| 1. |
- Karimi, Masoud, et al.
(författare)
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A retrospective study of extracolonic, non-endometrial cancer in Swedish Lynch syndrome families 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis 11 Medical and Health Sciences 1117 Public Health and Health Services
- 2018
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Ingår i: Hereditary Cancer in Clinical Practice. - : Springer Science and Business Media LLC. - 1731-2302 .- 1897-4287. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Lynch Syndrome is an autosomal dominant cancer syndrome caused by pathogenic germ-line variants in one of the DNA-mismatch-repair (MMR) genes MLH1, MSH2, MSH6 or PMS2. Carriers are predisposed to colorectal and endometrial cancer, but also other cancer types. The purpose of this retrospective study was to characterize the tumour spectrum of the Swedish Lynch syndrome families. Methods: Data were obtained from genetically verified 235 Lynch families from five of the six health care regions in Sweden. The material was stratified for gender, primary cancer, age and mutated gene and the relative proportions of specific cancer types were compared to those in the general population. Results: A total of 1053 family members had 1493 cancer diagnoses of which 1011 were colorectal or endometrial cancer. Individuals with pathogenic variants in MLH1 and MSH2 comprised 78% of the cohort. Among the 482 non-colorectal/non-endometrial cancer diagnoses, MSH2 carriers demonstrated a significantly increased proportion of urinary tract, gastric, small bowel, ovarian and non-melanoma skin cancer compared to the normal population. MLH1 carriers had an elevated proportion of gastrointestinal cancers (gastric, small bowel, pancreas), while MSH6 carriers had more ovarian cancer than expected. Gastric cancer was predominantly noted in older generations. Conclusion: Lynch syndrome confers an increased risk for multiple cancers other than colorectal and endometrial cancer. The proportions of other cancers vary between different MMR genes, with highest frequency in MSH2-carriers. Gender and age also affect the tumour spectrum, demonstrating the importance of additional environmental and constitutional parameters in determining the predisposition for different cancer types.
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| 2. |
- Avallin, Therese, et al.
(författare)
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Person-centred pain management for the patient with acute abdominal pain : An ethnography informed by the Fundamentals of Care framework
- 2018
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 74:11, s. 2596-2609
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contributes to or detract from successful pain management for the patient with acute abdominal pain (AAP) across the acute care pathway.Background: Although pain management is a recognized human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance.Design: Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework.Methods: Participant observation and informal interviews (92hr) were performed at one emergency department (ED) and two surgical wards at a University Hospital during April-November 2015. Data include 261 interactions between patients, aged 18years seeking care for AAP at the ED and admitted to a surgical ward (N=31; aged 20-90years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N=198).Results: The observations revealed an organizational culture with considerable impact on how well pain was managed. Well-managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics.Conclusions: Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management.
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| 3. |
- Björck, Erik
(författare)
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Genetic studies of follicular and mantle cell lymphoma
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Non-Hodgkin lymphoma is a malignancy derived from lymphoid tissues. In Sweden, non-Hodgkin lymphoma constituted 3% of all cancers recorded in 2003. Follicular and mantle cell lymphoma are the two types of non-Hodgkin lymphomas studied in this thesis. The treatment modalities of these lymphomas vary, and the reasons why some patients have a good response to therapy while other fail to respond are largely unknown. To address this problem we compared the gene expression of follicular lymphomas that had good response to therapy with follicular lymphomas that did not respond. The investigated treatment was combination chemotherapy with CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone). With high-density oligonucleotide arrays we could show that 14 genes involved in the G2/M transition of the cell cycle were up-regulated in the responders compared with the non-responders. Six out of these 14 genes were correlated with survival in a cohort of 57 patients with follicular lymphoma. Furthermore, one of these genes was also investigated with immunohistochemistry and there was a good correlation between mRNA expression and protein expression of this gene (Paper I). The gene expression measured with high-density oligonucleotide arrays was correlated with survival in two independent cohorts of follicular lymphoma. A total of 21 genes were associated with a prolonged survival in both cohorts. This association was independent of the international prognostic index. Genes of particular interest in this study were ERCC1, PTAFR, C4A, RPL23A, BCLAF and ABCC5 (Paper II). The gene expression in mantle cell lymphoma was also studied with high-density oligonucleotide arrays. Differences in genetic profiles were shown between tumors with a high and a low proliferation rate and also between primary and relapsed tumors (Paper III). In mantle cell lymphoma the prevalence of mutated V H-genes was investigated. In a cohort of 110, 17% of the tumors had somatic mutations. This implies that a subgroup of mantle cell lymphomas has a post germinal center origin. It was further demonstrated that there was a preferential V H3-21 usage in 19% of the tumors, and that patients with tumor usage of this V H-gene had a longer survival compared with the rest of the patients (Paper IV) .
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| 4. |
- Björck, Inger, et al.
(författare)
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Cereal grains for nutrition and health benefits: Overview of results from in vitro, animal and human studies in the HEALTHGRAIN project
- 2012
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Ingår i: Trends in Food Science & Technology. - : Elsevier BV. - 1879-3053 .- 0924-2244. ; 25:2, s. 87-100
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Tidskriftsartikel (refereegranskat)abstract
- Epidemiological studies have linked whole grain intake to the prevention of the metabolic syndrome, obesity and associated chronic diseases such as CVD and T2D. The Nutrition module within the HEALTHGRAIN project, included 10 partners and undertook in vitro, animal and humanin vivo studies with the overall aims of elucidating the components and mechanisms underlying the health benefits of cereal grains. This review summarises the major outcomes of these studies, including yet unpublished findings.
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| 5. |
- Bolander Laksov, Klara, 1973-, et al.
(författare)
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Developing clinical education based on medical education research - findings from a faculty development program
- 2018
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Ingår i: Amee 2018: Educating the Future Healthcare Professional and the Roles of the Teacher. ; , s. 52-52
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Konferensbidrag (refereegranskat)abstract
- BackgroundStudents in health and medical education spend a great deal of their education in clinical learning environments. There is today a growing knowledge of how learning in the clinical education environment can be facilitated, as well as about existing barriers to the implementation of these skills. By studying how clinical teachers engaged in educational development work, we wanted to better understand the conditions and systems required for successful implementation. This project aimed at examining the conditions for the successful use of medical-educational research results to stimulate learning in clinical education. Summary of workBased on knowledge generated from educational research, a faculty development program was designed to enable five teams of clinical teachers from three university hospitals to participate in a faculty development program aiming to develop, implement and evaluate an educational 'tool' together. The five teams that participated in the program were interviewed in focus groups at the start and end of the program. Observational and document data were collected throughout the process.Summary of resultsAll teams managed to develop a tool aimed at students or clinical teachers, implement and evaluate it. The faculty development program and its structure as a year-long scaffolding of driving and legitimising change processes in the clinical environment was acknowledged as facilitating the implementation of the educational tools. One year after the end of the program, four of the five teams had presented their work at medical education conferences, three teams are currently working to publish their work.Discussion & ConclusionThe design of the program around building capacity for change together with workshops focusing different aspects of Mayer and Stensaker's Change process prescriptors was identified as a successful framework for successful implementation and use of medical education research in the clinical education environment.Take-home messageThe invitation of teams to faculty development program, together with a design building on scaffolding educational change and leadership enabled participants to translate medical education research into their clinical teaching practice.
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| 6. |
- Bolander Laksov, Klara, 1973-, et al.
(författare)
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Från engagerad individ till fungerande systemperspektiv på pedagogisk utveckling i klinisk utbildningsmiljö
- 2018
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Konferensbidrag (refereegranskat)abstract
- Detta 10-åriga forskningsprojekt har titeln ’Från engagerad individ till fungerande systemperspektiv’. Projektet, som påbörjades 2010 tar sin utgångspunkt i problemet med att det trots att det återkommande tas goda initiativ till att förändra och utveckla den pedagogiska miljön, i detta fall inom den kliniska utbildningen, tycks vara svårt att etablera pedagogisk utveckling som är hållbar över tid. Syftet med projektet är att undersöka både hur studenter interagerar med utbildningsmiljön för att lära, och vilka förutsättningar som finns för lärares möjligheter att bedriva pedagogisk utveckling i sådan miljö, samt pröva en modell för pedagogisk utveckling och undersöka vad resultatet av detta blev. Vi har i projektet sökt oss till systemteori (Senge, Engeström, Billet) som ett sätt att bättre fö rstå den komplexa miljö som den kliniska utbildningsmiljön ugör. Olika teoretiska perspektiv har guidat olika stadier i projektet. Den övergripande forskningsfrågan bottnar i Peter Senges arbete och idén om den lärande organisationen (2006). Genom att förstå den kliniska utbildningsmiljön som en lärande organisation, som ett intrikat system där olika delar interagerar och skapar förutsättningar för lärande, hoppades vi kunna belysa skillnader mellan olika kliniska utbildningsmiljöer i en jämförande fallstudie. I utforskandet av studenters lärande i den kliniska utbildningsmiljön har Stephen Billets (2001; 2004; 2008) arbete, med lärande som ett resultat av relationen mellan praktikens/ arbetsplatsens erbjudande i fråga om deltagande och individens engagemang, utgjort en viktig utgångspunkt i studierna för att bättre förstå sjuksköterske- och läkarstudenters interaktion och lärande med den kliniska utbildningsmiljön. Vad gäller förutsättningarna för kliniska lärare att arbeta med pedagogiskt förändringsarbete i den kliniska miljön vände vi oss till Yrjö Engeströms arbete (1999; 2010; 2011). Engeströms syn på mänsklig aktivitet som sammanhängande i ett aktivitetssystem som påverkar varandra fungerar som utgångspunkt för en serie studier där vi undersöker lärares drivkrafter till att ägna sig åt pedagogiskt förändringsarbete och förutsättningarna för att bedriva utvecklingsprocesser samt dess resultat. De metodologiska utgångspunkterna för projektet har bottnat i ett sociokonstruktivistiskt perspektiv, och utgår från ett flertal olika sätt att samla data för att fokusera på olika aspekter i den kliniska utbildningsmiljön och de ledare, lärare och studenter som verkar i den. Det är dock huvudsakligen intervjuer, både individuella intervjuer (27) och fokusgruppintervjuer (6), men också ett stort antal observationer (200h), som utgjort underlag för våra studier. Resultaten av projektet som helhet visar på flera centrala aspekter för möjligheterna till lärande i den kliniska utbildningsmiljön. Studiernas visar att engagemanget och utgångspunkterna hos de individer, både studenter, kliniker som lärare, och ledare, som deltar i miljön är mycket centralt (Elmberger et al., inskickad). I våra studier identifierade vi systemför den kliniska utbildningsmiljön som har sin utgångspunkt i väldigt olika organisationsrationaliteter (Laksov et al, 2015). Dessa olikheter kunde ibland upplevas av studenter som motsägelsefulla (Liljedahl et al, 2015). Den kliniska utbildningsmiljön är komplex, men genom att lärare och pedagogiska ledare tar ett perspektiv på studenter som deltagare snarare än konsumenter, finns möjlighet att underlätta för studenters insocialisering i både sin profession, och i vad det innebär att vara student i den kliniska miljö n (Liljedahl et al 2016; 2017). Som deltagare lär sig studenterna att förhålla sig till de normer, värderingar och praktiker som förekommer i de olika miljöerna. Genom deltagandet i den kliniska miljön får de också möjlighet att lära sig vikten av att balansera mellan att anpassa sig, och att vara flexibel, och därmed utveckla sin professionella identitet (Liljedahl et al 2016; 2017). Förhållanden som framstår som särskilt utmanande i den kliniska utbildningsmiljön är de spä nningar som olika aktivitetssystem skapar i relation till utbildningsverksamheten och man kan ifrågasätta om och på vilket sätt olika aktörer som är involverade i högre utbildning tar ett sådant helhetsperspektiv, och om detta är möjligt? Seminariet läggs upp som en introduktion (15min) följt av en diskussion med utgångspunkt i följande frågor: Vilka styrkor och svagheter finns i ett systemperspektiv på pedagogisk utveckling? Med bas i vår och andras forskning, vad innebär hållbarhet i utvecklingen av pedagogisk verksamhet? Hur ser möjliga modeller ut för att implementera högskolepedagogisk forskning i olika utbildningsmiljöer? Vilken bäring har våra resultat i andra utbildningsmiljöer?
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| 7. |
- Conley, Daniel, et al.
(författare)
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Hypoxia-Related Processes in the Baltic Sea
- 2009
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Ingår i: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 43:10, s. 3412-3420
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Tidskriftsartikel (refereegranskat)abstract
- Hypoxia, a growing worldwide problem, has been intermittently present in the modern Baltic Sea since its formation ca. 8000 cal. yr BP. However, both the spatial extent and intensity of hypoxia have increased with anthropogenic eutrophication due to nutrient inputs. Physical processes, which control stratification and the renewal of oxygen in bottom waters, are important constraints on the formation and maintenance of hypoxia. Climate controlled inflows of saline water from the North Sea through the Danish Straits is a critical controlling factor governing the spatial extent and duration of hypoxia. Hypoxia regulates the biogeochemical cycles of both phosphorus (P) and nitrogen (N) in the water column and sediments. Significant amounts of P are currently released from sediments, an order of magnitude larger than anthropogenic inputs. The Baltic Sea is unique for coastal marine ecosystems experiencing N losses in hypoxic waters below the halocline. Although benthic communities in the Baltic Sea are naturally constrained by salinity gradients, hypoxia has resulted in habitat loss over vast areas and the elimination of benthic fauna, and has severely disrupted benthic food webs. Nutrient load reductions are needed to reduce the extent, severity, and effects of hypoxia.
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| 8. |
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| 9. |
- Elmberger, Agnes, et al.
(författare)
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Contradictions in clinical teachers' engagement in educational development : an activity theory analysis
- 2019
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Ingår i: Advances in Health Sciences Education. - : Springer Science and Business Media LLC. - 1382-4996 .- 1573-1677. ; 24:1, s. 125-140
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Tidskriftsartikel (refereegranskat)abstract
- Many medical universities offer educational development activities to support clinical teachers in their teaching role. Research has focused on the scope and effectiveness of such activities and on why individual teachers attend. However, systemic perspectives that go beyond a focus on individual participants are scarce in the existing literature. Employing activity theory, we explored how clinical teachers' engagement in educational development was affected by the systems they act within. Three focus groups were held with clinical teachers from different professions. A thematic analysis was used to map the contradictions between the systems that the participants were part of and the manifestations of these contradictions in the system of education. In our model, clinical teachers were part of three activity systems directed by the objects of patient care, research and education respectively. Contradictions arose between these systems as their objects were not aligned. This manifested through the enacted values of the academic hospital, difficulties establishing educational discussions in the clinical workplace, the transient nature of educational employments, and impediments to developing a teacher identity. These findings offer insights into the complexities of engaging in educational development as clinical teachers' priorities interact with the practices and values of the academic hospital, suggesting that attention needs to shift from individual teachers to developing the systems in which they work.
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| 10. |
- Elmberger, Agnes, et al.
(författare)
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From faculty development program to educational change in the clinical workplace : exploring the transfer of educational innovations through activity theory
- 2018
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Ingår i: Amee 2018: Educating the Future Healthcare Professional and the Roles of the Teacher. ; , s. 51-51
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Konferensbidrag (refereegranskat)abstract
- BackgroundFaculty development programs (FD) are aiming to advance the teaching practice in health professions education (HPE) by equipping teachers with knowledge and skills as professional educators. Research on faculty development has focused on scope and effectiveness of FD, however, little is regarding how knowledge learned in FD is transformed into the workplace and how change may happen as a result of FD. Drawing on activity theory and its notion of individual action as closely connected to context, we sought to explore the transfer of educational innovations into the clinical workplace . Summary of workFive interprofessional teams of clinical teachers attended a one-year FDP where they created and transferred educational innovations to their workplaces. The participants were interviewed in 3 focus groups at the end of the program, and analyzed thematically. The findings were discussed in relation to activity theory.Summary of resultsTransfer of the educational innovation was characterized by three interacting and iterative processes: the educational innovation itself 1) the innovation process, including time and support during development as well as the development of the aim of the innovation; 2) the clinical workplace process, including interactions with the workplace, acquiring mandate to change, communication and negotiation; 3) team process, including team development, collective action and adopting new roles.Discussion and ConclusionsUnderstanding change and pedagogical knowledge transfer is central in developing and sustaining educational scholarship and high quality teaching in HPE. This study suggest that transfer of educational innovations created in a FDP comprise multiple interacting processes taking place in two activity systems, the workplace and the team. Contradictions arise between these systems as they have partly differing objects.Take-home MessagesAs transfer between faculty development and teaching practices seem to be a case of interlinked processes in multiple social systems, faculty development should support participants in navigating this transfer and consider the workplace as an active part in the process.
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