Publikationer från Örebro universitet
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Sjuksköterskors upplevelser att utföra omvårdnad i krigszoner
No full textSammanfattningBakgrund: Dagens vårdsystem som sattes till grund av Florence Nightingale, har över tid förändrats men principen har alltid varit den samma. Sjuksköterskor är ledande i omvårdnaden ute i krig och är obligerade att vårda alla skadade utifrån allvarlighetsgrad.Syfte: Syftet med studien var att beskriva sjuksköterskors upplevelser av att utföra omvårdnad i krigszoner,Metod: En systematisk litteratursökning i Cinahl och Medline resulterade i 12 artiklar. Artiklarna granskades med hjälp av integrativ dataanalys. Efter sökningen kvalitetsgranskades de valda artiklarna med hjälp av SBU:s granskningsmall.Resultat: Tre huvudteman med sju subteman presenterades i studien för att beskriva sjuksköterskors upplevelser av att genomföra omvårdnad i krig. Huvudkategorierna innefattade vårda i krig, leva i krig och komma tillbaka hem från krig. Underrubrikerna var förberedelse och utbildning och omvårdnad av patienten, begränsningar och utmaningar, hot och konflikt, coping, professionell och personlig utveckling och komma tillbaka till ett normalt liv.Slutsats: Sjuksköterskorna beskrev att vårda i krig innebar nya utmaningar. Det handlade om att leva i den konstanta hotbild som finns, svårigheter att känna empati för skadade eller brist i hotbilden. Sjuksköterskorna uppgav trots detta en tacksamhetskänsla och erfarenheter att bära med sig hela sin yrkeskarriär.Nyckelord: Krig, militär, omvårdnad, sjuksköterska, upplevelser
Individual adaptations - a key to sustainable working lifeAn integrative literature study on work adaptations for people with Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder
No full textBakgrund: Yrkesverksamma personer med neuropsykiatriska funktionsnedsättningar (NPF)som Attention Deficit Hyperactivity Disorder (ADHD) och autismspektrumtillstånd (ASD) är vanligt förekommande. Funktionsnedsättningarna yttrar sig olika. Personer med ADHD är ofta överaktiva, impulsiva och har svårt att hålla fokus. Personer med ASD har ofta begränsad social förmåga, kommunikationssvårigheter och svårigheter att hantera förändringar.Funktionsnedsättningarna kan även påverka arbetslivet där arbetsanpassningar kan behöva genomföras. Syfte: Syftet var att belysa anpassningar i arbetsmiljön för personer med de neuropsykiatriska funktionsnedsättningarna Attention Deficit Hyperactivity Disorder och autismspektrumtillstånd. Metod: Integrativ litteraturstudie baserad på 14 orginalstudier som sökts i tre databaser: PubMed, Cinahl och PsycInfo. Resultat: Resultatet belyser vikten av organisatoriska, sociala och fysiska arbetsanpassningar där struktur, flexibilitet, praktisk genomförbarhet, tekniska hjälpmedel, tysta miljöer och anpassad kommunikation beskrivs betydelsefulla. Att arbetsanpassningar genomförs individuellt, är stödjande samt baserade på kunskap anses betydande. Slutsats: Att arbetsanpassningar genomförs individuellt och är baserade på kunskap anses vara nyckelfaktorer till framgångsrika och hållbara arbetsanpassningar. Uteblivna eller misslyckade arbetsanpassningar antas inte bara påverka arbetstagaren som riskerar drabbas av psykisk ohälsa utan även arbetsgivaren som riskerar produktionsförlust och samhället genom ökade kostnader på grund av sjukskrivningar. Med hjälp av stödjande insatser, gärna tillsammans med företagshälsovården, och ny teknologi kan arbetsplatser åstadkomma hållbara och hälsofrämjande arbetsplatser.
”Varför gör de inte som vi säger?” : En intervjustudie om förståelsen för patientens autonomi inom den psykiatriska slutenvården
No full textAutonomi har beskrivits, i såväl tidigare forskning som av vårdgivare själva, som centralt inom svensk hälso- och sjukvård samtidigt som det beskrivs som ett tvetydigt begrepp. Inte sällan betonas respekt för patientens autonomi samtidigt som patientens ibland svåra psykiatriska hälsotillstånd motiverar att begränsa patientens autonomi, eller med tvångsvårdslagstiftning överta den helt. Genom ett fenomenologiskt hermeneutiskt förhållningssätt ämnar denna studie undersöka professionernas upplevelse och förståelse för hur patienternas autonomi formas och förstås inom de psykiatriska teamen i den slutna psykiatriska hälso- och sjukvården. Studien baserades på en intervjustudie med åtta respondenter; två läkare, två kuratorer, två skötare samt två specialistpsykiatrisjuksköterskor i tre olika regioner i Mellansverige. Genom en kvalitativ innehållsanalys och genom att applicera Karl Weicks sensemaking begrepp samt Moscovicis teori om sociala representationer som teoretiska utgångspunkter identifierades flera aspekter som formar professionellas förståelse: utbildning, erfarenhet, den hierarkiska hälso- och sjukvårdsstrukturen, lagstiftning, politiska mål, patientens sjukdomstillstånd samt dialog. Dialog lyfts fram som särskilt viktigt för att skapa en gemensam förståelse kring patientens autonomi. Den tvetydighet kring autonomibegreppet som lyfts fram kan bero på olika professioners förståelse av begreppet och skulle möjligen kunna bli tydligare genom dialog och därigenom gemensamt meningsskapande.Respect for the patient's autonomy is often emphasized in the litrature and by caregivers. In spite of this, difficult psychiatric condition sometimes justifies limiting the patient's autonomy, or to completely override the patients autonomy through compulsory care. With a phenomenological hermeneutic approach, this study aims to examine professional´s experience and how they understand how patient's autonomy is formed and understood within the psychiatric teams in the inpatient psychiatric healthcare. This study was based on an interview study with eight respondents: two doctors, two counselors, two carer and two specialist psychiatric nurses in three different regions in Central Sweden. Through a qualitative content analysis and by applying Karl Weick's sensemaking concept and Moscovici's theory of social representations, several aspects were identified that are involved in shaping professionals' understanding of patients autonomy: education, experience, the hierarchical structure in the health care system, legislation, political goals, the patient's medical condition, and dialogue. To create a collective understanding of patient's autonomy, dialogue is valued as important. The concept of autonomy is surrounded by ambiguity, perhaps as a result of professionals' different understanding of the concept, wich could be reduced through dialogue and through shared sensemakin
Open score : Composing for mixed ensemble with an improvisational focus
No full textI den här uppsatsen beskriver jag mitt undersökande av den konstnärliga processen att komponera ett stycke i kompositionstekniken open score. Undersökandet har gått ut på att ta utgångspunkt och inspiration i existerande verk som är komponerade med tekniken och applicera olika aspekter av dem i en egen komposition. Syftet med arbetet har varit att komponera ett stycke som passar bra att framföras av på valfri ensemble, som tillåter improvisation hos utövande musiker och samtidigt förmedlar mina egna intentioner. Stycket spelades av en grupp musiker som dessutom bidrog till den konstnärliga arbetsprocessen genom workshops. Jag valde detta ämne för att jag önskade utveckla mina egna färdigheter inom komposition och då denna kompositionsteknik framstod som krävande men intressant. Jag ville bli bättre på att komponera för andra instrument än de jag själv behärskar.
Metodutvärdering av peniscancer-sekvenseringGMS560 på FFPE-vävnad från Penis
No full textBackground: Penile cancer is a rare malignancy with limited genomic characterization in the litterature. Implementation of next-generation sequencing (NGS) enable detailed analysis of the cancer genome, providing opportunities to objectively categorize tumors based on biomarkers, which could guide diagnosis, prognosis, and treatment. The Genomic Medicine Sweden (GMS) GMS560 panel targets 560 cancer-associated genes and is commonly used in solid tumor analysis and has not been systematically evaluated for penile cancer. This study aims to assess the feasibility and performance of the GMS560 panel on formalin-fixed, paraffin-embedded (FFPE) penile cancer tissue, and to compare the three DNA library preparation kits, KAPA HyperPlus (Hyp), KAPA EvoPlus V2 (Evo), and Watchmaker DNA library prep kit with fragmentation (WM). Methods: Eight archived penile cancer FFPE samples were processed using the three library preparation kits. DNA was extracted, quality-controlled, and sequenced on the Illumina NextSeq 2000 platform. Key performance metrics were analyzed. Results: All kits were sequenced with varying performance. The WM kit had significantly longer median insert size (p < 0.001) and coverage (p = 0.003), while Evo demonstrated the most bases on target with significance (p = 0.001), but failed to meet key sequencing quality thresholds. Hyp had elevated duplication rates (p = 0.001). WM consistently yielded a higher number of low variant allele frequency (VAF <5 %) calls. Conclusion: The GMS560 panel is feasible for penile cancer genomic analysis using FFPE-tissue. The WM kit demonstrated the most balanced and consistent performance, suggesting its suitability for future clinical and research use. Further validation in larger cohorts is needed
Implementering av en ny pacemakerterapi på ettlänssjukhus.-observationer under uppstartsfasen
No full textBackground Left bundle branch area pacing (LBBaP) has emerged as a more physiologicalpacing than right ventricular pacing (RVP). Occasionally, LBBaP is used as a bailout forcardiac resynchronization therapy (CRT). Aim Determine the success rate of LBBaP (left bundle branch pacing (LBBP), likely leftbundle branch pacing (lLBBP), left ventricular septal pacing (LVSP)) due to V6 R-wave peaktime (V6RWPT), V6-V1 inter-peak interval (V6V1int), and QR pattern (QRp) in V1. Assess thevalidity of intraoperative measurements and compare postoperative QRS durations. Method All patients with the intention to obtain an LBBaP during the initial 18 months inRegion Dalarna, with the start of May 2023, were included. The patients who received a leadin the ventricular septum were considered LBBaP and thus included for further analysis. Boththe intraoperative and postoperative ECG were analyzed regarding capture (LBBP, likelyLBBP, LVSP, or deep septal pacing (DSP)). Results In total 43 of 86 (50%) patients received successful LBBaP procedures. Indeed, 48received a septal lead, hence three were classified as DSP and two instances if missing dataoccurred. In the remaining 38 patients, 32 received RVP and six CRT. Nine occurrences ofcomplications were documented. The implantation rate was initially high but decreasingduring summer. Pacing QRS duration was shorter in LBBaP patients compared to RVP(114.8±12.4 milliseconds (ms) vs 161.3±19.1 ms; p<0.001). Moreover, five patients had aclass 1 recommendation for CRT, three received successful LBBaP. Intraoperative andpostoperative measurements indicated similar in measured parameters (V6RWPT 78.2±12.3ms vs 76.6±11.8 ms; p=0.34, V6V1int 40.8±12.5 vs 40.5±12.5 ms; p=0.83). However,significant differences were seen in outcomes (p<0.05). Conclusion It is possible to implement LBBaP procedure in a county hospital in Sweden,but it is of greatest importance to preserve continuity, indeed ensure sufficient education andresources. The pQRSd indicating LBBaP is preferable compared with RVP. Further, LBBaPwas used as a bailout for CRT
Högerkammarstrain hos patienter med septiskchock och dess samband med kliniska utfall
No full textBackground Right ventricular (RV) dysfunction is common in septic shock and worsens outcome. Strainechocardiography, especially RV free wall strain (FWS), is a sensitive method for detectingsubclinical myocardial dysfunction. However, their prognostic value in sepsis remains unclear. AimThe aim of this study was to investigate the association between RV-FWS and 30-day mortalityin patients with septic shock. Secondary objectives were to assess associations with intensiveunit care (ICU) mortality, organ support free days (OSFD), and myocardial injury. Methods Data from the Sepsis in the ICU study (SICU-2) was used for this project. Adult patients withseptic shock within 12 hours of ICU admission were included. Within 24 hours, transthoracicechocardiography was performed and RV-FWS was assessed using speckle trackingechocardiography. Abnormal RV-FWS was defined as > –20%. Outcomes included 30-daymortality, ICU mortality, OSFD, and myocardial injury (hsTnT >45 ng/L). Logistic regressionwas adjusted for age and sex. Results Of 261 patients, 72 (27.6%) had analyzable RV-FWS data. Median RV-FWS was –18.25%, and59.7% had abnormal strain. RV-FWS did not significantly differ between 30-day survivors andnon-survivors (p = 0.365), nor was abnormal RV-FWS independently associated with 30-daymortality (OR 1.31, 95% CI 0.40–4.27; p = 0.651). No differences were found for ICU mortalityor OSFD. However, abnormal RV-FWS was significantly associated with myocardial injury(74.3% vs. 50.0%; p = 0.040). Conclusion Abnormal RV-FWS was not associated with 30-day mortality or organ support but wasassociated with myocardial injury. RV-FWS may serve as a marker of subclinical cardiacdysfunction in sepsis
Immun- och oxidativ stressrespons hos vältränade idrottare efter enstaka sessioner av långvarig aerob träning
No full textBackground: The use of biomarkers in sports poses many challenges as individual biomarkers are not definitive for diagnosing broad physiological states of training adaption, performance or health. Physical exercise induces significant changes in various biological responses, particularly the immune system, by triggering acute stress response mechanisms and oxidative response. Finding reliable biomarkers that can provide information about an athletes’ stress and recovery status could provide an opportunity to optimize and individualize exercise capacity and stress tolerance. Methods: 12 well-trained athletes visited the lab on five occasions – a pre-test followed by four trials with low- versus moderate-intensity treadmill running and speed versus heart rate with blood and saliva sampling at pre-, post- and 45 minutes post-training. Saliva Flow Rate, sIgA concentration, sIgA secretion rate and cortisol was analyzed in saliva and FORT, FORD and OSI in blood. Results: Levels of saliva flow rate and sIgA secretion rate were significantly higher POST exercise than both PRE and after 45 minutes rest after exercise. In plasma was both FORT and FORD significantly higher at POST exercise than both PRE and after 45 minutes rest after exercise. Conclusion: sIgA concentration increases in saliva but less saliva is secreted, indicating a decrease in immune defence at the oral mucosa. The greater increase in antioxidant defence than oxidative response may be due to the upregulated antioxidant expression in well-trained athletes. This study indicated that immune- and stress response have no significant differences between the tested intensities
Preanalytiska livsstilsfaktorer som är vanliga i Norden och deras effekt på analysresultaten hos en kommersiell Renin- och Aldosteron assay
No full textBackground The RAAS system is a hormonal system that regulates blood pressure and fluid balance by means of the hormones renin, angiotensin and aldosterone. Renin and aldosterone can be measured in blood, but they are sensitive to preanalytical factors that may influence the results. In this experimental pilot study, we evaluate, in a smaller population, the impact on measurement results of preanalytical factors common to the Nordic lifestyle: snus, licorice, coffee. In addition, because renin and aldosterone secretion have circadian variation, we also evaluated the impact of a night shift on renin and aldosterone. Aim The aim was to evaluate the performance of renin and aldosterone assays on Liaison XL and examine whether measurement results were influenced by preanalytical factors common to the Nordic lifestyle, i.e. snus/coffee/licorice as well as night work. Method performance was assessed as repeatability, precision. Accuracy was assessed by comparing analysis results with Uppsala University Hospital (Akademiska sjukhuset) whose method served as the reference. Renin and aldosterone was measured in the same individual before and after exposure to Reference interval evaluation was performed on 20 individuals with high blood pressure by measuring blood pressure markers and comparing with the manufacturer´s reference interval.Results Method precision and repeatability was found to be slightly higher compared to the manufactures´ values but acceptable. Accuracy was acceptable, with renin correlating well with the Uppsala method, while aldosterone showed a slightly higher than desirable, measurement bias of 16%, possibly owing to preanalytical factors related to sample handling. In some individuals, measurement results differed after consumption of licorice, caffeine, snus or working a night shift, but none of the differences reached statistical significance, although licorice and snus was close (p = 0.08). Conclusion Snus, coffee, licorice and night work had a limited effect on renin and aldosterone concentrations, with, on average, minor mean differences in measurement results, that were not statistically significant. However, licorice and snus was close to statistical significance. The small population of this study entailed a lack of power, and the subject merits further study in larger populations
Teaching English, Teaching Empire? : A Dual Approach Analysis of Representation and Marginalisation in Swedish Upper Secondary School EFL Textbooks
No full textThis study investigates whether, and in what ways, cultural representation and linguistic imperialism are expressed in four textbooks used in English 6 courses in Swedish upper secondary schools. Using a mixed-methods approach that combines quantitative content analysis with critical discourse analysis, this study identifies patterns of representation concerning different geographical and cultural perspectives, with a particular focus on the relationship between core and peripheral English-speaking contexts. Terms including epistemic extractivism, Anglocentricity and naturalisation are used throughout the study to analyse whether, and if so how, power structures and hierarchies are reproduced by language and content choices within the textbooks. The results show an overrepresentation of core perspectives, both with regard to textual content and authorship, while peripheral perspectives are often absent or interpreted through a core lens. The study also discusses how representational imbalances contradict the Swedish curriculum Lgy11’s goals regarding diversity, intercultural understanding, and critical thinking, underscoring how critical literacy can be utilised as a pedagogical tool to strengthen students’ democratic competence