to deal with that issue.
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| 17. |
- Hansson, Anders, 1953-, et al.
(författare)
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Balancing - an equilibrium act between different positions : an exploratory study on general practitioners' comprehension of their professional role
- 2007
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 25:2, s. 80-85
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Tidskriftsartikel (refereegranskat)abstract
- Objective. There is a call to make the duties and working conditions of the GP more transparent. The aim of this study was to explore practising GPs’ personal experiences of their professional role and what they regard to be its salient characteristics. Design. An exploratory and descriptive study was undertaken by interviewing GPs and by performing a focus-group study of experienced GPs. The interviews were transcribed and analysed, and the text was categorized according to content analysis. Setting. The practice of the interviewed GPs. Subjects. Seven GPs in individual interviews and a focus group of experienced GPs. Results. A major theme, Balancing, was identified. It was derived from a number of opposing concepts to which different features were related. “The good shepherd” versus “The medical expert”; “Curing” versus “Caring”; “Short visits” versus “Long consultations”; “The personal doctor” versus “The society's doctor”. In many consultations the GP has to contemplate how to stay in focus between these diverse roles. Conclusion.General practice requires a balance to be achieved between a number of opposing conditions. In their clinical work GPs have to adjust to and integrate alternative perspectives. Problems of recruiting new GPs might be associated with dilemmas in this balancing act.
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| 18. |
- Hansson, Anders, 1953-, et al.
(författare)
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Flawed communications: Health professionals' experience of collaboration in the care of frail elderly patients
- 2018
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 46:7, s. 680-689
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Frail elderly patients who have multiple illnesses do not fare well in modern health care systems, mainly due to a lack of care planning and flawed communication between health professionals in different care organisations. This is especially noticeable when patients are discharged from hospital. The aim of this study was to explore health care professionals' experience of obstacles and opportunities for collaboration. Methods: Health professionals were invited to participate in three focus groups, each consisting of a hospital physician, a primary care physician, a hospital nurse, a primary care nurse, a municipal home care nurse or an assistant officer, a physical or occupational therapist and a patient or a family member representative. These individual people were then asked to discuss the obstacles and opportunities for communication between themselves and with the patients and their relatives when presented with the case report of a fictitious patient. Content analysis was used to identify categories. Results: Several obstacles were identified for effective communication and care planning: insufficient communication with patients and relatives; delayed collaboration between care-givers; the lack of an adequate responsible person for care planning; and resources not being distributed according to the actual needs of patients. The absence of an overarching responsibility for the patient, beyond organisational borders, was a recurring theme. These obstacles could also be seen as opportunities. Conclusions: Obstacles for collaboration were found on three levels: societal, organisational and individual. As health care professionals are well aware of the problems and also see solutions, management for health care should support employees' own initiatives for changes that are of benefit in the care of frail elderly patients with multiple illnesses.
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| 19. |
- Hansson, Anders, 1953-, et al.
(författare)
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Medical students' attitudes toward collaboration between doctors and nurses - a comparison between two Swedish universities.
- 2010
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Ingår i: Journal of interprofessional care. - : Informa UK Limited. - 1469-9567 .- 1356-1820. ; 24:3, s. 242-50
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate differences in attitudes towards collaboration between doctors and nurses among medical students in two medical schools: Gothenburg University (GU), which did not offer interprofessional education, and Linköping University (LiU), with a curriculum containing an interprofessional education programme; between male and female students; and between those with previous working experience in medical care and those without. A questionnaire, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, was distributed to 314 first year and final year students at GU and LiU: 261 (82%) answers were received. There was no significant difference in attitudes toward collaboration, between first students at GU and LiU, between final year students at the two universities; and between those who had or did not have earlier experience of working in health care. There was a significant difference between male and female students (p = 0.0017) implying a more positive attitude among female students. Females were in majority among final year students (females 80 and males 46) final year, yet, students at both universities did not show a more positive attitude towards collaboration, than did first year students. It was concluded that students who had an interprofessional thread within their medical curriculum did not show different attitudes towards collaboration. The impact of the interprofessional teaching and training programme is discussed and further, especially longitudinal, studies are advocated.
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| 20. |
- Hansson, Anders, 1953
(författare)
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Nya utmaningar, gamla strategier - om distriktsläkares yrkesroll och attityder till samarbete
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Being confronted by patients with incurable chronic and psychosocially complicated conditions constitutes one of the major challenges for today’s General Practitioners (GP). The traditional biomedical disease model is often insufficient. Furthermore, today’s patients are educated, self-assured and make demands. One feasible response would be for GPs to improve their knowledge of medical sociology, psychology and anthropology to enable them to handle the multidimensionality of the diseases. Another would be to share their responsibilities by collaborating with other professionals. Yet, the discussion of new strategies is quite uncommon among GPs; possibly because it is not a part of their professional role. Aims: To describe what GPs consider as the essence of their profession and their tasks (I). To understand why GPs’ are dubious about teamwork (II). To compare GPs’ and district nurses’ (DNs’) attitudes toward collaboration and to see if these attitude are influenced by gender, age and high professional self-esteem (III). To study whether medical students’ attitudes toward nurse-doctor collaboration are influenced by interprofessional training during their medical education (IV). Methods: Individual and focus-group interviews with experienced GPs were used (I-II). A simple random sample of 600 GPs and DNs were asked to answer two questionnaires, the Jefferson scale of attitudes towards collaboration between doctors and nurses ant the PSDF (III). The Jefferson questionnaire also was used for comparison of students’ attitudes towards collaboration at Gothenburg and Linköping Universities. The latter has had ongoing interprofessional training since 1986. Results: A major theme was the insecurity of GP’s in the professional role produced by the need to balance different perspectives; the humanistic position against the role of medical expert role, cure against care, short against long consultations, being the patient’s doctor against being the servant of society. Another major theme was the ambiguity of the doctor’s role as a team member and conflicts between seeing teamwork as a waste of time contra time-saving, sharing responsibility contra having everything under one’s control, medical expert contra generalist, and in becoming a learner contra being almighty. DNs seemed to have a more positive attitude towards collaboration and a higher self-esteem in their professional role than GPs. The attitudes of male and female and older and younger GPs respectively were the same. Nor was there any difference in attitudes towards collaboration between students who had or had not attended a special interprofessional training program during their medical education. Female students were more positive to collaboration than their male counterparts. Final year students were significantly less positive towards collaboration than their younger fellow students. Conclusions: One of the future major tasks for GPs is to reconcile the humanistic and the medical perspectives within health care. To be able to introduce teamwork it is necessary to consider GPs’ understanding of their professional role and to highlight the advantages. Training in interprofessional collaboration should start already during medical school. However, for medical students it seems more important to be accepted in their professional role than to collaborate with other health professionals.
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| 21. |
- Hansson, Anders, 1953-, et al.
(författare)
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Opening Pandora's box: The experiences of having an asymptomatic aortic aneurysm under surveillance
- 2012
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Ingår i: Health Risk & Society. - : Informa UK Limited. - 1369-8575 .- 1469-8331. ; 14:4, s. 341-359
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Tidskriftsartikel (refereegranskat)abstract
- Abdominal aortic aneurysm (AAA) is a ballooning-out of the aorta that does not normally give any symptoms. Undetected and untreated an aortic aneurysm can rupture, which in most cases is fatal. Mass screening of 65-year old men for the early detection of AAA and, in selected cases, operation seem to reduce mortality due to rupture, although, screening has not reduced the overall mortality in this group. In Vastra Gotaland, the southwest part of Sweden, screening for AAA amongst 65-year old men started in 2009. There are controversies within the medical community about the benefits and adverse effects of screening. In order to explore men's experiences of being screened and knowing they had an aortic aneurysm, we undertook a qualitative interview study with 15 men who in the screening programme were identified as having an aortic aneurysm and who were to be followed-up with annual ultrasonic examinations for an indeterminate number of years. The interviews were analysed for categories and themes using content analysis. The study found that the men were ambivalent about the knowledge that they had an AAA and about the follow-up monitoring. They appreciated having the knowledge but it was accompanied by worry, feelings of anxiety and existential thoughts about the fragility and finiteness of life. We recommend that before a screening programme is implemented, the psycho-social consequences should be thoroughly investigated. Participants should be given adequate and understandable information about the consequences of screening so that they can make an informed choice whether to participate or not.
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| 22. |
- Hansson, Anders, 1953-, et al.
(författare)
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ST-läkare vill se praktisk nytta av FoU-kurser [ST-doctors believe scientific courses should relate more to everyday practice]
- 2013
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 110:22, s. 1098-1098
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Tidskriftsartikel (refereegranskat)abstract
- Enligt Socialstyrelsens målbeskrivning för läkarnas specialistutbildning ska ST-läkaren tillägna sig ett vetenskapligt förhållningssätt.Det är oklart vad målet innebär och hur det ska tolkas, vilket speglas i de olika specialistföreningarnas olika anvisningar och kursernas olika utformning.De traditionella FoU-kurser som erbjuds har inte alltid motsvarat ST-läkarnas förväntningar.Två fokusgruppsintervjuer med ST-läkare från olika specialiteter visar att ST-läkare anser att det är viktigt att tillägna sig ett vetenskapligt kritiskt tänkande för att kunna granska sina egna behandlingsmetoder och bemöta patienternas frågor.
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| 23. |
- Hansson, Anders, 1953-, et al.
(författare)
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Two sides of the coin - general practitioners' experience of working in multidisciplinary teams.
- 2008
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Ingår i: Journal of interprofessional care. - : Informa UK Limited. - 1356-1820 .- 1469-9567. ; 22:1, s. 5-16
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Tidskriftsartikel (refereegranskat)abstract
- Multidisciplinary teamwork, defined as the collaboration between different professional groups to achieve a common purpose, is commonly regarded as a means to meet the complex tasks that medicine has to deal with today. However, many attempts to introduce the method in primary care have failed and this is supposed to be partly due to the fact that general practitioners (GPs) did not participate in the implementation of the method. The aim of this investigation was to get a deeper understanding of their attitude to teamwork by interviewing nine GPs at four Swedish health care centres, where successful teamwork had been ongoing since 1997. Themes and categories in the interviews were identified according to content analysis. Although the attitude in general was in favour of teamwork, four major themes: time-consuming versus time-saving; shared responsibility versus main responsibility; medical expert versus generalist; shared knowledge versus all knowing, could be identified, which all revealed ambivalence towards teamwork among the interviewees. It was concluded that, if teamwork is to be successfully introduced into primary care, the GPs' self-perception has to be taken into consideration as has the prestige and status associated with their traditional role and the benefits of teamwork to the profession of medicine. Apart from time, teamwork requires, professional supervision and doctors need to be trained in this method as early as in medical school.
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| 24. |
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| 25. |
- Hansson, Anders, 1953-, et al.
(författare)
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Working together--primary care doctors' and nurses' attitudes to collaboration.
- 2010
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 38:1, s. 78-85
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Tidskriftsartikel (refereegranskat)abstract
- Multidisciplinary teamwork is recommended for various disorders and it has been suggested that it is a way to meet the new challenges and demands facing general practitioners (GPs) in modern society. Attempts to introduce the method in primary care have failed partly due to GPs' unwillingness to participate. The aim of this study was to measure attitudes towards collaboration among GPs and district nurses (DN) and to investigate whether there is a correlation between a positive attitude toward collaboration and high self-esteem in the professional role.
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