187 research outputs found
Immunological Aspects of Endometriosis: An Update
No full textProblem: Endometriosis is a very complex disease that profoundly affects the quality of life of many women. Method of study: A review of the relationships between the female immune system and the occurrence and development of endometriosis. Results: Function and dysfunction of the female immune system plays important roles in the initiation and progression of the disease and its relation to infertility and cancer. Conclusions: Owing to obvious associations between endometriosis and the immune system, future treatment strategies might be based on immunological concepts and methods.</p
Junior doctors' experiences with interprofessional collaboration:Wandering the landscape
No full textContext: The transition from medical student to junior doctor is challenging. Junior doctors need to become part of the physician community of practice (CoP), while dealing with new responsibilities, tasks and expectations. At the same time, they need to learn how to navigate the frontiers and intersections with the other communities of practice that form the Landscape of Practice (LoP). This study aims to understand how junior doctors experience interprofessional collaboration (IPC) and what elements shape these experiences considering their transition to clinical practice.Methods: In this multicentre qualitative study, 13 junior doctors individually drew two rich pictures of IPC experiences, one positive and one negative. A rich picture is a visual representation, a drawing of a particular situation intended to capture the complex and non-verbal elements of an experience. We used semi-structured interviews to deepen the understanding of junior doctors' depicted IPC experiences. We analysed both visual materials and interview transcripts iteratively, for which we adopted an inductive constructivist thematic analysis.Results: While transitioning into a doctor, junior doctors become foremost members of the physician CoP and shape their professional identity based on perceived values in their physician community. Interprofessional learning occurs implicitly, without input from the interprofessional team. As a result, junior doctors struggle to bridge the gap between themselves and the interprofessional team, preventing IPC learning from developing into an integrative process. This professional isolation leaves junior doctors wandering the landscape of practice without understanding roles, attitudes and expectations of others.Conclusions: Learning IPC needs to become a collective endeavour and an explicit learning goal, based on multisource feedback to take advantage of the expertise already present in the LoP. Furthermore, junior doctors need a safe environment to embrace and reflect on the emotions aroused by interprofessional interactions, under the guidance of experienced facilitators.</p
Structural and functional properties of trophoblast cells of mouse egg‐cylinders in vitro
No full textEmbryos at the egg-cylinder stage were obtained by culturing blastocysts in vitro on an agarose surface for 4 days. The adhesiveness and outgrowth activity of the trophoblast of the egg-cylinder were compared with those properties of the flushed adhesive blastocyst. Trophoblast cells of egg-cylinders were found to be more adhesive and their outgrowth activity greater than in the case of trophoblast cells of adhesive blastocysts. The cultured egg-cylinders presented two subpopulations of giant trophoblast cells. They represent probably two stages of differentiation of the same trophoblast population. The most distinctive morphological differences of these subpopulations were that the surface of one was covered with small blebs and the cytoplasm had relatively few ribosomes, while the surface of the other subpopulation was covered with large blebs and microvilli and the cytoplasm was rich in ribosomes and large, dense granules. The two types of giant trophoblast cells of the day 7 implantation site consist of one subpopulation whose cytoplasm has few organelles, and the other subpopulation, whose cytoplasm is rich in ribosomes, lysosome-like bodies, and heterophagosomes. Hence, we conclude that the in vitro grown trophoblast cells have counterparts in the in vivo implanting embryos. The lectin binding pattern of the agarose cultured egg-cylinder trophoblast cells was similar to that of the adhesive and/or invasive trophoblast cells grown in vivo. Thus, the in vitro grown egg-cylinders are appropriate material for the analysis of trophoblast cells at the invasive stage of implantation.</p
Biotin labelling of chicken antibodies and their subsequent use in ELISA and immunohistochemistry
No full textAvian antibodies have many advantages to mammalian antibodies due to the phylogenetic differences between birds and mammals, resulting in an increased sensitivity and a decreased background in many immunological assays. Since the avidin-biotin system is an efficient detection system for antibodies with a high sensitivity, we wanted to investigate the activity and unspecific binding of optimally biotin labelled chicken antibodies in ELISA and immunohistochemistry. We report on the conditions for biotinylation of chicken antibodies and that optimally biotinylated antibodies show a high activity and a low background in both ELISA and immunohistochemistry.</p
Cross-cultural adaptation of the Swedish version of Endometriosis Health Profile-30
No full textThe Endometriosis Health Profile-30 (EHP-30) is focusing on the effect of endometriosis symptoms upon health-related quality of life. The aim of this study was to pre-test and culturally adapt the Swedish version of EHP-30. Eighteen Swedish-speaking women with laparoscopically verified diagnosis of endometriosis answered the questionnaire and 17 were interviewed regarding their interpretations of the questionnaire. Demographics, distribution of answers, roof-ceiling effects and missing answers were analysed. The interviews were analysed using the qualitative approach proposed by Beaton et al. The Swedish version of EHP-30 was experienced as accessible with 100% data completeness and a roof effect (11%) in one dimension. Some women had difficulties with the instructions and one word should be replaced in order to culturally adapt the questionnaire. In conclusion, the Swedish version of EHP-30 is a useful and well-accepted questionnaire for women with endometriosis in Sweden, but a minor change of wording is recommended.Impact statement What is already known on this subject? Cross-cultural adaptation and psychometric testing are crucial when introducing translated questionnaires. Cross-cultural adaptation is a process that looks at both translational and cultural issues when a questionnaire is being prepared for use in another country than the original. EHP-30 has been translated into Swedish but has not yet been cross-culturally adapted. What do the results of this study add? The Swedish version of EHP-30 was experienced as a useful and well-accepted questionnaire for women with endometriosis, but a minor change of wording is recommended in one question to make the questionnaire convergent with the original version
Age-related differences in experienced patient-centred care among women with endometriosis
No full textYounger women with endometriosis report lower quality of life and seek more care. Patient-centeredness is a central part of quality of care. The aim of this study was to investigate if women younger than 35 years experience endometriosis care as less patient-centred than women 35 years and older. The ENDOCARE Questionnaire was sent to 1000 randomly selected women with verified endometriosis from 10 clinics in Sweden. Answers from 469 women were analysed using Mann-Whitneys U-test and Spearmans correlation. Our findings show that younger women experience care as less patient-centred regarding Physical comfort, Continuity, Access to care, Technical skills, and overall patient-centeredness score in comparison with older women. On the contrary, younger women experience more patient-centeredness in Emotional support. Positive correlations were found for age and Access to care and Technical skills, while a negative correlation was found for age and Emotional support. Impact Statement What is already known on this subject? There is a need for improvement of quality of endometriosis care. Patient-centeredness is an important part of care improvement work. Many factors have an impact on experienced patient-centeredness in endometriosis care, whereof age is one possible determinant. Given the impact of age on QoL and care seeking behaviour, age may also have influence on the experience patient-centeredness. What do the results of this study add? Our findings show that younger women experience their endometriosis care as less patient-centred than older women. What are the implications of these findings for clinical practice and/or further research? Our results highlight the need of improvement of endometriosis care, especially for younger women. The results contribute to the understanding of the experience of patient-centeredness, which may be used as a guidance to how healthcare recourses should be allocated. Further research is needed to identify other factors contributing to the experience of patient-centeredness. Future studies could also evaluate how different interventions can improve patient-centeredness.Funding Agencies|Medical Research Council of Southeast Sweden [FORSS-964282]; Stiftelsen Tornspiran</p
Methods to produce stage-specific monoclonal antibodies against mouse trophoblast cells by intrasplenic and in vitro immunizations
No full textMonoclonal antibodies recognizing epitopes expressed by invasive mouse trophoblast cells were obtained by immunizing male mice of the NMRI strain with mouse egg-cylinders obtained by culturing blastocysts on agarose for 4 days. Immunization was achieved by intrasplenic and in vitro methods. The procedures described outline a rational way of producing and selecting antibodies which are stage-specific for the mouse trophoblast at implantation and early placentation. Preimplantation stage-specificity was tested and adhesive blastocysts only were detected by 4 antibodies. Thus, these antibodies become markers for that developmental stage which characterizes an adhesive blastocyst ready to implant. Postimplantation stage-specificity was demonstrated by 6 antibodies, which labelled trophoblast cells of day 7 implantations only. Thus, there is a specific expression of some epitopes by the invasive trophoblast. Cell surface epitopes were detected on adhesive blastocysts by 4 antibodies and on the invasive trophoblast of the egg-cylinder by 7 antibodies. Shedded antigens from egg-cylinders in vitro were detected by 5 antibodies. Four of these antibodies detected substances released only from early implantation stages. A functional effect was demonstrated for an IgM antibody which impaired hatching and outgrowth of blastocysts in vitro.</p
Demographic and clinical characteristics determining patient-centeredness in endometriosis care
No full textPurpose The primary aim of this study was to assess patient-centeredness of endometriosis care in a national sample of Swedish women with endometriosis. The secondary aims were to assess the importance of different dimensions of endometriosis care and to analyze demographic and clinical determinants associated with the experience of patient-centeredness. Methods This cross-sectional study included 476 women with confirmed endometriosis. An invitation to participate was sent to 1000 randomly selected women aged &gt;= 18 years having any endometriosis diagnosis and who had visited a gynecological clinic due to endometriosis problems any time during the past five years. Participants were recruited from ten different-sized gynecology clinics all over Sweden. The invitation letter had a link to the digital survey, which consisted of demographic and clinical questions, and the ENDOCARE questionnaire (ECQ). ECQ measures experiences, importance and patient-centeredness of ten dimensions of endometriosis care. Univariate and multiple regression analyses were used to analyze which patient-specific demographic and clinical determinants were associated with the experience of patient-centeredness. Results The response rate was 48%. The results indicate that Swedish women with endometriosis experience low patient-centeredness and rate relational aspects with healthcare professionals as the most important aspects of care. Having a gynecologist with patient responsibility was an independent predictor for high patient-centeredness. Conclusion Women with endometriosis in Sweden experience low patient-centeredness, reflecting the urgent need for improvement. More effort should be given to develop the relational aspects of care. Women with endometriosis should have a responsible gynecologist to care for treatment and follow-up.Funding Agencies|Uppsala University; Medical Research Council of Southeast Sweden; Stiftelsen Tornspiran</p
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