| 1. |
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| 2. |
- Blaus, Johan, et al.
(författare)
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Structures, processes, and methods for collaboration with stakeholders on relevance assessment of higher education
- 2021
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Konferensbidrag (refereegranskat)abstract
- Introduction Higher education institutions (HEIs) face challenges assessing the relevance of educational programmes. Upon graduation, the student should have acquired knowledge and understanding, competence and skills as well as good judgement and approaches to operate in a changing labour market. Ideas on new programmes and courses mainly emanate from research findings identified at the HEIs. Needs and expectations from external stakeholders have the potential to further contribute if room for collaboration is created. Extensive rapid societal changes increase this need for collaboration. The Standards and Guidelines for Quality Assurance in the European Higher Education Area (ESG) state that higher education aims to fulfil multiple purposes, including preparing students for active citizenship, future careers, personal development and create a broad, advanced knowledge base and stimulate research and innovation (ENQA, 2015). However, different stakeholders may have other priorities. Therefore, quality assurance needs to take these different perspectives into account. Relevance is considered an aspect of quality in higher education, but many HEIs in Sweden lack structures, processes, and methods for assessing relevance and involving stakeholders in these processes.This project aimed to increase the knowledge and provide methods to systematically assess relevance and use university-industry collaborations as tools for educational development. Methods/Approach This paper is a summary of the project MERUT focused on methods for assessment of relevance in higher education. The project was carried out during 2017-2020 with financial support from Vinnova (The Swedish Innovation Agency) and involved seven Swedish HEIs. The connection to future career paths is often stated as the primary factor to describe the relevance of educational programmes and was selected as the focus of MERUT. Data have been collected using workshops, meetings, literature reviews, interview studies, and surveys. Important parts of the work have been interviews with external stakeholders in different labour-market areas who, in various ways, are involved in higher education, most often in advisory boards. Also, interviews with quality coordinators at university programmes as well as at faculty and university management levels at each HEI have been carried out.The seven participating Swedish universities in MERUT have been Karolinska Institutet, Kristianstad University, KTH Royal Institute of Technology, Mälardalen University, Linköping University, Stockholm University, and Umeå University.Results The project resulted in knowledge, tools, and methods to work systematically with relevance in higher education. The results can be summarized as follows:· Interviews with HEIs showed that they collaborate with external stakeholders in many ways, primarily around teaching and learning and to a lesser extent around programme management and quality assurance. · Further, the involvement of stakeholders varied both between and within the universities (faculties, subject areas, levels of education). Therefore, it is difficult to evaluate, in a systematic way, how collaboration is included in the quality systems of the HEIs. · A toolbox with methods for how to involve external stakeholders in the process of assessing and developing the relevance of a study programme. These methods can be used in continuous quality work, in major curriculum revisions as well as in the establishment of new programmes.· A checklist for external stakeholders' involvement in educational development to facilitate and clarify roles, structures, and tasks in connection with external stakeholders in both the development and operational phases of a study programme. The results show that there are many similarities between the HEIs in the study in terms of relevance assessment and dimensioning decisions. However, the potential of a systematic collaboration with stakeholders and society for relevance assessment and dimensioning of education is not yet fully being realised. Conclusion HEIs interact with external stakeholders in many ways within education. However, it is rare to find examples where external stakeholders are involved in the quality assurance process, at least not in a systematic way. The MERUT project has developed recommendations for collaboration perspectives and stakeholder participation in the governing of educational programmes. A systematic dialogue and interaction with stakeholders contribute to a mutual understanding of different stakeholder groups’ needs and expectations, and their view of quality of higher education. Furthermore, to consider relevance as a quality aspect creates a basis for a more methodical assessment process where external stakeholders can contribute in a clear role. MERUT has developed a toolbox and a checklist to facilitate such systematic interaction and collaboration with stakeholder groups. A conclusion of this project is that a reciprocal, transparent, and systematic approach leads to a sustainable educational collaboration with improved quality and relevance of higher education.It would constitute a large gain for society if the HEIs are able to systematically and by efficient processes take external stakeholders’ and societal needs and expectations into account when building comprehensive and systematic relevance assessment processes and in dimensioning of education. ReferencesEuropean Association for Quality Assurance in Higher Education (ENQA). (2015). Standards and Guidelines for Quality Assurance in the European Higher Education Area (ESG). Brussels, EURASHE.
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| 3. |
- Dyar, Anna, et al.
(författare)
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The learning environment on a student ward : an observational study
- 2019
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Ingår i: Perspectives on medical education. - : Bohn Stafleu van Loghum. - 2212-2761 .- 2212-277X. ; 8:5, s. 276-283
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Worldwide, a growing number of healthcare students require clinical environments for learning. Some wards have become adapted 'student wards' to meet this demand. Benefits have been reported from the students', supervisors' and patients' perspectives. There is no definition of a student ward, and little research on what the term means. A deeper understanding of the characteristics of student wards is needed to support their use. The aim of this study is to describe what characterises the learning environment on one student ward.METHODS: An ethnographic approach was used for an observational study on a student ward in a hospital in Sweden. Student nurses, supervisors and others on the ward were observed. Field notes were thematically analysed.RESULTS: Four themes were identified: 'Student-led learning' described students learning by actively performing clinical tasks and taking responsibility for patients and for their own learning. 'Learning together' described peer learning and supervision. 'Staff's approach to learning' described personalised relationships between the students and staff and the build-up of trust, the unified inter-professional approach to teaching, and the supervisors' motivation for teaching and for their own learning. 'Student-dedicated space' described the effect of the student room on the learning environment.DISCUSSION AND CONCLUSIONS: This study describes the characteristics of a student ward that centred around a community of practice that shared a view of learning as a priority, allowing staff to provide clinical care without compromising students' learning. This qualitative study at a single centre lays the groundwork for future research into other student wards.
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| 4. |
- Dyar, Anna, et al.
(författare)
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What about the supervisor? Clinical supervisors' role in student nurses' peer learning : a phenomenographic study
- 2021
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Ingår i: Medical Education. - : John Wiley & Sons. - 0308-0110 .- 1365-2923. ; 55:6, s. 713-723
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Peer learning is increasingly used for healthcare students in the clinical setting. However, as peer learning between students involves students taking a teaching role, it is unclear what the supervisor's role then becomes. It is vital to determine the role of the supervisor in student peer learning to ensure high quality learning and patient safety.METHODS: Semi-structured interviews were performed with 15 student nurse supervisors (nurses and assistant nurses) from two hospital wards that practice peer learning to investigate the different ways clinical supervisors view their role in students' peer learning. Transcribed data were coded and analysed using a phenomenographic approach.RESULTS: Four hierarchical levels of the supervisor's understanding of their role in students' peer learning were identified: the teacher; the facilitator; the stimulator; and the team player. These categories represent an increasingly inclusive view of which people present on the ward play a role in enabling effective peer learning.CONCLUSIONS: The various understandings of supervisor roles have implications for how supervision of peer learning could be implemented in the future.
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| 6. |
- Laurell, Anna, et al.
(författare)
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Intratumorally injected pro-inflammatory allogeneic dendritic cells as immune enhancers: a first-in-human study in unfavourable risk patients with metastatic renal cell carcinoma
- 2017
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Ingår i: Journal for Immunotherapy of Cancer. - : BMJ. - 2051-1426. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Accumulating pre-clinical data indicate that the efficient induction of antigen-specific cytotoxic CD8+ T cells characterizing viral infections is caused by cross-priming where initially infected DCs produce an unique set of inflammatory factors that recruit and activate non-infected bystander DCs. Our DC-based immunotherapy concept is guided by such bystander view and accordingly, we have developed a cellular adjuvant consisting of pre-activated allogeneic DCs producing high levels of DC-recruiting and DC-activating factors. This concept doesn't require MHC-compatibility between injected cells and the patient and therefore introduces the possibility of using pre-produced and freeze-stored DCs from healthy blood donors as an off-the-shelf immune enhancer. The use of MHC-incompatible allogeneic DCs will further induce a local rejection process at the injection site that is expected to further enhance recruitment and maturation of endogenous bystander DCs. Methods: Twelve intermediate and poor risk patients with newly diagnosed metastatic renal cell carcinoma (mRCC) where included in a phase I/II study. Pro-inflammatory allogeneic DCs were produced from a leukapheresis product collected from one healthy blood donor and subsequently deep-frozen. A dose of 5-20 x 106 DCs (INTUVAX) was injected into the renal tumor twice with 2 weeks interval before planned nephrectomy and subsequent standard of care. Results: No INTUVAX-related severe adverse events were observed. A massive infiltration of CD8+ T cells was found in 5 out of 12 removed kidney tumors. No objective tumor response was observed and 6 out of 11 evaluable patients have subsequently received additional treatment with standard tyrosine kinase inhibitors (TKI). Three of these 6 patients experienced an objective tumor response including one sunitinib-treated patient who responded with a complete and durable regression of 4 brain metastases. Median overall survival (mOS) is still not reached (currently 42.5 months) but has already passed historical mOS in patients with unfavourable risk mRCC on standard TKI therapy. Conclusions: Our findings indicate that intratumoral administration of proinflammatory allogeneic DCs induces an antitumor immune response that may prolong survival in unfavourable risk mRCC-patients given subsequent standard of care. A randomized, multi-center, phase II mRCC trial (MERECA) with INTUVAX in conjuction with sunitinib has been initiated.
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| 7. |
- Antoniewicz, Lukasz, et al.
(författare)
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Electronic cigarettes increase endothelial progenitor cells in the blood of healthy volunteers
- 2016
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Ingår i: Atherosclerosis. - : Elsevier BV. - 0021-9150 .- 1879-1484. ; 255, s. 179-185
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: The use of electronic cigarettes is increasing dramatically on a global scale and its effects on human health remain uncertain. In the present study, we measured endothelial progenitor cells (EPCs) and microvesicles (MVs) in healthy young volunteers following short-term exposure to inhalation of e-cigarette vapor (ECV) to determine vascular changes.Methods: Sixteen healthy seldom smokers were randomized into two groups either exposed or not exposed to 10 puffs of ECV for 10 min, in a crossover design. Blood samples were obtained at baseline and 1, 4 and 24 h following exposure. EPCs (CD34 + CD309) and MVs were analyzed by flow cytometry. MVs were phenotyped according to origin (platelet (CD41), endothelial (CD144), leukocytes (CD45), monocytes (CD14)) and nuclear content (SYTO 13 dye). In addition, expression of inflammation markers such P-selectin (CD62P), E-selectin (CD62E), CD40-ligand (CD154) and HMGB1 was investigated. Fractional exhaled nitric oxide (FeNO) was also measured at baseline and after 24 h.Results: EPC levels in blood were significantly increased 1 h following exposure to ECV and returned to baseline values after 24 h. Only E-selectin positive MVs (endothelial origin) were slightly elevated (p < 0.038). FeNO was unaffected by exposure to ECV. Conclusions: In healthy volunteers, ten puffs of e-cigarette vapor inhalation caused an increase in EPCs. This increase was of the same magnitude as following smoking of one traditional cigarette, as we previously demonstrated. Taken together, these results may represent signs of possible vascular changes after short e-cigarette inhalation. Further studies analyzing potential cardiovascular health effects are critical as the e-cigarette market continues to burgeon.
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| 8. |
- Barral, Anna-Maria, 1963-
(författare)
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Immunological Studies in Malignant Melanoma : Importance of TNF and the Thioredoxin System
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Malignant melanoma is a tumor whose incidence is dramatically increasing in persons with light-coloured skin in all parts of the world. Due to its resistance against traditional chemo- and radiotherapy, melanoma has been a favourite target of alternative therapies, in particular those involving immunological mechanisms. Cytokines and particularly tumor necrosis factor (TNF) have been studied as possible antitumoral agents, but also as endogenous growth or differentiation factors. Previous studies showed that melanomas could express TNF in situ and that this expression correlated to decreased lymphocyte infiltration. On the other hand, redox reagents can modulate expression of cytokines, and the thioredoxin (Trx) system is particularly known to influence expression and secretion of TNF in vitro.The overall aim of this research was to explore immunological aspects of melanoma, particularly the role of TNF both in vitro and in vivo, as well as its possible modulation by Trx.In the in vitro studies first we developed a novel method for obtention of monoclonal antibodies against melanoma antigens, and generated and characterized specific monoclonal antibodies against both full-length and truncated Trx. We studied the cytokine expression of a panel of normal and transformed melanocytic cells by immunofluorescence, all of which presented TNF and Trx at levels comparable to monocytic cells, and TNF-receptors (TNFR) at low but detectable levels. Melanoma cells did not secrete TNF upon stimulation in spite of its presence in the Golgi apparatus. However, melanoma cells expressed the TNF-processing enzyme TACE and were capable of cleaving transfected GFP-tagged TNF. Imaging studies point to a possible cell-cell tranfer of endogenous TNF in melanoma cells.On the other hand, TNF and Trx expression in melanoma cell lines correlated to resistance against exogenous TNF. We studied then the in situ expression of TNF and Trx by immunohistochemistry in a group of 44 cutaneous melanoma patients. Trx expression did not correlated to survival or other clinicalpathological parameters. TNF expression significantly correlated to better survival in tumors thicker than 0,8 mm, and constituted an independent prognostic factor.These results point to a biological role of endogenous TNF in malignant melanoma, either by constituting an autocrine/paracrine differentiation factor or by modulating communication with other cell types, particularly of the host’s immune system.
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| 9. |
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| 11. |
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| 12. |
- Hägg Martinell, Ann, et al.
(författare)
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Nursing Students Learn to Handle Stress and to Prioritize in a Complex Context During Workplace Learning in Acute Internal Medicine Care – An Ethnographic Study
- 2020
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Ingår i: Advances in Medical Education and Practice. - : Dove Press. - 1179-7258. ; 11, s. 21-30
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: A common focus in many studies, in the short-term perspective, is to evaluate students’ workplace learning and its outcome. However, the outcome can be perceived differently depending on when it was evaluated. The aim of this study was to explore student nurses’ learning activities in an acute internal medicine unit and the nurses perceived learning outcome in a long-term perspective.Material and Methods: Repetitive ethnographic observations were performed in an internal medicine care unit at a teaching hospital in Sweden between 2011 and 2013. Four student nurses and supervisors were repetitively observed. Two years later retrospective interviews were performed with four nurses who had performed workplace learning, as students, in this unit during the observation period. An inductive comparative analysis involving all interviews and observational data was applied.Results: Three themes were identified: To handle shifting situations – illustrating how student nurses learnt to adapt to shifting situations, to manage stress, to create structure and space for learning and to deal with hierarchies; To build relationships – illustrating how student nurses learnt to collaborate and to interact with patients; To act independently – illustrating how student nurses trained to act independently in the unit, took responsibility, and prioritized in this complex context.Conclusion: Learning activities in a complex acute medical unit setting were characterized by a high workload and frequent stressful situations, and a demand on students to interact, to take responsibility, and to prioritize. To learn in such a stressful context, have in a long-term perspective, a potential to develop students’ embodied understanding of and in practice, making them more prepared to work and independently apply their nursing expertise in similar contexts as graduated nurses.
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| 13. |
- Hägg Martinell, Ann, et al.
(författare)
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Possibilities for interprofessional learning at a Swedish acute healthcare ward not dedicated to interprofessional education : an ethnographic study
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Almost all healthcare today is team-based in collaboration over professional borders, and numerous students have work-based learning in such contexts. However, interprofessional learning (IPL) in clinical settings has mostly been systematically explored in specially designed contexts dedicated to interprofessional education (IPE). This study aimed to explore the possibilities for IPL activities, and if or how they occur, in an acute ward context not dedicated to IPE.DESIGN AND SETTING: Between 2011 and 2013 ethnographic observations were performed of medical and nursing students' interactions and IPL during early clerkship at an acute internal medicine ward in Sweden. Field notes were taken and analysed based on the framework of IPE: learning with, from and about.PARTICIPANTS: 21 medical, 4 nursing students and 30 supervisors participated.RESULTS: Learning with-there were no organised IPE activities. Instead, medical and nursing students learnt in parallel. However, students interacted with staff members from other professions. Learning from-interprofessional supervision was frequent. Interprofessional supervision of nursing students by doctors focused on theoretical questions and answers, while interprofessional supervision of medical students by nurses focused on the performance of technical skills. Learning about-students were observed to actively observe interactions between staff and learnt how staff conducted different tasks.CONCLUSION: This study shows that there were plenty of possibilities for IPL activities, but the potential was not fully utilised or facilitated. Serendipitous IPL activities differed between observed medical and nursing students. Although interprofessional supervision was fairly frequent, students were not learning with, from or about each other over professional borders.
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| 14. |
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| 15. |
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| 16. |
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| 17. |
- Hägg Martinell, Ann, et al.
(författare)
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Students perceive healthcare as a valuable learning environment when accepted as a part of the workplace community
- 2014
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Ingår i: Education for Health. - : Wolters Kluwer. - 1357-6283 .- 1469-5804. ; 27:1, s. 15-23
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The healthcare system is complex and the education of medical and nursing students is not always a priority within it. However, education offered at the point of care provides students with opportunities to apply knowledge, and to develop the necessary skills and attitudes needed to practice their future profession. The major objective of this study was to identify students' views of generic aspects of the healthcare environment that influences their progress towards professional competence.METHODS: We collected free text answers of 75 medical students and 23 nursing students who had completed an extensive questionnaire concerning their learning in clinical wards. In order to obtain richer data and a deeper understanding, we also interviewed a purposive sample of students. Qualitative content analysis was conducted.RESULTS: We identified three themes: (1) How management, planning and organising for learning enabled content and learning activities to relate to the syllabus and workplace, and how this management influenced space and resources for supervision and learning; (2) Workplace culture elucidated how hierarchies and communication affected student learning and influenced their professional development and (3) Learning a profession illustrated the importance of supervisors' approaches to students, their enthusiasm and ability to build relationships, and their feedback to students on performance.DISCUSSION: From a student perspective, a valuable learning environment is characterised as one where management, planning and organising are aligned and support learning. Students experience a professional growth when the community of practice accepts them, and competent and enthusiastic supervisors give them opportunities to interact with patients and to develop their own responsibilities.
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| 18. |
- Jonsson, Marina, et al.
(författare)
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Adherence to national guidelines for children with asthma at primary health centres in Sweden : potential for improvement
- 2012
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Ingår i: Primary Care Respiratory Journal. - : Elsevier. - 1471-4418 .- 1475-1534. ; 21:3, s. 276-282
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although asthma is the most common chronic paediatric disease in Western Europe, the extent of adherence to guidelines for primary care management of paediatric asthma remains unclear. AIMS: To evaluate adherence to national guidelines for primary care management of children with asthma. METHODS: This survey involved 18 primary healthcare centres in Stockholm, Sweden. The medical records of 647 children aged 6 months to 16 years with a diagnosis of asthma, obstructive bronchitis, or cough were selected and scrutinised. 223 children with obstructive bronchitis or cough not fulfilling the evidence-based criteria for asthma were excluded, yielding a total of 424 subjects. Documentation of the most important indicators of quality as stipulated in national guidelines (i.e., tobacco smoke, spirometry, pharmacological treatment, patient education, and demonstration of inhalation technique) was examined. RESULTS: Only 22% (n=49) of the children 6 years of age or older had ever undergone a spirometry test, but the frequency was greater when patients had access to an asthma nurse (p=0.003). Although 58% (n=246) of the total study population were treated with inhaled steroids, documented patient education and demonstration of inhalation technique was present in 14% (n=59). Exposure to tobacco smoke was documented in 14% (n=58). CONCLUSIONS: This study reveals a substantial gap between the actual care provided for paediatric asthma and the recommendations formulated in national guidelines.
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| 19. |
- Kiessling, Anna
(författare)
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Quality of care and quality of life in coronary artery disease
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim was to study the efficacy in primary care of Case method learning (CML) in secondary prevention of patients with coronary artery disease (CAD). A further aim was to explore the structure of health related quality of life (HRQL) in these patients and its relations to chest pain and ill health. 54 general practitioners and 255 consecutive patients with CAD participated in a randomised controlled educational trial with the intention to improve the quality of care in secondary prevention of CAD. Practice guidelines were initially distributed and presented at a lecture. General practitioners - whose Primary health care centre (PHCC) - was randomised to the intervention group participated in recurrent interactive Case method learning dialogues at their own PHCC during the two years of the study. Statistical analysis was performed according to intention-to-treat based on group affiliation at baseline. CML resulted in a lipid lowering in patients in primary care - whose general practitioners participated in recurrent interactive CML dialogues - comparable to what was concurrently achieved at a specialist clinic. Presentation of practice guidelines had no effect per se. Low-density lipoprotein cholesterol concentration decreased 9.3% from 4.2 (CI 4.0-4.5) to 3.7 (CI 3.4-4.0) mmol/l in the intervention group and was 0.5 (CI 0.1-0.9) mmol/l lower (effect size 0.56) in the intervention group as compared to the control group (p < 0.05) after two years. We found no change in the control group. The cost of the education represented only 2% of the cost of lipid lowering drugs. The resulting discounted cost per gained QALY was equal to US$ 24 300. This indicates that CML supported lipid lowering is a cost-effective strategy. HRQL was assessed by the Cardiac Health Profile (CHP), EuroQol-VAS and EuroQol-5D questionnaires. Chest pain was ranked according to the Canadian Cardiovascular Society (CCS) classification. Principal component analysis of HRQL - as assessed by CHP - identified four principal components (independent sub domains) representing perceived cognitive function, physical function/general health, and social respectively emotional functions. All components correlated to EuroQoL-VAS. Perceived cognitive function - reflecting the ability to concentrate, activity drive, memory and problem solving - had a major impact on HRQL. Physical function/general health (p = 0.000000) and emotional domains (p<0.04) related to CCS but perceived cognitive function and social function did not. Furthermore, both perceived cognitive function (p=0.0006) and physical function/general health predicted unemployment at baseline and at two years in patients at a working age. CCS decreased during the two years (p<0.00022). By contrast, HRQL did not change as assessed by any of the instruments or sub domains. To conclude, CML for general practitioners resulted in lipid lowering in their CAD patients due changed clinical practice. Furthermore, CML is cost-effective. The low cost in addition to its positive effects should probably warrant its use in the improvement of the quality of care of other major diseases. Perceived cognitive function is a major determinant of HRQL in CAD patients and predicts ill health as assessed by prevalence of unemployment. Perceived cognitive function was not related to prevalence and grade of chest pain. Furthermore, the major part of the HRQL in these unselected patients was insensitive to change in chest pain symptoms during a two-year period.
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| 20. |
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| 21. |
- Michelsen, Halldora Ögmundsdottir, et al.
(författare)
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Organizational and patient-level predictors for attaining key risk factor targets in cardiac rehabilitation after myocardial infarction: The Perfect-CR study.
- 2023
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 371, s. 40-48
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Tidskriftsartikel (refereegranskat)abstract
- Benefits of cardiac rehabilitation (CR) programme components on attaining risk factor targets post-myocardial infarction (MI) and their predictive strength relative to patient characteristics remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at one-year post-MI.In this observational study data on CR organization at 78 Swedish CR centres was collected and merged with patient-level registry data (n=7549). Orthogonal partial least squares discriminant analysis identified predictors (Variables of Importance for the Projection (VIP) values >0.8) of attaining low-density lipoprotein-cholesterol (LDL-C) <1.8mmol/L, blood pressure (BP) <140/90mmHg and smoking abstinence.The strongest predictors (VIP [95% CI]) for attaining LDL-C and BP targets were offering psychosocial management (2.14 [1.78-2.50]; 2.45 [1.91-2.99]), having a psychologist in the CR team (1.62 [1.36-1.87]; 2.05 [1.67-2.44]), extended opening hours (2.13 [2.00-2.27]; 1.50 [0.91-2.10]), adequate facilities (1.54 [0.91-2.18]; 1.89 [1.38-2.40]), and having a medical director (1.70 [0.91-2.48]; 1.46 [1.04-1.88]). The strongest patient-level predictors of attaining LDL-C and/or BP targets were low baseline LDL-C (3.95 [3.39-4.51]) and having no history of hypertension (2.93 [2.60-3.26]), respectively, followed by exercise-based CR participation (1.38 [0.66-2.10]; 1.46 [1.14-1.78]). For smoking abstinence, the strongest organizational predictor was varenicline being prescribed by CR physicians (1.88 [0.95-2.80]) and patient-level predictors were participation in exercise-based CR (2.47 [2.07-2.88]) and group education (1.92 [1.43-2-42]), and no cardiovascular disease history (2.13 [1.78-2.48]).We identified multiple CR organizational and patient-level predictors of attaining risk factor targets post-MI. These results may influence the future design of comprehensive CR programmes.
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| 22. |
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| 23. |
- Nymark, Carolin, et al.
(författare)
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Inability to act was associated with an extended delay prior to care-seeking, in patients with an acute myocardial infarction
- 2019
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 18:6, s. 512-520
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The out-of-hospital mortality in patients with acute myocardial infarction remains unchanged in contrast to a decrease in inhospital mortality. Interventions aiming to shorten patient delay have been largely unsuccessful. A deeper understanding is apparently needed on patients' appraisal prior to care-seeking.AIM: To investigate whether appraisal processes influence patient delay, and if the questionnaire 'Patients' appraisal, emotions and action tendencies preceding care seeking in acute myocardial infarction' (PA-AMI) could discriminate between patients with prolonged care-seeking and those with a short delay.METHODS: A cross-sectional study including 326 acute myocardial infarction patients filling out the validated questionnaire PA-AMI. The impact of subscales on delay was analysed by projection to latent structures regression. Discrimination opportunities between patients with short and long delays were analysed by projection to latent structures discriminant analysis.RESULTS: The subscales 'perceived inability to act' and 'symptom appraisal' had a major impact on patient delay ( P<0.0001). 'Perceived inability to act' had its main influence in patients with a delay exceeding 12 hours, and 'symptom appraisal' had its main influence in patients with a delay shorter than one hour.CONCLUSION: Appraisal processes influence patient delay. Acute myocardial infarction patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterised by a perceived loss of control and ability to act. Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.
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| 24. |
- Nymark, Carolin, et al.
(författare)
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The turning point : from self-regulative illness behaviour to care-seeking in patients with an acute myocardial infarction.
- 2009
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Ingår i: Journal of clinical nursing. - : Wiley. - 1365-2702 .- 0962-1067. ; 18:23, s. 3358-3365
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. To describe the care-seeking process from interpretation of an initial symptom to the decision to seek medical care in patients with an acute myocardial infarction. Background. Patients afflicted by symptoms of an acute myocardial infarction delay in seeking care far exceeding the desired time limits. This results in avoidable loss of life. There is thus a need to understand these patients' initial discomfort, appraisal and behaviour to design interventions that could reduce delay in care-seeking. Design. Focus group discussions with patients who had had a recent acute myocardial infarction. Methods. The analysis of the transcribed text was inspired by the self-regulatory model of illness behaviour. Results. Patients with acute myocardial infarction describe problems to identify the exact time of onset of often vague symptoms. Their experiences of symptoms did not match their expectations. These patients exhibit self-regulatory illness behaviour that seems to cause a considerable delay in care-seeking. Conclusions. We found indications of a pertinent shift in appraisal and coping-strategy when a patient changes from self-regulative illness behaviour to seeking care - the turning point. This shift seems to be affected by several partly contradictory influences and it takes a considerable time for a person to reach this stage. All aspects of the patients' self-regulative illness behaviour have to be considered if we want patients to seek medical care more rapidly. Relevance to clinical practice. Our findings are important to consider in future design of public health and rehabilitation strategies to save patient lives. To identify the turning point is a profitable way to deepen the understanding of patient behaviour during the initial phase of an acute myocardial infarction.
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| 25. |
- Perk, Joep, 1945-, et al.
(författare)
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Hälsosamma levnadsvanor i fokus för nya riktlinjer : 2016 års europeiska riktlinjer för hjärt–kärlprevention ger också folkhälsoperspektiv och råd åt beslutsfattare
- 2016
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Ingår i: Läkartidningen. - : Läkartidningen förlag. - 0023-7205 .- 1652-7518. ; 113:43, s. 1862-1862
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Nyligen publicerades en ny version av de europeiska riktlinjerna för kardiovaskulär prevention [1]. Tio större organisationer inom Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice har tagit fram publikationen. Dokumentet är en uppdatering av 2012 års publikation [2] och följer väsentligen samma struktur: Vad är kardiovaskulär prevention, vem behöver det, hur och var ska det erbjudas? Här presenterar vi några av de viktigaste nyheterna, t ex att riktlinjerna nu även inkluderar ett folkhälsoperspektiv i ett avsnitt med rekommendationer om prevention på befolkningsnivå. För första gången presenteras i detta sammanhang vetenskaplig evidens och råd åt beslutsfattare.
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| 26. |
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| 27. |
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| 28. |
- Poschke, Isabel C., et al.
(författare)
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The Outcome of Ex Vivo TIL Expansion Is Highly Influenced by Spatial Heterogeneity of the Tumor T-Cell Repertoire and Differences in Intrinsic In Vitro Growth Capacity between T-Cell Clones
- 2020
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Ingår i: Clinical Cancer Research. - : AMER ASSOC CANCER RESEARCH. - 1078-0432 .- 1557-3265. ; 26:16, s. 4289-4301
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: During our efforts to develop tumor-infiltrating lymphocyte (TIL) therapy to counter the devastating recurrence rate in patients with primary resectable pancreatic ductal adenocarcinoma (PDA), we found that PDA TILs can readily be expanded in vitro and that the majority of resulting TIL cultures show reactivity against the autologous tumor. However, the fraction of tumor-reactive T cells is low. We investigated to which extent this was related to the in vitro expansion. Experimental Design: We compared the clonal composition of TIL preparations before and after in vitro expansion using T-cell receptor (TCR) deep sequencing. Our findings for PDA were benchmarked to experiments with melanoma TILs. Results: We found that the TIL TCR repertoire changes dramatically during in vitro expansion, leading to loss of tumor-dominant T-cell clones and overgrowth by newly emerging T-cell clones that are barely detectable in the tumor. These changes are primarily driven by differences in the intrinsic in vitro expansion capacity of T-cell clones. Single-cell experiments showed an association between poor proliferative capacity and expression of markers related to antigen experience and dysfunction. Furthermore, we found that spatial heterogeneity of the TIL repertoire resulted in TCR repertoires that are greatly divergent between TIL cultures derived from distant tumor samples of the same patient. Conclusions: Culture-induced changes in clonal composition are likely to affect tumor reactivity of TIL preparations. TCR deep sequencing provides important insights into the factors that govern the outcome of in vitro TIL expansion and thereby a path toward optimization of the production of TIL preparations with high therapeutic efficacy.
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| 29. |
- Rydell Karlsson, Monica, et al.
(författare)
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Patients with chronic heart failure who plan their own self- care education decrease their outpatient visits
- 2011
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Ingår i: The International Journal of Person Centered Medicine. - 2043-7730 .- 2043-7749. ; 1:4, s. 705-718
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Tidskriftsartikel (refereegranskat)abstract
- Background, aims and objectives: Patient education programs delivering a defined package of information aimed to optimise the care of chronic heart failure have been evaluated. However, there is a lack of knowledge about the effects of programs designed to support the patients’ learning by allowing them to self-direct their learning activities. We aimed to contribute to the associated knowledge base.Method: We compared an intervention group of patients choosing among different learning activities with a control group, where the nurse practitioner scheduled a package of learning activities. One hundred and eighty two patients with chronic heart failure in NYHA class I-IV who were referred to the nurse practitioner outpatient clinic randomised to either a structured control education program (92 patients) or to a self-directed intervention program (90 patients). Additionally, both groups received the same nurse-practitioner based self-care advice and treatment. Outcome measures were quality of life, knowledge acquisition, visits to the outpatient clinic, readmissions and medication during one year.Results: All patients significantly increased their knowledge and quality of life, with no difference between the groups. However, the intervention group patients had fewer visits to the outpatient clinic as compared to controls (p=0.007). This was accomplished without a concomitant increase in re-admission rate. Both groups increased, as intended, their use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers and beta-blockers.Conclusion: In conclusion, our findings show that it is safe and results in fewer outpatient visits if patients with chronic heart failure actively plan their own education program. To encouraging patients taking own decisions lead to an increased self-control of their healthcare behaviour.
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| 30. |
- Thurfjell, Åsa, et al.
(författare)
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SK-kurser i levnadsvanor rustar läkare att motivera hälsosamt val. Svenska läkaresällskapets uppdaterade förslag och kursarrangörers erfarenheter : [SK courses in lifestyle habits. Updated proposals and course organizers' experiences]
- 2024
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 121
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Tidskriftsartikel (refereegranskat)abstract
- The physician has an important role in identifying unhealthy lifestyles, offering counselling and, if necessary, referring the patient to another profession or care unit. Therefore, knowledge and skills related to lifestyle habits are included in the goal description for residents in all clinical specialities. SK courses in lifestyle habits should be based on National Guidelines for Prevention and Treatment - Support for Governance and Management (2018), issued by the Swedish National Board of Health and Welfare. Preferably, the course should include training sessions where the participants can practice the counselling techniques. The ethical principles provide the foundation for work related to lifestyle habits. The course should include evidence-based knowledge on how lifestyle habits affect symptoms, risk factors, and diseases, as well as the effect of changing lifestyle habits. Also, discussions about local routines and the physician's role in addressing lifestyle habits are valuable components of the course.
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| 31. |
- Ögmundsdottir Michelsen, Halldora, et al.
(författare)
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Cardiac rehabilitation after acute myocardial infarction in Sweden : evaluation of programme characteristics and adherence to European guidelines: The Perfect Cardiac Rehabilitation (Perfect-CR) study
- 2020
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 27:1, s. 18-27
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: While patient performance after participating in cardiac rehabilitation programmes after acute myocardial infarction is regularly reported through registry and survey data, information on cardiac rehabilitation programme characteristics is less well described.AIM: The aim of this study was to evaluate Swedish cardiac rehabilitation programme characteristics and adherence to European Guidelines on Cardiovascular Disease Prevention.METHOD: Cardiac rehabilitation programme characteristics at all 78 cardiac rehabilitation centres in Sweden in 2016 were surveyed using a web-based questionnaire (100% response rate). The questions were based on core components of cardiac rehabilitation as recommended by European Guidelines.RESULTS: There was a wide variation in programme duration (2-14 months). All programmes reported offering an individual post-discharge visit with a nurse, and 90% (n = 70) did so within three weeks from discharge. Most programmes offered centre-based exercise training (n = 76, 97%) and group educational sessions (n = 61, 78%). All programmes reported to the national audit, SWEDEHEART, and 60% (n = 47) reported that performance was regularly assessed using audit data, to improve quality of care. Ninety-six per cent (n = 75) had a core team consisting of a cardiologist, a physiotherapist and a nurse and 76% (n = 59) reported having a medical director. Having other allied healthcare professionals included in the cardiac rehabilitation team varied. Forty per cent (n = 31) reported having regular team meetings where nurses, physiotherapists and cardiologist could discuss patient cases.CONCLUSION: The overall quality of cardiac rehabilitation programmes provided in Sweden is high. Still, there are several areas of potential improvement. Monitoring programme characteristics as well as patient outcomes might improve programme quality and patient outcomes both at a local and a national level.
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