| 11. |
- Johansson, Karin, et al.
(författare)
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Patients' experiences of support for learning to live with diabetes to promote health and well-being : A lifeworld phenomenological study
- 2016
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Learning to live with diabetes in such a way that the new conditions will be a normal and natural part of life imposes requirements on the person living with diabetes. Previous studies have shown that there is no clear picture of what and how the learning that would allow persons to incorporate the illness into their everyday life will be supported. The aim of this study is to describe the phenomenon of support for learning to live with diabetes to promote health and well-being, from the patient's perspective. Data were collected by interviews with patients living with type 1 or type 2 diabetes. The interviews were analysed using a reflective lifeworld approach. The results show that reflection plays a central role for patients with diabetes in achieving a new understanding of the health process, and awareness of their own responsibility was found to be the key factor for such a reflection. The constituents are responsibility creating curiosity and willpower, openness enabling support, technology verifying bodily feelings, a permissive climate providing for participation and exchanging experiences with others. The study concludes that the challenge for caregivers is to create interactions in an open learning climate that initiates and supports reflection to promote health and well-being.
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| 12. |
- Johansson, Karin, 1955-
(författare)
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Reflektion, Insikt och Ansvar : Lärandet i att leva med diabetes
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim is to develop knowledge about learning to live with diabetes.Methods: All four studies have been carried out within the caring science and using a life-world phenomenological approach. Study (I): data was collected through written narratives from seven patients with insulin treatment. Studies (II and III): data was collected through interviews with twelve patients with diabetes. Study (IV): Data was collected from four groups and two individual interviews with sixteen diabetes nurses. The method for the analysis can be described as a dialectic process, beginning with the whole, analyzing its parts, and then reconstructing the whole in order to understand the essence of the phenomenon.Main Findings: The result showed that patients’ experiences of the most obvious meanings of the phenomenon of being stricken by diabetes (I) are the fight against becoming your illness, a wish that everything would be as usual and that the new situation should only be natural. Furthermore, after having been diagnosed with the illness, the results demonstrated two themes that were particularly important in learning to live with diabetes. These were your own responsibility for gaining knowledge in order to incorporate the illness into your life and to find a balance between fear and control (II). As support for the learning (III), reflection over the learning and experiences has a crucial role for a new understanding of health processes. Insight into your own responsibility was a key factor for this reflection. To be able to give support (1V), the diabetes nurse must adopt a reflecting, self-critical attitude with an insight that the responsibility for learning lies with the patient and that the role for the diabetes nurse is to encourage and challenge the patient to self-reflection and taking responsibility on the basis of individual goals and pre-requisites.To give support in this way, the diabetes nurse must downplay the medical requirements for control and make more use of his/her medical competence to ask reflection-triggering questions based on a life-world perspective.Conclusion: Based on the patient’s life-world, an understanding is created that supports learning, which thereby can reduce the influence of the illness on the patient's life. This understanding makes it possible to incorporate the illness into the patient's life and create a balance between fear and control.
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| 13. |
- Johansson, Karin, et al.
(författare)
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Supporting patients learning to live with diabetes : a phenomenological study
- 2018
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Ingår i: British Journal of Nursing. - London : MA Healthcare Limited. - 0966-0461 .- 2052-2819. ; 27:12, s. 697-704
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Tidskriftsartikel (refereegranskat)abstract
- This article describes a study of the phenomenon of supporting patients who are learning to live with diabetes, from a diabetes specialist nurse (DSN) perspective. Guided by principles of reflective lifeworld research, data from six interviews (four in groups and two individual) with 16 DSNs were analysed. The results show that, in order to support learning, DSNs use a self-critical approach with the insight that they should not take over responsibility for their patients' diabetes. The DSNs support, encourage and challenge the patients to self-reflect and take responsibility based on patients' own goals and needs. To provide support, DSNs need to assume a tactful, critically challenging approach, dare to confront patients' fears and other emotions and have the insight to know that the responsibility for learning and integration of the condition lies with the patient. To be able to support patients in this way, it is necessary that the DSN is mentored and supported in this role.
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| 14. |
- La Fleur, Linnea, et al.
(författare)
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Expression of scavenger receptor MARCO defines a targetable tumor-associated macrophage subset in non-small cell lung cancer
- 2018
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Ingår i: International Journal of Cancer. - : WILEY. - 0020-7136 .- 1097-0215. ; 143:7, s. 1741-1752
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Tidskriftsartikel (refereegranskat)abstract
- Tumor-associated macrophages (TAMs) are attractive targets for immunotherapy. Recently, studies in animal models showed that treatment with an anti-TAM antibody directed against the scavenger receptor MARCO resulted in suppression of tumor growth and metastatic dissemination. Here we investigated the expression of MARCO in relation to other macrophage markers and immune pathways in a non-small cell lung cancer (NSCLC) cohort (n=352). MARCO, CD68, CD163, MSR1 and programmed death ligand-1 (PD-L1) were analyzed by immunohistochemistry and immunofluorescence, and associations to other immune cells and regulatory pathways were studied in a subset of cases (n=199) with available RNA-seq data. We observed a large variation in macrophage density between cases and a strong correlation between CD68 and CD163, suggesting that the majority of TAMs present in NSCLC exhibit a protumor phenotype. Correlation to clinical data only showed a weak trend toward worse survival for patients with high macrophage infiltration. Interestingly, MARCO was expressed on a distinct subpopulation of TAMs, which tended to aggregate in close proximity to tumor cell nests. On the transcriptomic level, we found a positive association between MARCO gene expression and general immune response pathways including strong links to immunosuppressive TAMs, T-cell infiltration and immune checkpoint molecules. Indeed, a higher macrophage infiltration was seen in tumors expressing PD-L1, and macrophages residing within tumor cell nests co-expressed MARCO and PD-L1. Thus, MARCO is a potential new immune target for anti-TAM treatment in a subset of NSCLC patients, possibly in combination with available immune checkpoint inhibitors.
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| 15. |
- La Fleur, Linnea, et al.
(författare)
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Mutation patterns in a population-based non-small cell lung cancer cohort and prognostic impact of concomitant mutations in KRAS and TP53 or STK11
- 2019
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Ingår i: Lung Cancer. - : Elsevier BV. - 0169-5002 .- 1872-8332. ; 130, s. 50-58
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Non-small cell lung cancer (NSCLC) is a heterogeneous disease with unique combinations of somatic molecular alterations in individual patients, as well as significant differences in populations across the world with regard to mutation spectra and mutation frequencies. Here we aim to describe mutational patterns and linked clinical parameters in a population-based NSCLC cohort.MATERIALS AND METHODS: Using targeted resequencing the mutational status of 82 genes was evaluated in a consecutive Swedish surgical NSCLC cohort, consisting of 352 patient samples from either fresh frozen or formalin fixed paraffin embedded (FFPE) tissues. The panel covers all exons of the 82 genes and utilizes reduced target fragment length and two-strand capture making it compatible with degraded FFPE samples.RESULTS: We obtained a uniform sequencing coverage and mutation load across the fresh frozen and FFPE samples by adaption of sequencing depth and bioinformatic pipeline, thereby avoiding a technical bias between these two sample types. At large, the mutation frequencies resembled the frequencies seen in other western populations, except for a high frequency of KRAS hotspot mutations (43%) in adenocarcinoma patients. Worse overall survival was observed for adenocarcinoma patients with a mutation in either TP53, STK11 or SMARCA4. In the adenocarcinoma KRAS-mutated group poor survival appeared to be linked to concomitant TP53 or STK11 mutations, and not to KRAS mutation as a single aberration. Similar results were seen in the analysis of publicly available data from the cBioPortal. In squamous cell carcinoma a worse prognosis could be observed for patients with MLL2 mutations, while CSMD3 mutations were linked to a better prognosis.CONCLUSION: Here we have evaluated the mutational status of a NSCLC cohort. We could not confirm any survival impact of isolated driver mutations. Instead, concurrent mutations in TP53 and STK11 were shown to confer poor survival in the KRAS-positive adenocarcinoma subgroup.
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| 16. |
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| 17. |
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| 18. |
- Larsson, Gerry, Professor, 1952-, et al.
(författare)
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Daily uplifts and adaptive coping as a buffer against daily hassles : relationship with stress reactions over time in military personnel
- 2017
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Ingår i: Scandinavian Psychologist. - : Scandinavian Psychologist. - 1894-5570. ; :4
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this research was to gain a deeper understanding of how daily hassles and uplifts interact with each other and with stress reactions over time in military personnel. Interviews were conducted with 15 Swedish veterans five years after an international peace enforcement mission. The grounded theory method was used and result patterns were generated for six specific time periods distributed before, during, and after the mission. A theoretical model was developed showing that everyday uplifts combined with adaptive coping can be sufficient to limit stress reactions related to daily hassles. The model was supported by the fact that, five years after the mission, none of interviewees had received a PTSD diagnosis or needed professional psychological treatment. The last-mentioned outcome is noteworthy in itself given the severe stress often encountered in peace enforcement missions and previous research observations of high PTSD incidence, suicide rates, criminality, and substance abuse in mission participants.
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| 19. |
- Magalhaes, Isabelle, et al.
(författare)
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Facing the future : challenges and opportunities in adoptive T cell therapy in cancer
- 2019
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Ingår i: Expert Opinion on Biological Therapy. - : Taylor & Francis Group. - 1471-2598 .- 1744-7682. ; 19:8, s. 811-827
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: In recent years, immunotherapy for the treatment of solid cancer has emerged as a promising therapeutic alternative. Adoptive cell therapy (ACT), especially T cell-based, has been found to cause tumor regression and even cure in a percentage of treated patients. Checkpoint inhibitors further underscore the potential of the T cell compartment in the treatment of cancer. Not all patients respond to these treatments; however, many challenges remain.AREAS COVERED: This review covers the challenges and progress in tumor antigen target identification and selection, and cell product manufacturing for T cell ACT. Tumor immune escape mechanisms and strategies to overcome those in the context of T cell ACT are also discussed.EXPERT OPINION: The immunotherapy toolbox is rapidly expanding and improving, and the future promises further breakthroughs in the T cell ACT field. The heterogeneity of the tumor microenvironment and the multiplicity of tumor immune escape mechanisms pose formidable challenges to successful T cell immunotherapy in solid tumors, however. Individualized approaches and strategies combining treatments targeting different immunotherapeutic aspects will be needed in order to expand the applicability and improve the response rates in future.
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| 20. |
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