| 1. |
- Joona, Therse Björkin, et al.
(författare)
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Influenza vaccination in breast cancer patients during subcutaneous trastuzumab in adjuvant setting
- 2020
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Ingår i: Breast Cancer Research and Treatment. - : Springer. - 0167-6806 .- 1573-7217. ; 184:1, s. 45-52
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the current recommendation for influenza vaccination in cancer patients with active oncological therapy, limited data are available on the efficacy of vaccination in cancer patients receiving targeted therapies. We aimed to investigate the immunogenicity and tolerability of influenza vaccination in breast cancer patients treated with trastuzumab in adjuvant setting.Methods: A prospective open-label multicenter study was performed including patients with breast cancer during trastuzumab treatment in adjuvant setting and healthy controls. Blood samples were taken before, 4 weeks after, and 12 weeks after a single dose of trivalent influenza vaccine containing inactivated A/California/7/2009 (H1N1) pdm09, A/Hongkong4801/2014 (H3N2), and B/Brisbane/60/2008. Levels of serum antibody titers to hemagglutinin for H1N1 and influenza B strains were measured.Results: Twenty breast cancer patients and 37 controls were included in the study. No difference in seroprotection rate between trastuzumab-treated patients and controls was observed for either H1N1 (100% in both groups) or B strain (78.9% vs. 89.2%,pvalue = 0.423). A statistically significant increase in geometric mean titers from baseline was seen in both groups and was evident both 4 weeks and 12 weeks after vaccination. Adverse events in the trastuzumab-treated group were uncommon and mild with only one serious adverse event not related to vaccination.Conclusion: Breast cancer patients treated with trastuzumab in adjuvant setting seem to benefit from influenza vaccination in terms of immunogenicity without increasing the risk for adverse events. The current data support the recommendation to offer influenza vaccination in breast cancer patients treated with this type of targeted therapy.
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| 2. |
- Kirvalidze, Mariam, et al.
(författare)
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Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts’ perspective
- 2024
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Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 1365-2796 .- 0954-6820. ; 295:6, s. 804-824
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Tidskriftsartikel (refereegranskat)abstract
- Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers’ scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.
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| 3. |
- Mouazzen, Anna-Karin, 1967-, et al.
(författare)
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Adaptation and psychometric evaluation of the Swedish version of the Assessment of Inter professional Team Collaboration Scale (AITCS-S) for use in occupational health services
- 2022
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Ingår i: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567. ; 36:6, s. 908-915
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Tidskriftsartikel (refereegranskat)abstract
- Interprofessional team collaboration (ITC) in the Swedish Occupational Health Service is an important part of the service given to the customer. The Occupational Health Service (OHS) could be more competitive if they were able to show how successful is their ITC. The Assessment of Interprofessional Team Collaboration Scale (AITCS) is an instrument that measures ITC in teams working with the client as part of the team. The aim of this study was to adapt the Swedish version of the instrument for use in OHS and to evaluate the psychometric properties of the adapted version and the adapted short version. The study included 472 participants from different OHSs, all members of the trade association of occupational health care in Sweden. Face and content validity of the instrument were assessed, and floor and ceiling effects were measured. Internal consistency was measured with Cronbach's alpha and an exploratory factor analysis was conducted on the 42-item adapted instrument and the short, 24-item version. The exploratory factor analysis gave a three-factor solution with an eigenvalue >1 and explaining a total variance of 57.1% and 62.3% for the short version. The study concludes that AITCS-S-(OHS) as well as the short version, is a reliable and valid questionnaire. Further development of the AITCS-S-(OHS) needs to be undertaken and assessed by confirmatory factor analysis.
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| 4. |
- Andersson, Erik, 1979-, et al.
(författare)
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Kollegialt Lärande i Örebros Skolor – KLÖS-projektet : Hur kan lärares kollegiala lärprocesser stödjas i syfte att skapa hållbara strukturer för utvecklingsarbete?
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Projektet KLÖS har undersökt hur lärares kollegiala lärprocesser kan stödjas i syfte att skapa hållbara strukturer för utvecklingsarbete. Målet var att skapa en Örebromodell för kollegialt lärande. En avslutande reflektion kring resultatet är att etableringen av denna modell kräver ett omfattande engagemang och tar tid att få på plats. Det är vår uppfattning att ett flertal aspekter återstår att undersöka. Bland annat är det intressant att undersöka hur arbetet med det kollegiala lärandet fortskrider på pilotskolan. Frågor som är intressanta är: Vilka faktorer har betydelse för att arbetet med kollegialt lärande ska bli permanent och fungera som ett naturligt sätt att arbeta med utveckling av praktiken? Vad blir resultatet av de utvecklingsomgångar som genomförts? Hur följs detta resultat upp och leder det till bestående gynnsamma förändringar? Frågorna handlar om hållbarhet och därmed om hur projektet går från att vara ett projekt som avslutas och glöms bort till att bli ett levande verktyg för utvecklingsarbete som kan göra en verklig skillnad i och för praktiken över tid. Eftersom mycket tid och resurser används till utvecklingsarbete i skolan är det viktigt att det arbete som görs verkligen leder till en konkret och för verksamheten gynnsam förändring. Det innebär att frågan om utvecklings- arbetets hållbarhet är en av de viktigaste frågorna. Det verktyg som utvecklats i projektet och som kommit att symbolisera det kollegiala arbetet på pilotskolan är KLÖS-hjulet. Frågan om hur KLÖS-hjulet 2.0 kan utvecklas och anpassas så att det verkligen blir ett flexibelt och användbart verktyg för att stötta det kollegiala lärandet är kanske den alla viktigaste konkreta frågan. Frågor som är besläktade med frågan om hållbarhet är de som syftar till att undersöka hur det kollegiala lärandet kan bli mer robust. Till dessa hör frågor om hur lärledarens roll kan förstärkas, hur verktyg som stöttar lärares observation och analys av den egna verksamheten kan designas, hur ansvar och engagemang på alla nivåer kan förstärkas och bli synligt samt hur arbetet med kollegialt lärande kan utvärderas. Vi har under projektets gång sett hur lärare behöver stöd i arbetet med att systematiskt identifiera behov i verksamheten för att sedan utforska möjligheter att utveckla och förändra praktiken. Medverkan från forskare som ställt frågor, problematiserat och belyst olika perspektiv har i flera fall varit avgörande för hur ett utvecklingsbehov har identifierats, avgränsats och formulerats som en undersökningsbar fråga. Det är av avgörande betydelse att utvecklingsarbetet inte står och faller med denna medverkan. Verksamheten måste själv ta fram strukturer för hur lärare och lärledare får ett tillfredsställande stöd i sitt utvecklingsarbete så att de har möjlighet att göra kollegialt lärande till en naturlig del av sitt arbete där de känner sig så bekanta med KLÖS-hjulet att de själva kan ställa de frågor som krävs. Således behöver många funktioner, både centralt och lokalt samverka för att vidareutveckla och stötta kollegialt lärande för att utveckla undervisningen i Örebro skolor.
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| 5. |
- Bomark, Niklas, 1984-
(författare)
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Drawing Lines in the Sand : Organizational Responses to Evaluations in a Swedish University
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As organizations are increasingly evaluated, evaluative practices are becoming central to organization theory. While highlighting how organizations may respond to evaluations, earlier work on organizations and evaluation has been limited to inter-organizational evaluations, such as third-party rankings or ratings. As a consequence, the prevailing perspective on organizational responses has been developed almost entirely based on an idea that what is being evaluated in the first place – the evaluation entities – is unproblematic. Acknowledging that the definition of the evaluation entity may be ambiguous prior to the evaluation, and that this definition might vary over time, some interesting areas of inquiry emerge in relation to current understandings of organizational responses to evaluations.First, it raises questions of how entities are defined in evaluations, and how this can be seen as an organizational response? Second, it raises questions about our current understanding of the dynamics of organizational responses and how organizational responses shape organizational adaptation and change. Third, it raises question about how entity definitions shape how organizations become evaluated. Despite recent interest in understanding organizational responses to evaluations, organizational scholars have largely refrained from entertaining these questions.The objective of this dissertation is to revisit the assumption of the unambiguously defined evaluation entity in the current theorizing on organizational responses to evaluations. An opportunity to investigate this question emerged when the oldest university in Sweden, Uppsala University, decided to carry out two large evaluations of the research activities within the university – in 2007 and in 2011. The evaluation was made public and aimed to identify and evaluate (partly through a rating) the research achievements of the departments of the university. This presented an opportunity to study organizational responses to evaluations in a setting that is different from what has been studied previously. Based on a study of 44 of the departments within the university my main finding show how entities are defined and how this can be seen as an organizational response to evaluations. My findings also show how entity definitions interact with the more traditional responses taken after an evaluation, and that entity definitions shape the evaluation of the department. This dissertation thus lends support for the idea that apart from responding by changing activities or their organizational units, organizations can also respond to evaluations by the way they shape what will be evaluated – the entities being subject for the evaluation. The findings in this dissertation holds consequences for organizational theory and the evaluation of organizations.
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| 6. |
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| 7. |
- Göras, Camilla, 1969-, et al.
(författare)
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Tasks, multitasking and interruptions among the surgical team in an operating room : a prospective observational study
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:5, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR.DESIGN: Prospective observational study using the Work Observation Method By Activity Timing tool.SETTING: An OR department at a county hospital in Sweden.PARTICIPANTS: OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9).RESULTS: The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication.CONCLUSIONS: The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system.TRIAL REGISTRATION NUMBER: 2016/264.
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| 8. |
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| 9. |
- Jansson, Andreas, et al.
(författare)
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Toward quantifying the thymic dysfunction state in mouse models of inflammatory bowel disease
- 2013
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Ingår i: Inflammatory Bowel Diseases. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1078-0998 .- 1536-4844. ; 19:4, s. 881-888
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Forskningsöversikt (refereegranskat)abstract
- Inflammatory bowel disease is characterized by a number of immunological alterations, not the least in the T-cell compartment. Numerous animal models of colitis have revealed aberrant thymocyte dynamics associated with skewed thymocyte development. The recent advancements in quantitative methods have proposed critical kinetic alterations in the thymocyte development during the progression of colitis. This review focuses on the aberrant thymocyte dynamics in Gαi2-deficient mice as this mouse model provides most quantitative data of the thymocyte development associated with colitis. Herein, we discuss several dynamic changes during the progression of colitis and propose a hypothesis for the underlying causes for the skewed proportions of the thymocyte populations seen in the Gαi2-deficient mice and in other mouse models of colitis.
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| 10. |
- Jansson, Markus, 1982-
(författare)
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Pelvic Floor Dysfunction and Perineal and Vaginal Tears in Primiparous Women
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pelvic floor dysfunction (PFD), including urinary incontinence, faecal incontinence (FI), and pelvic organ prolapse, is highly prevalent among parous women. There is evidence that pregnancy, vaginal delivery, and obstetric perineal tears increase the risk of pelvic floor dysfunction, but many of the studies in this field are retrospective. The overall aim of this thesis was to prospectively examine risk factors for perineal and vaginal tears and postpartum PFD in primiparous women.Study I was a validation study of a protocol for documentation of perineal tears, including 187 primiparous women in 2015–2016. The coverage of documentation was higher in the protocol compared to the obstetric record system (ObstetriX). Incidence of second degree perineal tears was 26% according to the protocol and 11% according to ObstetriX.Studies II–IV utilized a cohort of initially nulliparous women (n=1049) prospectively included in early pregnancy in 2014–2017. Women completed questionnaires on PFD in early and late pregnancy and at 8 weeks and 1 year postpartum.Study II (n=644) showed that high foetal weight and vacuum extraction were risk factors for both second degree tears and OASI, suggesting that these tears should be viewed as a continuum rather than different entities. Risk factors for high vaginal tears were large foetal head circumference, vacuum extraction, and heredity of PFD/connective tissue deficiency. Study III (n=670) found that vaginal delivery increased the risk of stress urinary incontinence (SUI) but not urgency urinary incontinence (UUI) 1 year postpartum. No single characteristic of the vaginal delivery was associated with SUI. SUI during pregnancy increased the risk of SUI postpartum, and UUI during pregnancy increased the risk of UUI postpartum.Study IV (n=898) showed that FI increased by late pregnancy, and that this increase persisted 1 year postpartum. Obstructed defecation was associated with increased FI postpartum, suggesting that post-defecatory faecal loss may be an underlying mechanism of FI. Overall conclusion: The extent to which pregnancy, vaginal delivery, and their respective characteristics contributed to the development of PFD differed between the pelvic floor disorders studied. For SUI, both the pregnancy and the vaginal delivery increased the risk, whereas for FI it was the pregnancy itself rather than the vaginal delivery that was demonstrated to increase the risk.
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