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- Andersson, Lena, 1979-
(author)
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När strävan efter samsyn blir en kamp : Meningsskapande och meningsgivande i mångtydiga sammanhang
- 2010
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Doctoral thesis (other academic/artistic)abstract
- När personer och grupper med olika bakgrund och erfarenheter möts för att sam-arbeta förutsätts ofta att samsyn kring målen med verksamheten är en förutsätt-ning för koordinerad handling. Forskningen har dock inte kunnat visa empiriskt i vilken utsträckning samsyn är viktigt för att åstadkomma samhandling. I förelig-gande avhandling presenteras en studie som undersöker hur gemensam mening formas i sammanhang präglade av heterogenitet respektive mångtydighet samt hur koordinerad handling uppstår under sådana förutsättningar. Som empirisk grund för att kunna besvara frågeställningarna studeras FöretagsNära med stöd i me-ningsskapandeperspektiv. FöretagsNära är en ny verksamhet organiserad som ett projekt i samverkan mellan Norrköpings kommun och Arbetsförmedlingen i Norr-köping. Syftet med satsningen är att föra samman näringslivsutvecklande och ar-betsmarknadsinriktade insatser och bidra till fler arbetstillfällen i Norrköping. Ba-serat på en longitudinell fältstudie berättas om meningsskiljaktigheter och strävan efter samsyn. Den longitudinella ansatsen gör det möjligt att se utvecklingen av och komplexiteten i formandet av samsyn och samhandling. Skildringen av Före-tagsNära visar att meningsskapandet i processen tar sig olika uttryck. I fråga om syftet med FöretagsNära uppstår en kamp om meningen. Studien visar hur samsyn och samhandling relaterar till varandra på mer komplexa sätt än tidigare forskning föreslagit. Det finns ingen entydig relation mellan gemensam mening och koordi-nerad handling. Studiens resultat har både teoretisk relevans och stor praktisk be-tydelse.
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| 3. |
- Eriksson, Jesper, et al.
(author)
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Temporal patterns of organ dysfunction after severe trauma
- 2021
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In: Critical Care. - : Springer Nature. - 1364-8535 .- 1466-609X. ; 25:1
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Journal article (peer-reviewed)abstract
- Background Understanding temporal patterns of organ dysfunction (OD) may aid early recognition of complications after trauma and assist timing and modality of treatment strategies. Our aim was to analyse and characterise temporal patterns of OD in intensive care unit-admitted trauma patients. Methods We used group-based trajectory modelling to identify temporal trajectories of OD after trauma. Modelling was based on the joint development of all six subdomains comprising the sequential organ failure assessment score measured daily during the first two weeks post trauma. Further, the time for trajectories to stabilise and transition to final group assignments were evaluated. Results Six-hundred and sixty patients were included in the final model. Median age was 40 years, and median ISS was 26 (IQR 17-38). We identified five distinct trajectories of OD. Group 1, mild OD (n = 300), median ISS of 20 (IQR 14-27), had an early resolution of OD and a low mortality. Group 2, moderate OD (n = 135), and group 3, severe OD (n = 87), were fairly similar in admission characteristics and initial OD but differed in subsequent OD trajectories, the latter experiencing an extended course and higher mortality. In group 3, 56% of the patients developed sepsis as compared with 19% in group 2. Group 4, extreme OD (n = 40), received most blood transfusions, had the highest proportion of shock at admission and a median ISS of 41 (IQR 29-50). They experienced significant and sustained OD affecting all organ systems and a 28-day mortality of 30%. Group 5, traumatic brain injury with OD (n = 98), had the highest mortality of 35% and the shortest time to death for non-survivors, median 3.5 (IQR 2.4-4.8) days. Groups 1 and 5 reached their final group assignment early, > 80% of the patients within 48 h. In contrast, groups 2 and 3 had a prolonged time to final group assignment. Conclusions We identified five distinct trajectories of OD after severe trauma during the first two weeks post-trauma. Our findings underline the heterogeneous course after trauma and describe some potentially important clinical insights that are suggested by the groupings and temporal trajectories.
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| 4. |
- Hellgren, Laila, et al.
(author)
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Biological versus mechanical prosthesis in 3279 patients from the Swedish in-patients register
- 2011
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In: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 45:4, s. 223-228
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Journal article (peer-reviewed)abstract
- Objectives. To compare valve-related morbidity among patients aged = 70 years, receiving either a mechanical or a biological prosthesis in a population-based setting. Design. In total, 3279 patients (21 644 patient-years) were followed up through the Swedish National In-Patients Register, which registers all hospital admissions. Death, thromboembolism, bleeding, endocarditis, valve thrombosis and reoperations were all captured. Results. Survival was lower among patients aged 5 years). Event-free survival was higher in younger patients with a mechanical prosthesis compared to bioprosthesis recipients (p < 0.001), but equal among older patients. Conclusions. Survival was comparable in older patients irrespective of prosthesis type. Bleeding was increased with a mechanical prosthesis, especially in the elderly. The risk of thromboembolism was higher in patients with a bioprosthesis.
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| 6. |
- Hellgren, Laila, 1967-
(author)
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Heart Valve Surgery : Preoperative Assessment and Clinical Outcome
- 2005
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Doctoral thesis (other academic/artistic)abstract
- A more global analysis of the outcome of heart valve surgery is desirable to reflect the actual benefit for the patient. This thesis focuses on the preoperative assessment of the patient, and the outcome after surgery with regard to operative mortality, long-term survival, valve-related complications, and quality of life.Magnetic resonance imaging and echocardiography were comparable in assessing severe mitral regurgitation, but did not agree in measuring regurgitant fraction. Natriuretic peptides correlated well to regurgitant fraction on magnetic resonance imaging and to PISA and vena contracta on echocardiography.The risk of death, myocardial injury and postoperative heart failure after valve surgery has decreased over the last decade whereas the proportion older patients has increased.Survival is reduced after mitral valve replacement in patients with severe symptoms whereas patients with less symptoms have excellent survival. Older patients are more often severly symptomatic at the time of mitral valve surgery.Event-free survival is superior in patients with a mechanical prosthesis, but not influenced by valve type in older patients. A mechanical prosthesis is associated with a higher risk of bleeding < 5 years from surgery, especially in older patients; and a bioprosthesis is associated with a higher risk of thromboembolism > 5 years from surgery. Ageing with a mechanical prosthesis implied an increased risk for an adverse event, this was not true for bioprostheses.Quality of life after complicated heart valve surgery resulted in reduced physical health but equal mental health compared to uncomplicated controls.
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| 10. |
- Hellgren, Laila, et al.
(author)
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Optimal timing of aortic valve replacement for aortic stenosis : are we operating late?
- 2003
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In: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 37:5, s. 266-269
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate the adherence to current guidelines for surgery in patients with aortic valve stenosis.DESIGN: From 1 January 1997 to 31 May 1999, 99 patients were accepted for aortic valve surgery with preserved left ventricular function and normal coronary angiogram. On admission for operation, 20 patients were evaluated regarding symptoms, exercise capacity, and left ventricular morphology and function.RESULTS: There were 14 men and 6 women, mean age 64.3 years. Years from symptom onset varied from 2.1 to 3.2. Dyspnoea was the most common limiting symptom. Thirty per cent of the patients were classified as NYHA IIIB. Physical capacity was reduced to 79% of the expected. Left ventricular hypertrophy was present in 14/20 patients. Left ventricular systolic function was reduced with mean ejection fraction of 0.46. Diastolic dysfunction (E/A ratio <1) was present in 12 patients.CONCLUSION: Many patients accepted for aortic valve replacement due to aortic stenosis show advanced disease and are referred for surgery later in the disease process than is recommended in the current guidelines.
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