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  • 1.
    Ahlberg, Hans
    et al.
    Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Östersund).
    Wallgren, Daniel
    Department of Surgical and € Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sunderbyn).
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Department of Surgical and € Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sunderbyn).
    Johansson, Joakim
    Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Östersund).
    Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery: A randomised controlled trial2023In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 40, no 9, p. 636-642Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Surgery for breast cancer is common, and intravenous opioids are often used to control postoperative pain. Recently, pectoralis-2 (PECS-2) block has emerged as a promising regional anaesthetic alternative. With nomenclature recently proposed, this block is termed combined PSP/IPP-block (pectoserratus plane block/interpectoral plane block).

    OBJECTIVE: We aimed to compare the need for postoperative rescue morphine between the intervention group that received a pre-operative combined PSP/IPP-block and a control group that received peri-operative long-acting opioids for postoperative analgesia.

    DESIGN: A randomised controlled study.

    SETTING: Operating theatres of two Swedish hospitals. The patients were recruited between May 2017 and October 2020.

    PATIENTS: Among the 199 women scheduled to undergo breast cancer surgery (sector resection or radical mastectomy) who were enrolled in the study, 185 were available for follow up.

    INTERVENTION: All patients received general anaesthesia. The intervention group received a combined PSP/IPP-block before surgery. The control group received intravenous morphine 30 min before emergence from anaesthesia.

    MAIN OUTCOME MEASURE: The primary endpoint was the cumulative need for intravenous rescue morphine to reach a predefined level of pain control (visual analogue scale score <40 mm) during the first 48 h after surgery.

    RESULTS: Data from 92 and 93 patients in the intervention and control groups, respectively, were analysed. The amount of rescue morphine administered in the 48 h after surgery was significantly lower in the intervention group than in the control group (median: 2.25 vs 3.0 mg, P  = 0.021). The first measured pain score was lower in the intervention group than in the control group (35 vs. 40 mm, P  = 0.035). There was no significant difference in the incidence of nausea between the groups (8.7 vs. 12.9%, P  = 0.357).

    CONCLUSION: The use of a combined PSP/IPP-block block before breast cancer surgery reduces the need for postoperative rescue morphine, even when compared with the use of intra-operative morphine.

    TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03117894.

  • 2.
    Allvin, Renée
    et al.
    Clinical Skills Centre, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro.
    Berndtzon, Magnus
    Metodikum – Skill Centre of Medical Simulation Region County Jönköping, Jönköping.
    Carlzon, Liisa
    Simulation Centre West, Department of Research, Education and Development, Sahlgrenska University Hospital, Gothenburg.
    Edelbring, Samuel
    Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping.
    Hult, Håkan
    Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Karlgren, Klas
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm.
    Masiello, Italo
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset Hospital, Stockholm.
    Södersved Källestedt, Marie-Louise
    Clinical Skills Centre, Centre for Clinical Research, Uppsala University, Västerås.
    Tamás, Éva
    Department of Cardiovascular Diseases, Institute of Medicine and Health, Medical Faculty, University of Linköping, Linköping.
    Confident but not theoretically grounded: experienced simulation educators’ perceptions of their own professional development2017In: Advances in Medical Education and Practice, E-ISSN 1179-7258, no 8, p. 99-108Article in journal (Refereed)
    Abstract [en]

    Background: Medical simulation enables the design of learning activities for competency areas (eg, communication and leadership) identi ed as crucial for future health care professionals. Simulation educators and medical teachers follow different career paths, and their education backgrounds and teaching contexts may be very different in a simulation setting. Although they have a key role in facilitating learning, information on the continuing professional development (pedagogical development) of simulation educators is not available in the literature. Objectives: To explore changes in experienced simulation educators’ perceptions of their own teaching skills, practices, and understanding of teaching over time.

    Methods: A qualitative exploratory study. Fourteen experienced simulation educators partici- pated in individual open-ended interviews focusing on their development as simulation educators. Data were analyzed using an inductive thematic analysis. Results: Marked educator development was discerned over time, expressed mainly in an altered way of thinking and acting. Five themes were identi ed: shifting focus, from following to utilizing a structure, setting goals, application of technology, and alignment with profession. Being con dent in the role as an instructor seemed to constitute a foundation for the instructor’s pedagogical development.

    Conclusion: Experienced simulation educators’ pedagogical development was based on self- con dence in the educator role, and not on a deeper theoretical understanding of teaching and learning. This is the rst clue to gain increased understanding regarding educational level and possible education needs among simulation educators, and it might generate several lines of research for further studies. 

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  • 3.
    Andersson, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Att skapa läkare i glesbygd2018In: Allmänmedicin : tidskrift för Svensk förening för allmänmedicin, ISSN 0281-3513, no 3, p. 26-27Article in journal (Other (popular science, discussion, etc.))
  • 4.
    Andersson, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sjöström, Lars-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Karlsson, Marcus
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Karpe, Fredrik
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Dysregulation of subcutaneous adipose tissue blood flow in overweight postmenopausal women2010In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 17, no 2, p. 365-371Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A putative link between abdominal obesity and metabolic-vascular complications after menopause may be due to a decreased adipose tissue blood flow (ATBF). The present work aimed to analyze possible changes in ATBF with being overweight and menopausal and its putative link to endothelial dysfunction and autonomic nervous system balance.

    METHODS: Forty-three healthy women were classified into four groups according to weight and menopause status. The ATBF was measured by xenon washout while fasting and after oral glucose intake. The nitric oxide synthase inhibitor asymmetric dimethylarginine was used as a marker of endothelial function and heart rate variability-estimated autonomic nervous system activity.

    RESULTS: Fasting ATBF was decreased in both overweight groups (P = 0.044 and P = 0.048) versus normal-weight premenopausal women. Normal-weight and overweight postmenopausal women exhibited lower maximum ATBF compared with normal-weight premenopausal women (P = 0.015 and P = 0.001, respectively), and overweight postmenopausal women exhibited lower maximum ATBF compared with normal-weight postmenopausal women (P = 0.003). A negative correlation was found between fasting ATBF and asymmetric dimethylarginine (P = 0.015), whereas maximum ATBF was negatively associated with sympathetic-parasympathetic nervous system balance (ratio of the power of the low frequency to the power of the high frequency; P = 0.002).

    CONCLUSIONS: Loss of ATBF flexibility in overweight postmenopausal women may contribute to the metabolic dysfunction seen in this group of women.

  • 5.
    Atterhem, Veronica
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    The incidence of hemodynamic and respiratory adverse events in morbidly obese presenting for Bariatric surgery2018In: International Journal of Clinical Anesthesia and Research, Vol. 2, no 1, p. 009-017Article in journal (Refereed)
    Abstract [en]

    Context: Perioperative management of morbidly obese patients undergoing bariatric surgery is challenging. Lacking standardized perioperative protocols, complication rates may be high. This retrospective study aims to quantify the incidence of significant blood pressure decreases on induction of anesthesia and intraoperative hypoxemia, before implementation of a standardized protocol designed for bariatric surgery.

    Design: Retrospective, observational study.

    Setting: A 250-bed county hospital in northern Sweden.

    Subjects: 219 morbidly obese patients (body mass index > 35 kg/m2) who underwent bariatric surgery between 2003 and 2008.

    Main outcome measures: Incidence of systolic blood pressure (SAP) falls to less than 70% of the preoperative baseline during induction of anesthesia and incidence of perioperative hypoxemia.

    Results: The incidence of confirmed SAP falls to below 70% of baseline at induction of anesthesia was 56.2% (n = 123/219). This incidence rose with increasing age (p < 0.001) but not with body mass index (BMI). 3.7% (n = 8/219) of cases were marked as difficult intubations. A transient period of hypoxemia was observed in 6.8% (n = 15/219) and was more common with increasing BMI (p = 0.005). Fourteen different drug combinations were used in the study population. Of those administered an induction anesthetic drug, 72.6% (n = 159/193) were given an overdose when calculated by lean body weight, but this did not correlate significantly to SAP falls (p = 0.468).

    Conclusions: The incidence of a significant blood pressure fall upon induction of anesthesia was common. The incidence of airway and ventilation problems were low. Overdosing of anesthetics and excessive variation in applied anesthesia methods were found.

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  • 6.
    Bromfalk, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Engström, Åsa
    Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Sweden.
    Walldén, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Posthospital negative behavioural changes in children: a secondary analysis of a previous randomized clinical trial including a narrative reviewManuscript (preprint) (Other academic)
  • 7.
    Bromfalk, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Engström, Åsa
    Luleå Tekniska universitet.
    Walldén, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine2023In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 33, no 11, p. 962-972Article in journal (Refereed)
    Abstract [en]

    Background: Preoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2–6 years.

    Methods: In this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured.

    Results: After excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups.

    Conclusions: No statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2-agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.

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  • 8.
    Bromfalk, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Wallden, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Cardiorespiratory response to sedative premedication in preschool children: a randomized controlled trial comparing midazolam, clonidine, and dexmedetomidine2023In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 38, no 3, p. 454-460Article in journal (Refereed)
    Abstract [en]

    Purpose: Sedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia.

    Design: A single-center randomized controlled trial.

    Methods: This is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2–6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg–1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period.

    Findings: The final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P<0.001 and P=0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r=-0.570, P<0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min–1, CLO 20.6±2.6 min–1, DEX 20.2±1.7 min–1; P=0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min–1; CLO, 87.4±9.6 min–1; DEX, 87.6±7.9 min–1; P<0.001). The HR was lower immediately after induction (P=0.009) and intraoperatively (P=0.025) in the CLO and DEX groups than in the MID group.

    Conclusions: When used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period.

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  • 9.
    Bromfalk, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Walldén, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Engström, Åsa
    Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Sweden.
    Perioperative staff’s experiences of premedication for children2024In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473Article in journal (Refereed)
  • 10.
    Bromfalk, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Walldén, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Engström, Åsa
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine2021In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 31, no 11, p. 1225-1233Article in journal (Refereed)
    Abstract [en]

    Introduction: Anxiety in pediatric patients may challenge perioperative anesthesiology management and worsen postoperative outcomes. Sedative drugs aimed to reducing anxiety are available with different pharmacologic profiles, and there is no consensus on their effect or the best option for preschool children. In this study, we aimed to compare the effect of three different premedications on anxiety before anesthesia induction in preschool children aged 2-6 years scheduled for elective surgery. The secondary outcomes comprised distress during peripheral catheter (PVC) insertion, compliance at anesthesia induction, and level of sedation.

    Patients and methods: In this double-blinded randomized clinical trial, we enrolled 90 participants aged 2-6 years, who were scheduled for elective ear-, nose-and-throat surgery. The participants were randomly assigned to three groups: those who were administered 0.5 mg/kg oral midazolam, 4 µg/kg oral clonidine, or 2 µg/kg intranasal dexmedetomidine. Anxiety, distress during PVC insertion, compliance with mask during preoxygenation, and sedation were measured using the modified Yale Preoperative Anxiety Scale, Behavioral Distress Scale, Induction Compliance Checklist, and Ramsay Sedation Scale, respectively.

    Results: Six children who refused premedication were excluded, leaving 84 enrolled patients. At baseline, all groups had similar levels of preoperative anxiety and distress. During anesthesia preparation, anxiety was increased in the children who received clonidine and dexmedetomidine; however, it remained unaltered in the midazolam group. There were no differences in distress during PVC insertion or compliance at induction between the groups. The children in the clonidine and dexmedetomidine groups developed higher levels of sedation than those in the midazolam group.

    Conclusions: In preschool children, midazolam resulted in a more effective anxiolysis and less sedation compared to clonidine and dexmedetomidine.

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  • 11.
    Carson, Dean
    et al.
    School of Business and Law, University of Australia, Cairns..
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Andersson, Jenny
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hedman, Mante
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Berggren, Peter
    Centre of Rural Medicine, Västerbotten County Counsil, Storuman, Sweden.
    Umeå University's proposed "Rural Stream": An effective alternative to the longitudinal integrated clerkship model for small rural communities?2020In: Education for Health, ISSN 1357-6283, E-ISSN 1469-5804, Vol. 33, no 1, p. 3-7Article in journal (Refereed)
    Abstract [en]

    Background: Umeå University Faculty of Medicine (UUFM), Sweden, has a regionalized medical program in which students spend the final 2½ years of their undergraduate degree in district hospitals. In late 2018, UUFM started a "rural stream" pilot exposing students to smaller rural locations.

    Methods: The objectives are to deliver the benefits for medical education and rural workforce development that have been observed in longitudinal integrated clerkships (LICs) while maintaining consistency between learning experiences in the main campus, regional campuses, and rural locations. This article compares the UUFM rural stream with those typical of the LICs described in the medical education literature. Comparisons are made in terms of the four key criteria for LIC success, and additional characteristics including peer and interprofessional learning, "'continuity," and curriculum development.

    Results: The rural stream has elements of length, immersion, position in the degree program, and community engagement that are both similar to, and different from, LICs. Key challenges are to ensure that participating students create close relationships with host medical facilities and communities. The rural stream also has some potential advantages, particularly in relation to team learning.

    Discussion: Alternatives to the LIC rural stream model as typically described in the literature may be required to allow for immersive medical education to occur in smaller rural communities and to be suitable for medical schools with more traditional approaches to education.

  • 12.
    Chevreuil, O
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Hultin, M
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Ostergaard, P
    Olivecrona, T
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Biphasic effects of low-molecular-weight and conventional heparins on chylomicron clearance in rats.1993In: Arteriosclerosis and thrombosis : a journal of vascular biology / American Heart Association, ISSN 1049-8834, Vol. 13, no 10, p. 1397-403Article in journal (Refereed)
    Abstract [en]

    Chylomicrons labeled in vivo with [14C]triglycerides and [3H]retinyl esters were injected in rats at a series of times after administration of conventional unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), or saline. In saline controls the clearance of both chylomicron triglycerides and retinyl esters seemed to follow exponential courses, with half-lives of about 5 and 10 minutes, respectively. Five minutes after administration of LMWH or UFH, the triglyceride clearance rates were dramatically increased and were associated with an increased appearance of the radiolabel in circulating free fatty acids (FFAs). The clearance of [3H]retinol radioactivity, ie, chylomicron particles, was also enhanced 5 minutes after heparin injection. From 75% to 90% disappeared from the circulation within the first 5 minutes. Their continued disappearance was much slower, with a slope similar to that of the saline-treated rats. Hence, it was as if a new, rapid exponent had been added to the disappearance curve that accounted for most of the particle clearance. Injection of chylomicrons 1 hour after the heparins resulted in substantially slower clearance compared with saline-treated controls of both triglyceride and retinol radioactivity in rats given a high dose of LMWH or a low dose of either heparin. Appearance of label in plasma FFAs was also decreased, suggesting that impeded lipolysis was responsible, at least in part, for the impeded chylomicron clearance. Four and 24 hours after heparin injection all studied parameters of chylomicron clearance had returned to normal.(ABSTRACT TRUNCATED AT 250 WORDS)

  • 13.
    Chevreuil, O
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Hultin, M
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Ostergaard, P
    Olivecrona, T
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Depletion of lipoprotein lipase after heparin administration.1993In: Arteriosclerosis and thrombosis : a journal of vascular biology / American Heart Association, ISSN 1049-8834, Vol. 13, no 10, p. 1391-6Article in journal (Refereed)
    Abstract [en]

    Some or most of the turnover of lipoprotein lipase (LPL) occurs by dissociation from vascular endothelial sites in extrahepatic tissues and further degradation in the liver. Heparin greatly enhances this dissociation and delays but does not abolish uptake in the liver, raising the possibility that heparin could lead to accelerated catabolism of functional LPL. To investigate this, we determined time curves for heparin (anti-factor Xa activity) and for LPL and hepatic lipase after injection in rats of two doses of conventional unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). The high dose (250 U/kg) of both heparins resulted in similar initial levels of LPL activity in plasma, but at 30 minutes the activity with LMWH had declined by more than 80%, whereas with UFH it remained essentially unchanged during this time. In contrast, time curves for heparin activity in blood were similar for the two heparins. The low dose (50 U/kg) led to lower initial levels of LPL activity with LMWH in spite of slower elimination of heparin activity from the blood. These results agree with previous studies that indicate that LMWH has a similar ability as UFH to release LPL, but a lesser ability to delay its removal by the liver. Only slight differences were noted in the time curves for hepatic lipase with the two heparins. To assess the possible depletion of the lipases, we administered a second large dose of conventional heparin. One hour after the first injection, the second injection resulted in lower plasma LPL activities in all four groups.(ABSTRACT TRUNCATED AT 250 WORDS)

  • 14.
    Chevreuil, O
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Hultin, M
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Ostergaard, P
    Olivecrona, T
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Heparin-decasaccharides impair the catabolism of chylomicrons.1996In: Biochemical Journal, ISSN 0264-6021, E-ISSN 1470-8728, Vol. 320 ( Pt 2), p. 437-44Article in journal (Refereed)
    Abstract [en]

    On intravenous injection to rats, decasaccharides gave rise to a short-lived peak of lipoprotein lipase (LPL) activity, whereas octa- and hexasaccharides caused only marginal increases. In isolated hearts perfused by a single pass, decasaccharides released LPL more efficiently than conventional heparin on a mass basis. Octa- and hexasaccharides were much less efficient. Similar results were obtained for hepatic lipase, which was studied both in vivo and by liver perfusion. In the intact rat, the heparin fragments themselves disappeared rapidly from the circulating blood. The decay of hepatic lipase activity after the early peak roughly paralleled the decay of decasaccharide concentration, but for LPL the decay was faster, presumably because the liver extracted this lipase from plasma. To assess the lipase activities remaining in contact with blood a large dose of conventional heparin was injected at a series of times after the decasaccharides. LPL was decreased by 40% after 1 h. At that time, the LPL activity that could be released from isolated hearts by single-pass perfusion with heparin for 2 min ("functional LPL') was decreased by 75%. Chylomicrons labelled in vivo with [14C]oleic acid (primarily in triacylglycerols, providing a tracer for lipolysis) and [3H]retinol (primarily in ester form, providing a tracer for the particles) were injected intravenously to explore the effects of the LPL depletion on lipoprotein metabolism. Triacylglycerol lipolysis and particle clearance was markedly delayed from 30 min to 2 h after injection of decasaccharides. After 1 h the fractional catabolic rate was only one-third of the control value and the catabolism of chylomicron triacylglycerols by perfused hearts was delayed to a similar extent. Thus injection of decasaccharides leads to accelerated turnover of LPL with loss of functional LPL from extrahepatic tissues. This in turn leads to a period of delayed lipolysis and removal of chylomicron particles.

  • 15.
    Claesson, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Anestesiologi och intensivvård.
    Lehtipalo, Stefan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Anestesiologi och intensivvård.
    Bergstrand, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Anestesiologi och intensivvård.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Kirurgi.
    Rocksen, David
    Hultin, Magnus
    Winsö, Ola
    Intestinal circulation, oxygenation and metabolism is not affected by oleic acid lung injury.2005In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 25, no 6, p. 357-363Article in journal (Refereed)
    Abstract [en]

    This study was performed to establish a platform for further studies on effects of ventilatory treatment modalities on the intestines during mechanical ventilation of acute lung injury (ALI). We tested the hypotheses that oleic acid (OA) infusion causes changes in intestinal circulation, oxygenation and metabolism, and that OA is distributed to tissues outside the lung. This was performed as an experimental, prospective and controlled study in an university animal research laboratory. Thirteen juvenile anaesthetized pigs were used in the main study, where seven were given an intravenous infusion of 0.1 ml kg(-1) OA and six served as control (surgery only). In a separate study, four animals were given an intravenous infusion of 0.1 ml kg(-1) (3)H-labelled OA. We measured systemic and mesenteric (portal venous blood flow, jejunal mucosal perfusion) haemodynamic parameters, mesenteric oxygenation (jejunal tissue oxygen tension) and systemic cytokines (tumour necrosis factor-alpha and interleukin-6). We calculated mesenteric lactate flux and mesenteric oxygen delivery, uptake and extraction ratio. In the animals given 3H-OA, we measured 3H-OA in different tissues (lungs, heart, liver, kidney, stomach, jejunum, colon and arterial blood). We found that OA given intravenously is distributed in small amounts to the intestines. This intestinal exposure to OA does not cause intestinal injury when evaluating mesenteric blood flow, metabolism or oxygenation. OA infusion induced a moderate increase in mean pulmonary arterial pressure and a decrease in PaO2/Fraction inspired O2 (P/F) ratio, giving evidence of severe lung injury. Consequently, the OA lung injury model is suitable for studies on intestinal effects of ventilatory treatment modalities during mechanical ventilation of ALI.

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  • 16.
    Edelbring, Samuel
    et al.
    Institutionen för hälsovetenskaper, Örebro universitet, Örebro, Sverige.
    Edgren, Gudrun
    Medicinska fakulteten, Lunds universitet, Lund, Sverige.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lindgren, Stefan
    Medicinska fakulteten, Lunds universitet, Lund, Sverige.
    Svensk medicinpedagogisk forskningsproduktion och förutsättningar för tillämpning för kvalitet och innovation2023Conference paper (Refereed)
    Abstract [sv]

    Bakgrund: Beslut och metoder inom hälso- och sjukvården bygger på vetenskaplig grund vilket förutsätter en forskningsbas. Inom detta område är svensk vetenskaplig produktion och tillämpning relativt stark, däremot ser vi inte motsvarande styrka i kunskapsbasen för utbildningsuppdraget. I diskussionen om utbildningens forskningsförankring är det vanligtvis innehållet som avses eller kontakt med aktiva forskare, mer sällan hur utbildningen bör utformas för att stödja lärande eller förutsättningarna för lärarskicklighet.

    Det saknas inte forskning inom området, på den internationella arenan ser vi en växande högskolepedagogisk forskningsproduktion med medicin och hälsa som kontext, sk. medicinsk pedagogik. Däremot finns anledning att uppmärksamma från vilken kontext forskningen kommer och förutsättningarna att omsätta den till kvalitet och innovation i utbildningarna. Merparten av fältets forskningsproduktion kommer från USA, UK, Canada och Australien (Thomas, 2019). Den internationella prägeln på kunskapsbasen är inte alltid optimal för implementering i svenska förhållanden då resultaten och slutsatser är dragna från en kontext som i flera avseenden skiljer sig från vår. Förutom tillgång till forskning behövs möjligheter att ta del av den och omsätta till godo för utbildningen. Europeiska lärare anser inte att ny forskning når deras arbetsgrupper i någon hög utsträckning (Thomas et al., 2019).  Medicinskt skolade lärare är ofta ovana vid den högskolepedagogiska forskningsgenren som evidensgrund (Kneebone, 2002). Nederländerna, som är mer befolkat än Sverige men har snarligt antal läkarutbildningar samt likartade förhållanden för högre utbildning, har satsat på en medicinpedagogisk utveckling som givit avtryck i fältet.

    Syftet med denna studie är att undersöka svensk forskningsproduktion inom det medicinpedagogiska området samt att föreslå en förstärkning av förutsättningar för denna produktion och dess tillämpning i utbildningar för medicin och hälsa.

    Metod: Författarna är pedagogiska aktörer vid tre medicinska fakulteter och har granskat svensk och nederländsk kunskapsproduktion för medicinsk pedagogik och aspekter av dess tillämpning.  En bibliometrisk analys genomfördes av antal svenska och nederländska publikationer i 9 etablerade medicinpedagogiska tidskrifter för åren 1995-2021. Svenska affilieringar och finansieringskällor samt antal svenskar i tidskriftsredaktionerna analyserades också. Tidskrifterna var Medical education, Medical teacher, BMC medical education, Advances in health sciences education, Academic medicine, Perspectives on medical education, Anatomical sciences education, Teaching and learning in medicine samt International journal of medical education. Förutsättningar för forskning i medicinsk pedagogik identifierades genom sökningar på medicinska fakulteternas hemsidor samt på respektive lärosätes forskningsämnen/institutioner/forskargrupper. 

    Resultat: Under tioårsperioden 2012–2021 publicerades 17 013 artiklar i dessa tidskrifter varav 1 441 från Nederländerna och 217 från Sverige. Nederländska publikationer ökade dramatiskt i det längre perspektivet för att plana ut till en hög produktion med 117–187 årliga publikationer under perioden, medan svenska publikationer ökade makligt till 16–33 årliga publikationer. Samtliga svenska medicinska fakulteter bidrog till produktionen, men andelen från KI dominerade. Tidskrifternas redaktioner bestod sammanlagt av 466 personer varav 31 (7%) nederländare och fyra svenskar (<1%). Organisatoriskt stöd till pedagogisk forskningsanknytning finns på alla medicinska fakulteter men i de flesta fall som en del av universitetets pedagogiska utveckling, inte anpassat till professionsutbildningar inom medicin och hälsa.

    Diskussion och slutsats: Forskningsbaserad kunskap bör vägleda utbildningarna, och eget forskningsengagemang i fältet skapar omdöme i utveckling och strategiska beslut. Hög forskningsproduktion är inte per se ett kvalitetsmått på utbildningarna, dock är det rimligt att anta att en satsning på produktion avspeglas i högre pedagogisk medvetenhet och säkrare beslutsunderlag i såväl fakultets- och kursledningar som hos lärare och handledare. En stark produktion och engagemang skapar delaktighet i det internationella forskarsamhället som vi både kan lära av och bidra i. Nederländerna har visat att även ett europeiskt land kan göra avtryck i fältet (Doja et al., 2014). Vi föreslår specifika svenska satsningar för en hållbar kvalitetssäkring och innovationskraft. 

  • 17.
    Ekman, Agneta
    et al.
    Göteborgs universitet.
    Brynhildsen, Jan
    Linköpings unuversitet.
    Larsson, Christer
    Lunds universitet.
    Möller, Riitta
    Karolinska institutet, Stockholm.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lindahl, Bertil
    Uppsala universitet.
    Grenegård, Magnus
    Örebro universitet.
    Fusk hotar tilliten till blivande läkares professionalitet2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 115Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Det är med stor sorg vi noterat att några studenter valt att fuska sig till en plats på läkarutbildningarna. Vi förväntar oss nu att Universitets- och högskolerådet skärper säkerheten vid högskoleprovet för att förhindra att fusket fortsätter och att utredningen om vilka som fuskat sig in på utbildningarna drivs vidare.

  • 18.
    Gottfridsson, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    A’Roch, Roman
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Law, Lucy
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Myrberg, Tomi
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    A'Roch, Alexander
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Haney, Michael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Left atrial contraction strain and controlled preload alterations, a study in healthy individuals2022In: Cardiovascular Ultrasound, E-ISSN 1476-7120, Vol. 20, no 1, article id 8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In order to assess left atrial contractile function in disturbed circulatory conditions, it is necessary to have a clear understanding of how it behaves in a normal resting state with changes in loading conditions. However, currently the understanding of this relationship is incomplete. We hypothesize that in healthy individuals, left atrial contraction strain and its peak strain rate are increased or decreased by increasing or decreasing preload, respectively.

    METHODS: Controlled maneuvers used to change preload included continuous positive airway pressure by mask (CPAP 20 cmH2O) for preload decrease, and passive leg raise (15 degrees angle) for preload increase. Cardiac ultrasound 4-chamber views of the left atria and left ventricle were acquired at baseline and during maneuver. Acquired images were post processed and analyzed offline. Comparisons were made using paired t-test and means with 95% confidence interval.

    RESULTS: There were 38 participants, complete results were obtained from 23 in the CPAP maneuver and 27 in the passive leg raise maneuver. For the CPAP group, left atrial contraction strain was 11.6% (10.1 to 13.1) at baseline and 12.8% (11.0 to 14.6) during the maneuver (p = 0.16). Left atrial contraction peak strain rate was - 1.7 s- 1 (- 1.8 to - 1.5) at baseline and - 1.8 s- 1 (- 2.0 to - 1.6) during the maneuver (p = 0.29). For the passive leg raise-group, left atrial contraction strain was 10.1% (9.0 to 11.2) at baseline and 10.8% (9.4 to 12.3) during the maneuver (p = 0.28). Left atrial contraction peak strain rate was - 1.5 s- 1 (- 1.6 to - 1.4) at baseline and - 1.6 s- 1 (- 1.8 to - 1.5) during the maneuver (p = 0.29). Left atrial area, an indicator of preload, increased significantly during passive leg raise and decreased during CPAP.

    CONCLUSION: In healthy individuals, left atrial contraction strain and its peak strain rate seem to be preload-independent.

    TRIAL REGISTRATION: The study was 2018-02-19 registered at clinicaltrials.gov ( NCT03436030 ).

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  • 19.
    Gottfridsson, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Law, Lucy
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Aroch, Roman
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Haney, Michael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Left atrial contraction strain during a Valsalva manoeuvre: A study in healthy humans2023In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 43, no 3, p. 165-169Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiac mechanics are influenced by loading conditions as well as sympathetic tone. Left atrial (LA) contractile function assessed by two-dimensional (2D) strain has been described in the setting of controlled preload alterations; however, studies show conflicting findings about change or direction of change. We hypothesized that the controlled preload reduction and the sympathetic nervous system activation that occurs during a standardized Valsalva manoeuvre would bring about a change in LA contraction strain.a

    METHODS: Healthy young adults of both sexes were recruited. Transthoracic echocardiographic ultrasound images were collected before and during a Valsalva manoeuvre. Standard imaging windows for LA strain assessment were used and the images were copied and stored for later offline analysis. These were assessed for adequate atrial wall visualization in 2D strain assessment. Paired comparisons were carried out using Student's T test.

    RESULT: Thirty-eight participants were included and there were 22 complete studies with paired pre- and during Valsalva manoeuvre. LA contraction strain at baseline was 10.5 ± 2.8% (standard deviation) and during the Valsalva manoeuvre 10.6 ± 4.6%, p = 0.86.

    CONCLUSION: The Valsalva manoeuvre, a combination of preload reduction and sympathetic nervous system activation, seems not to be associated with a change in LA contraction strain in healthy young individuals. LA contraction strain should be interpreted in the context of both atrial loading conditions and prevailing autonomic nervous system activity.

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  • 20.
    Gummesson, Christina
    et al.
    Faculty of Medicine, Faculty of Odontology, Lund University, Malmö University, Malmö, Sweden.
    Alm, Stina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Department of Clinical Sciences, Futurum - the Academy for Health and Care, Region Jönköping County, Sweden.
    Cederborg, Anna
    Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden; Department of Medicine, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ekstedt, Mattias
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Hellman, Jarl
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Hjelmqvist, Hans
    Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Jood, Katarina
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Department of Neurology, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
    Leanderson, Charlotte
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Lindahl, Bertil
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Möller, Riitta
    Department of Clinical Science, Intervention and Technology, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Karolinska Institutet, Stockholm, Sweden.
    Rosengren, Björn
    Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
    Själander, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Svensson, Peter J.
    Department of Clinical Sciences Lund University, Lund, Sweden; Skåne University Hospital, Malmö, Sweden.
    Särnblad, Stefan
    Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Tejera, Alexander
    Division of Translational Cancer Research, Department of Laboratory Medicine, Skåne University Hospital, Lund University, Lund University, Lund, Sweden.
    Entrustable professional activities (EPAs) for undergraduate medical education: development and exploration of social validity2023In: BMC Medical Education, E-ISSN 1472-6920, Vol. 23, no 1, article id 635Article in journal (Refereed)
    Abstract [en]

    Background: The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders.

    Aim: The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs.

    Method and material: In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater’s perception of the present graduates’ required level of supervision when performing the activity. Free-text comments were also included and analyzed.

    Results: Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as “important” by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported “independent”. The three themes of the free text comments were: ‘relevant target areas and content’; ‘definition of the activities’; and ‘clinical practice and learning’.

    Conclusion: Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.

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  • 21.
    Halliday, T. A.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Anesthesiology and Intensive Care, Sundsvall, Sweden.
    Sundqvist, Jonas
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Anesthesiology and Intensive Care, Sundsvall, Sweden.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Anesthesiology and Intensive Care, Sundsvall, Sweden.
    Wallden, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Anesthesiology and Intensive Care, Sundsvall, Sweden.
    Post-operative nausea and vomiting in bariatric surgery patients: an observational study2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 5, p. 471-479Article in journal (Refereed)
    Abstract [en]

    Background: The risk of post-operative nausea and vomiting (PONV) in patients undergoing bariatric surgery is unclear. The aim of the study was to investigate the risk of PONV and the use and effectiveness of PONV prophylaxis.

    Methods: This prospective observational study included 74 patients undergoing bariatric surgery with total intravenous anaesthesia. Patients were given PONV prophylaxis based on published guidelines and a simplified PONV risk score. Perioperative data were collected and a questionnaire was used at 2, 4, 6, 24, 48 and 72 h after the operation to evaluate PONV. Data are presented as risk (%) with the 95% confidence interval.

    Results: Sixty five per cent (54-75) of the patients experienced PONV in the first 24 post-operative hours and the risk increased with the number of risk factors for PONV. PONV occurred in 78% (66-87) of women and 26% (12-49) of men during the first 24 h. In relation to the guidelines, one patient received suboptimal PONV prophylaxis, 23% received optimal prophylaxis and 76% supra-optimal prophylaxis. The risk of PONV was 82% (59-94) with optimal prophylaxis and 59% (46-71) with supra-optimal prophylaxis. Of all patients, 34% (24-45) experienced severe PONV in the first 24 h that limited their activity.

    Conclusions: The incidence of PONV in bariatric surgery patients was high despite a PONV prophylaxis regime following current guidelines. These results cast doubt as to the effectiveness of the usual PONV prophylaxis in this patient group and point to the need for further investigation of PONV prophylaxis and treatment in bariatric surgery patients.

  • 22.
    Hultin, M
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Bengtsson-Olivecrona, G
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Olivecrona, T
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Release of lipoprotein lipase to plasma by triacylglycerol emulsions. Comparison to the effect of heparin.1992In: Biochimica et Biophysica Acta, ISSN 0006-3002, E-ISSN 1878-2434, Vol. 1125, no 1, p. 97-103Article in journal (Refereed)
    Abstract [en]

    It was previously known that lipoprotein lipase (LPL) activity in plasma rises after infusion of a fat emulsion. To explore the mechanism we have compared the release of LPL by emulsion to that by heparin. After bolus injections of a fat emulsion (Intralipid) to rats, plasma LPL activity gradually rose 5-fold to a maximum at 6-8 min. During the same time the concentration of injected triacylglycerols (TG) decreased by about half. Hence, the time-course for plasma LPL activity was quite different from that for plasma TG. The disappearance of injected 125I-labelled bovine LPL from circulation was retarded by emulsion. This effect was more marked 30 min than 3 min after injection of the emulsion. The data indicate that the release of LPL into plasma is not solely due to binding of the lipase to the emulsion particles as such, but involves metabolism of the particles. Emulsion increased the fraction of labelled LPL found in adipose tissue, heart and the red muscle studied, but had no significant effect on the fraction found in liver. The effects of emulsion were quite different from those of heparin, which caused an immediate release of the lipase to plasma, decreased uptake of LPL in most extrahepatic tissues by 60-95%, and increased the fraction taken up in the liver.

  • 23.
    Hultin, M
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Carneheim, C
    Rosenqvist, K
    Olivecrona, T
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Intravenous lipid emulsions: removal mechanisms as compared to chylomicrons.1995In: Journal of Lipid Research, ISSN 0022-2275, E-ISSN 1539-7262, Vol. 36, no 10, p. 2174-84Article in journal (Refereed)
    Abstract [en]

    We have compared the metabolism of chylomicrons and a labeled emulsion, similar to those used for parenteral nutrition. Both were labeled in their triglyceride moieties and by a core label. It is known that chylomicron triglycerides are cleared by two processes: removal of triglycerides from the particles through lipolysis and removal of whole or partly lipolyzed particles. It has been proposed that emulsion droplets are cleared by the same pathways. After intravenous injection to postprandial rats, triglycerides were cleared less rapidly from the emulsion than from the chylomicrons (half-lives of 6.4 and 4.0 min), whereas the core labels were cleared at the same rate (half-lives around 7.5 min). This suggests that there was less lipolysis of the emulsion droplets which was further supported by the finding that less label appeared in the plasma free fatty acids (FFA). In adipose tissue of fed rats given chylomicrons, the ratio between fatty acid and core label was above 6, showing that fatty acids had been taken up after lipoprotein lipase-mediated hydrolysis. In contrast, for rats given emulsion, that ratio was only 1.2 showing that nearly as much emulsion droplets as emulsion-derived fatty acids were present in the tissue. In the liver the ratio was 0.55 after chylomicrons but 0.93 after emulsion. In further support of more lipolysis, fatty acids were oxidized more rapidly from chylomicrons than from emulsion. These data suggest that a large fraction of the emulsion droplets was removed from plasma with little or no preceding lipolysis. A substantial proportion, more than 50%, of this uptake occurred in extrahepatic tissues.

  • 24.
    Hultin, M
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Müllertz, A
    Zundel, M A
    Olivecrona, G
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Hansen, T T
    Deckelbaum, R J
    Carpentier, Y A
    Olivecrona, T
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Metabolism of emulsions containing medium- and long-chain triglycerides or interesterified triglycerides.1994In: Journal of Lipid Research, ISSN 0022-2275, E-ISSN 1539-7262, Vol. 35, no 10, p. 1850-60Article in journal (Refereed)
    Abstract [en]

    This study compares the clearing and metabolism of three different lipid emulsions. They had the same phospholipid emulsifier and similar particle sizes. In one (LLL) the core component was long-chain triglycerides (TG), the second (MMM/LLL) contained equal molar amounts of medium- and long-chain TG, the third (MLM) contained synthetic TG with medium-chain (M) fatty acids in the 1,3-positions and a long-chain (L) fatty acid in the 2-position. In model experiments with bovine lipoprotein lipase, the MMM component was hydrolyzed preferentially in the MMM/LLL emulsion so that the initial products were M fatty acids and M monoglycerides. The MLM emulsion, in contrast, gave M fatty acids and formation of L-MG (monoglyceride) throughout hydrolysis. For in vivo studies [3H]oleic acid was incorporated into the emulsion TG as marker for the long-chain component. After bolus injection to rats, the MMM/LLL and MLM emulsions were cleared more rapidly than the LLL emulsion. This was true at all TG loads studied (4-64 mg for a 200 g rat). The labeled oleic acid was oxidized somewhat more rapidly when administered in the MLM emulsion compared to the MMM/LLL emulsion. There were only slight differences in tissue distribution of label. Hence, differences in in vivo metabolism of the long-chain fatty acids were small compared to the marked differences in TG structure and in patterns of product release during in vitro lipolysis.

  • 25.
    Hultin, M
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Olivecrona, G
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Olivecrona, T
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Effect of protamine on lipoprotein lipase and hepatic lipase in rats.1994In: Biochemical Journal, ISSN 0264-6021, E-ISSN 1470-8728, Vol. 304 ( Pt 3), p. 959-66Article in journal (Refereed)
    Abstract [en]

    The polycation protamine impedes the catabolism of triglyceride-rich lipoproteins and this has been suggested to be due to intravascular inactivation of lipoprotein lipase. We have made intravenous injections of protamine to rats and found that both lipoprotein lipase and hepatic lipase activities were released to plasma. The effect of protamine was more short-lived than that obtained by injection of heparin. The release of hepatic lipase by protamine was as effective as the release by heparin, while the amount of lipoprotein lipase released by protamine was only about one-tenth of that released by heparin. This was not due to inactivation of lipoprotein lipase, since injection of an excess of heparin 10 min after injection of protamine released as much lipoprotein lipase activity to plasma as in controls. The results in vivo differed from those obtained in model experiments in vitro. Protamine was able to almost quantitatively release both lipoprotein lipase and hepatic lipase from columns of heparin-agarose. The displacement was dependent on the total amount of protamine that had passed over the column, indicating that it was due to occupation by protamine of all available binding sites. Our results in vivo showed that the binding sites for lipoprotein lipase were not blocked as efficiently as those for hepatic lipase, indicating that the binding structures were not identical. It was concluded that the impaired turnover of lipoproteins by protamine probably was due to prevention of binding of the lipoproteins to endothelial cell surfaces rather than to impaired lipase function.

  • 26.
    Hultin, M
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Olivecrona, T
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Conversion of chylomicrons into remnants.1998In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 141 Suppl 1, p. S25-9Article in journal (Refereed)
    Abstract [en]

    The turnover of chylomicrons in the blood is the sum of several processes. The native chylomicron is synthesized in the intestine out of available substrates. When the chylomicron enters the circulation exchanges of apolipoproteins with other lipoproteins, it also binds to the vascular endothelium where the chylomicron is lipolyzed by lipoprotein lipase. After a short period in the circulation the chylomicron/chylomicron remnant appears to be available for receptor mediated uptake. In this paper several of the processes involved in generation and clearance of chylomicron remnants are discussed.

  • 27.
    Hultin, M
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Savonen, R
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Olivecrona, T
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Chylomicron metabolism in rats: lipolysis, recirculation of triglyceride-derived fatty acids in plasma FFA, and fate of core lipids as analyzed by compartmental modelling.1996In: Journal of Lipid Research, ISSN 0022-2275, E-ISSN 1539-7262, Vol. 37, no 5, p. 1022-36Article in journal (Refereed)
    Abstract [en]

    Chylomicrons labeled in vivo with [14C]oleic acid (primarily in triglycerides (TG), providing a tracer for lipolysis) and [3H]retinol (primarily in ester form, providing a tracer for the corelipids) were injected into rats. Disappearance of the two labels from plasma and appearance of label in plasma free fatty acids (FFA) were analyzed by compartmental modelling. Both core and TG label distributed into an apparent volume 10-15% larger than the blood volume. Part of this probably represents margination to endothelial-binding-lipolysis sites. An open two-compartmental model for plasma FFA was derived from experiments where unesterified oleic acid complexed to albumin was injected. Applying this model revealed that most of the oleic acid from chylomicron triglycerides mixes with the FFA. The disappearance of chylomicron core label required a model in which the label transfers into a second compartment before it leaves the blood. The rate constant for the transformation was high and predicted that, on average, chylomicron spent less than 2 min in the first compartment. The rate out from the second compartment predicted that about 60% of the core label left blood while, on average, chylomicron retained more than half of its triglyceride molecules, i.e., after rather limited lipolysis. The mechanism by which the core label leaves blood is not clear. Modelling showed that under the assumption that the process is shared by chylomicron triglycerides, about half of them go out by this pathway. Comparing fed and fasted rats, the main differences were in the turnover of FFA and in the extent to which chylomicron TG label reappeared in the FFA. This study indicates that a large fraction of the triglycerides in chylomicrons leave plasma together with the core lipids and that most of the fatty acids from chylomicron triglycerides mix into the same metabolic compartments as do plasma free fatty acids.

  • 28.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Medical Biochemistry and Biophysics.
    Turnover of chylomicrons in the rat1995Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Mechanisms involved in the clearance of chylomicrons and aspects of the interactions at the vascular endothelium were studied in the rat.

    The poly-anion heparin, known to release lipoprotein lipase (LPL) from the vascular endothelium, enhanced the clearance of chylomicrons. Five minutes after heparin injection, the clearance of chylomicron triglycerides and retinyl esters was markedly accelerated. The rapid initial clearance was followed by a slower clearance of heavily lipolyzed chylomicrons. In contrast, one hour after heparin the clearance of both triglycerides and retinyl esters was retarded. This decreased removal of chylomicrons coincided with a decrease in the heparin releasable LPL activity, indicating that the previous release to plasma by heparin had resulted in net loss of functional LPL in the tissues.

    The poly-cation protamine released hepatic lipase and some LPL from their binding sites to plasma. One hour after protamine, plasma triglyceride levels were increased, indicating that chylomicron removal was impeded. It has been speculated that protamine inactivates LPL in vivo, but this was not the case. Ten minutes after injection of protamine normal amounts of LPL could be released by heparin. Thus, the accumulation of plasma triglycerides was not due to a rapid inactivation of LPL by protamine.

    LPL has specificity for sn-1,3-ester bonds. To investigate if this specificity is important in vivo, a lipid emulsion containing medium-chain fatty acids (MCFA) in the sn-1,3-position and long-chain fatty acids (LCFA) in the sn-2-position was synthesized, as well as an emulsion containing MCFA-TG mixed with LCFA-TGs (MMM/LLL). In vitro experiments showed large differences in the hydrolysis of the emulsions, but in vivo there were only small differences in the metabolism.

    To further study if lipid emulsions are cleared by the same mechanisms as chylomicrons, an emulsion was made by the same formulation as Intralipid® with addition of 3H-triolein and ,4C-cholesteryl ester. As measured by the removal of cholesteryl esters, the emulsion was cleared at the same rate as was chylomicrons. The triglyceride label was, however, removed more slowly from the emulsion droplets than from chylomicrons. Together with the lower recirculation of labeled free fatty acids (FFA) in plasma, this suggests that there was less lipolysis of the emulsion. The current view that removal of lipid emulsions in vivo is mainly dependent on LPL-mediated hydrolysis might thus not be correct.

    To further analyze the metabolism of chylomicrons, a compartmental model was developed. In this process, the distribution volume for chylomicrons was shown to be larger than the blood volume, a model for the metabolism of FFA in the rat was validated, and the full tissue distribution of injected chylomicrons was determined. According to the model, about half of the triglyceride label was removed from the circulation together with the core label while for the emulsion this number was about 80 %. In fasted rats all labeled fatty acids appeared to mix with the plasma FFA pool, while in fed rats about one-fifth of the fatty acids did not mix with the FFA but was apparently channeled directly to tissue metabolism.

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  • 29.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Edin, Benoni B.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Själander, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Inviting the Test Takers to Challenge the Items Might Drive Quality Improvement in National Licensing Tests for International Medical Graduates2020In: EBMA 2020: Past, Present and Future Assessment in Medical Education / [ed] Adrian Freeman, The European Board of Medical Assessors (EBMA) , 2020Conference paper (Refereed)
    Abstract [en]

    Background International medical graduates need to show their proficiencies to obtain a medical license in a new country. In 2016 the Swedish National Board of Health and Welfare redesigned the proficiency test for Doctors of Medicine. The theoretical test consists of around 180 MCQ/SBA. All tests are made public after being used in accordance with the Swedish Public Access to Information and Secrecy Act. Thus, new tests have to be continuously developed. In addition, as a public institution, the test giver is required to reply to all challenges of the items on the test. 

    Summary of Work To involve the stakeholders and to improve the quality of the test, the items and corresponding answer keys were made public immediately after the test was finished. The test takers were invited to challenge any item and correct answer via a web form and support challenge with literature references. The item authors then reviewed and replied to each individual challenge. Based on these challenges and the associated review, definitive answer keys were decided. Three weeks after test admission, the test takers received their results, a copy of their test together with correct answers, and the response to their challenges. 

    Summary of Results So far, 13 different tests have been given to totally 2,328 test takers. 3,047 challenges were submitted and resulted in 87 changes in answer keys or deletions of an item from the test (3.7% of the 2,360 items across all 13 tests). The number of changes/deletions has decreased significantly with the number of developed tests. 

    Discussion & Conclusion We consider the number of test items that have been rejected or adjusted answer keys to be low. Nevertheless, it was necessary to build a system where the challenges from the test takers were built into the test process. In the Swedish educational system appealing a grade is not possible, but if any item in a test is incorrect, the 1992 administrative law requires test givers to promptly adjust test scores. While the implemented process is resource demanding, we believe that it is crucial both for test acceptance among the examinees and to improve the skills of the item authors. 

    Take-home Message Involving the test takers in quality assurance of a national licensing test might improve item quality.

  • 30.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Edin, Benoni B.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Själander, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Two Years Experiences of a new Swedish National Proficiency Test for Doctors of Medicine.2018Conference paper (Other academic)
  • 31.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Hedberg, Hans
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Härgestam, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderström, Tor
    Umeå University, Faculty of Social Sciences, Department of Education.
    Thorstensson, Mirko
    Swedish Defense Research Agency (FOI), Linköping, Sweden.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Has five years of team training in non-technical skills improved trauma team performance in our University Hospital?2011In: Inspire... and be inspired: AMEE 2011 Abstract Book: 29-31 August 2011, Vienna, Austria, Scotland: Association for Medical Education in Europe , 2011, p. 447-447Conference paper (Refereed)
    Abstract [en]

    Background: For five years our emergency ward has trained non-technical skills using trauma scenarios in a simulator environment. Reflection-on-action was accomplished by 60 minutes video-facilitated structured debriefing. The aim of this study was to explore whether teams trained in non-technical skills are more efficient in the management of severely wounded patients.

    Summary of work: The standardized trauma patient scenario started with an ambulance crew being called

    to a location outside the hospital. Patient care was followed from the site of trauma, in the ambulance and

    in the emergency room. When the hand-over was finished, the condition was worsened. All ambulance crew and trauma team communication were recorded, synchronised in F-REX and key events time-logged. Nineteen teams with 144 participants were included in the study.

     

    Summary of results: 56% of the participants had trained non-technical skills. 78% of those with ontechnical

    skills training, and 62% of those without previous simulator based training, estimated themselves to have appropriate training for the task. The time from the induced worsened condition until the trauma team had assessed airways, breathing, circulation and disabilities were 74±39, 104±45, 172±85 and 223±194 s respectively. No significant effect on the medical performance on basis of previous training in non-technical skills could be detected. Further video analysis is required to more deeply understand the links between teamwork and medical performance.

     

    Conclusions: Trauma team training in CRM principles improves the self-confidence in trauma teams, but not the medical performance.

     

    Take-home messages: Improved non-technical skills might be difficult to translate into improvements in technical skills.

  • 32.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hultberg, Pernilla
    Göteborgs universitet, Sverige.
    Hur bäst integrera KU-studenter med utländsk professionsutbildning som har svenska som andra språk?2024Conference paper (Refereed)
    Abstract [sv]

    Denna workshop fokuserar på hur man bäst stöttar att personer med en utländsk professionsutbildning och som har svenska som andra språk att integreras med svenska studenter då de går en kompletterande utbildning.

    Problemet – integration i svenskt utbildningssystem och svensk sjukvård av studenter som behöver komplettera sin utländska utbildning och dessutom behöver det ske på ett nytt språk (svenska). 

    En person som har en utländsk akademisk utbildning och examen kan gå en kompletterande utbildning för att få behörighet att utöva yrket i Sverige. Det gäller exempelvis lärare, socionomer, jurister och olika professioner inom hälso- och sjukvård som läkare, sjuksköterskor, tandläkare.

    Studenterna som går en kompletterande utbildning har vanligtvis erfarenheter från utbildningssystem som skiljer sig mycket från det svenska. De har också redan en examen från annat land, många har även lång yrkeserfarenhet. 

    Vi tror att heterogenitet och mångfald bidrar till undervisningen på flera sätt, både teoretisk undervisning och verksamhetsförlagd utbildning, men hur gör vi på bästa sätt för att undanröja eventuella problem som kan uppstå?

    Under denna workshop fokuserar vi på utlandsutbildade läkare som behöver komplettera för att få arbeta som läkare i Sverige.

    Frågeställningar som kommer att beröras:

    • Hur kan vi underlätta integrationen med svenska studenter under en kompletterande utbildning?
    • Hur påverkas undervisningen när dessa studenter möter svenska studenter i klassrummen?Hur möter vi studenterna i dessa olikheter?
    • Hur påverkas lärarna av heterogeniteten i klassrummen med äldre erfarna studenter och studenter utan yrkeserfarenhet som kommer direkt från gymnasiet?
    • Hur hanterar handledare under verksamhetsförlagd utbildning att handleda dessa olika studenter?Hur handleder man en kollega?

    Hur kan vi dra nytta av heterogeniteten och mångfalden så att den bidrar till positiva värden för alla studenter som läser tillsammans?Under denna workshop kommer man gruppvis och helgrupp att diskutera:

    • Inledande språktermin för att utveckla de utlandsutbildade kompletteringsutbildningsstudenternas svenska
    • Integrerad undervisning och handledning av studenter som är skolade i vitt skilda system och som därmed har olika erfarenheter med sig i bagage
    • Stöd till studenter på kompletteringsutbildningar som läser kurser integrerat med svenska studenter och genomför praktikperioder

    Resultatet av denna workshop kommer att kunna användas som underlag för att utveckla Kompletteringsutbildningar som baseras på Förordning (2008:1101) om högskoleutbildning som kompletterar avslutad utländsk utbildning.  

  • 33.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Härgestam, Maria
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Kunskap och kommunikation är en ledares plattform: tvärvetenskaplig studie av traumateamövningar visar betydelsen av verbal och icke-verbal kommunikation2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, no 39, p. 1-5Article in journal (Refereed)
  • 34.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Jonsson, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Umeå University, Faculty of Medicine, Department of Nursing.
    Härgestam, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Reliability of instruments that measure situation awareness, team performance and task performance in a simulation setting with medical students2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 9, article id e029412Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The assessment of situation awareness (SA), team performance and task performance in a simulation training session requires reliable and feasible measurement techniques. The objectives of this study were to test the Airways-Breathing-Circulation-Disability-Exposure (ABCDE) checklist and the Team Emergency Assessment Measure (TEAM) for inter-rater reliability, as well as the application of Situation Awareness Global Assessment Technique (SAGAT) for feasibility and internal consistency.

    DESIGN: Methodological approach.

    SETTING: Data collection during team training using full-scale simulation at a university clinical training centre. The video-recorded scenarios were rated independently by four raters.

    PARTICIPANTS: 55 medical students aged 22-40 years in their fourth year of medical studies, during the clerkship in anaesthesiology and critical care medicine, formed 23 different teams. All students answered the SAGAT questionnaires, and of these students, 24 answered the follow-up postsimulation questionnaire (PSQ). TEAM and ABCDE were scored by four professionals.

    MEASURES: The ABCDE and TEAM were tested for inter-rater reliability. The feasibility of SAGAT was tested using PSQ. SAGAT was tested for internal consistency both at an individual level (SAGAT) and a team level (Team Situation Awareness Global Assessment Technique (TSAGAT)).

    RESULTS: The intraclass correlation was 0.54/0.83 (single/average measurements) for TEAM and 0.55/0.83 for ABCDE. According to the PSQ, the items in SAGAT were rated as relevant to the scenario by 96% of the participants. Cronbach's alpha for SAGAT/TSAGAT for the two scenarios was 0.80/0.83 vs 0.62/0.76, and normed χ² was 1.72 vs 1.62.

    CONCLUSION: Task performance, team performance and SA could be purposefully measured, and the reliability of the measurements was good.

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  • 35.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Magnusson, Erik
    Socialstyrelsen.
    Vi tror provet ger ett bra resultat2017In: Dagens Medicin, ISSN 1104-7488Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Vår förhoppning är att det nya systemet ger förutsättningar för fler att få arbeta med det som han eller hon är utbildad för och med det som svensk hälso- och sjukvård så tydligt efter­frågar, skriver Magnus Hultin och Erik Magnusson i ett svar till ett tidigare debattinlägg.

  • 36.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Möller, Riitta
    Medicinsk epidemiologi och biostatistik, Karolinska institutet, Sweden.
    En grundutbildning i förändring2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, article id FMSRArticle in journal (Other academic)
  • 37.
    Hultin, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Möller, RiittaKarolinska institutet.
    Tema läkares grundutbildning2019Conference proceedings (editor) (Refereed)
  • 38. Hultin, Magnus
    et al.
    Sandborg Englund, Gunilla
    Karolinska institutet.
    Momemi, Shima
    Uppsala universitet.
    Jansson, Inger
    Göteborgs universitet.
    Hultberg, Pernilla
    Göteborgs universitet.
    Patienter har rätt att känna sig säkra i vården2019In: Dagens samhälle, ISSN 1652-6511Article in journal (Other (popular science, discussion, etc.))
  • 39.
    Hultin, Magnus