| 1. |
- Björnsson, Einar, 1958, et al.
(författare)
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Intestinal permeability and bacterial growth of the small bowel in patients with primary sclerosing cholangitis.
- 2005
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 40:9, s. 1090-4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Animal studies show that small intestinal bacterial overgrowth and infusion of bacterial antigens into portal blood cause hepatic histological changes similar to those seen in primary sclerosing cholangitis in man. It has been suggested that aa similar mechanism involving bacterial overgrowth with increased small-bowel permeability may play a pathogenic role in patients with primary sclerosing cholangitis (13 M, 9 F, median age 37 years, range 21-74 years), 19 of whom (83%) had quiescent inflammatory bowel disease, were included in the study along with 18 healthy volunteers (9 F, ( M, median age 36 years, range 23-80 years). Small-bowel bacterial overgrowth was defined as the presence of colonic flora>10(5) colony-forming units (cfu)/ml from duodenal aspirations. Small-bowel intestinal permeability was assessed as the differential urinary excretion of lactulose/L-rhamnose. RESULTS: Bacterial overgrowth was evident in one patient with primary sclerosing cholangitis (4.5%) (Enterobacter) and in none of the controls. Intestinal permeability in patients with primary sclerosing cholangitis (0.034 (0.026-0.041) (median, interquartile range (IQR)) did not differ significantly from that of the controls (0.033 (0.025-0.041). CONCLUSIONS: Small intestinal bacterial overgrowth and increased intestinal permeability does not seem to play an important pathogenic role in patients with primary sclerosing cholangitis.
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| 2. |
- Cederborg, Anna, 1976
(författare)
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On kidney dysfunction in advanced liver disease
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The overall aim of this thesis was to characterize factors affecting kidney function in advanced liver disease as well as after liver transplantation and to further understand the complex interaction between acute and chronic kidney disease in cirrhosis. The aim of the first study was to investigate the association between acute kidney injury (AKI), including hepatorenal syndrome and subsequent chronic kidney disease (CKD) in patients with cirrhosis and to quantify the cumulative incidence of CKD in patients with cirrhosis, with or without prior AKI. The second study aimed to investigate the association between AKI in cirrhosis, AKI in acute-on-chronic liver failure (ACLF) and the impact on survival as well as the development of CKD. The aim of the third study was to evaluate the effect of basiliximab induction with delayed reduced-dose tacrolimus on kidney function, rejection episodes and survival rates after liver transplantation. Methods: All three studies are retrospective cohort studies using different study cohorts. In studies I and II patients with liver cirrhosis were included from a national healthcare register (study I) and from a hospital-based register (study II). In study III, patients with advanced liver disease who were transplanted at Sahlgrenska University Hospital were included. Kidney function as well as dysfunction were evaluated using international classification of disease (ICD) codes in study I, serum creatinine and estimated glomerular filtration rate in studies II and III, as well as measured glomerular filtration rate in study III. Results: Patients with cirrhosis and AKI had a more than six-fold increased rate of CKD compared to patients without, when adjusting for risk factors for CKD, such as age, hypertension, and diabetes. AKI in cirrhosis was associated with a high short-term mortality from both kidney and non-kidney sources. AKI progression further decreased survival, even after adjusting for ACLF and bacterial infections. Induction immunotherapy with interleukin-2 receptor antibodies and delayed reduced-dose tacrolimus did not increase the risk for rejection, graft loss or death and reduced kidney injury after liver transplantation. Conclusions: This thesis shows that AKI constitutes a significant risk factor for CKD in cirrhosis. Also, that short-term survival in patients with cirrhosis and AKI is decreased due to both kidney and non-kidney related causes. These findings highlight the importance of an early diagnosis of AKI and distinct actions to prevent further progression and deterioration beyond kidney function. Furthermore, an updated immunosuppressive protocol with non-depleting induction therapy, allowing for a reduced early impact of calcineurin inhibitors is safe and can prevent kidney injury in liver transplanted patients, independent of pre-transplant kidney function.
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| 3. |
- Cederborg, Anna, 1976, et al.
(författare)
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Renal function after liver transplantation: Real-world experience with basiliximab induction and delayed reduced-dose tacrolimus
- 2022
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Ingår i: Digestive and Liver Disease. - : Elsevier BV. - 1590-8658. ; 54:8, s. 1076-1083
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Tidskriftsartikel (refereegranskat)abstract
- Background: Routine use of delayed reduced-dose calcineurin-inhibitor treatment with induction immunosuppression in liver transplantation to minimize post-operative kidney injury is still scarce. Aim: To evaluate real-world experience of basiliximab induction with delayed reduced-dose tacrolimus. Methods: In a retrospective cohort study, kidney function was evaluated pre- and postoperatively by measured glomerular filtration rate (mGFR). Adult patients undergoing liver transplantation between 2000 and 2017 were divided into a conventional treatment group (immediate-introduction of tacrolimus, target trough levels 10–15 ng/mL, and corticosteroids, n = 203) and a revised treatment group (basiliximab induction, reduced-dose tacrolimus, target through levels 5–8 ng/mL, delayed until day three, and mycophenolate mofetil 2000 mg/day, n = 343). Results: Mean mGFR was similar between groups at wait-listing (85.3 vs 84.1 ml/min/1.73m², p = 0.60), but higher in the revised treatment group at 3 (56.8 vs 63.4 ml/min/1.73m², p = 0.004) and 12 months post-transplant (60.9 vs 69.7 ml/min/1.73m², p<0.001); this difference remained after correcting for multiple confounders and was independent of pre-transplant mGFR. In the revised treatment group, biopsy proven acute rejection rate was lower (38% vs. 21%, p<0.001), and graft-survival better (p = 0.01). Conclusion: Basiliximab induction with delayed reduced-dose tacrolimus is associated with less kidney injury when compared to standard-dose tacrolimus, without increased risk of rejection, graft loss or death. © 2021
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| 4. |
- Gummesson, Christina, et al.
(författare)
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Entrustable professional activities (EPAs) for undergraduate medical education : development and exploration of social validity
- 2023
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Ingår i: BMC Medical Education. - : BioMed Central (BMC). - 1472-6920. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders.Aim: The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs.Method and material: In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater’s perception of the present graduates’ required level of supervision when performing the activity. Free-text comments were also included and analyzed.Results: Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as “important” by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported “independent”. The three themes of the free text comments were: ‘relevant target areas and content’; ‘definition of the activities’; and ‘clinical practice and learning’.Conclusion: Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.
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| 5. |
- Lorentzon, Ylva, 1982-
(författare)
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Öppna världar, slutna rum : Om status och barnkulturpolitik i scenkonstens vardagspraktik
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This doctoral thesis is about child culture and status, power and social relations in everyday practice. The aim is to explore the everyday practice within the production of performing arts and problematize what is at stake in the practice with regard to child culture as an artistic field. The research focuses on how the everyday practice is organized, how status-power influences the practice, and lastly, the potential relevance that the everyday practice within the production of performing arts has for understanding child culture as an artistic field. The thesis ethnographically explores the everyday practice of a theater. The fieldwork was performed in a section that produces performing arts for children and young people. The practice is analyzed and interpreted through the practice theory of Theodore Schatzki, Stephen Kemmis et al.’s methodological concept of practice architecture and Theodore Kemper’s theory on status-power. Other important concepts are child culture, culture and childhood. The analysis shows the everyday practice as organized around an artistic objective that is simultaneously artistically and pedagogically oriented. This split orientation of the objective sets the section apart from the other artistic sections within the theater. The artistic objective generates important status for a production aimed at children and young people. However, compared to other sections within the institution, this section has differing material and economical prerequisites, which complicates, and sometimes obstructs, the process of asserting artistic status within the theater. The weaker material and economical arrangements underlines the importance of positive social relatings (Kemmis’ term), social status and the maneuvering of power-relations within the theater, in order to ensure artistic, technical and material resources. The practice appears organized in a practice tradition that displays a firm artistic hierarchy, and this illuminates how what is understood as artistic rather than pedagogical or technical in nature always carries a higher status within the practice. This is significant in the work of the section, since large parts of their production are presented as pedagogical rather than artistic projects, and therefore generate lower artistic status. Yet, the analysis also shows a third kind of policy related status being generated by the production of the section. The section and its production is a central part of legitimizing the production of the theater regarding cultural policy, state bureaucracy and funding. Its production therefore upholds a kind of policy related status within the institution. The analysis reveals three kinds of status in the practice, one social, one artistic and one related to cultural policy. The weaker power position and lower artistic status of child culture creates dependence of visibility within the theater. It also shows child culture and pedagogy as deeply intertwined phenomena, with pedagogy both diluting and obscuring the production of artistic status while simultaneously generating possibilities for the policy related kind of status within the institution. Thus while pedagogy can generate low artistic status, the analysis shows it can also be understood as creating a radical artistic potential within child culture as an artistic field.
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| 6. |
- Nasr, Patrik, et al.
(författare)
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A rapid, non-invasive, clinical surveillance for CachExia, sarcopenia, portal hypertension, and hepatocellular carcinoma in end-stage liver disease : the ACCESS-ESLD study protocol
- 2023
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Ingår i: BMC Gastroenterology. - : BioMed Central (BMC). - 1471-230X. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Liver cirrhosis, the advanced stage of many chronic liver diseases, is associated with escalated risks of liver-related complications like decompensation and hepatocellular carcinoma (HCC). Morbidity and mortality in cirrhosis patients are linked to portal hypertension, sarcopenia, and hepatocellular carcinoma. Although conventional cirrhosis management centered on treating complications, contemporary approaches prioritize preemptive measures. This study aims to formulate novel blood- and imaging-centric methodologies for monitoring liver cirrhosis patients.METHODS: In this prospective study, 150 liver cirrhosis patients will be enrolled from three Swedish liver clinics. Their conditions will be assessed through extensive blood-based markers and magnetic resonance imaging (MRI). The MRI protocol encompasses body composition profile with Muscle Assement Score, portal flow assessment, magnet resonance elastography, and a abbreviated MRI for HCC screening. Evaluation of lifestyle, muscular strength, physical performance, body composition, and quality of life will be conducted. Additionally, DNA, serum, and plasma biobanking will facilitate future investigations.DISCUSSION: The anticipated outcomes involve the identification and validation of non-invasive blood- and imaging-oriented biomarkers, enhancing the care paradigm for liver cirrhosis patients. Notably, the temporal evolution of these biomarkers will be crucial for understanding dynamic changes.TRIAL REGISTRATION: Clinicaltrials.gov, registration identifier NCT05502198. Registered on 16 August 2022. Link: https://classic. CLINICALTRIALS: gov/ct2/show/NCT05502198 .
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| 7. |
- Rosengren, Björn, et al.
(författare)
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Tio »väsentliga aktiviteter« framtagna för läkarprogrammen
- 2019
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Ingår i: Läkartidningen. - 0023-7205. ; 47:19
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- De 10 EPA som presenteras här (Fakta 1) har tagits fram av läkare och studenter som representerar läkarutbildningarna vid samtliga lärosäten. Utvecklingsarbetet baserades på internationell litteratur och förslagen har genomgått valideringsprocesser [2]. Samtliga avser aktiviteter som ingår i en läkares dagliga arbete och som läkaren ska klara självständigt (i förhållande till handledare) första dagen som legitimerad läkare. Det är samtidigt viktigt att poängtera att de bara täcker in en del av examensmålen för läkare.
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