| 1. |
- Barman, Linda, 1972-, et al.
(författare)
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Hardness or Resignation : How Emotional Challenges During Work‑Based Education Influence the Professional Becoming of Medical Students and Student Teachers
- 2023
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Ingår i: Vocations and Learning. - : Springer Nature. - 1874-785X .- 1874-7868.
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Tidskriftsartikel (refereegranskat)abstract
- This paper addresses how emotionally challenging experiences during work-basededucation may influence the professional becoming of student teachers and medicalstudents. We conducted a qualitative analysis of eight focus group interviewswith undergraduates from two universities in Sweden who studied to become eitherphysicians or teachers, and interpreted their experiences through Wenger’s theory ofcommunities of practice. The findings show that students’ ideal view of how to becaring in their aspiring professional role as physician or teacher collided with existingpractices, which affected them emotionally. In particular, the students found itchallenging when norms and practices differed from their values of professionalismand when the professional culture within practices reflected hardness (physicians) orresignation (teachers). Both medical students and student teachers experienced thatprofessional decision making and legitimacy challenged them emotionally, howeverin different ways and for different reasons. This study makes visible both generaland specific aspects of how students view their future role in the welfare sector andchallenging dimensions of professional practice. The findings bring into focus thequestion of how professional education can support students’ professional becomingin relation to their emotional challenges.
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| 2. |
- Bjällmark, Anna, et al.
(författare)
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Effects of hemodialysis on the cardiovascular system: Quantitative analysis using wave intensity wall analysis and tissue velocity imaging
- 2010
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Ingår i: Heart and Vessels. - : Springer Science and Business Media LLC. - 0910-8327 .- 1615-2573.
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Tidskriftsartikel (refereegranskat)abstract
- Cardiovascular disease is the leading cause of death in patients with end stage renal disease (ESRD). The aim of this study was to investigate the changes in cardiovascular function induced by a single session of hemodialysis (HD) by the analysis of cardiovascular dynamics using wave intensity wall analysis (WIWA) and of systolic and diastolic myocardial function using tissue velocity imaging (TVI). Grey-scale cine loops of the left common carotid artery, conventional echocardiography and TVI images of the left ventricle were acquired before and after HD in 45 patients (17 women, mean age 54) with ESRD. The WIWA indexes, W1 preload-adjusted W1, W2 and preload-adjusted W2, and the TVI variables, isovolumic contraction velocity (IVCV), isovolumic contraction time (IVCT), peak systolic velocity (PSV), displacement, isovolumic relaxation velocity (IVRV), isovolumic relaxation time (IVRT), peak early diastolic velocity (E’) and peak late diastolic velocity (A’), were compared before and after HD. The WIWA measurements showed significant increases in W1 (p < 0.05) and preload-adjusted W1 (p < 0.01) after HD. W2 was significantly decreased (p < 0.05) after HD, whereas the change in preload-adjusted W2 was not significant. Systolic velocities, IVCV (p < 0.001) and PSV (p < 0.01), were increased after HD, whereas the AV-plane displacement were decreased (p < 0.01). For the measured diastolic variables, E’ was significantly decreased (p < 0.01) and IVRT was significantly prolonged (p < 0.05), after HD. A few correlations were found between WIWA and TVI variables. The WIWA and TVI measurements indicate that a single session of HD improves systolic function. The load dependency of the diastolic variables seems to be more pronounced than for the systolic variables. Preload-adjusted wave intensity indexes may contribute in the assessment of true LV contractility and relaxation.
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| 3. |
- Fehrman-Ekholm, Ingela, 1947, et al.
(författare)
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Serum cystatin C: a useful marker of kidney function in very old people.
- 2009
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Ingår i: Scandinavian journal of clinical and laboratory investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; 69:5, s. 606-11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Serum creatinine-based estimates of GFR may be inaccurate in the elderly and there is need for improvement. Serum Cystatin C, not being influenced by muscle volume, may be more accurate. MATERIAL AND METHODS: GFR was measured with plasma clearance of iohexol in 50 elderly persons aged >70 years. Blood tests were drawn for analysis of creatinine, albumin and urea. Cystatin C was analysed on frozen specimens using the Dade Behring method. GFR estimates based on cystatin C were compared to estimates based on serum creatinine, using earlier published equations. RESULTS: Significant increase with age was found with cystatin C (rs=0.62, p<0.0001) and urea (rs=0.43, p=0.0018) but no correlation with creatinine (rs=0.05, p=0.7502). All equations underestimated GFR with a bias ranging from -2.2 to -31%. The equation with the greatest accuracy was the Hoek equation (Cystatin C based) with 98% of estimates within 30% of mGFR and confidence interval 89-100%. Estimated GFR using the MDRD Study equations (creatinine based) showed accuracy of 94% with 4 or 6 factors used. There was a gender difference with an accuracy higher among males (p<0.002). The Cockcroft Gault equation was not found useful with high bias and a low accuracy. CONCLUSION: S-cystatin C seems a useful marker for kidney function in the elderly. Two equations based on serum cystatin C as well as the two MDRD equations seem adequate for estimating kidney function.
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| 4. |
- Hayashi, Shirley Yumi, et al.
(författare)
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A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease : A pilot tissue synchronization imaging study
- 2008
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 23:11, s. 3622-3628
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Tidskriftsartikel (refereegranskat)abstract
- Background. Mechanical left ventricular (LV) dyssynchrony impairs cardiac function in patients with heart failure and LV hypertrophy (LVH) and may be a factor contributing to the high incidence of cardiac deaths in patients with end-stage renal disease (ESRD). Objectives. To evaluate the possible presence of LV dyssynchrony in ESRD patients, and acute effect of haemodialysis (HD) on LV synchronicity using a tailored echocardiographic modality, tissue synchronization imaging (TSI). Methods. In 13 clinically stable ESRD patients (7 men; 65 +/- 10 years) with LVH, echocardiography data were acquired before and after a single HD session for subsequent off-line TSI analysis enabling the retrieval of regional intraventricular systolic delay data. Six basal and six midventricular LV segments were evaluated. Dyssynchrony was defined as a regional difference in time to peak systolic velocity > 105 ms. Results. Before HD, all patients had at least one dyssynchronous LV segment. The percentage of delayed segments correlated positively to LV end-diastolic diameter (r = 0.68, P < 0.05). HD induced a substantial decrease in the percentage of delayed segments from 36 +/- 25% to 19 +/- 14% (P < 0.01), reduced average maximal mechanical systolic LV delay from 300 +/- 89 to 225 +/- 116 ms (P < 0.05) and completely normalized LV synchronicity in three patients (23%). Conclusions. LV dyssynchrony appears to be present frequently in ESRD patients with LVH. The severity of LV dyssynchrony correlates with LV end-diastolic diameter and decreases after a single session of HD suggesting a mechanistic relevance of volume overload and possibly other toxins accumulating in HD patients.
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| 5. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Acute effects of low and high intravenous doses of furosemide on myocardial function in anuric haemodialysis patients : a tissue Doppler study
- 2008
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 23:4, s. 1355-1361
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Tidskriftsartikel (refereegranskat)abstract
- Background. In patients with pulmonary oedema and preserved renal function, furosemide has not only a renal, but also a vascular effect, causing a rapid fall in left ventricular filling pressure accompanied by an increase in venous compliance. Previous studies have shown conflicting findings regarding the vascular effects of furosemide in patients with end-stage renal disease (ESRD). The objective of our study was to investigate whether furosemide induces changes in central cardiac haemodynamics in anuric ESRD patients, using conventional echocardiography and colour tissue Doppler velocity imaging (TVI), a new quantitative and sensitive method. Methods. Repeated low doses (40 mg followed by an additional dose of 40 mg after 30 min) of i.v. furosemide were administered to 12 (61.6 +/- 16 years, 7 men) and a high dose (250 mg) of i.v. furosemide to 6 (64.1 +/- 3.6 years, 5 men) clinically stable anuric haemodialysis (HD) patients. Conventional two-dimensional echocardiography and colour TVI images were recorded immediately before (0 min) the furosemide infusion in both groups, and in the group receiving the repeated low-dose infusion (at 0 and 30 min), 10, 20, 30, 40, 50 and 70 min after the administration of the first infusion. In the group receiving the single high dose of furosemide the ultrasound investigation was repeated 10, 20, 30 and 40 min after the infusion. The myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVC), peak systole (PS), early (E') and late (A') myocardial diastolic filling velocities were measured in the left ventricle (LV) at six sites (infero-septal, antero-lateral, inferior, anterior, infero-lateral and antero-septal walls) at the basal region. IVC time (IVCT), IV relaxation time (IVRT), PS time (PSt), RR interval, mitral annulus motion (MAM), strain rate (SR), left ventricular filling pressure (E/E') and cardiac output were also measured. The average of the different walls was used to evaluate global function. Right ventricle (RV) dynamics was evaluated from measurements of IVC velocity (IVCv), peak systolic velocity (PSv), E' and A' from the RV free wall. Results. No significant changes in cardiac output, IVCv, PSv, SR, MAM, E', A', E'/A', IVRT and LV filling pressure were observed, indicating that neither 40 mg (plus additional 40 mg after 30 min) nor 250 mg of furosemide had any measurable effects on LV filling pressure and LV and RV systolic and diastolic function. Conclusions. In anuric HD patients, low and high doses of furosemide had no significant effects on central cardiac haemodynamics. Therefore, the use of furosemide infusion in anuric ESRD patients with acute pulmonary oedema is not supported by the results of this study.
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| 6. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Analysis of mitral annulus motion measurements derived from M-mode, anatomic M-mode, tissue Doppler displacement, and 2-dimensional strain imaging
- 2006
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 19:9, s. 1092-1101
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Tidskriftsartikel (refereegranskat)abstract
- Background: Left ventricular longitudinal shortening plays an important role in cardiac contraction and can be measured by the mitral annulus motion (MAM) toward the cardiac apex. MAM can be evaluated by conventional M-mode, anatomic M-mode (AM-mode), tissue Doppler displacement (TDD), and 2-dimensional strain imaging (2DSI). Objective: The aim of the study was to compare these 4 different methods for measuring MAM. Methods: MAM was evaluated in 25 patients by M-mode, AM-mode, TDD, and 2DSI. Two walls (septal and lateral) in apical 4-chamber view were analyzed. Results. The angle correction between M-mode and AM-mode was significantly higher in the lateral wall (septum 2.2+/-1.6 vs lateral 4.1+/-1.6 degrees, P<0.01). However, with angle correction up to 8 degrees, the measurements obtained were not significantly different from those obtained by M-mode. No significant differences were found among 2DSI. M-mode, and AM-mode either, although all of them were significantly higher in comparison with TDD measurements in both septal (M-mode [11.0 +/- 2.4 nun], AM-mode [11.8 +/- 2.4 mm], 2DSI [11.0 +/- 3.4 mm] vs TDD [9.2 +/- 3.3 mm], P<.01) and lateral (M-mode [11.9 +/- 2.3 min], AM-mode [12.4 +/- 2.8 mm], 2DSI [10.4 +/- 3.9 mm] vs TDD [8.9 +/- 3.0 mm], P<.05) walls. The +/- 2SD variation from the mean difference in septal and lateral walls were, respectively, between: M-mode and TDD, -2.4 to 5.9 and -2.2 to 8.2 mm; M-mode and 2DSI, -5.7 to 5.7 and -5.8 to 8.7; AM-mode and TDD, -2.5 to 5.6 and -2.7 to 9.6; AM-mode and 2DSI, -5.7 to 5.87 and -5.9 to 9.8 and TDD and 2DSI, -3.2 to 6.6 and -5.3 to 8.4. Conclusions: AM-mode and M-mode measurements did not differ significantly. Despite the good correlation among all methods they were not interchangeable. TDD measurements were significantly lower than M-mode, AM-mode, and 2DSI measurements. M-mode and AM-mode are angle dependent and can, therefore, underestimate or overestimate MAM. The new method of 2DSI is promising because it tracks natural acoustic markers and is not angle dependent and, therefore, measures the true local tissue motion.
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| 7. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Improvement of cardiac function after haemodialysis : Quantitative evaluation by colour tissue velocity imaging
- 2004
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 19:6, s. 1497-1506
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Tidskriftsartikel (refereegranskat)abstract
- Background. Overhydration and accumulation of uraemic toxins may influence the myocardial function in haemodialysis (HD) patients. To evaluate cardiac function and the effects of fluid and solute removal during a single session of HD, colour tissue velocity imaging (TVI) was used. This new technique, which is less load dependent than conventional echocardiography, allows an objective quantitative assessment of myocardial contractility, contraction and relaxation. Methods. Conventional echocardiographic and TVI images were recorded before and after a single HD session in 13 clinically stable HD patients (62 +/- 10 years, six males) and in 13 sex- and age-matched healthy controls. Myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVC), peak systole (PS), early (E) and late (A') diastolic filling and strain rate (SR) were measured. Results. Left ventricular hypertrophy (LVH) was present in 12 patients. TVI gave additional information in comparison with conventional echocardiography. Before HD, PS (5.0 +/- 0.8 vs 6.0 +/- 1.2 cm/s, P < 0.05), E' (5.7 +/- 1.7 vs 7.3 +/- 2.0 cm/s, P < 0.05) and A' (6.6 +/- 1.7 vs. 8.3 +/- 2.9 cm/s, P < 0.05) velocities were lower in the patients than in the controls, indicating systolic and diastolic dysfunction. The HD session increased IVCv (4.0 +/- 1.7 to 5.5 +/- 1.9 cm/s; P < 0.001), PSv (5.0 +/- 0.8 to 5.7 +/- 0.8 cm/s; P < 0.05) and SR (0.7 +/- 0.2 to 0.9 +/- 0.2 1/s; P < 0.05) and decreased E/E' (16.7 +/- 7.7 to 12.2 +/- 4.0, P < 0.05), indicating improved systolic function and decreased LV filling pressure, respectively. Linear regression analysis demonstrated a dependency of systolic contraction (PSv) and contractility (IVCv) upon plasma levels of phosphate (r(2) = 0.70, P < 0.005, r(2) = 0.33, P < 0.01). Conclusions. Using TVI, HD patients demonstrate myocardial dysfunction, which is found less frequently when using conventional echocardiography. The systolic function seems to be impaired by high plasma levels of phosphate and an increased Ca x P product. One single session of HD improved systolic function as indicated by increases in IVCv, PSv and SR. Further studies are needed to clarify if this effect of HD is due to the acute removal of fluid, the removal of solutes or both.
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| 8. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging
- 2006
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 21:1, s. 125-132
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Tidskriftsartikel (refereegranskat)abstract
- Background. Cardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients. Tissue Doppler velocity imaging (TVI) is a new objective method that accurately quantifies myocardial tissue velocities, deformation, time intervals and left ventricular (LV) filling pressure. In this study, TVI was compared with conventional echocardiography for the assessment of left ventricular (LV) function in pre-dialysis patients with different stages of CKD. The results obtained by TVI were used to analyse possible relationships between LV function and clinical factors such as hyperparathyroidism and hypertension that could influence LV function. Methods. Conventional echocardiography and TVI images were recorded in 40 patients (36 men and 4 women, mean age 60 +/- 14 years, range 28-80 years) and in 27 healthy controls (21 men and 6 women, mean age 58 +/- 17 years, range 28-82 years). Twenty-two patients had mild/moderate CKD (CCr > 29 ml/min; Group 1) and 18 patients had severe CKD (CCr <= 29 ml/min; Group 2). Using TVI, the myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVCv), peak systole (PSv), early (E') and late (A') diastolic filling velocities as well as strain rate (SR), mitral annulus displacement, isovolumetric relaxation time (IVRT) and LV filling pressure were estimated using TVI. The average of six LV wall measurements was used to evaluate LV global function. Results. Using TVI, we were able to identify significantly more patients with diastolic dysfunction than using conventional echocardiography (33 vs 26, P < 0.05). There was no difference in the prevalence of diastolic dysfunction between Group 1 and 2. However, using TVI, Group 2 CKD patients had lower E' velocities (6.2 +/- 1.9 vs 8.0 +/- 2.9 cm/s, P < 0.05) and higher IVRT (137.4 +/- 13 vs 88.2 +/- 26 ms, P < 0.001) in comparison with controls, indicating more accentuated diastolic dysfunction. Systolic blood pressure (SBP) was associated with E' velocities (rho = -0.68, P < 0.005) and E'/A' was strongly associated with SBP (rho = -0.60; P < 0.01) and PTH (rho = -0.64, P < 0.005) in Group 2. Using conventional echocardiography, there was no difference in the prevalence of systolic and diastolic dysfunction between patients with and without LVH. However, using TVI, patients with LVH had significantly lower IVCv (2.8 +/- 1.3 vs 3.8 +/- 1.5 and 3.8 +/- 1.5 cm/s, P < 0.05) and PSv (5.5 +/- 1.0 vs 6.3 +/- 1.2 and 6.4 +/- 1.3 cm/s, P < 0.05) compared with patients without LVH and controls, and they also had lower E' velocities (7.1 +/- 2.7 vs 8.0 +/- 2.9 cm/s, P < 0.05) compared with controls, indicating disturbances in systolic and diastolic left ventricular function. Conclusions. TVI provided additional information on left ventricular function in CKD patients. In patients with advanced renal failure, TVI revealed more accentuated diastolic dysfunction associated with increased systolic blood pressure (SBP) and increased levels of PTH. TVI also demonstrated disturbances in contractility and contraction in patients with LVH, which could not be detected by conventional echocardiography.
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| 9. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Left ventricular mechanical dyssynchrony in patients with different stages of chronic kidney disease and the effects of hemodialysis
- 2013
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Ingår i: Hemodialysis International. - : Wiley-Blackwell. - 1492-7535 .- 1542-4758. ; 17:3, s. 346-358
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Tidskriftsartikel (refereegranskat)abstract
- Left ventricular (LV) dyssynchrony is a known cause of mortality in patients with heart failure and may possibly play a similar role in patients with chronic kidney disease (CKD) in whom sudden death is one of the most common and as yet not fully explained cause of death. LV synchronicity and its relationship with increased volume load and various biomarkers was analyzed in 145 patients including 53 patients with CKD stages 3 and 4 and in 92 CKD stage 5 patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) using color tissue Doppler imaging and tissue synchronization imaging. The HD patients were evaluated both before and after a single HD session. LV dyssynchrony was defined as a regional difference in time to peak systolic myocardial velocity, between 12 LV segments>105milliseconds. LV dyssynchrony was present in 54% of the patients with no difference between CKD 3 and 4 (58%), HD (48%), and PD (51%). LV dyssynchrony was independently associated with LV mass index and increased estimation of LV end-diastolic pressure. A single HD session resulted in significant changes in LV synchronicity variableswith improvement in 50% of the patientsespecially in patients with higher myocardial systolic velocities and lower LV mass index. Abnormalities in LV synchronicity are highly prevalent in CKD patients already prior to dialysis treatment and are associated with LV hypertrophy, LV dysfunction and load conditions, underlining the importance of volume status for LV synchronicity in CKD patients.
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| 10. |
- Isaksson, Elin, et al.
(författare)
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Is low pre-transplant parathyroid hormone a risk marker for cardiovascular disease in long-term follow-up of renal transplant recipients?
- 2018
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Ingår i: Clinical and Experimental Nephrology. - : Springer Science and Business Media LLC. - 1342-1751 .- 1437-7799. ; 22:5, s. 1188-1197
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Tidskriftsartikel (refereegranskat)abstract
- Background: Secondary hyperparathyroidism and altered levels of parathyroid hormone (PTH) are associated with vascular events in chronic kidney disease. After renal transplantation, this association is not clear. Pre-transplant parathyroidectomy (PTX) is common, but post-transplant data are scarce. We aimed to study the effect of PTH at the time of transplantation on risk of post-transplant vascular events in renal transplant recipients with and without pre-transplant PTX. Methods: 258 patients from two Swedish transplant units were followed for 6 years. Separate analyses were made for patients with or without pre-transplant PTX. Patients with no pre-transplant PTX were stratified by quartiles of PTH at time of transplantation and patients with pre-transplant PTX were stratified by above and below median levels of PTH at time of transplantation. Hazard ratios for vascular events, mortality, and graft failure were calculated in adjusted Cox regression models. Results: In patients with no pre-transplant PTX, the lowest quartile of PTH at transplantation had a higher risk of cardiovascular events compared to quartile 3 with an adjusted hazard ratio (95% CI) of 2.63 (1.04–6.67). In patients with pre-transplant PTX, the group below median of PTH had a higher risk of cardiovascular events with an adjusted hazard ratio (95% CI) of 18.15 (1.62–203.82) compared to patients above median of PTH. Conclusion: Low levels of parathyroid hormone before transplantation were associated with increased risk of post-transplant vascular events both in patients with and without pre-transplant parathyroidectomy. Any conclusions on causal or direct effect of PTH on outcome cannot be drawn from this observational study.
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| 11. |
- Lönn, Annalena, et al.
(författare)
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The impact of emotionally challenging situations on medical students’ professional identity formation
- 2023
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Ingår i: Advances in Health Sciences Education. - : SPRINGER. - 1382-4996 .- 1573-1677. ; 28, s. 1557-1578
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Tidskriftsartikel (refereegranskat)abstract
- In their interactions with patients and health care professionals during work-based learning, medical students are known to experience emotionally challenging situations that can evoke negative feelings. Students have to manage these emotions. Students learn and develop their professional identity formation through interactions with patients and members of the healthcare teams. Earlier studies have highlighted the issues involved with processing emotionally challenging situations, although studies concerning learning and professional identity formation in response to these experiences are rare. In this study, we explored medical students’ experiences of emotionally challenging situations in work-based learning, and the impact these experiences had on forming medical students’ professional identities. We conducted an analysis of narrative data (n = 85), using a constructivist grounded theory approach. The narratives were made up of medical students’ reflective essays at the end of their education (tenth term). The analysis showed that students’ main concern when facing emotionally challenging situations during their work-based education was the struggle to achieve and maintain a professional approach. They reported different strategies for managing their feelings and how these strategies led to diverse consequences. In the process, students also described arriving at insights into their own personal needs and shortcomings. We consider this development of self-awareness and resulting self-knowledge to be an important part of the continuously ongoing socialization process of forming a professional identity. Thus, experiencing emotionally challenging situations can be considered a unique and invaluable opportunity, as well as a catalyst for students’ development. We believe that highlighting the impact of emotions in medical education can constitute an important contribution to knowledge about the process of professional identity formation. This knowledge can enable faculty to provide students with more effective and sufficient support, facilitating their journey in becoming physicians.
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| 12. |
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| 13. |
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| 14. |
- Ottosson-Seeberger, Astrid
(författare)
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Cardiovascular and metabolic effects of endothelins in man : an experimental and clinical study
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Increased plasma concentrations of endothelin-1 (ET-1) and of its propeptide big endothelin-1 have been reported in diseases associated with endothelial dysfunction, cardiovascular remodelling and insulin resistance. In this thesis, we studied the hemodynamic effects of big ET-1 in healthy humans focusing on the mechanisms of the effects (study I-IV). We also investigated whether ET-1 and big ET-1 preserve their vasoactive potency in the presence of end-stage renal failure, since permanently increased plasma levels of ET, which are seen in this condition, do not necessarily imply an increased endothelin activity. In addition, we studied the way in which the hemodialysis procedure and ischemic heart disease affect plasma concentrations of ET-1 and big ET-1 in chronic hemodialysis patients (study V). Finally we studied the effects of ET-1 on insulin sensitivity and the vasoactive interactions between insulin and ET-1 in healthy humans (study VI). We made the following findings: I) Exogenous big ET-1 caused potent and long-lasting cardiovascular effects in healthy humans as demonstrated by an increase in mean arterial blood pressure and a decrease in heart rate, cardiac output and stroke volume and a fall in renal and splanchnic blood flow. Circulating big ET-1 was removed from the circulation in the renal and splanchnic vascular beds and probably also in the vasculature of forearm skeletal muscle with a plasma half-life that was longer than that previously shown for ET-1. The renal and splanchnic extraction of big ET-1 appeared to be accompanied by regional conversion of big ET-1. Big ET-1 itself was demonstrated to be without major intrinsic vasoactivity. The C-terminal big ET-1 (22-3 8) fragment, which is also formed during the conversion of big ET-1 to ET-1, had no intrinsic vasoactive potency or capacity to potentiate the cardiovascular effects of ET-1. II) Circulating ET-1 and big ET-1 preserved their vasoactive potency in end-stage renal failure. Thus, big ET-1 seems to be converted to ET-1 even in the presence of renal insufficiency. The plasma half-lives of both peptides were significantly prolonged compared with those of healthy subjects. Chronic hemodialysis patients with ischemic heart disease had higher plasma concentrations of ET-1 and big ET-1 than hemodialysis patients without this disorder. Hemodialysis lowered plasma levels of ET-1 and big ET-1 whereby high-flux membranes removed big ET-1 more efficiently than low-flux membranes. III) Exogenous ET-1 induced peripheral insulin resistance as demonstrated by a decrease in whole-body and leg glucose uptake without causing any changes in leg blood flow. Furthermore, ET-1 blocked not only the metabolic but also the vasoactive potency of insulin in healthy humans. In summary, we demonstrated that circulating ET-1 and big ET-1 give rise to symtoms commonly noted in cardiovascular diseases which are associated with increased plasma concentrations of ET-1 and big ET-1. Since exogenous ET-1 and big ET-1 were shown to preserve their vasoactive potency in the presence of permanently elevated plasma levels of endogenous ET-1 and big ET-1, we conclude that ET-1 and big ET-1 could conceivably contribute to the genesis of endothelial dysfunction, cardiovascular remodelling and insulin resistance in cardiovascular diseases.
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| 15. |
- Pleijel, Agneta, et al.
(författare)
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Agneta Pleijel, Torgny Lindgren, Gertrude Stein, Ingo Schulze, Heinrich Böll, Reflection on Argentine identity, Filmöversättning och språklekar
- 2008
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- InnehållRed: InledningAgneta Pleijel: Varför litteraturen?Maria Bergom-Larsson: Lord Nevermore – Europa genom den kvinnliga blickenSverker Ek: ”Utan berättelser förtorkar tiden”. Kring Agneta Pleijels roman Lord NevermoreAstrid Seeberger: Om mörkret kring människorna som bör skingras. Agneta Pleijels sökande efter sanningen – om den nu finnsIngela Pehrson Berger: ”Jag avbildar inte världen sådan som vi ser den.” Konsten som tema i fyra berättelser av Torgny LindgrenIngemar Haag: Om sanning och lögn i självbiografisk mening. Gertrude Steins The Autobiography of Alice B. Toklas och Evererybody’s AutobiographKatharina Strohkirch: Der gejagte Jäger. Emsige Erwerbslosigkeit in Ingo Schulzes CalcuttaThorsten M. Päplow: Heinrich Bölls Irländsk dagbok. Ett exempel på potentialen hos reselitteraturDébora Rottenberg: Identity rewritten: the representation of Indians and Britons in Argentine novels taking place in Tierra del FuegoThorsten Schröter: På spaning efter den wit som flytt: dubbning och textning av språklekar i film
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| 16. |
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| 17. |
- Seeberger, Astrid, et al.
(författare)
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Can empathy be preserved in medical education?
- 2020
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Ingår i: International Journal of Medical Education. - : INT JOURNAL MEDICAL EDUCATION-IJML. - 2042-6372. ; 11, s. 83-89
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to investigate changes in empathy during medical education, as well as to identify promoters and inhibitors of empathy and analyse their roles. Methods: We used qualitative content analysis to examine 69 critically reflective essays written by medical students as a part of their final examination at the end of the medical program. The essays were based on previous self-evaluations performed each term and represented retrospective reflections on their professional development. Results: A majority of the students felt that their empathy did not decrease during medical education. On the contrary, many felt that their empathy had increased, especially the cognitive part of empathy, without loss of affective empathy. Many of them described a professionalisation process resulting in an ability to meet patients with preserved empathy but without being overwhelmed by emotions. They identified several factors that promoted the development of empathy: a multiplicity of patients, positive role models, and educational activities focusing on reflection and self-awareness. They also identified inhibitors of empathy: lack of professional competence and a stressful and empathy-hostile medical culture. Conclusions: Our analysis of these retrospective reflections by students suggests that empathy can be preserved during medical education, despite the presence of important inhibitors of empathy. This finding might be due to the presence of more potent promoters and/or to the fact that educational activities might result in a decreased susceptibility to empathy-decreasing circumstances.
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| 18. |
- Weurlander, Maria, 1969-, et al.
(författare)
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Development and validation of the physician self-efficacy to manage emotional challenges Scale (PSMEC)
- 2024
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Ingår i: BMC Medical Education. - : Springer Nature. - 1472-6920. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Medical students experience emotional challenges during their undergraduate education, often related to work-based learning. Consequently, they may experience feelings of uncertainty and self-doubt, which can negatively affect their well-being. Therefore, it is crucial to support students’ development of their ability to manage distressful situations. Self-efficacy beliefs may be a central aspect of supporting them in this development, and have been shown to relate to resilient factors such as students’ motivation, learning, and well-being.Methods We constructed a scale to measure medical students’ physician self-efficacy to manage emotional challenges during work-based learning, the PSMEC scale. The aim of the present study was to evaluate some of the psychometric properties of the PSMEC scale. The scale consists of 17 items covering five subscales: (1) medical knowledge and competence, (2) communication with difficult patients and delivering bad news, (3) being questioned and challenged, (4) educative competence in patient encounters, and (5) ability to establish and maintain relationships with healthcare professionals. Data were collected from 655 medical students from all seven medical schools in Sweden. To investigate the scale’s dimensionality and measurement invariance with regard to gender and time in education, single and multiple group confirmatory factor models were estimated using techniques suitable for ordered categorical data. Measures of Cronbach’s alpha were calculated to evaluate internal consistency.Results The scale showed good internal consistency on both the global dimension and the five subdimensions of self-efficacy. In addition, the scale was shown to be measurement invariant across genders and times in education, indicating that the scale means of male and female medical students and the scale means of students at the middle and end of their education can be compared.Conclusions The physician self-efficacy to manage emotional challenges scale demonstrated satisfactory psychometric properties, with regards to dimensionality, internal consistency, and measurement invariance relating to gender and time in education, and this study supports the usefulness of this scale when measuring self-efficacy in relation to emotional challenges.
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| 19. |
- Weurlander, Maria, 1969-, et al.
(författare)
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Emotional challenges of medical students generate feelings of uncertainty
- 2019
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Ingår i: Medical Education. - : John Wiley & Sons. - 0308-0110 .- 1365-2923. ; 53, s. 1037-1048
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES Health care students face many situations during their education that might be emotionally challenging. Students are confronted with illness, suffering, death, patient treatment dilemmas, and witnessing unprofessional behaviour on the part of health care professionals. Few studies have focused on what these experiences lead to inrelation to the process of becoming a professional. The purpose of the study was toexplore medical students’ main concerns relating to emotionally challenging situations during their medical education.METHODS A constructivist grounded theory approach was used to explore and analyse medical students’ experiences. Data were gathered by means of focus group interviews, including two interviews in the middle and two interviews at the end of the students’ undergraduate programme. A total of 14 medical students participated.RESULTS Students’ main concerns relating to emotionally challenging situations were feelings of uncertainty. These feelings of uncertainty concerned: (i) insufficient knowledge and skills; (ii) the struggle to manage emotions in patient encounters; (iii)perceived negative culture and values amongst health care professionals and in the health care system, and (iv) lacking a self-evident position on the health care team. The first two aspectsr elate to uncertainties concerning their own capabilities and the other two aspects relate to uncertainties regarding the detached medical culture and the unclear expectations of them as students in the health care team.CONCLUSIONS In the process of becoming a physician, students develop their professional identity in constant negotiation with their own perceptions, values and norms and what they experience in the local clinical context in which they participate during workplace education. The two dimensions that students have to resolve during this process concern the questions: Do I have what it takes? Do I want to belong to this medical culture? Until these struggles are resolved, students are likely to experience worry about their future professional role.
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| 20. |
- Weurlander, Maria, 1969-, et al.
(författare)
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How do medical and nursing students experience emotional challenges during clinical placements?
- 2018
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Ingår i: International Journal of Medical Education. - : International Journal of Medical Education. - 2042-6372. ; 9, s. 74-82
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate which kinds of situations medical and nursing students found emotionally challenging during their undergraduate education, and how they managed their experiences.Methods: This study used an exploratory research design. We gathered qualitative data using an open-ended questionnaire distributed to students in the middle and at the end of their education. In total, 49 nursing and 65 medical students participated. Also, five students were interviewed individually to acquire richer data. Data were analysed using narrative thematic analysis.Results: Medical and nursing students experienced a range of situations during their undergraduate education that they found emotionally challenging, mainly during clinical placements. The students’ narratives concerned confronting patients’ illness and death, unprofessional behaviour among healthcare professionals, dilemmas regarding patient treatment, students relating to patients as individuals and not diagnoses, and using patients for their own learning. The narratives concerned both the formal and the hidden curriculum, i.e., what is included in the profession (confronting illness and death), and what is not (unprofessional behaviour among healthcare professionals). Students managed their experiences by talking to trusted peers or supervisors, and by getting used to these situations.Conclusions: Despite the different knowledge, experiences, and conditions for medical and nursing students, our findings suggest that their experiences of emotional challenges are similar. Support and opportunities to talk about these experiences are important. Teachers, supervisors, and students need to be aware that students might experience emotionally difficult situations, and that the students need time for reflection and support.
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| 21. |
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