| 1. |
|
|
| 2. |
- Friedrichsen, Maria, 1966-, et al.
(författare)
-
Assistant nurses' experiences of thirst and ethical dilemmas in dying patients in specialized palliative care — A qualitative study
- 2023
-
Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 79:11, s. 4292-4303
-
Tidskriftsartikel (refereegranskat)abstract
- AimsTo describe assistant nurses' experiences of thirst and ethical challenges in relation to thirst in terminally ill patients in specialized palliative care (PC) units.DesignA qualitative, reflexive thematic design with an inductive analysis was used.MethodsData were collected during November 2021-January 2023. Twelve qualitative interviews with assistant nurses working in five different specialized PC units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. The study was guided by the Standards for Reporting Qualitative Research (SRQR).ResultsTwo main themes were found in this study. (1) 'A world of practice for thirst relief' where assistant nurses present a task-oriented world where the knowledge of thirst is an experience-based unspoken knowledge where mainly routines rule. (2) Ethical challenges presents different ethical problems that they meet in their practice, such as when patients express thirst towards the end of their life but are too severely ill to drink or when they watch lack of knowledge in the area among other health professionals.ConclusionThirst in dying patients is a neglected area that assistant nurses work with, without communicating it. Their knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patient's record. There is a need for nurses to take the lead in changing nursing practice regarding thirst.Patient or Public ContributionNo patient or public contribution.ImpactIn palliative care, previous studies have shown that dying patients might be thirsty. Assistant nurses recognize thirst in dying patients, but thirst is not discussed in the team. Nurses must consider the patient's fundamental care needs and address thirst, for example in the nursing process to ensure patients quality of life in the last days of life.Reporting MethodThe study was guided by the SRQR.What does this Article Contribute to the Wider Global Clinical Community?Thirst is a distressing symptom for all humans. However, when a patient is dying, he or she loses several functions and can no longer drink independently. The knowledge from this article contributes to our understanding of current practice and shows an area that requires immediate attention for the improvement of fundamental palliative care delivery.
|
|
| 3. |
- Friedrichsen, Maria, et al.
(författare)
-
Ethical challenges around thirst in end-of-life care -experiences of palliative care physicians
- 2023
-
Ingår i: BMC Medical Ethics. - : BioMed Central (BMC). - 1472-6939. ; 24:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundThirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area.AimThe aim of this study was to explore palliative care physicians' experiences of ethical challenges in relation to thirst in terminally ill patients.MethodsA qualitative interview study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis.ResultsWhen presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient's autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering.ConclusionsAll physicians in this study reported that "Starting, continuing or discontinuing drips" was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular.
|
|
| 4. |
- Friedrichsen, Maria, et al.
(författare)
-
Thirst or dry mouth in dying patients? -A qualitative study of palliative care physicians' experiences
- 2023
-
Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 18:8
-
Tidskriftsartikel (refereegranskat)abstract
- IntroductionThirst and dry mouth are common symptoms among patients at the end of life. In palliative care today, there is a focus on mouth care to alleviate thirst. There are no qualitative studies on thirst from a physician's experience, which is why this study is needed. PurposeThis study aimed to explore palliative care physicians' experiences and views of thirst in patients at the end of life. MethodsA qualitative interview study with an inductive approach was carried out. Sixteen physicians working in specialised palliative care units in Sweden were included. The interviews were analysed with a reflexive thematic analysis. ResultsThe analysis resulted in three basic assumptions regarding thirst: It is dry mouth, not thirst; patients are dry in their mouth and thirsty; and, I do not know if they are thirsty. Further, four different themes regarding how to relieve thirst appeared: drips will not help thirst but cause harm; the body takes care of thirst itself; drips might help thirst; and, mouth care to relieve thirst or dry mouth. ConclusionsThe palliative care physicians had different experiences regarding thirst, from thirst never arising, to a lack of awareness. They thought good mouth care worked well to alleviate the feeling of thirst and dry mouth. Most physicians did not want to give patients drips, while some did. This study indicates that there are many unanswered questions when it comes to thirst at end-of-life and that further research is needed.
|
|
| 5. |
- Grönberg Eskel, Marit, 1971-
(författare)
-
Från slutna institutioner till institutionaliserat omhändertagande
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In recent years, a number of reforms have been made regarding the provision of care to people experiencing psychiatric disabilities. The aim of these reforms was to enable these people to participate in society and to ”live as others”. This political ambition, as well as research on recovery, stands to a certain extent in contrast to the message conveyed in the media, where the mentally ill/disabled to a great extent are represented as dangerous and incurable. The aim of the thesis is to analyse if, and how a group of people experiencing psychiatric disabilities create a sense of being like others, and to relate the analysis to the historical emergence of the contemporary conception of mental illness/psychiatric disability. This thesis employs the method of interviews.I highlight the informants encounter with the historically based stereotype that defines the persons as unreasonable, irrational and incapable of taking care of themselves. When the informants face the stereotype, they act to reduce the negative consequences. The informants’ actions can be interpreted in terms of approaches and in this perspective the informants appear as strong actors, who, contrary to the stereotype, are capable of take care of themselves. Three approaches are described: expertise, adaptation, and distancing. In situations where the stereotype is not present, the informants can create a feeling of being like anyone else. Their stories show that the feeling of being like others is individual. The development taking place in the field is “path-dependent”, meaning that the initial activity, the differentiation of persons with mental illness and the subsequent events is a development following a pattern which could explain the failure of the good political intentions. It has progressed from closed institutions to an institutionalized care service.
|
|
| 6. |
- He, Fei, et al.
(författare)
-
FPR2 Shapes an Immune-Excluded Pancreatic Tumor Microenvironment and Drives T-cell Exhaustion in a Sex-Dependent Manner
- 2023
-
Ingår i: Cancer Research. - : American Association for Cancer Research (AACR). - 0008-5472 .- 1538-7445. ; 83:10, s. 1628-1645
-
Tidskriftsartikel (refereegranskat)abstract
- Sex-driven immune differences can affect tumor progression and the landscape of the tumor microenvironment. Deeper understanding of these differences in males and females can inform patient selection to improve sex-optimized immunotherapy treatments. In this study, single-cell RNA sequencing and protein analyses uncovered a subpopulation of myeloid cells in pancreatic lesions associated with an immune-excluded tumor phenotype and effector T-cell exhaustion exclusively in females. This myeloid subpopulation was positively correlated with poor survival and genetic signatures of M2-like macrophages and T-cell exhaustion in females. The G-protein coupled receptor formyl peptide receptor 2 (FPR2) mediated these immunosuppressive effects. In vitro, treatment of myeloid cells with a specific FPR2 antagonist prevented exhaustion and enhanced cytotoxicity of effector cells. Proteomic analysis revealed high expression of immunosuppressive secretory proteins PGE2 and galectin-9, enriched integrin pathway, and reduced proinflammatory signals like TNFα and IFNγ in female M2-like macrophages upon FPR2 agonist treatment. In addition, myeloid cells treated with FPR2 agonists induced TIM3 and PD-1 expression only in female T cells. Treatment with anti-TIM3 antibodies reversed T-cell exhaustion and stimulated their ability to infiltrate and kill pancreatic spheroids. In vivo, progression of syngeneic pancreatic tumors was significantly suppressed in FPR2 knockout (KO) female mice compared with wild-type (WT) female mice and to WT and FPR2 KO male mice. In female mice, inoculation of tumors with FPR2 KO macrophages significantly reduced tumor growth compared with WT macrophages. Overall, this study identified an immunosuppressive function of FPR2 in females, highlighting a potential sex-specific precision immunotherapy strategy.
|
|
| 7. |
- Heidenreich, Kaja, 1973-, et al.
(författare)
-
Exploring what is reasonable : uncovering moral reasoning of vascular surgeons in daily practice
- 2023
-
Ingår i: BMC Medical Ethics. - : BioMed Central (BMC). - 1472-6939. ; 24:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Vascular surgery offers a range of treatments to relieve pain and ulcerations, and to prevent sudden death by rupture of blood vessels. The surgical procedures involve risk of injury and harm, which increases with age and frailty leading to complex decision-making processes that raise ethical questions. However, how vascular surgeons negotiate these questions is scarcely studied. The aim was therefore to explore vascular surgeons' moral reasoning of what ought to be done for the patient.METHODS: Qualitative, semi-structured interviews were conducted with 19 vascular surgeons working at three Swedish university hospitals. Data were analysed according to systematic text condensation.RESULTS: The surgeons' moral reasoning about what ought to be done comprised a quest to relieve suffering and avoid harm by exploring what is reasonable to do for the patient. Exploring reasonableness included to shift one´s perspective from the vessels to the whole person, to balance patient's conflicting needs and to place responsibility for right decision on one´s shoulders. The shift from blood vessels to the whole person implied gaining holistic knowledge in pondering of what is best, struggling with one´s authority for surgery through dialogue, and building relationship for mutual security. To balance patient's conflicting needs implied weighing the patient's independence and a sense of being whole against ease of suffering, respecting the patient's will against protecting life and well-being, and weighing longer life against protecting the present well-being. Finally, to place responsibility on one´s shoulders was conveyed as an urge to remind oneself of the risk of complications, withholding one's power of proficiency, and managing time during the illness course.CONCLUSIONS: This study contributes to uncovering how moral reasoning is embodied in the vascular surgeons' everyday clinical discourse as a tangible part of their patient care. The results underpin the significance of moral considerations in the assemblage of medical knowledge and technical skills to further understand vascular surgeons' clinical practice. The clinical application of these results is the need of forums with sufficient possibilities for articulating these important moral considerations in everyday care.
|
|
| 8. |
- Johansson, Magnus, et al.
(författare)
-
Valid and Reliable? : Basic and Expanded Recommendations for Psychometric Reporting and Quality Assessment
- 2023
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- There is a need to improve the validity, reliability, and replicability of social and health science research and its applications through raising the quality of measurement. An important step is to establish and implement a clear and useful guideline for reporting and assessing psychometric properties of measures. We propose five basic criteria as a minimal checklist to help end users assess the quality of psychometric studies: unidimensionality; ordered response categories, invariance; targeting; and, contingent upon the previous four being fulfilled, reliability. An expanded and detailed reporting guideline is also presented, intended for use in reports and scientific publications of psychometric analyses. We argue that reliability should be reported using a Test Information Function curve, which describes the properties of the items, rather than a point estimate describing sample properties. Additionally, we present a freely available R package to streamline psychometric analysis with Rasch Measurement Theory and its documentation in line with the reporting guideline.
|
|
| 9. |
- Karlsson, Karl Göran, et al.
(författare)
-
Scientific Literacy and Educational Reforms in Norway and Sweden
- 2006
-
Ingår i: Northern Lights on PISA 2003. - 9289313005 ; , s. 267-
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- In December 2004, when results from PISA 2003 were presented, much focus in media was on ranking lists and overall changes since PISA 2000. In Sweden no significant changes between 2000 and 2003 occurred in none of the three test domains in PISA (reading literacy, mathematical literacy and scientific literacy). Moreover, Swedish scores were significantly above the OECD average in all three domains. In Norway results in reading and mathematics showed no significant changes but a considerable drop in science results. The Norwegian science score was also below the OECD average, whereas reading and mathematics scores were close to the international means (OECD 2001, 2004). In this article we will take a closer look at the PISA science results for the two countries in order to discuss some possible links to educational reforms that has been introduced during the last decennium. For that purpose we will also discuss some results from TIMSS (Trends in International Mathematics and Science Study), or more precisely: results for the science grade 8 part of the study. In addition to the national PISA 2003 reports for Sweden (Skolverket 2004c) and Norway (Kjærnsli et al 2004), also the national TIMSS 2003 reports (Skolverket 2004a, Grønmo et al 2004) discuss the achievement drop in science. In addition, Kjærnsli et al (2005) has recently focused quite specifically on the general drop of competencies in the Nordic countries during the last decennium.
|
|
| 10. |
- Karlsson, Marit, et al.
(författare)
-
Attitudes toward euthanasia among Swedish medical students
- 2007
-
Ingår i: Palliative Medicine. - : SAGE Publications. - 0269-2163 .- 1477-030X. ; 21:7, s. 615-22
-
Tidskriftsartikel (refereegranskat)abstract
- Attitudes toward euthanasia differ between individuals and populations, and in many studies the medical profession is more reluctant than the general public. Our goal was to explore medical students' attitude toward euthanasia. A questionnaire containing open-ended questions was answered anonymously by 165 first- and fifth-year medical students. Data were analysed using qualitative content analysis with no predetermined categories. The students' arguments opposing euthanasia were based on opinions of 1. euthanasia being morally wrong, 2. fear of possible negative effects on society, 3. euthanasia causing strain on physicians and 4. doubts about the true meaning of requests of euthanasia from patients. Arguments supporting euthanasia were based on 1. patients' autonomy and 2. the relief of suffering, which could be caused by severe illnesses, reduced integrity, hopelessness, social factors and old age. There are several contradictions in the students' arguments and the results indicate a possible need for education focusing on the possibility of symptom control in palliative care and patients' perceived quality of life. Palliative Medicine 2007; 21 : 615—622
|
|
| 11. |
|
|
| 12. |
- Karlsson, Milla, et al.
(författare)
-
CRISPR/Cas9 genome editing of potato StDMR6-1 results in plants less affected by different stress conditions
- 2024
-
Ingår i: Horticulture Research. - 2052-7276. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- Potato is the third most important food crop, but cultivation is challenged by numerous diseases and adverse abiotic conditions. To combat diseases, frequent fungicide application is common. Knocking out susceptibility genes by genome editing could be a durable option to increase resistance. DMR6 has been described as a susceptibility gene in several crops, based on data that indicates increased resistance upon interruption of the gene function. In potato, Stdmr6-1 mutants have been described to have increased resistance against the late blight pathogen Phytophthora infestans in controlled conditions. Here, we present field evaluations of CRISPR/Cas9 mutants, in a location with a complex population of P. infestans, during four consecutive years that indicate increased resistance to late blight without any trade-off in terms of yield penalty or tuber quality. Furthermore, studies of potato tubers from the field trials indicated increased resistance to common scab, and the mutant lines exhibit increased resistance to early blight pathogen Alternaria solani in controlled conditions. Early blight and common scab are problematic targets in potato resistance breeding, as resistance genes are very scarce. The described broad-spectrum resistance of Stdmr6-1 mutants may further extend to some abiotic stress conditions. In controlled experiments of either drought simulation or salinity, Stdmr6-1 mutant plants are less affected than the background cultivar. Together, these results demonstrate the prospect of the Stdmr6-1 mutants as a useful tool in future sustainable potato cultivation without any apparent trade-offs.
|
|
| 13. |
|
|
| 14. |
- Karlsson, Marit, et al.
(författare)
-
Dying cancer patients' own opinions on euthanasia : An expression of autonomy? A qualitative study.
- 2012
-
Ingår i: Palliative Medicine. - London, UK : Sage Publications Ltd.. - 0269-2163 .- 1477-030X. ; 26:1, s. 34-42
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Deliberations on euthanasia are mostly theoretical, and often lack first-hand perspectives of the affected persons. METHOD: Sixty-six patients suffering from cancer in a palliative phase were interviewed about their perspectives of euthanasia in relation to autonomy. The interviews were transcribed verbatim and analysed using qualitative content analysis with no predetermined categories. RESULTS: The informants expressed different positions on euthanasia, ranging from support to opposition, but the majority were undecided due to the complexity of the problem. The informants' perspectives on euthanasia in relation to autonomy focused on decision making, being affected by (1) power and (2) trust. Legalization of euthanasia was perceived as either (a) increasing patient autonomy by patient empowerment, or (b) decreasing patient autonomy by increasing the medical power of the health care staff, which could be frightening. The informants experienced dependence on others, and expressed various levels of trust in others' intentions, ranging from full trust to complete mistrust. CONCLUSIONS: Dying cancer patients perceive that they cannot feel completely independent, which affects true autonomous decision making. Further, when considering legalization of euthanasia, the perspectives of patients fearing the effects of legalization should also be taken into account, not only those of patients opting for it.
|
|
| 15. |
- Karlsson, Marit, et al.
(författare)
-
Dying with dignity according to Swedish medical students
- 2006
-
Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 14:4, s. 334-339
-
Tidskriftsartikel (refereegranskat)abstract
- Goal of work: To die with dignity is an important but ambiguous concept, and it is used in contradictory contexts, both for the promotion of palliative care and as an argument for euthanasia. Our goal was to explore medical students' definition of a dignified death. Patients and methods: A questionnaire containing open-ended questions was answered anonymously by 165 first-and fifth-year medical students. The data were analysed using qualitative content analysis with no predetermined categories. Main results: The students' descriptions of a dignified death resulted in five categories of death: (1) without suffering, (2) with limited medical interventions, (3) with a sense of security, which implied a safe environment nursed by professional staff, (4) with autonomy, respect for the individual and empowerment to the patient and (5) with acceptance. These findings show similarity to the established concepts of a good death, as well as the view of a dignified death by terminally ill patients. Conclusions: The data suggest that the students perceive that the medical system is over-treating patients and sometimes causing harm to dying patients. The results reveal a potential misunderstanding and contradiction relating to death without suffering and the use of necessary palliative interventions. These findings are important when planning education as regards palliative care and dignified death. © Springer-Verlag 2005.
|
|
| 16. |
- Karlsson, Marit
(författare)
-
End-of-life care and euthanasia : attitudes of medical students and dying cancer patients
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: In end-of-life care, supporting the factors required for a good death is a goal. Core concepts in a good death are dignity, autonomy, and the relief of suffering. Paradoxically, these concepts are used both in palliative care and to promote euthanasia, which are traditionally seen as conflicting alternatives. In this thesis, attitudes towards end-of-life care and especially euthanasia were explored in medical students and dying cancer patients. Material and methods: Two separate studies were performed: in the first study, data were collected from 165 medical students using a questionnaire (Papers I and II) and, in the second study, 66 dying cancer patients were interviewed on their attitudes to euthanasia (Papers III and IV). The data were analyzed by inductive qualitative content analysis without predetermined categories. Results: Heterogeneous attitudes to euthanasia were identified in the studies, where the medical students more frequently had a fixed opinion of opposition to or support of euthanasia, while the dying cancer patients were more often undecided. None of the dying cancer patients wanted euthanasia for themselves at the time of the interview. The medical students described a dignified death as involving relief of suffering, respect for autonomy, being nursed professionally in a secure environment, acceptance of impending death, and with limited medical-technical interventions. The students criticized the medicalization of death and preferred a “natural death”. The medical students’ attitudes toward euthanasia were explained using well-known arguments as supporting euthanasia due to respect for autonomy and the relief of suffering, and opposing euthanasia due to the sanctity of life, the fear of unwanted gradual changes in society’s norms (the slippery slope argument), doubts about the true meaning of euthanasia requests, and because of the strain put on medical staff. In contrast to the medical students’ perspectives on euthanasia, the dying cancer patients reasoning on euthanasia was more complex and involved more consideration of practical problems. The patients’ perspectives on autonomy in relation to euthanasia focused on medical decision-making, where aspects of trust and power were important. Euthanasia was not solely seen as a means to increase patient empowerment, but also, in contrast, as a means to decrease patient influence. Patients expressed various levels of trust in healthcare, ranging from complete trust to mistrust, which affected their attitudes toward euthanasia. Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead them to advocate euthanasia. Patients experiencing continued meaning in their existence and feelings of trust, and who find strategies to handle suffering opposed euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help advocated euthanasia. Conclusion: These results have possible implications for the education of medical students and the understanding of patients’ situations in end of life. The findings indicate a need for healthcare staff to address issues of trust, meaning, and anticipatory fears in patients. The results also serve as a background to the current debate on euthanasia in end-of-life care.
|
|
| 17. |
- Karlsson, Marit, et al.
(författare)
-
Hur vill vi dö? Snabbt, smärtfritt, sederad och med sällskap? : Den goda döden och konsekvenser för sjukvården
- 2013
-
Ingår i: Socialmedicinsk Tidskrift. - : Stiftelsen Socialmedicinsk Tidskrift. - 0037-833X. ; 90:1, s. 132-139
-
Tidskriftsartikel (refereegranskat)abstract
- Majoriteten av människor i dagens västerländska samhälle dör en långsam förväntad död till följd av kronisk sjukdom. Under livets sista tid fattas många beslut inom sjukvården, som bidrar till formandet av döendet. Det finns ingen enhetlig beskrivning av vad som utgör en god död, utan detta varierar på grupp- och individnivå. Oomstridda kriterier för en god död är att få dö värdigt och utan lidande, med god livskvalitet och medbestämmande, samt med bevarade sociala relationer. Mer omdiskuterade kriterier för en god död rör personlig acceptans av döden, med kontroll och oberoende, och med fullständigt självbestämmande och uttryckt individualitet. För att sjukvården skall möjliggöra en god död för patienten behövs individualiserad vård baserad på samtal där patienten fått uttrycka sina önskemål.
|
|
| 18. |
- Karlsson, Marit, et al.
(författare)
-
Suffering and euthanasia : a qualitative study of dying cancer patients' perspectives.
- 2012
-
Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 20:5, s. 1065-1071
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Although intolerable suffering is a core concept used to justify euthanasia, little is known about dying cancer patients' own interpretations and conclusions of suffering in relation to euthanasia. METHODS: Sixty-six patients with cancer in a palliative phase were selected through maximum-variation sampling, and in-depth interviews were conducted on suffering and euthanasia. The interviews were analyzed using qualitative content analysis with no predetermined categories. RESULTS: The analysis demonstrated patients' different perspectives on suffering in connection to their attitude to euthanasia. Those advocating euthanasia, though not for themselves at the time of the study, did so due to (1) perceptions of suffering as meaningless, (2) anticipatory fears of losses and multi-dimensional suffering, or (3) doubts over the possibility of receiving help to alleviate suffering. Those opposing euthanasia did so due to (1) perceptions of life, despite suffering, as being meaningful, (2) trust in bodily or psychological adaptation to reduce suffering, a phenomenon personally experienced by informants, and (3) by placing trust in the provision of help and support by healthcare services to reduce future suffering. CONCLUSIONS: Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.
|
|
| 19. |
- Karlsson, Sofia A., et al.
(författare)
-
The impact of a changed legislation on reporting of adverse drug reactions in Sweden, with focus on nurses' reporting
- 2015
-
Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 71:5, s. 631-636
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: In March 2007, a legislative amendment was issued in Sweden compelling nurses to report all suspected adverse drug reactions (ADRs) to the national pharmacovigilance system. The aims of this study were to describe the status of ADR reporting, before and after the implementation of the legislative changes, and to describe the general characteristics of suspected ADRs reported by nurses. Methods: The Swedish pharmacovigilance system during the study period constituted six regional centres responsible for the handling of all spontaneous ADR reports within their region. In this study, we identified all individual ADR reports from 2005 and 2010, analysed in depth the ADR reports from two regional centres and collated information about the reporter and the nature of the reported ADR. Results: From the two regional centres, a total of 898 and 1074 reports were submitted in 2005 and 2010 respectively. Nurses submitted 31% (275 reports) of the reports in 2005 and 24% (260 reports) in 2010. Nurses' reporting of serious ADRs was 3% (seven reports) in 2005 and 7% (17 reports) in 2010 with reporting of unlabelled ADRs at 4% (11 reports) in 2005 and 17% (45 reports) in 2010. Most of the serious and/or unlabelled reactions were related to vaccine administration (14 reports in 2005 and 36 reports in 2010). Conclusions: The overall ADR reporting by nurses did not appear to increase after the change in reporting legislation. The proportion of serious and/or unlabelled ADRs reported by nurses did however appear to increase during the same period. Taken together, our data suggests that further pro-active measures should be considered in order to involve nurses in the reporting of suspected ADRs.
|
|
| 20. |
- Kastbom, Lisa, et al.
(författare)
-
A good death from the perspective of palliative cancer patients
- 2017
-
Ingår i: Supportive Care in Cancer. - : SPRINGER. - 0941-4355 .- 1433-7339. ; 25:3, s. 933-939
-
Tidskriftsartikel (refereegranskat)abstract
- Although previous research has indicated some recurrent themes and similarities between what patients from different cultures regard as a good death, the concept is complex and there is lack of studies from the Nordic countries. The aim of this study was to explore the perception of a good death in dying cancer patients in Sweden. Interviews were conducted with 66 adult patients with cancer in the palliative phase who were recruited from home care and hospital care. Interviews were analysed using qualitative content analysis. Participants viewed death as a process. A good death was associated with living with the prospect of imminent death, preparing for death and dying comfortably, e.g., dying quickly, with independence, with minimised suffering and with social relations intact. Some were comforted by their belief that death is predetermined. Others felt uneasy as they considered death an end to existence. Past experiences of the death of others influenced participants views of a good death. Healthcare staff caring for palliative patients should consider asking them to describe what they consider a good death in order to identify goals for care. Exploring patients personal experience of death and dying can help address their fears as death approaches.
|
|
| 21. |
- Kastbom, Lisa, 1978-
(författare)
-
A good death from the perspective of patients with severe illness and advance care planning (ACP) in patients near end-of-life
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Previous research has indicated that what constitutes a good death is heterogenic and complex although there are some recurrent themes and similarities regardless individual background factors. Studies on advance care planning (ACP), i.e. making proactive plans regarding content of care and treatment limitations, on nursing home (NH) patients are rare. Positive effects of ACPs are shown, but also that these often are lacking. The overall aim with this thesis was to explore the perceptions of a good death from the perspective of patients with severe illness and to investigate, from different perspectives, experiences of ACP in a NH context. In paper I, patients with cancer in a palliative phase were interviewed on their perceptions of a good death. Death was viewed as a process and previous experiences on the death of others influenced their own perceptions. A good death was associated with living with the prospect of imminent death, preparing oneself and others for one’s death and dying comfortably, e.g. without suffering, with independence and with social relations intact. Some were comforted by their belief that death is predetermined, and that after death, there is something else. Others felt uncomfortable when they viewed death as the end of the existence. In paper II, nurses and physicians were interviewed on their experiences of the factors that shape the ACP process in NHs. Exploration of the patient’s preferences regarding content of care and treatment limitations was important, as well as integration of the patient’s preferences and the views of the family members and staff concerning these questions. ACP documentation had to be clear, updated and available for staff and the implementation and reevaluation of ACP were also considered important, according to the participants. Significance of clinicians’ perceiving beneficence as well as fear of accusations of maleficence were shown to be essential factors to contemplate. In a retrospective chart review (paper III), medical records of 367 deceased NH patients were analysed. A high prevalence of ACP was shown, using two different definitions of ACP (ACP I and ACP II). Moreover, adherence to the ACP content was strong and positive associations were seen between ACP and variables of the three research aims, such as: diagnosis (dementia), physician attendance at NH and end-of-life (EOL) care. In paper IV, family members of deceased NH patients were interviewed on their experiences of ACP in NHs. EOL issues were challenging to talk about, although the family members appreciated staff raising these questions. The patient’s preferences were sometimes explicitly or implicitly communicated. However, in some cases, family members had a feeling of the patient’s preferences, although they had not been clearly communicated. Everyday details symbolised staff commitment. The family members viewed the nurse as central. The physician was described as absent and ACP meetings often went unnoticed. Both involvement and lack of involvement could cause the family members feelings of guilt. In conclusion, we found that what constitutes a good death is highly individual, although recurrent themes are seen. EOL conversations are important and challenging and need staff training and experience. It seems important to support healthcare staff not only to initiate ACP in NH patients, but also to involve the patient and family members in the ACP and planning EOL care. Making proactive plans regarding content of care including treatment limitations, could enable patient autonomy, optimise the chances for the patient to experience a good death and enhance for the family members during the dying trajectory and after the patient’s death.
|
|
| 22. |
- Kastbom, Lisa, et al.
(författare)
-
Elephant in the room-Family members perspectives on advance care planning
- 2020
-
Ingår i: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 38:4, s. 421-429
-
Tidskriftsartikel (refereegranskat)abstract
- Objective To explore family members experiences of advance care planning in nursing homes. Design Individual interviews. Thematic analysis. Setting Four nursing homes in Sweden. Subjects Eighteen family members of deceased nursing home patients. Main outcome measures Family members experiences of advance care planning in nursing homes. Results Family members experiences of advance care planning in a nursing home context involved five themes: Elephant in the room, comprising end-of-life issues being difficult to talk about; Also silent understanding, e.g. patients preferences explicitly communicated, but also implicitly conveyed. In some cases family members had a sense of the patients wishes although preferences had not been communicated openly; Significance of small details, e.g. family members perceive everyday details as symbols of staff commitment; Invisible physician, supporting nurse, e.g. nurse being a gatekeeper, providing a first line assessment in the physicians absence; and Feeling of guilt, e.g. family members wish to participate in decisions regarding direction of care and treatment limits, and need guidance in the decisions. Conclusion Our study stresses the significance of staff involving the patient and family members in the advance care planning process in nursing homes, thereby adapting the care in line with patients wishes, and for the patient to share these preferences with family members. Education in communication related to the subject may be important to shape advance care planning.
|
|
| 23. |
- Kastbom, Lisa, 1978-, et al.
(författare)
-
Prevalence, content and significance of advance care planning in nursing home patients
- 2022
-
Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis Ltd. - 0281-3432 .- 1502-7724. ; 40:1, s. 29-38
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Studies on advance care planning in nursing homes are rare, and despite their demonstrated favourable effects on end-of-life care, advance care plans are often lacking. Therefore, we wished to explore: (i) the prevalence of advance care plans in a Swedish nursing home setting using two different definitions, (ii) the content of advance care plans, (iii) adherence to the content of care plans and (iv) possible associations between the presence of advance care planning and background characteristics, physician attendance and end-of-life care. Design Retrospective chart review. Setting Twenty-two nursing homes in Sweden. Subjects A total of 367 deceased patients (included between 1 June 2018 and 23 May 2020) who had lived in nursing homes. Main outcome measures Electronic health record data on the prevalence of advance care plans with two different definitions and variables regarding background characteristics, physician attendance and end-of-life care, were collected. Results Of the study population, 97% had a limited care plan (ACP I) documented. When using the comprehensive definition (ACP II), also including patients preferences and involvement of family members in advance care planning, the prevalence was 77%. Patients with dementia more often had care plans, and a higher physician attendance was associated with presence of advance care plans. Prescription of palliative drugs and information to family members of the patients deterioration and impending death were more common in patients with care plans compared to those where such plans were missing. There was adherence to the care plan content. Conclusion In contrast to previous research, this study showed a high prevalence of advance care plans in nursing home patients. Patients with care plans more frequently received prescriptions of palliative drugs and their family members were informed to a greater extent about the patients deterioration and impending death compared to those without care plans. These aspects are often seen as vital components of good palliative care.
|
|
| 24. |
- Kastbom, Lisa, et al.
(författare)
-
We have no crystal ball-advance care planning at nursing homes from the perspective of nurses and physicians
- 2019
-
Ingår i: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 37:2, s. 191-199
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate clinicians perspectives on the factors that shape the process of advance care planning in a nursing home context. Design: Interviews. Latent qualitative content analysis. Setting: Nine nursing homes in Sweden. Subjects: 14 physicians and 11 nurses working at nursing homes. Main outcome measures: Participants views on advance care planning (ACP) at nursing homes. Results: The analysis of the interviews resulted in four manifest categories: Exploration of preferences and views, e.g. exploring patient wishes regarding end-of-life issues and restrictions in care at an early stage, and sensitivity to patients readiness to discuss end-of-life issues; Integration of preferences and views, e.g. integration of patients preferences and staffs and family members views; Decision amp; documentation of the ACP, e.g. clear documentation in patients medical records that are up-to-date and available for staff caring for the patient, and Implementation amp; re-evaluation of the ACP, e.g. nurse following up after ACP-appointment to confirm the content of the documented ACP. The latent theme, Establishing beneficence - defending oneself against tacit accusations of maleficence, emerged as a deeper meaning of all the four (manifest) parts of the ACP-process Conclusion: This study stresses the importance of involving patients, family members, and the team in the work with advance care planning in nursing homes. In addition, clear medical record documentation and proficiency in end-of-life communication related to advance care planning for physicians as well as nurses may also be factors that significantly shape advance care planning in a nursing home context.
|
|
| 25. |
- Kilpeläinen, Tuomas O, et al.
(författare)
-
Genome-wide meta-analysis uncovers novel loci influencing circulating leptin levels
- 2016
-
Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 7
-
Tidskriftsartikel (refereegranskat)abstract
- Leptin is an adipocyte-secreted hormone, the circulating levels of which correlate closely with overall adiposity. Although rare mutations in the leptin (LEP) gene are well known to cause leptin deficiency and severe obesity, no common loci regulating circulating leptin levels have been uncovered. Therefore, we performed a genome-wide association study (GWAS) of circulating leptin levels from 32,161 individuals and followed up loci reaching P<10(-6) in 19,979 additional individuals. We identify five loci robustly associated (P<5 × 10(-8)) with leptin levels in/near LEP, SLC32A1, GCKR, CCNL1 and FTO. Although the association of the FTO obesity locus with leptin levels is abolished by adjustment for BMI, associations of the four other loci are independent of adiposity. The GCKR locus was found associated with multiple metabolic traits in previous GWAS and the CCNL1 locus with birth weight. Knockdown experiments in mouse adipose tissue explants show convincing evidence for adipogenin, a regulator of adipocyte differentiation, as the novel causal gene in the SLC32A1 locus influencing leptin levels. Our findings provide novel insights into the regulation of leptin production by adipose tissue and open new avenues for examining the influence of variation in leptin levels on adiposity and metabolic health.
|
|
| 26. |
- Lambe, Mats, et al.
(författare)
-
Reductions in use of hormone replacement therapy: effects on Swedish breast cancer incidence trends only seen after several years.
- 2010
-
Ingår i: Breast cancer research and treatment. - : Springer Science and Business Media LLC. - 1573-7217 .- 0167-6806. ; 121:3, s. 679-83
-
Tidskriftsartikel (refereegranskat)abstract
- Studies from Western countries have found evidence of a recent decline in breast cancer incidence rates in postmenopausal women, findings which have been hypothesized to reflect a reduced use of hormonal replacement therapy (HRT). We examined breast cancer incidence trends in Sweden between 1997 and 2007, a period characterized by a drop in the use of HRT. Incidence trends were assessed using data from three population-based Regional Clinical Registries on breast cancer covering 2/3 of the Swedish population. Information on HRT sales was obtained from national pharmacy data. The prevalence of HRT use in age group 50-59 years decreased from a peak of 36% in 1999 to 27% in 2002 and further to 9% in 2007. Incidence rates of breast cancer in women 50 years and older increased between 1997 and 2003. A significant decrease in incidence between 2003 and 2007 was confined to women 50-59 years of age, the group in which the prevalence of HRT use has been highest and the decrease in use most pronounced. As opposed to the immediate effects reported from the United States and other regions, there was a time lag between the drop in HRT use and clear reductions in breast cancer incidence. This may reflect between country differences with regard to types of HRT used, and the rate, magnitude and pattern of change in use. The present findings give further support to the notion that HRT use is a driver of breast cancer incidence trends on the population level.
|
|
| 27. |
- Lau, Danny C. P., et al.
(författare)
-
Multitrophic biodiversity patterns and environmental descriptors of sub‐Arctic lakes in northern Europe
- 2022
-
Ingår i: Freshwater Biology. - : John Wiley & Sons. - 0046-5070 .- 1365-2427. ; 67:1, s. 30-48
-
Tidskriftsartikel (refereegranskat)abstract
- 1. Arctic and sub‐Arctic lakes in northern Europe are increasingly threatened by climate change, which can affect their biodiversity directly by shifting thermal and hydrological regimes, and indirectly by altering landscape processes and catchment vegetation. Most previous studies of northern lake biodiversity responses to environmental changes have focused on only a single organismal group. Investigations at whole‐lake scales that integrate different habitats and trophic levels are currently rare, but highly necessary for future lake monitoring and management.2. We analysed spatial biodiversity patterns of 74 sub‐Arctic lakes in Norway, Sweden, Finland, and the Faroe Islands with monitoring data for at least three biological focal ecosystem components (FECs)—benthic diatoms, macrophytes, phytoplankton, littoral benthic macroinvertebrates, zooplankton, and fish—that covered both pelagic and benthic habitats and multiple trophic levels.3. We calculated the richnessrelative (i.e. taxon richness of a FEC in the lake divided by the total richness of that FEC in all 74 lakes) and the biodiversity metrics (i.e. taxon richness, inverse Simpson index (diversity), and taxon evenness) of individual FECs using presence–absence and abundance data, respectively. We then investigated whether the FEC richnessrelative and biodiversity metrics were correlated with lake abiotic and geospatial variables. We hypothesised that (1) individual FECs would be more diverse in a warmer and wetter climate (e.g. at lower latitudes and/or elevations), and in hydrobasins with greater forest cover that could enhance the supply of terrestrial organic matter and nutrients that stimulated lake productivity; and (2) patterns in FEC responses would be coupled among trophic levels.4. Results from redundancy analyses showed that the richnessrelative of phytoplankton, macrophytes, and fish decreased, but those of the intermediate trophic levels (i.e. macroinvertebrates and zooplankton) increased with decreasing latitude and/or elevation. Fish richnessrelative and diversity increased with increasing temporal variation in climate (temperature and/or precipitation), ambient nutrient concentrations (e.g. total nitrogen) in lakes, and woody vegetation (e.g. taiga forest) cover in hydrobasins, whereas taxon richness of macroinvertebrates and zooplankton decreased with increasing temporal variation in climate.5. The similar patterns detected for richnessrelative of fish, macrophytes, and phytoplankton could be caused by similar responses to the environmental descriptors, and/or the beneficial effects of macrophytes as habitat structure. By creating habitat, macrophytes may increase fish diversity and production, which in turn may promote higher densities and probably more diverse assemblages of phytoplankton through trophic cascades. Lakes with greater fish richnessrelative tended to have greater average richnessrelative among FECs, suggesting that fish are a potential indicator for overall lake biodiversity.6. Overall, the biodiversity patterns observed along the environmental gradients were trophic‐level specific, indicating that an integrated food‐web perspective may lead to a more holistic understanding of ecosystem biodiversity in future monitoring and management of high‐latitude lakes. In future, monitoring should also focus on collecting more abundance data for fish and lower trophic levels in both benthic and pelagic habitats. This may require more concentrated sampling effort on fewer lakes at smaller spatial scales, while continuing to sample lakes distributed along environmental gradients.
|
|
| 28. |
- Lindberg, Jenny, et al.
(författare)
-
Bör individualiserad utbildning för läkarstudenter eftersträvas?
- 2024
-
Ingår i: Läkartidningen. - 0023-7205. ; 121:9-10
-
Tidskriftsartikel (refereegranskat)abstract
- Vi upplever en ökad efterfrågan på anpassad utbildning från studenter på läkarprogrammet, exempelvis att avstå från obligatoriska moment eller delta i modifierad form. I denna artikel behandlar vi önskemål om anpassning av utbildningen på grund av moraliska, religiösa eller andra personliga övertygelser. Läkarprogrammet syftar till att studenterna ska uppnå gemensamma examensmål. Vid omfattande anpassning riskerar utbildning och examination att inte bli likvärdig för alla studenter. Anpassningar är också ofta resurskrävande. Vi efterfrågar en nationell samsyn och stöd till lärosätena avseende hur frågan om individuell anpassning ska hanteras.
|
|
| 29. |
- Malmström, Annika, et al.
(författare)
-
Do I want to know it all?
- 2021
-
Ingår i: Supportive Care in Cancer. - : SPRINGER. - 0941-4355 .- 1433-7339. ; 29:6, s. 3339-3346
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose Glioma patients have poor prognosis. The amount of detail of disease-related information patients wish to receive is not known. The aim of this study was to explore glioma patients experiences and preferences regarding receiving information on diagnosis and prognosis. Methods Semi-structured interviews were performed with patients diagnosed with glioma. The interviews were analysed by qualitative content analysis without predefined categories by two independent coders. Results Ten women and 15 men, with newly diagnosed grade II-IV glioma, age 25-76 years, were interviewed. Participants experience on diagnosis communication was either indirect, meaning they found out their diagnosis unintentionally, e.g., from their electronic health record (EHR) instead of from their doctor, this causing anxiety and feelings of abandonment, insufficiently tailored: lacking in many aspects or individualised and compassionate. Participants generally wanted to know "the truth" about diagnosis and prognosis, but what they meant varied; some desired full honest information to allow for autonomous choices, others preferred general information without details, and some wanted no bad news at all, only positive information. Participants disclosed vulnerability after receiving their diagnosis, being cast into the unknown. They expressed a need for better everyday practical information to help create some control. Supportive staff could reduce participants distress. Conclusion There is a need to further develop and implement individually tailored information to glioma patients, both in consultations and patient-accessed EHR systems, which should have safe guards for sensitive information. Not all patients want to know it all, one size does not fit all.
|
|
| 30. |
- Malmström, Annika, 1957-
(författare)
-
Studies for Better Treatment of Patients with Glioma
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden annually over 500 people will be diagnosed with the malignant brain tumor glioma. They are graded from I-IV. The majority are glioblastoma (grade IV) (GBM), these being the most aggressive type. Median survival for those treated with standard of care is expected to be around 15 months. This tumor will mainly affect those 60 years or older.The studies in this thesis focus on treatment of patients with malignant gliomas grade III and IV. The aim of the studies is to improve the care of glioma patients. Papers I and II explored different therapeutic options in randomized trials, to facilitate individualized treatment recommendations. Findings from studies I and II, together with additional trials, demonstrated the importance of analyzing the tumor marker O6-methylguanine DNA methyltransferase (MGMT) methylation status for survival of GBM patients treated with Temozolomide (TMZ). The third paper investigated how the analysis of this marker is implemented internationally.The first study (paper I, Nordic trial) investigated treatment options for patients 60 years or older with GBM. The trial compared standard radiotherapy (SRT) over 6 weeks versus hypofractionated radiotherapy (HRT) over 2 weeks versus single agent TMZ administered in up to six 4 weekly cycles. In all, 342 patients were included in the trial. This study demonstrated that those randomized to TMZ had superior survival as compared to SRT. In addition, quality of life (QoL) data also suggested a better QoL for TMZ treatment than for radiotherapy. The benefit of TMZ treatment seemed to be limited to those with the tumor molecular marker MGMT methylated (inactivated).The second trial (paper II, Neoadjuvant trial) studied whether integrating TMZ treatment with SRT for patients younger than 60 years with GBM (grade IV) and astrocytoma grade III would confer a survival benefit, if administered postoperatively, before the start of SRT (neoadjuvant). TMZ was provided for 2-3 four weekly cycles followed by SRT to patients randomized to neoadjuvant treatment and was compared to postoperative SRT alone. Although this trial could not illustrate any advantage of delaying the start of SRT while administering TMZ for the study cohort in general, for those included as astrocytoma grade III the median survival was found to be superior by 5 years when randomized to neoadjuvant TMZ. This trial also confirmed the importance of MGMT promoter methylation for the efficacy of TMZ.The third study (paper III) investigated international practices for analyzing tumor MGMT promoter methylation status. MGMT analysis can be conducted by various laboratory methods, which in some cases can provide opposing results regarding the MGMT methylation status of the patient´s tumor. This can lead to incorrect treatment recommendations. To establish which methods and cut-offs that are regularly used to determine tumor MGMT status in the clinic, an international survey was provided to those working in the field. We also inquired about opinions regarding an international consensus on how MGMT should be tested. The 152 respondents reported several methodologies and different cut-off levels also for the same method. A majority of respondents warrant international guidelines.In conclusion, the results of the 2 randomized trials contribute to individualized treatment recommendations for patients affected by GBM or astrocytoma grade III. The results of the survey regarding analyses of MGMT clarify the current problematic situation. The request of the respondents regarding international guidelines might contribute to their future development, so that personalized treatment recommendations can be improved.
|
|
| 31. |
- Melin, Jeanette, et al.
(författare)
-
A sustainable organization for measurement quality assurance of category based measurements : Tasked with coordinating and ensuring reliable and comparable measurements of experiences, feelings, behaviours and abilities
- 2023
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Why?Society's need for knowledge about experiences, feelings, behaviours and abilities is increasing. It is important to know how people and society feel or how a product or service is perceived, and to be able to compare how these change over time and between different areas, for example when making decisions about priorities, efforts and effects. In order for measurements of experiences, feelings, behaviours and abilities to be useful and provide reliable data, quality-assured measurement is required for socalled category based measurements1. It is therefore necessary that basic measurement principles are applied, which is often not the case today in this field. For the physical quantities (length, mass, time, etc.) there has long been an internationally established measurement quality infrastructure. In Sweden, it is mainly RISE as the National Metrological Institute which, through its national measurement sites, is responsible for ensuring access to quality-assured and traceable measurements for society. However, the corresponding measurement quality infrastructure is so far missing for category based measurements.What?RISE has been working for several years to develop methodology and working methods for measurement quality assurance of experiences, feelings, behaviours and abilities. Through dialogue over several years with actors at various levels, including in health care and academia, it has emerged that there is a great need for support for this development. RISE has therefore produced a first draft of a possible sustainable organization for measurement quality assurance of category based measurements. A national centre for quality assurance of category based measurements would be tasked with coordinating and ensuring reliable and comparable measurements of experiences, feelings, behaviours and abilities. Such infrastructural support must make methodologies available to enable quality assurance for category based measurements. The organization must meet society's need for support by offering services based on internationally accepted metrological principles and scientific methods, as well as adopting a neutral and independent role.How?We have humility about the fact that it is a long process to establish an organization for category based measurements and that it needs to happen through a dynamic and iterative development in co-creation with the actors involved. We look forward to continuing to develop ideas and revise the proposal in dialogue in the coming years. It is also important to start a dialogue together with relevant actors about how the implementation of the organization can take place in the future.
|
|
| 32. |
- Melin, Jeanette, et al.
(författare)
-
En hållbar organisering för mätkvalitetssäkring av kategoribaserade mätningar : Med uppdrag att samordna och säkerställa tillförlitliga och jämförbara mätningar av upplevelser, känslor, beteenden och förmågor
- 2023
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Varför?Samhällets behov av kunskap om upplevelser, känslor, beteenden och förmågor ökar. Det är viktigt att veta hur personer och samhället mår eller hur en produkt eller tjänst upplevs samt att kunna jämföra hur detta förändras över tid och mellan olika områden, för att exempelvis fatta beslut om prioriteringar, insatser och effekter. För att mätningar av upplevelser, känslor, beteenden och förmågor ska vara användbara och ge tillförlitliga underlag krävs kvalitetssäkrad mätteknik för s.k. kategoribaserade mätningar. Det är alltså nödvändigt att grundläggande mättekniska principer tillämpas, vilket ofta inte är fallet i dag inom detta område. För de fysikaliska storheterna (längd, massa, tid etc.) finns sedan länge en internationellt etablerad mätkvalitetsinfrastruktur. I Sverige är det huvudsakligen RISE som Nationellt Metrologiskt Institut som genom sina riksmätplatser ansvarar för att säkerställa tillgång till kvalitetssäkrade och spårbara mätningar för samhället. Motsvarande mätkvalitetsinfrastruktur saknas dock för kategoribaserade mätningar.Vad?RISE arbetar sedan flera år för att utveckla metoder och arbetssätt för mätkvalitetssäkring av upplevelser, känslor, beteenden och förmågor. Genom dialoger med aktörer på olika nivåer, bland annat inom hälso- och sjukvården och akademin, som pågått under flera års tid har det framkommit att det finns ett stort behov av stöd för denna utveckling. RISE har därför tagit fram ett första utkast för en möjlig hållbar organisering för mätkvalitetssäkring av kategoribaserade mätningar. Ett nationellt centrum för mätkvalitetssäkring av kategoribaserade mätningar skulle ha i uppdrag att samordna och säkerställa tillförlitliga och jämförbara mätningar av upplevelser, känslor, beteenden och förmågor. Ett sådant infrastrukturellt stöd ska tillgängliggöra metodiker för att möjliggöra mätkvalitetssäkring för kategoribaserade mätningar. Organiseringen ska möta samhällets behov av stöd genom att erbjuda tjänster baserade på internationellt vedertagna mättekniska principer och vetenskapliga metoder samt ha en neutral och oberoende roll.Hur?Det finns en stor ödmjukhet kring att det är en lång process att etablera en organisering för kategoribaserade mätningar och att det behöver ske genom en dynamisk och iterativ utveckling i samskapande med berörda aktörer. Vi ser fram emot att fortsätta utveckla tankar och revidera förslaget i dialog under kommande år. Det är också viktigt att påbörja en dialog tillsammans med relevanta aktörer om hur implementeringen av organiseringen kan ske i framtiden.
|
|
| 33. |
|
|
| 34. |
- Nilsberth, Camilla, 1968-, et al.
(författare)
-
Symptom clusters in palliative-stage cancer correlate with proinflammatory cytokine cluster
- 2023
-
Ingår i: Annals of Palliative Medicine. - : AME Publishing Company. - 2224-5820 .- 2224-5839. ; 12:3, s. 458-471
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with palliative-stage cancer often suffer from a variety of debilitating symptoms which have been shown to appear in clusters. It is suggested that cytokines cause many such symptoms, and elevated cytokine production has been shown to correlate with symptoms. However, symptom clusters have not been thoroughly analyzed in relation to cytokine clusters. The aim of the present study was to identify symptom clusters and cytokine clusters in Swedish cancer patients, and to investigate correlations between the identified symptom clusters and cytokine clusters. Methods: The EORTC Quality of Life Questionnaire Core 15 Palliative Care questionnaire was completed by 110 cancer patients, with blood samples taken at two time points four weeks apart. Meso scale discovery (MSD) assays were used to analyze 23 cytokines. Statistical analysis was performed using principal component analysis (PCA) of symptoms and cytokines, followed by correlation analysis of the obtained clusters. Results: Three symptom clusters were identified: (I) pain-sleep disorder, (II) gastro-intestinal-fatigue, (III) physical functioning. The cytokines were divided into three clusters that can be characterized as (I) pro-tumorigenic, (II) cell-mediated immune response and (III) proinflammatory. At the second time point, a fourth cytokine cluster was isolated (IV) immunostimulation. Correlations were found at both time points between the proinflammatory cytokine cluster and the physical functioning symptom cluster, and at the week four time point between the proinflammatory cytokine cluster and the gastro-intestinal-fatigue symptom cluster. Conclusions: We show a correlation between symptom clusters and the proinflammatory cytokine cluster. Proinflammatory cytokines are known to cause symptoms that resemble palliative cancer symptoms. Increased knowledge of biochemical processes and their effect on patients’ wellbeing may give clues for counteracting symptoms that affect quality of life (QOL) in palliative cancer care. © Annals of Palliative Medicine. All rights reserved.
|
|
| 35. |
|
|
| 36. |
- Sarhan, Dhifaf, et al.
(författare)
-
885 Targeting FPR2 as a novel approach for immunotherapy in pancreatic cancer female patients : studies of sexual immune dimorphism in the tumor microenvironment
- 2021
-
Ingår i: Journal for ImmunoTherapy of Cancer. - : BMJ. - 2051-1426. ; 9:Suppl 2, s. A927-A927
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundImmunotherapy for pancreatic cancer (PC) is inefficient due to a highly immune-suppressive tumor microenvironment (TME) orchestrated by myeloid suppressor cells, which limit the infiltration and function of cytotoxic immune cells. We have evidence that accumulation of a subpopulation of myeloid cells in human pancreatic lesions is associated with immune-exclusive tumor phenotype and effector T cell exhaustion by mechanisms involving the G-coupled protein receptor formyl peptide receptor 2 (FPR2), exclusively in women. We hypothesize that female FPR2+ myeloid cells in tumors induce immune exhaustion and contribute to immune-cold tumor phenotype.MethodsTo test our hypothesis, we first investigated the FPR2 RNA and protein expression in PC transcriptomic data and in murine and human PC tissues. Further, in vitro cytokine differentiated, alternatively tumor conditioned myeloid cells (TCM) were co-cultured with T cells to mimic their interaction in the TME. In vivo, PC cells were injected subcutaneously in FPR2 WT and KO mice to study tumor progression and the immune landscape in male vs. female mice. Later, human myeloid cells were treated with FPR2 agonists and antagonists to study the interaction mechanisms in detail.ResultsWe found high FPR2 expression in tumor compared to healthy tissues and higher in women compared to men. In mice and human, FPR2+ myeloid cells were associated with immune cold-exclusive and cold-ignored tumor phenotype in women and men, respectively. Notably, analysis in PC and other gastrointestinal (GI)-tract cancers revealed a significant association of FPR2 expression and poor survival only in women, emerging the potential impact of sex factors in the TME. Such sexual dimorphism in the TME was associated with T cell exhaustion apparent by high expression of TIM3 and PD1. In vitro, FPR2-agonist treated myeloid-suppressive cells induced TIM3 and PD1 expression in T cells specifically in female T cells. However, a significant repression of TIM3 and a trend of PD1 expression was observed in T cells when interacting with FPR2-inhibited or -deficient myeloid cells. Finally, tumor progression was significantly slower in FPR2 KO female mice compared to WT and male FPR2 WT and KO mice.ConclusionsIn this study, we have shown that sex differences are involved in shaping the TME in PC, where sexual dimorphism is still a largely unknown area allowing novel personalized/sex-specific immunotherapies. We found that FPR2 is highly involved in T cell exhaustion and can potentially be a therapeutic target for immunotherapy in women developing PC and other GI-tract cancers.
|
|
| 37. |
- Skålén, Per, 1972-, et al.
(författare)
-
Public Service Innovation : A Public Service dominant logic view
- 2016
-
Ingår i: WHAT'S AHEAD IN SERVICE RESEARCH?. - Neapel, Italien : UNIV NAPLES FEDERICO II, DEPT ECON MGMT & INST. - 9791220013840 ; , s. 756-770
-
Konferensbidrag (refereegranskat)abstract
- The paper departs from research on Public Service Dominant Logic (PSDL) to advance a framework of service innovation for the public sector. It continues the incorporation of Service-Dominant Logic (SDL) concepts that has been initiated by PSDL research to the public management domain, in particular the notions of resource integration and value propositions is incorporated to PSDL, and builds a conceptual framework of Public Service Innovation (PSI). This framework consist of three resource integration processes, users value creation in use, users and personnel's' value cocreation in direct interaction and internal value facilitation, and suggest that these three processes contribute to service innovation by integrating resources into value propositions. Through an empirical study of primary care the paper finds that the framework describes how PSI is conducted in practice in the public management domain. The paper contributes to articulate a PSDL-based service innovation framework. It also contributes by grounding this framework in an empirical study. In addition, it contributes by elaborating PSDL in such a way that may be drawn on to study public service innovation.
|
|
| 38. |
- Skålén, Per, 1972-, et al.
(författare)
-
Understanding public service innovation as resource integration and creation of value propositions
- 2018
-
Ingår i: Australian journal of public administration. - : Wiley. - 0313-6647 .- 1467-8500. ; 77:4, s. 700-714
-
Tidskriftsartikel (refereegranskat)abstract
- This paper departs from research on Public Service Logic (PSL) to advance a framework ofpublic service innovation (PSI) by incorporating the notions of resource integration and valueproposition. The framework consists of three resource integration processes, referred to asvalue creation, value co-creation and value facilitation, through which users and employeesdetect problems and suggest solutions that contribute to service innovation by creatingnew, or by developing existing, value propositions. To test and illustrate the framework, astudy of six service innovation groups in primary care was drawn on. Four aggregates ofservice innovation ideas were identified in the study: access, patient experience, physicalenvironment and organization of work. In line with the framework, the findings suggest thatusers and employees contribute to PSI by drawing on their knowledge and experience ofconducting resource integration, and by detecting problems and suggesting solutions to theseproblems.
|
|
| 39. |
- Stockfelt, Marit, et al.
(författare)
-
Research interest and activity among medical students in Gothenburg, Sweden, a cross-sectional study
- 2016
-
Ingår i: Bmc Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 16
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The proportion of physicians undertaking doctoral studies is decreasing. Early recruitment of medical students could counteract this trend. This follow-up survey investigated research interest and activity among medical students at the Sahlgrenska Academy, Gothenburg, Sweden. Methods: A questionnaire was administered to all medical students at the Sahlgrenska Academy, as a follow-up to a 2006 survey. The Mann-Whitney U test was used for ordinal variables and the Fisher exact test for categorical variables. Data from Statistics Sweden was used to analyse the number of PhDs awarded to individuals who earned a medical degree in 2000-2012. Results: Of the students, 16 % were already conducting and another 36 % wanted to conduct research during their studies. The interest was at the same level compared to 2006. The main reasons for conducting research consisted of an interest in scientific problems or the research topic, a wish for personal development or intellectual stimulation. Students engaged in research reported lack of time, increased workload and less time to study as hindering factors. Conclusions: Recruitment could be improved by offering improved and regular information, clarifying career paths, broadly announcing available projects, and creating new and expanding existing research programmes. The potential for recruitment of Gothenburg medical students to research is substantial, but students are hampered by lack of time, lack of supervisors and lack of information.
|
|
