| 1. |
|
|
| 2. |
- Frank, Catharina, 1961-, et al.
(författare)
-
Ethics rounds in the ambulance service: a qualitative evaluation
- 2024
-
Ingår i: BMC Medical Ethics. - : Springer Nature. - 1472-6939. ; 25:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundIt is a common ethical challenge for ambulance clinicians to care for patients with impaired decision-making capacities while assessing and determining the degree of decision-making ability and considering ethical values. Ambulance clinicians’ ethical competence seems to be increasingly important in coping with such varied ethical dilemmas. Ethics rounds is a model designed to promote the development of ethical competence among clinicians. While standard in other contexts, to the best of our knowledge, it has not been applied within the ambulance service context. Thus, the aim of this study was to describe ambulance clinicians’ experiences of participating in ethics rounds.MethodsThis was a qualitative descriptive study, evaluating an intervention. Data were collected through sixteen interviews with ambulance clinicians who had participated in an intervention involving ethics rounds. The analysis was performed by use of content analysis.ResultsTwo themes describe the participants’ experiences: (1) Reflecting freely within a given framework, and (2) Being surprised by new insights. The following categories form the basis of the themes; 1a) Gentle guidance by the facilitator, 1b) A comprehensible structure, 2a) New awareness in the face of ethical problems, and 2b) Shared learning through dialogue.ConclusionIncorporating structured ethics rounds seems to create a continuous development in ethical competence that may improve the quality of care in the ambulance service. Structured guidance and facilitated group reflections offer ambulance clinicians opportunities for both personal and professional development. An important prerequisite for the development of ethical competence is a well-educated facilitator. Consequently, this type of ethics rounds may be considered a useful pedagogical model for the development of ethical competence in the ambulance service.
|
|
| 3. |
- Andersson, Henrik, et al.
(författare)
-
Ethics education to support ethical competence learning in healthcare : an integrative systematic review
- 2022
-
Ingår i: BMC Medical Ethics. - : BioMed Central. - 1472-6939. ; 23
-
Forskningsöversikt (refereegranskat)abstract
- Background: Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethi- cal values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.Methods: In this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 arti- cles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.Results: The review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previ- ously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.Conclusions: The review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations.
|
|
| 4. |
- Bennesved, Anna, et al.
(författare)
-
Ambulance clinicians’ understanding of older patients’ self-determination : A vignette study
- 2023
-
Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; , s. 1-13
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy.Aim: To describe ambulance clinicians’ understanding of older patients’ self-determination when the pa- tient’s decision-making ability is impaired.Research design: A qualitative design with an inductive approach, guided by descriptive phenomenology.Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews.Ethical considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority.Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination.Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous.
|
|
| 5. |
- Fager, Cecilia, et al.
(författare)
-
Nurses' use of an advisory decision support system in ambulance services : A qualitative study
- 2024
-
Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648.
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: To illuminate from the perspective of nurses in ambulance services the experiences of using a web-based advisory decision support system to assess care needs and refer patients.Design: Inductive and descriptive approaches.Method: Thirteen semi-structured interviews were conducted in the spring of 2020. The data were analysed through the reflexive thematic analysis.Results: The Swedish web-based advisory decision support system (ADSS) was found to strengthen nurses' feelings of security when they assess patients' care needs, promote their competence and professional pride, and help them manage stress. However, the system also generated difficulties for nurses to adjust to the dynamic ambulance team and revealed a discrepancy between their professional roles and responsibilities to refer patients and provide self-care advice. The nurses thought that the support system facilitated their increased participation and helped them understand patients and significant others by offering transparency in assessment and decision making. Thus, the support system provides nurses with an opportunity to strengthen patients' independence through information and education. However, in the care relationship, nurses worked to overcome patients' expectations.Conclusion: Nurses using the ADSS increased their security while performing assessments and referrals and found new opportunities to provide information and promote understanding of their decisions. However, nursing care values can be threatened when new support systems are introduced, especially as ambulance services become increasingly protocol-driven.Implications for Profession and/or Patient Care: These findings have implications for nurses' work environments and help them maintain consistency in making medical assessments and in providing equivalent self-care advice when referring patients to the different levels of care. The findings will also impact researchers and policymakers who formulate decision support systems.Reporting Method: Consolidated criteria for reporting qualitative research (COREQ).Patient or Public Contribution: None.
|
|
| 6. |
- Funkquist, Anders, 1977-, et al.
(författare)
-
Low CSF/serum ratio of free T4 is associated with decreased quality of life in mild hypothyroidism – A pilot study : CSF/s-T4 associated with QoL in hypothyroidism
- 2020
-
Ingår i: Journal of Clinical and Translational Endocrinology. - Netherlands : Elsevier BV. - 2214-6237. ; 19
-
Tidskriftsartikel (refereegranskat)abstract
- Background & Objective: Patients with mild hypothyroidism often are depressed and have impaired quality of life despite serum free-T4 and T3 within reference values. Therefore, we investigated whether their symptoms were dependent on the concentrations of free -T4 and T3 in the circulation and cerebrospinal fluid (CSF). Methods: Twenty-five newly diagnosed, untreated hypothyroid subjects and as many age- and sex-matched healthy controls were investigated. Blood and CSF sampling was performed in the morning after an overnight fast. Quality of life (QoL) was assessed by a Likert scale. In the hypothyroid subjects, the MADRS rating scale was also used to evaluate symptoms of depression. Furthermore, the results obtained by the questionnaires were related to serum and CSF levels of free- T4 and T3 as well as the ratios between them in CSF and in serum. Results: Self-reported health was considerably lower in hypothyroid subjects. MADRS was considerably higher than the normal range for healthy individuals. Low CSF/serum free-T4 ratio was correlated with an increased depressed state according to MADRS (p < 0.01), and in addition, CSF/serum free-T4 ratio correlated positively with the self-reported general health Likert scale (p < 0.05). Concentrations of TSH, or free-T3 in serum or CSF, were not associated with an increased depressed state or self-reported general health. Conclusions: Low CSF/serum ratio of free-T4 was correlated with impaired general health and mood, in contrast to serum measurements not showing any correlations. These findings might partly explain why some patients with hypothyroidism suffer from mental symptoms, despite adequate serum levels of free-T4. However, the findings need to be confirmed in further and larger studies.
|
|
| 7. |
- Holmberg, Bodil, 1970-, et al.
(författare)
-
Self-determination in older patients: Experiences from nurse-dominated ambulance services
- 2024
-
Ingår i: Journal of Advanced Nursing. - : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; , s. 1-11
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe ambulance clinicians' experiences of self-determination in older patients.Design: The study had an inductive and explorative design, guided from a life-world perspective.Methods: Thirty-two Swedish ambulance clinicians were interviewed in six focus groups in November 2019. The data were analysed with content analysis, developing manifest categories and latent themes.Findings: The ambulance clinicians assessed the older patients' exercise of self-determination by engaging in conversation and by being visually alert, to eventually gain an overall picture of their decision-making capacity. This assessment was used as a platform when informing older patients of their rights, thus promoting their participation in care. Having limited time and narrow guidelines counteracted ambulance clinicians' ambitions to support older patients' general desire to avoid hospitalization, which resulted in an urge to displace their responsibility to external decision-makers.Conclusion: Expectations that older patients with impaired decision-making ability will give homogeneous responses mean an increased risk of ageist attitudes with a simplified view of patient autonomy. Such attitudes risk the withholding of information about options that healthcare professionals do not wish older patients to choose. When decision-making is difficult, requests for expanded guidelines may paradoxically risk alienation from the professional nursing role.Implications and Impact: The findings show ambulance clinicians' unwillingness to shoulder their professional responsibility when encountering older patients with impaired decision-making ability. In assuming that all older patients reason in the same way, ambulance clinicians tend to adopt a simplistic and somewhat ageist approach when it comes to patient autonomy. This points to deficiencies in ethical competence, which is why increased ethics support is deemed suitable to promote and develop ethical competence. Such support can increase the ability to act as autonomous professionals in accordance with professional ethical codes.Reporting Method: This study adhered to COREQ guidelines.Patient and Public Contribution: None.
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Jacobsson, Amanda, et al.
(författare)
-
”Ambulanssjukvården behöver genomgripande förändringar”
- 2021
-
Ingår i: Dagens Medicin. - : Dagens Medicin. - 1402-1943. ; :2021-06-23
-
Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Debattörer från Ambulance health research network vill se en nationell ledningsstruktur, ökad evidens för vården, akademisk kompetens i ledningsfunktioner samt en nationell utbildnings- och kompetensstandard.
|
|
| 11. |
- Svensson, Anders, 1977-, et al.
(författare)
-
Ambulance clinicians' attitudes to older patients' self-determination when the patient has impaired decision-making ability : a Delphi study
- 2022
-
Ingår i: International Journal of Older People Nursing. - : Wiley-Blackwell Publishing Inc.. - 1748-3735 .- 1748-3743. ; 17:2
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision-making ability is impaired. Self-determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients ’self-determination in cases where patients have impaired decision-making ability, and who are in urgent need of care.Materials and methods: An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N = 31) of prehospital emergency nurses (n = 14), registered nurses (n = 10) and emergency medical technicians (n = 7). Focus group conversations (Round 1) and questionnaires (Rounds 2–4) generated data. Round 1 was analyzed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five-point Likert scale together with free-text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale.Results: Round 1 identified 108 items which were divided into four categories: (1) at- titudes regarding the patient (n = 35), (2) attitudes regarding the patient relationship (n = 8), (3) attitudes regarding oneself and one's colleagues (n = 45), and (4) attitudes regarding other involved factors (n = 20). In Rounds 2–4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus.Conclusions: The findings highlight the complexity of ACs 'attitudes towards older patients' self-determination. The respect of older patients' self-determination is challenged by the patient, other healthcare personnel, significant others and / or colleagues. The study provided a unique opportunity to explore self-determination and shared decision-making. AS have to provide continued ethical training, for ex- ample to increase the use of simulation-based training or moral case deliberations in order to strengthen the ACs ’moral abilities within their professional practice.Implications for practice: Ambulance services must develop opportunities to pro- vide continued training within this topic. One option would be to increase the use of simulation-based training, focusing on ethical aspects of care. Another option might be to facilitate moral case deliberations to strengthen the ACs' abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team.
|
|
| 12. |
- Svensson, Anders, 1977-, et al.
(författare)
-
Response times in rural areas for emergency medical services, fire and rescue services and voluntary first responders during out-of-hospital cardiac arrests
- 2024
-
Ingår i: Resuscitation Plus. - : Elsevier. - 2666-5204. ; 17
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: To increase survival in out-of-hospital cardiac arrests (OHCA), great efforts are made to improve the number of voluntary first responders (VFR). However, evidence of the potential utility of such efforts is sparse, especially in rural areas. Therefore, the aim was to describe and compare response times for emergency medical services (EMS), fire and rescue services (FRS), and VFR during OHCA in relation to population density. Methods: This observational and comparative study was based on data including positions and time stamps for VFR and response times for EMS and FRS in a region in southern Sweden. Results: In total, 285 OHCAs between 1 July 2020 and 31 December 2021 were analysed. VFR had the shortest median response time in comparison to EMS and FRS in all studied population densities. The overall median (Q1–Q3) time gain for VFR was 03:07 (01:39–05:41) minutes. A small proportion (19.2%) of alerted VFR accepted the assignments. This is most problematic in rural and sub-rural areas, where there were low numbers of alerted VFR. Also, FRS had shorter response time than EMS in all studied population densities except in urban areas. Conclusion: The differences found in median response times between rural and urban areas are worrisome from an equality perspective. More focus should be placed on recruiting VFR, especially in rural areas since VFR can potentially contribute to saving more lives. Also, since FRS has a shorter response time than EMS in rural, sub-rural, and sub-urban areas, FRS should be dispatched more frequently.
|
|
| 13. |
- Allert, Camilla, 1972-, et al.
(författare)
-
Voluntary first responders’ experiences of being dispatched to suspected out-of-hospital cardiac arrest in rural areas : an interview study
- 2024
-
Ingår i: BMC Cardiovascular Disorders. - : BioMed Central (BMC). - 1471-2261. ; 24:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death, and survival outcomes vary across countries and regions. To improve survival, the European Resuscitation Council Guidelines encourage the implementation of technologies like smartphone applications to alert voluntary first responders (VFRs) who are near a suspected OHCA. VFRs are of great importance in the ´chain of survival´, but there is still a lack of knowledge about their experiences; especially of those operating in rural areas. Understanding those experiences is crucial in developing appropriate interventions to train, encourage, and safeguard VFRs in their mission. Therefore, the aim of this study was to describe VFRs´ experiences of being dispatched to suspected OHCA in rural areas.Methods: The study used an inductive design. The data were collected using individual interviews with 16 VFRs and analysed using qualitative content analysis.Results: The results are presented in terms of six generic categories ‘‘Being motivated and prepared’’, ‘‘Having strategies to undertake the mission’’, ‘‘Collaborating with others’’, ‘‘Being ethically aware’’, ‘‘Supporting the family members’’, and ‘‘Coping with the mission’’, which formed the basis of the main category ‘Desire to save lives and help others’. The findings showed that VFRs had a genuine desire to contribute to save lives in this rural area. Regardless of the circumstances, they were prepared to leave everything and act to the best for the victim and their family members. In theirs’ missions they collaborated with others at the scene and were guided by ethics while they acted in complex circumstances.Conclusions: VFRs dispatched in rural areas express a desire to save lives. In their missions, they acted in complex situations and experienced both emotional and ethical challenges.The design, implementation, and evaluation of support interventions directed at VFRs should be prioritised, especially in rural areas, as it can contribute to more people becoming and remaining VFRs, which in turn could contribute to sustainable development.
|
|
| 14. |
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
- Bonagas, Nadilly, et al.
(författare)
-
Pharmacological targeting of MTHFD2 suppresses acute myeloid leukemia by inducing thymidine depletion and replication stress
- 2022
-
Ingår i: NATURE CANCER. - : Springer Science and Business Media LLC. - 2662-1347. ; 3:2, s. 156-
-
Tidskriftsartikel (refereegranskat)abstract
- The folate metabolism enzyme MTHFD2 (methylenetetrahydrofolate dehydrogenase/cyclohydrolase) is consistently overexpressed in cancer but its roles are not fully characterized, and current candidate inhibitors have limited potency for clinical development. In the present study, we demonstrate a role for MTHFD2 in DNA replication and genomic stability in cancer cells, and perform a drug screen to identify potent and selective nanomolar MTHFD2 inhibitors; protein cocrystal structures demonstrated binding to the active site of MTHFD2 and target engagement. MTHFD2 inhibitors reduced replication fork speed and induced replication stress followed by S-phase arrest and apoptosis of acute myeloid leukemia cells in vitro and in vivo, with a therapeutic window spanning four orders of magnitude compared with nontumorigenic cells. Mechanistically, MTHFD2 inhibitors prevented thymidine production leading to misincorporation of uracil into DNA and replication stress. Overall, these results demonstrate a functional link between MTHFD2-dependent cancer metabolism and replication stress that can be exploited therapeutically with this new class of inhibitors. Helleday and colleagues describe a nanomolar MTHFD2 inhibitor that causes replication stress and DNA damage accumulation in cancer cells via thymidine depletion, demonstrating a potential therapeutic strategy in AML tumors in vivo.
|
|
| 18. |
|
|
| 19. |
|
|
| 20. |
- Broström, Anders, et al.
(författare)
-
Entreprenörskap i Sverige – Nationell GEM-rapport 2022
- 2022
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Från förordet: Årets rapport kartlägger det svenska entreprenörskapets utveckling under en turbulent tid präglad av pandemi, restriktioner och nedstängningar av hela samhällen vilket du kan läsa om i kapitel två. Trots pandemin ökar svenskt entreprenörskap under 2021 till nio procent (TEA) vilket är den högsta siffran som redovisats i GEM-projektet för Sveriges del sedan 2010. En minst sagt glädjande siffra.Det är emellertid inte en anledning att luta sig tillbaka. Världen står inför stora utmaningar i form av komponentbrist, störningar i leveranskedjor samt en oroande geopolitisk situation, inte minst i och med Rysslands invasion av Ukraina. Därtill kan tilläggas att Sverige dras med olösta och kända problem som till exempel en dysfunktionell arbetsmarknad präglad av kompetensbrist kombinerat med hög arbetslöshet och låg självförsörjningsgrad bland stora delar av befolkningen.I årets rapport görs även nedslag i entreprenörernas relation till miljömässig- och social hållbarhet. Svenska entreprenörer uppvisar på intet sätt det största engagemanget för bland annat miljömässig hållbarhet globalt sett. Men det finns anledning att tro att det åtminstone delvis kan bero på att företagare i Sverige ställer högre krav inom sin verksamhet, speciellt jämfört med företagare i utvecklingsländer.
|
|
| 21. |
- Dambrauskas, Zilvinas, et al.
(författare)
-
Expression of major histocompatibility complex class I-related chain A/B (MICA/B) in pancreatic carcinoma.
- 2014
-
Ingår i: International Journal of Oncology. - : Spandidos Publications. - 1019-6439 .- 1791-2423. ; 44:1, s. 99-104
-
Tidskriftsartikel (refereegranskat)abstract
- Major histocompatibility complex classI-related chain A and B (MICA/B) are two stress-inducible ligands that bind to the immunoreceptor NKG2D and play an important role in mediating cytotoxicity of NK and Tcells. Release of MIC molecules from the cell surface is thought to constitute an immune escape mechanism of tumor cells and thus could be associated with more aggressive course of tumor growth. In this study, we investigated the expression of MICA/B in ductal pancreatic carcinoma and serum in relation to tumor stage, differentiation and survival. MICA/B expression in tumor tissues and sera from patients with pancreatic cancer were analyzed by immunohistochemical staining (IHC), western blotting and ELISA, respectively. MICA/B expression was present in 17 of 22 (77%) of the tumors but not in normal pancreatic ductal epithelial cells. Poorly differentiated tumors showed more pronounced MICA/B expression compared to differentiated tumors, but did not correlate significantly to other tumor characteristics. MICA/B-negative tumors displayed significantly lower incidence of lymph node metastases (p<0.01), and less mortality within 3 years following resection (p<0.02). In conclusion, tissue levels of MICA/B expression were elevated in pancreatic cancer cells without elevated levels in serum, despite well-recognized acute phase reactants in serum. Poorly differentiated tumors showed high MICA/B expression, which was related to extended tumor lymph node metastases and less frequent long-term survival.
|
|
| 22. |
|
|
| 23. |
- Elmqvist, Carina, 1964-, et al.
(författare)
-
”Vi vill ha en statlig nationell översikt över mobil vård”
- 2019
-
Ingår i: Dagens medicin. - : Bonnier Business Media AB. - 1104-7488 .- 1402-1943. ; :2019-09-26
-
Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Den mobila vården behöver definieras nationellt och bli en egen organisationsform och vårdnivå, skriver företrädare från Centrum för interprofessionell samverkan inom akut vård.
|
|
| 24. |
- Elmqvist, Niklas, 1977, et al.
(författare)
-
3DVN: A Mixed Reality Platform for Mobile Navigation Assistance
- 2006
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- We present 3DVN, a Mixed Reality platform for navigation assistance in indoor environments. Built on top of a PC-based wearable computer running the Windows operating system, the platform provides a multimodal user interface for navigating in existing physical buildings, including wireless networking, data glove gestural input, voice communication, head-mounted display, and a 3DOF head tracker. Local positioning is performed using a software-only positioning engine making use of WLAN features for accurately pinpointing the mobile device in three dimensions. The 3DVN system has been implemented as a proof-of-concept of a navigation guidance support device for visitors, and has been field-tested with human subjects in the student center of our university. Informal evaluation of subject ratings indicate a strong interest for the new system, both for guests as well as people familiar with the campus and the building.
|
|
| 25. |
- Elmqvist, Niklas, 1977, et al.
(författare)
-
3DVN: A Mixed Reality Platform for Mobile Navigation Assistance
- 2007
-
Ingår i: ACM CHI2007 Workshop on Mobile Spatial Interaction. ; , s. 1-4
-
Konferensbidrag (refereegranskat)abstract
- We present 3DVN, a Mixed Reality platform for navigation assistance in indoor environments. Built on top of a PC-based wearable computer running the Windows operating system, the platform provides a multimodal user interface to navigate existing physical buildings, including wireless networking, data glove gestural input, voice communication, head-mounted display, and a 3DOF head tracker. Local positioning is performed using a software-only WLAN-based engine to accurately pinpoint the mobile device in three dimensions. We use this system as a platform for a simple theoretical framework for classifying interaction for mobile navigation assistance. Informal qualitative evaluation of our system seems to conform to predictions derived from our framework and shows the need for a rich set of interaction components for successful mobile navigation.
|
|
| 26. |
|
|
| 27. |
|
|
| 28. |
- Esguerra, John Laurence, 1991-
(författare)
-
Developing strategies for improved economic performance and reduced climate impact of landfill mining in Europe
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Landfill mining refers to the re-circulation of resources from the previously deposited wastes. It is an alternative approach for managing landfills that integrates resource recovery with site remediation. Several resources that can be recovered in landfills include scrap metals for recycling, combustibles for energy recovery, and inert materials for construction applications. In addition, land can be recovered for alternative uses, or landfill void space can be liberated for the deposition of future wastes. At present, landfill mining is still an emerging concept with few project implementations. Consequently, the assessments of its economic and climate implications are case study-specific, limiting the understanding of its potential in a wider geographical scope. This thesis aims to assess the economic performance and climate impact of landfill mining in Europe towards the development of sound strategies for implementation. Different project setups are assessed in relation to varying factors at the site level such as waste composition and landfill settings, and at the system level such as policy and market conditions and background material and energy. In doing so, a factor-based method is developed and applied to generate multiple scenarios (531, 441 scenarios per project setup) and determine the underlying important factors and their interrelations that drive the results. Such understanding is used to develop and discuss strategies for improvement by addressing relevant questions for specific stakeholders, including project investors (i.e., which landfill sites to prioritize?), landfill mining practitioners (i.e., how to set up such projects?), and policymakers (i.e., which policy instruments can effectively support such projects?). Results show that landfill mining is preferable in terms of climate than economy. In general, about 50% of the scenarios are climate beneficial, while only about 20% of the scenarios are profitable. Possible economic and climate improvements are shown by employing internal thermal treatment of combustibles and extending fines residue utilization as construction aggregates. However, these require overarching conditions such that the choice of project setup must be in line with the selection of landfills for mining. Preferable site and system-level conditions are identified in general but it is also discussed that the plausibility of finding such conditions may be difficult at present. This steers the development of more tailored strategies on what can be done now by the landfill practitioners in terms of setting up projects under current policy and market conditions in specific regions, or what can be done by the policymakers in terms of implementing various policy instruments that can drive such changes at the system level. In this regard, the future of landfill mining research can be guided towards addressing key challenges and potential solutions for improvement elicited through a generic and learning-oriented assessment. Furthermore, this thesis highlights the role of assessment as a tool for learning and guiding the development of emerging concepts such as landfill mining.
|
|
| 29. |
- Forsgärde, Elin-Sofie
(författare)
-
Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim was to describe and compare pathways for older patients and the involved actors’ experiences of decision-making in acute situations in ambulatory care.Methods: The overall three-fold design, comprising exploratory, descriptive as well as comparative ones, was conducted inductively, including a mixed method with a convergent integrated approach to empirical data. The four involved studies were analysed using either quantitative or qualitative analysis methods.Results: Most older patients’ pathways when being assessed by ambulance personnel involved receiving care at hospitals. However, an increasing trend of non-conveyance to hospitals was identified during a five-year period (2014–2018), which means receiving care, for example, at home or primary healthcare (PHC) centres. Decision-making about the level-of-care for older patients was more or less uncertain for all involved actors, i.e. older patients, significant others and healthcare professionals such as ambulance personnel, registered nurses, specialists in general practice at PHC centres and community health nurses. To increase the level of certainty in the decision-making process, all actors was supported by both an individual and external dialogue. Individual dialogue gave support by using own experience and knowledge. For ambulance personnel and community health nurses, support was also partially gained from decision support tools but was regarded as insufficient when older patients had non-specific symptoms. External dialogue provided support through mutuality, and via collaboration, a common goal, trust and responsibility. Mutuality gave support through experience and knowledge being shared with all involved actors, which provided a common comprehensive understanding that facilitated consensus in the decision-making.Conclusion: The increasing level of non-conveyance to hospitals and uncertainty during decision-making highlights the need to develop and extend the availability of dialogue-based collaborations as support in ambulatory care. Dialogue-based support involves all actors contributing to the decision-making. Healthcare professionals need to be aware of the prerequisites and the support that mutuality in external dialogues brings. Healthcare organisations need to develop and extend dialogue-based collaboration in ambulatory care by combining different expertise and providing conditions to increase support in decisions adapted to older patients' needs.
|
|
| 30. |
- Forsgärde, Elin-Sofie, et al.
(författare)
-
Patients' aged ≥ 65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital : a longitudinal and comparative study
- 2020
-
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:11, s. 1-7
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives Patients >= 65 years old represent 30%-50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients' aged >= 65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals. Design A longitudinal and comparative database study. Setting Ambulance service in a Swedish region. Participants 32 085 AAs with patients >= 65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients' dispositions data. Outcome measures Dependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season. Results The majority (n=29 060; 90.6%) of patients' dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85-89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections. Conclusions The study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients >= 65 years old.
|
|
| 31. |
|
|
| 32. |
- Forsgärde, Elin-Sofie, et al.
(författare)
-
Physicians’ experiences and actions in making complex level-of-care decisions during acute situations within older patients’ homes : a critical incident study
- 2023
-
Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 23:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Complex level-of-care decisions involve uncertainty in which decisions are beneficial for older patients. Knowledge of physicians’ decision-making during acute situations in older patients’ homes is limited. Therefore, this study aimed to describe physicians’ experiences and actions in making complex level-of-care decisions during the assessment of older patients in acute situations within their own homes. Methods: Individual interviews and analyses were performed according to the critical incident technique (CIT). In total, 14 physicians from Sweden were included. Results: In making complex level-of-care decisions, physicians experienced collaborating with and including older patients, significant others and health care professionals to be essential for making individualized decisions regarding the patients’ and their significant others’ needs. During decision-making, physicians experienced difficulties when doubt or collaborative obstructions occurred. Physicians’ actions involved searching for an understanding of older patients’ and their significant others’ wishes and needs, considering their unique conditions, guiding them, and adjusting care according to their wishes. Actions further involved promoting collaboration and reaching a consensus with all persons involved. Conclusion: Physicians strive to individualize complex level-of-care decisions based on older patients’ and their significant others’ wishes and needs. Furthermore, individualized decisions depend on successful collaboration and consensus among older patients, their significant others and other health care professionals. Therefore, to facilitate individualized level-of-care decisions, the health care organizations need to support physicians when they are making individualized decisions, provide sufficient resources and promote 24 − 7 collaboration between organizations and health care professionals.
|
|
| 33. |
- Forsgärde, Elin-Sofie, et al.
(författare)
-
Support in acute situations when a community health nurse is called: experiences of older patients, their significant others, and involved healthcare professionals- a qualitative interview study
- 2023
-
Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 23:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Care decisions for older patients in acute situations are challenging to make, and there is limited knowledge of support in home healthcare settings, where older patients receive ongoing health care from, for example, community health nurses. Therefore, this study aimed to describe the support for all involved in acute situations when a community health nurse was called, as experienced by older patients, their significant others and healthcare professionals involved.Methods: The study was conducted using a phenomenological reflective lifeworld research approach, in which meanings of the study phenomenon were analyzed. The included participants were those who had been involved in acute situations. Twelve participants from four acute situations were interviewed. The participant included three older patients, one significant other, four community health nurses, one registered nurse student, one specialist in general practice, and two ambulance personnel, with one being a registered nurse and the other a specialist ambulance nurse.Results: Support in decision-making was received from the knowledge of temporality, which provided a comprehensive understanding based on past and present knowledge of the older patient. The knowledge of temporality allowed for the early detection of new symptoms and facilitated care decisions tailored to the older patient. There was a dependency on pre-existing mutual interpersonal support, and confidence developed through relational, caring, and medical competence.Conclusions: The advantages of temporality, confidence and mutual interpersonal support in acute situations highlight the importance of enhancing relational continuity in home healthcare settings and establishing a structural collaboration among community health nurses, specialists in general practice, and ambulance personnel. This collaboration aims to provide support for making decisions regarding tailored care.
|
|
| 34. |
- Forsgärde, Elin-Sofie, et al.
(författare)
-
The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called
- 2021
-
Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis Group. - 1748-2623 .- 1748-2631. ; 16:8
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and primary healthcare (PHC) centre personnel. Methods The study used a phenomenological reflective lifeworld research (RLR) approach. Participants included in three specific situations with extended collaboration were interviewed: three older patients, one significant other, three ambulance personnel and four personnel at the PHC centre. The transcribed interviews were analysed for meanings of the phenomenon. Results The extended collaboration means that decisions were supported through dialogue by bridging knowledge spaces between person, within-team and across-team levels. Through dialogue experience and knowledge were shared and certainty in decisions was increased. The extended collaboration was built on trust, responsibility taken, shared and entrusted, and the common goal of adapted care for the unique patient. A need for further improvement and transparency was elucidated. Conclusions The difficulty of making care decisions stresses the importance of available extended collaboration based on the dialogue between patients, significant others, and ambulance- and PHC centre personnel to increase certainty in decisions. Collaboration further requires respectful encounters, trust, responsibility and a common goal of adapting the care for the unique patient.
|
|
| 35. |
|
|
| 36. |
- Funkquist, Anders, 1977-, et al.
(författare)
-
Higher CSF/serum free-T4 ratio is associated with improvement of quality of life during treatment with L-thyroxine
- 2023
-
Ingår i: Journal of Neuroendocrinology. - : Wiley-Blackwell Publishing Inc.. - 0953-8194 .- 1365-2826. ; 35:5
-
Tidskriftsartikel (refereegranskat)abstract
- Up to 20% of individuals with primary hypothyroidism treated with L-thyroxine still suffer from severe symptoms. These are supposedly brain derived and involve both cognitive and emotional domains. Previously, no consistent relationship has been found between thyroid hormones (TH) or TSH levels in blood and quality of life (QoL). Recently, we reported an association between cerebrospinal fluid (CSF)/serum free-thyroxine (f-T4) ratio and QoL, in juvenile hypothyroid patients. Here, we investigated if CSF/serum f-T4 ratio and QoL estimates correlate also during L-thyroxine treatment. Moreover, the CSF biomarker neurogranin (Ng) was used as a biomarker for synaptic function and integrity in clinical research. Ng is partially controlled by TH and therefore we investigated the relationship between QoL parameters and Ng levels. Patients diagnosed with primary hypothyroidism were investigated using vital parameters, serum and CSF analyses of TH, TSH, Ng and QoL questionnaires. Similar procedures were performed after 6 months of treatment. The most marked associations with QoL were found for CSF/serum f-T4 ratio, which was strongly related to several QoL parameters such as the mental subscore of SF-36 (r = 0.83, p < .0005). Ng, which did not differ from that in our healthy controls, was lower in some patients during treatment and higher in others. However, the change in Ng during treatment was significantly correlated with QoL parameters including the mental subscore of SF-36 (r = -0.86, p < .0001). In addition, the CSF/serum f-T4 ratio correlated with the change in Ng (r = -0.75, p = .001). Our results suggest that the ratio between CSF and serum f-T4 is an important biomarker for QoL during treatment of patients with primary hypothyroidism, so far in research, but in the future maybe also in clinical settings. Moreover, this ratio also correlates with the changes in Ng levels during L-thyroxine treatment, further supporting the impact of the TH balance between serum and CSF on QoL.
|
|
| 37. |
- Herault, Romain Christian, et al.
(författare)
-
Design and Evaluation of a 360 Degrees Interactive Video System to Support Collaborative Training for Nursing Students in Patient Trauma Treatment
- 2018
-
Ingår i: 26TH INTERNATIONAL CONFERENCE ON COMPUTERS IN EDUCATION (ICCE 2018). - : Asia-Pacific Society for Computers in Education. ; , s. 298-303
-
Konferensbidrag (refereegranskat)abstract
- Extreme catastrophe situations are rare in Sweden, which makes training opportunities important to secure the competence among emergency personnel that should be actively involved during those situations. There is a need to conceptualize, design and implement interactive learning environments that allow to educate, train and assess these catastrophe situations more often and in different settings, conditions and places. In order to address these challenges, a prototype system has been designed and developed containing immersive interactive 360 degrees educational videos that are available via a web browser. The content of these videos includes simulated learning scenes of a trauma team working at the hospital emergency department. Different types of interaction mechanisms are integrated within the videos in which learners should act upon and respond. The prototype was tested during the fall term 2017 with 17 students from the specialist nursing program, and four medical experts. These activities were assessed in order to get new insights into issues related to the proposed approach and feedback connected to the usefulness, usability and learnability of the suggested prototype. The initial outcomes of the evaluation indicate that the system can provide students with novel interaction mechanisms to improve their skills and it can be applied as a complementary tool to the methods used currently in their education.
|
|
| 38. |
- Holmberg, Mats, Med.Dr. 1976-, et al.
(författare)
-
Delfimetoden
- 2023. - 3
-
Ingår i: Vetenskaplig teori och metod. - Lund : Studentlitteratur AB. - 9789144161389 ; , s. 407-422
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 39. |
- Holmberg, Mats, Med.Dr. 1976-, et al.
(författare)
-
Dyadic teams and nursing care : a critical incident study of nurses in the emergency medical service
- 2020
-
Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 29:19-20, s. 3743-3753
-
Tidskriftsartikel (refereegranskat)abstract
- Aim and objectives: The aim of the study was to describe Emergency Medical Services (EMS) nurses’ experiences of and coping with critical incidents, when providing nursing care as a member of a dyadic team.Background: Nursing care in EMS is a complex task, taking into account the physical, psychological as well as existential dimensions of the patient's suffering. In this, EMS nurses are dependent on the dyadic team. Teams in EMS are described as essential for providing safe medical care. However, nursing care also comprises relationships with patients as a means of reducing patient suffering.Design: The study has an inductive descriptive qualitative design, in adherence to the COREQ‐checklist.Methods: A critical incident technique was used. Thirty‐five EMS nurses were interviewed individually, with a focus on dyadic teams providing nursing care. The interviews were analysed with the aim of defining main areas, categories and sub‐categories.Results: The experiences of critical incidents emerged to form two main areas: “Functional co‐operation” and “Dysfunctional co‐operation,” comprising seven categories and sixteen sub‐categories. Their coping with critical incidents encompassed two main areas: “Adapting oneself” and “Adapting nursing care and the colleague,” comprising four categories and eight sub‐categories.Conclusions: Reflection as part of the daily practice emerges as important for the development of nursing care both in relation to individual team members and also the dyadic team as a unit. In addition, the results highlight consensus within dyadic teams regarding the objectives of nursing care, as well as the importance of defined roles.Relevance to clinical practice: This study underlines the importance of strengthening the dyadic EMS team's ability to co‐operate using common goals and knowledge within clinical nursing care. The individual team members’ different roles have to be explicit. In addition, clinical care has to be organised to generate preconditions for mutual performance monitoring through collegial feedback and reflection.
|
|
| 40. |
|
|
| 41. |
|
|
| 42. |
- Janek, Sara, 1977-, et al.
(författare)
-
Development of dose delivery verification by PET imaging of photonuclear reactions following high energy photon therapy
- 2006
-
Ingår i: Physics in Medicine and Biology. - : IOP Publishing. - 0031-9155 .- 1361-6560. ; 51:22, s. 5769-
-
Tidskriftsartikel (refereegranskat)abstract
- A method for dose delivery monitoring after high energy photon therapy has been investigated based on positron emission tomography (PET). The technique is based on the activation of body tissues by high energy bremsstrahlung beams, preferably with energies well above 20 MeV, resulting primarily in 11C and 15O but also 13N, all positron-emitting radionuclides produced by photoneutron reactions in the nuclei of 12C, 16O and 14N. A PMMA phantom and animal tissue, a frozen hind leg of a pig, were irradiated to 10 Gy and the induced positron activity distributions were measured off-line in a PET camera a couple of minutes after irradiation. The accelerator used was a Racetrack Microtron at the Karolinska University Hospital using 50 MV scanned photon beams. From photonuclear cross-section data integrated over the 50 MV photon fluence spectrum the predicted PET signal was calculated and compared with experimental measurements. Since measured PET images change with time post irradiation, as a result of the different decay times of the radionuclides, the signals from activated 12C, 16O and 14N within the irradiated volume could be separated from each other. Most information is obtained from the carbon and oxygen radionuclides which are the most abundant elements in soft tissue. The predicted and measured overall positron activities are almost equal (−3%) while the predicted activity originating from nitrogen is overestimated by almost a factor of two, possibly due to experimental noise. Based on the results obtained in this first feasibility study the great value of a combined radiotherapy–PET–CT unit is indicated in order to fully exploit the high activity signal from oxygen immediately after treatment and to avoid patient repositioning. With an RT–PET–CT unit a high signal could be collected even at a dose level of 2 Gy and the acquisition time for the PET could be reduced considerably. Real patient dose delivery verification by means of PET imaging seems to be applicable provided that biological transport processes such as capillary blood flow containing mobile 15O and 11C in the activated tissue volume can be accounted for.
|
|
| 43. |
- Joffrin, E., et al.
(författare)
-
Overview of the JET preparation for deuterium-tritium operation with the ITER like-wall
- 2019
-
Ingår i: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 59:11
-
Forskningsöversikt (refereegranskat)abstract
- For the past several years, the JET scientific programme (Pamela et al 2007 Fusion Eng. Des. 82 590) has been engaged in a multi-campaign effort, including experiments in D, H and T, leading up to 2020 and the first experiments with 50%/50% D-T mixtures since 1997 and the first ever D-T plasmas with the ITER mix of plasma-facing component materials. For this purpose, a concerted physics and technology programme was launched with a view to prepare the D-T campaign (DTE2). This paper addresses the key elements developed by the JET programme directly contributing to the D-T preparation. This intense preparation includes the review of the physics basis for the D-T operational scenarios, including the fusion power predictions through first principle and integrated modelling, and the impact of isotopes in the operation and physics of D-T plasmas (thermal and particle transport, high confinement mode (H-mode) access, Be and W erosion, fuel recovery, etc). This effort also requires improving several aspects of plasma operation for DTE2, such as real time control schemes, heat load control, disruption avoidance and a mitigation system (including the installation of a new shattered pellet injector), novel ion cyclotron resonance heating schemes (such as the three-ions scheme), new diagnostics (neutron camera and spectrometer, active Alfven eigenmode antennas, neutral gauges, radiation hard imaging systems...) and the calibration of the JET neutron diagnostics at 14 MeV for accurate fusion power measurement. The active preparation of JET for the 2020 D-T campaign provides an incomparable source of information and a basis for the future D-T operation of ITER, and it is also foreseen that a large number of key physics issues will be addressed in support of burning plasmas.
|
|
| 44. |
|
|
| 45. |
|
|
| 46. |
|
|
| 47. |
- Karlsson, Camilla, 1977, et al.
(författare)
-
Differentiation of human mesenchymal stem cells and articular chondrocytes: analysis of chondrogenic potential and expression pattern of differentiation-related transcription factors.
- 2007
-
Ingår i: Journal of orthopaedic research : official publication of the Orthopaedic Research Society. - : Wiley. - 0736-0266. ; 25:2, s. 152-63
-
Tidskriftsartikel (refereegranskat)abstract
- Mesenchymal stem cells (MSCs) are a candidate for replacing chondrocytes in cell-based repair of cartilage lesions. However, it has not been clarified if these cells can acquire the hyaline phenotype, and whether chondrocytes and MSCs show the same expression patterns of critical control genes in development. In order to study this, articular chondrocytes and iliac crest derived MSCs were allowed to differentiate in pellet mass cultures. Gene expression of markers for the cartilage phenotype, helix-loop-helix (HLH) transcription factors, and chondrogenic transcription factors were analyzed by real-time PCR. Matrix production was assayed using biochemical analysis for hydroxyproline, glycosaminoglycans, and immunohistochemistry for collagen types I and II. Significantly decreased expression of collagen type I was accompanied by increased expression of collagen types IIA and IIB during differentiation of chondrocytes, indicating differentiation towards a hyaline phenotype. Chondrogenesis in MSCs on the other hand resulted in up-regulation of collagen types I, IIA, IIB, and X, demonstrating differentiation towards cartilage of a mixed phenotype. Expression of HES1 increased significantly during chondrogenesis in chondrocytes while expression in MSCs was maintained at a low level. The HLH gene HES5 on the other hand was only detected in chondrocytes. Expression of ID1 decreased significantly in chondrocytes while the opposite was seen in MSCs. These findings suggest that chondrocytes and MSCs differentiated and formed different subtypes of cartilage, the hyaline and a mixed cartilage phenotype, respectively. Differentially regulated HLH genes indicated the possibility for HLH proteins in regulating chondrogenic differentiation. This information is important to understand the potential use of MSCs in cartilage repair.
|
|
| 48. |
|
|
| 49. |
|
|
| 50. |
|
|
