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  • 1.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Foreman, Dawn
    Curtin University, Perth, Australia.
    Emerging criteria for assessment of interprofessional conference. Straddling the contexts of professional education and clinical practice2011Conference paper (Other academic)
  • 2.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköping University, Department of Medical and Health Sciences, Medical Pedagogics. Linköping University, Faculty of Health Sciences.
    Dahlgren, Lars Owe
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Learning professional practice through education2012In: Practice, Learning and Change: Practice-theory perspectives on professional learning. / [ed] Paul Hager, Ann Reich & Alison Lee, Dordrecht: Springer Publishing Company, 2012, 1Chapter in book (Other academic)
    Abstract [en]

    The three concepts central to this volume--practice, learning and change--have received very different treatments in the educational literature, an oversight directly confronted here. While learning and change have been extensively theorised, their various contexts articulated and analysed, practice is notably underrepresented. Where much of the literature on learning and change takes the notion of 'practice' as an unexamined given, its co-location as a term with various classifiers, as in 'legal practice' and 'teaching practice', render it curiously devoid of semantic force. In this book, 'practice' is the super-ordinate organising idea. Drawing on what has been termed the 'practice turn in contemporary theory', the work develops a conceptual framework for researching learning in, and on, practice. It challenges received notions of practice, questioning the assumptions, elisions, conflations and silences on the subject. In so doing, it offers fresh insights into learning and change, and how they relate to practice. In tandem with this conceptual work, the book details site-ontological studies of practice and learning in diverse professional and workplace contexts, examining the work of occupations as various as doctors, chefs and orchestral musicians. It demonstrates the value of theorising practice, learning and change, as well as exploring the connections between them amid our evolving social and institutional structures.

  • 3.
    Berglund, Ebba
    et al.
    Östergötlands Läns Landsting.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Our future health care employees – educated in clinical Quality Improvement2012Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    Quality improvement is common knowledge among engineers or human resource management but often missing in health care education. Our two organizations have started a collaboration to increase knowledge of quality improvement work in faculty and in clinic. We will describe and share experiences of how 400 undergraduate students in interprofessional teams practically and theoretically learn about Quality Improvement work in real health care settings. Outcome is measured as improvement in patient, student, and staff “value”.

  • 4.
    Brewer, Margo
    et al.
    Curtin University, Perth, Australia.
    Forman, Dawn
    Curtin University, Perth, Australia.
    D'Avray, Linda
    St Georges University, London.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Interprofessional Training Wards: Reviewing Linköping University (Sweden) and St Georges University (London) in the development of an Interprofessional Training Ward in Perth, Western Australia2010Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    Context: Curtin University has quickly established a reputation for the providing of authentic Interprofessional community placements for students. The next obvious stage seemed to be the development of a similarly authentic ward experience for the students. In doing so, Curtin has visited existing training wards internationally to learn from their work. With other Universities and a major acute hospital locally documentation are developed in order to ensure staff and students to experience a ward where students will learn “with, from and about” each other, to provide better care of the patient.

    Objectives: The objectives of the project were: To learn from established good practice in providing an authentic practice-based learning environment where final year undergraduate (or healthcare) students can develop the knowledge, skills and attitude required for interprofessional patient-centred collaborative practice.

    To ensure that all appropriate documentation was in place and both staff and students were appropriately prepared prior to the opening of the training ward

    To bring together 5 Universities working with an acute hospital in the design of the training ward, which would be used initially by students training for 5 professions; medicine, nursing, pharmacy, physiotherapy and occupational therapy.

    Main Outcomes: The review of established interprofessional training wards facilitated Curtin (the lead university) in this exercise to derive the key documentation and development criteria, which would be necessary to establish a training ward. Working together with the hospital and 4 other Universities (previous training wards have only worked with one university) it was possible to establish a list of key documentation and development interventions which were necessary prior to the start of the training ward.[JD1]  This workshop will provide a similar experience for participants to review practice in training wards internationally and hear of the successes and difficulties experienced in the development of a training ward.

    Conclusion: It is important to learn from existing good practice, ensure that all parties recognise their responsibilities and create an Interprofessional team of staff from the Universities and hospital in order to ensure a high quality authentic Interprofessional training ward experience for final year students.

  • 5.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care Centres.
    Berglund, Ebba
    Östergötlands Läns Landsting.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Health care student teams participating in Quality Improvement - A large scale implementation in collaboration between University and County council2013Conference paper (Other academic)
    Abstract [en]

    Introduction

    In Health care we always need to improve patient quality and safety. Therefore from an employer’s perspective, it is very important that future employees have knowledge about Quality Improvement (QI) work. Together the Faculty of Health Sciences of Linköping University and the County Council of Östergötland have designed a learning experience where undergraduate students participate and learn about QI work in clinical practice.

     

    Methods

    Our two organizations started this project together in 2006 with an investigation. Then we begun the work with each semester as a testcycle which were evaluated. After decisions and planning we started in full scale in January 2011. Each semester, about 300 undergraduate students, in interprofessional teams, learn about Quality Improvement in 45 clinical settings, supervised by a tutor and a member of the clinical team.

     

    Results

    Since we started the outcome of the project is measured as improvement in

    student, staff and patient value. The results have been used to continuously improve the project itself. The satisfaction in the different groups has improved over time. We will show data of this at the presentation.

     

    Discussion

    This is an example of large scale implementation in two different organizations. There are also a lot of interests involved, students, tutors, staff, patients and leaders in our two companies.

    In the workshop experiences from this large scale implementation performed in cooperation between the university and the health care providers will be described. One of the student projects will also be presented. After that we invite to a discussion with the audience regarding the project and to problematize around large scale implementation. Our suggested time table is 45 min for presentation and 45 minutes for questions and discussion.

    We also plan for more presentations of student projects in poster format to be shown in the lecture hall.

  • 6.
    Dahlberg, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Berglund, Ebba
    Östergötlands Läns Landsting.
    Interprofessional Student Groups as Change Agents in Continuous Quality Improvement work in clinical setting2010Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    In designing a curriculum for “learning and performing quality improvement work”, we have exploited the fundamental principles of Continuous Quality Improvement (CQI) in the evaluation and reconstruction of the course modules. The Faculty of Health Sciences (FHS) has in close collaboration with the County Council of Ostergotland (CCO) developed a learning module based on a mutual interest of increased knowledge in CQI. Hence, we have integrated students learning to the learning among professionals in the everyday work at the clinics.

     

    To be powerful, improvement of quality and safety (IQS) should be performed by all involved health professionals and patients in cooperation. Since the mid-80ies, all students at FHS have been engaged in educational modules within their undergraduate programs aiming at the development of interprofessional competence. We believe that interprofessional competencies is one of the key elements for working with CQI in healthcare.

     

    In addition, at the FHS, all curricula are based on Problem-Based Learning (PBL). The procedure (PDSA-cycle) for CQI-work has great similarities to the process for PBL. Hence, CQI and PBL reinforce the way individuals identify and solve problems in addition to needs of learning.

     

    Since 2008, students from all our undergraduate programs learn CQI-methodology in personal improvement projects during the first semester, as part of the curricula for interprofessional learning. The partnership with the CCO now includes practice of CQI in clinical settings. In close collaboration with the staff from primary health care centers or clinical wards, interprofessional student groups identify and explore areas of quality and safety improvement and suggest interventions that are evaluated. For example; i) use of search-terms in a web-based medical record system, ii) accessibility to acute care, or iii) reception of frequent visitors in primary health care. The suggested interventions and conclusions were well received, discussed and developed at the clinics.

     

    The project group designing the learning module evaluated the design in a small test with three students groups. The experiences and results were scrutinized and minor improvements were implemented in the following semester, with an increased number of student groups. Examples of improvements were i) the description of the expected contribution from the clinical staff, ii) modification of the estimated “size” of the improvement work, and iii) how students are introduced to “the problem of clinical interest”. After four test-cycles we are now engaging all thirty groups of undergraduate students (total 320 students) in the CQI –projects.

     

    Our learning in the project group has been challenging, coming from two different working cultures with different approaches to quality, different management etc. However, we strongly support the design for integrated learning between academy and practice, students and professionals, and novices with experts.

  • 7.
    Dahlberg, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Karlsson, Katarina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Pelling, Staffan
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Interprofessional undergraduate student teams performe quality improvement work in clinical settings2010Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    To be powerful, improvement of quality and safety (IQS) should be performed by all involved professionals in cooperation. Here we describe how we have designed and implemented improvement of quality and safety as a recurring interprofessional learning objective to all programmes at The Faculty of Health Sciences (FHS), Linköping University, Sweden. This initiative was strongly argued and implemented in close collaboration with the County Council of Östergötland (CCO), the main provider of health care in the region.

     

    The Faculty of Health Sciences has experience of interprofessional education since more than 20 years, which we and external evaluations have found to be successful. In addition, all our educational programs are based on Problem-Based Learning (PBL) throughout the whole curricula. The procedures for IQS-work have great similarities to the processes of PBL, and the research process, hence, the implementation of IQS are easily acknowledged by the students, faculty and clinical staff.

     

    Since 2008, students from all our undergraduate programs learn IQS-methodology during their first semester as individual projects, as part of the first module of interprofessional learning. Now the partnership with the CCO has offered opportunities to include practice of IQS in clinical settings. In close collaboration with the staff from primary health care centers or clinical wards, interprofessional student teams have identified areas of quality and safety improvement. These were e.g. i) accessibility to acute care, ii) routines regarding the discharge process at a surgery ward, or iii) hygiene aspects in primary health care The suggested conclusions and interventions were received, discussed and developed at the clinics.

  • 8.
    Dahlberg, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Mining, Simeon
    Moi University, Eldoret, Kenya.
    Twenty years experience of mutual learning experiences and empowerment between Moi university in Eldoret, Kenya, and the Faculty of Health Sciences in Linköping Sweden2012Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    More than twenty years ago, the Ministry of health in Nairobi, Kenya, decided to start the second medical school in the country.  The Ministry was recommended by WHO to establish the new school with a strong community focus, using problem-based learning methods and other principles adopted by the “Network: Towards Unity for Health”.  The founders approached members of the Network including McMaster in Canada and Maastricht in The Netherlands (two schools who served as models when FHS, LiU was established 1986) and Faculty of Health Sciences, Linkoping University. The Linkoping experience of inter-professional learning was of special interest.  In 1990, the first Medical students were admitted to the new medical school in Eldoret. Teachers form Linkoping supported the faculty in Eldoret in the general outline and pedagogical design of first, the medical and later, the nursing curriculum. Over the years 253 students and 225 teachers have been able to learn from our different cultures by exchange visits. We now meet the challenge of a new generation that will succeed and hopefully continue this important work.

     

    What did we learn and how will we make this continue?

  • 9.
    Dahlberg, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berglund, Ebba
    Östergötlands Läns Landsting.
    Interprofessionella studentgruppers medverkan i kliniskt förbättringsarbete2010Conference paper (Other (popular science, discussion, etc.))
    Abstract [sv]

    I Östergötland samverkar Hälsouniversitetet och Landstinget i ett utvecklingsprojekt kring förbättringskunskap. Syftet är att studenterna under grundutbildningen ska tillägna sig kunskaper om kvalitets- och förbättringsarbete samtidigt som de inspirerar och bidrar till det kliniska förbättringsarbetet i landstingets verksamheter.

     

    Hälsouniversitet skapar därför ett curriculum kring förbättringskunskap som i huvudsak är förlagt till dem interprofessionella utbildningsmomenten, sammanlagt 12 veckor. I steg 1 gör studenterna ett personligt förbättringsarbete. Detta är förlagt till termin 1. Mot slutet av utbildningarna kommer studenterna att samlas i interprofessionella basgrupper och delta i kliniska förbättringsarbeten. I tredje steget planeras ett kontinuerligt förbättringsarbete under den verksamhetsförlagda praktiken på Klinisk undervisningsavdelning (KUA), där de olika studentteamen jobbar med ett projekt som sträcker sig över en eller flera terminer.

     

    Formerna för studenternas deltagande i kliniska förbättringsarbeten, steg 2, har provats under tre terminer, med sammanlagt 19 basgrupper (19x8 studenter). Studenterna har bland annat engagerats i:

     

    • Förbättrad vårdprocess för Astma-patienter och      ”mångsökare”
    • Hänvisning av patienter från sjuksköterska till sjukgymnast
    • Studie kring användning av britspapper
    • Undersökning av följsamheten till dokumentationsrutiner      vid läkemedelsordinationer i landstingets elektroniska patientjournal
    • Utskrivningssamtal från kirurgiska kliniken

     

    Studenternas erfarenheter har utvärderats. Studenterna har blivit väl mottagna och lärandet hos studenterna har ökat, såväl avseende interprofessionell kompetens som kring förbättringsarbete i vården. Vårdverksamheterna redovisar positiva resultat, ”över förväntan bra”.

     

    Förutom att studenterna får utbildning i förbättringskunskap krävs motsvarande kompetensökning hos lärare inom akademien såväl som hos personal i landstinget. Därför genomförs gemensamma utbildningar av basgruppshandledare och kontaktpersoner inom landstinget, för att på så sätt stödja organisationernas lärande.

     

    Höstterminen 2010 kommer 30-35 grupper av studenter, i interprofessionella team, att delta i kliniskt förbättringsarbete.

  • 10.
    Dahlberg, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berglund, Ebba
    Östergötlands Läns Landsting.
    Student groups in Continuous Quality Improvement work in clinical setting2010Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    The Faculty of Health Sciences (FHS), Linköping University, Sweden, has introduced Continuous Quality Improvement (CQI) to all its undergraduate programs in close collaboration with the County Council of Ostergotland (CCO). To be powerful, improvement of quality and safety (IQS) should be performed by all involved health professionals and patients in cooperation. Since the mid-80ies, all students have been engaged in educational modules within their undergraduate programs aiming at the development of inter-professional competence. We suggest that inter-professional competence is one of the key elements for working with CQI in healthcare.

    At the FHS, all curricula are based on Problem-Based Learning (PBL). The procedure for CQI-work has great similarities to the process for PBL. Hence, CQI and PBL reinforce the way individuals identify and solve problems in addition to needs of learning.

    Since 2008, students from all our undergraduate programs learn CQI-methodology during their first semester in individual projects, as part of the curricula for inter-professional learning. The partnership with the CCO now offere opportunities to include practice of CQI in clinical settings. In close collaboration with the staff from primary health care centers or clinical wards, inter-professional student groups identifiy areas of quality and safety improvement and suggest interventions that are evaluated. For example; i) use of search-terms in a web-based medical record system, ii) accessibility to acute care, or iii) reception of frequent visitors in primary health care. The suggested interventions and conclusions were well received, discussed and developed at the clinics.

  • 11.
    Danielsson, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Öst, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Lystedt, Erika
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Gustavsson, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik H.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Insulin resistance in human adipocytes occurs downstream of IRS1 after surgical cell isolation but at the level of phosphorylation of IRS1 in type 2 diabetes2005In: The FEBS Journal, ISSN 1742-464X, E-ISSN 1742-4658, Vol. 272, no 1, p. 141-151Article in journal (Refereed)
    Abstract [en]

    Insulin resistance is a cardinal feature of type 2 diabetes and also a consequence of trauma such as surgery. Directly after surgery and cell isolation, adipocytes were insulin resistant, but this was reversed after overnight incubation in 10% CO2 at 37 °C. Tyrosine phosphorylation of the insulin receptor and insulin receptor substrate (IRS)1 was insulin sensitive, but protein kinase B (PKB) and downstream metabolic effects exhibited insulin resistance that was reversed by overnight incubation. MAP-kinases ERK1/2 and p38 were strongly phosphorylated after surgery, but was dephosphorylated during reversal of insulin resistance. Phosphorylation of MAP-kinase was not caused by collagenase treatment during cell isolation and was present also in tissue pieces that were not subjected to cell isolation procedures. The insulin resistance directly after surgery and cell isolation was different from insulin resistance of type 2 diabetes; adipocytes from patients with type 2 diabetes remained insulin resistant after overnight incubation. IRS1, PKB, and downstream metabolic effects, but not insulin-stimulated tyrosine phosphorylation of insulin receptor, exhibited insulin resistance. These findings suggest a new approach in the study of surgery-induced insulin resistance and indicate that human adipocytes should recover after surgical procedures for analysis of insulin signalling. Moreover, we pinpoint the signalling dysregulation in type 2 diabetes to be the insulin-stimulated phosphorylation of IRS1 in human adipocytes.

  • 12.
    Escher, Cecilia
    et al.
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Rystedt, Hans
    Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden.
    Creutzfeldt, Johan
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Meurling, Lisbet
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Nyström, Sofia
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nordahl Amorøe, Torben
    Simulator Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hult, Håkan
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden.
    Felländer-Tsai, Li
    CLINTEC-Department of Clinical Science Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; CAMST-Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Method matters: impact of in-scenario instruction on simulation-based teamwork training2017In: Advances in Science and Technology Research Journal, ISSN 2364-3277, E-ISSN 2059-0628, Vol. 2, no 25Article in journal (Refereed)
    Abstract [en]

    Background

    The rationale for introducing full-scale patient simulators in training to improve patient safety is to recreate clinical situations in a realistic setting. Although high-fidelity simulators mimic a wide range of human features, simulators differ from the body of a sick patient. The gap between the simulator and the human body implies a need for facilitators to provide information to help participants understand scenarios. The authors aimed at describing different methods that facilitators in our dataset used to provide such extra scenario information and how the different methods to convey information affected how scenarios played out.

    Methods

    A descriptive qualitative study was conducted to examine the variation of methods to deliver extra scenario information to participants. A multistage approach was employed. The authors selected film clips from a shared database of 31 scenarios from three participating simulation centers. A multidisciplinary research team performed a collaborative analysis of representative film clips focusing on the interplay between participants, facilitators, and the physical environment. After that, the entire material was revisited to further examine and elaborate the initial findings.

    Results

    The material displayed four distinct methods for facilitators to convey information to participants in simulation-based teamwork training. The choice of method had impact on the participating teams regarding flow of work, pace, and team communication. Facilitators’ close access to the teams’ activities when present in the simulation suite, either embodied or disembodied in the simulation, facilitated the timing for providing information, which was critical for maintaining the flow of activities in the scenario. The mediation of information by a loudspeaker or an earpiece from the adjacent operator room could be disturbing for team communication.

    Conclusions

    In-scenario instruction is an essential component of simulation-based teamwork training that has been largely overlooked in previous research. The ways in which facilitators convey information about the simulated patient have the potential to shape the simulation activities and thereby serve different learning goals. Although immediate timing to maintain an adequate pace is necessary for professionals to engage in training of medical emergencies, novices may gain from a slower tempo to train complex clinical team tasks systematically.

  • 13.
    Forman, Dawn
    et al.
    Curtin University, Perth, Australia.
    Fyfe, Sue
    Curtin University, Perth, Australia.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Challenges when designing, implementing and revising curricula for interprofessional learning. How, what, and for whom?2012Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    In the reports by the World Health Organisation (2008) and (2010) the need to provide an interprofessional service is highlighted as imperative if we are to meet the challenges of health service delivery into the future. Providing an undergraduate interprofessional curriculum which focuses on the need of the client is we believe a means to improving the quality and efficacy of patient outcome.

    Curtin University, Australia has started their implementation process utilizing a common core curriculum in the first year, interactive case based workshops throughout the year of study of its 18 health professional groups and in clinical practice where it has 20 interprofessional placement opportunities for students. Curtin is now developing an undergraduate medical curriculum and will be ensuring its graduates are equipped to be “doctors for the future” by incorporating interprofessional curricula and practice provision to the programme. Linkoping University, Sweden is in a process of revising their curricula for interprofessional learning, which has been successfully provided for the last 25 years.

    This oral paper will address the following questions when considering each of these developments:

    What are the challenges, and what are the processes to manage? What should be the interprofessional subjects for students in health care education? How should the education be designed? What are the learning methodologies which are most appropriate? How can interprofessional placements be designed for such a variety of professional groups? What models of health care will result as these new practitioners enter into the workforce? How will we evaluate this provision?

  • 14.
    Gjessing, Kristian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Torgé, Cristina Joy
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Improvement of quality and safety in health care as a new interprofessional learning module – evaluation from students2014In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, no 7, p. 341-347Article in journal (Refereed)
    Abstract [en]

    Background: Interprofessional teamwork is in many ways a norm in modern health care, and needs to be taught during professional education.

    Description: This study is an evaluation of a newly introduced and mandatory learning module where students from different health profession programs used Improvement of Quality and Safety as a way to develop interprofessional competence in a real-life setting. The intention of this learning module was to integrate interprofessional teamwork within the students' basic education, and to give students a basic knowledge about Improvement of Quality and Safety. This report focuses on evaluations from the participating students (n=222), mainly medical and nursing students.

    Materials and methods: To evaluate this new learning module, a questionnaire was developed and analyzed using a mixed methods design, integrating both qualitative and quantitative methods. The evaluation addressed learning concepts, learning objectives, and interprofessional and professional development.

    Results and conclusion: A majority of students responded positively to the learning module as a whole, but many were negative towards specific parts of the learning module and its implementation. Medical students and male students were less positive towards this learning module. Improvements and alterations were suggested. 

  • 15.
    Gustavsson, Johanna
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Insulin control of glucose transport in caveolae microdomains of the plasma membrane1997Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Caveolae are invaginated, dynamic microdomains in the plasma membrane and believed to be involved in receptor-mediated uptake of small molecules (potocytosis) and in signal transduction. A phosphatidylinositol glycan, a precursor of potential insulin second messengers, has been found to be enriched in the caveolae-fraction of adipocyte plasma membranes (Parpal et al., 1995, J Cell Biol 131:125-135). We now demonstrate that the insulin receptor is localized to caveolae microdomains. This was investigated in i) 3T3-Ll adipocyte plasma membranes by a morphological method (double immunofluorescence labeling and contbcal microscopy) and in ii) caveolae isolated by a biochemical, detergent-free method. The insulin receptor was enriched in caveolae and, in response to insulin, phosphorylated on tyrosine which indicated that the insulin receptor was active.

    Insulin stimulates the translocation of glUcose transporter protcins from intracellular stores to the plasma membrane which leads to an increased glucose uptake. Long-chain 1 ,2-diacylgiycerol, one of two potential second messengers for insulin, has been found to stimulate glucose uptake in rat adipocytes (Stn\1fors, 1988, Nature, 335:554-556). Here, we report that long-chain 1,2-diacylglycerol, emulsified in taurodeoxycholate, stimulates the translocation of GLUT4 to the plasma membrane. Moreover, physiological long-chain 1,2~diacylglycerols are taken up by different cell types in amounts sufficient to have biological eftects, equally well in the absence or presence of taurodeoxycholate.

    We also report that a rapid translocation of GLUT4 to the plasma membrane was followed by a slower transition of GLUT4 into caveolae. Accumulation of GLUT4 in caveolae coincided with the insulin-stimulated increase in glucose uptake. This offers a mechanistic explanation for the observed discrepancy between the appearance of GLUT4 in the plasma membrane and the delayed increase in glucose uptake.

    Non-hydrolyzable GTP-analogs stimulate the translocation of GLUT4 and increase glucose uptake in permeabilized cells. The small GTP·binding protein RaM is suggested to be involved in these processes since Rab4 has been localized to GLUT4-containing vesicles and is redistributed in response to insulin. We found that Rab4 is enriched in caveolae and that the amount of Rab4 increased in caveolae, in the same extent a<> GLUT4 did, in re!.J)Onse to insulin.

    Caveolae are characterized by high levels of sphingolipids and cholesterol. Depletion of cholesterol, which disrupts the integrity of caveolae, abolished insulin-stimulated glucose uptake reversibly. Insulin's control of protein pho.<:phorylation was also abolished while j3-adrenergic signaling was unaffected.

    The results suggest that caveolae are crucial Jor insulin-signuling in adipocytes and a disruption of these structures may have consequences for the development of insulin re.~istance and diabetes mellitus.

  • 16.
    Gustavsson, Johanna
    et al.
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Parpal, Santiago
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Karlsson, Margareta
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Ramsing, Cecilia
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Thorn, Hans
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Borg, Marie
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Lindroth, Margaretha
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Holmgren Peterson, Kajsa
    Linköping University, Department of Molecular and Clinical Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Magnusson, Karl-Eric
    Linköping University, Department of Molecular and Clinical Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Localization of the insulin receptor in caveolae of adipocyte plasma membrane1999In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 13, no 14, p. 1961-1971Article in journal (Refereed)
    Abstract [en]

    The insulin receptor is a transmembrane protein of the plasma membrane, where it recognizes extracellular insulin and transmits signals into the cellular signaling network. We report that insulin receptors are localized and signal in caveolae microdomains of adipocyte plasma membrane. Immunogold electron microscopy and immunofluorescence microscopy show that insulin receptors are restricted to caveolae and are colocalized with caveolin over the plasma membrane. Insulin receptor was enriched in a caveolae-enriched fraction of plasma membrane. By extraction with β-cyclodextrin or destruction with cholesterol oxidase, cholesterol reduction attenuated insulin receptor signaling to protein phosphorylation or glucose transport. Insulin signaling was regained by spontaneous recovery or by exogenous replenishment of cholesterol. β-Cyclodextrin treatment caused a nearly complete annihilation of caveolae invaginations as examined by electron microscopy. This suggests that the receptor is dependent on the caveolae environment for signaling. Insulin stimulation of cells prior to isolation of caveolae or insulin stimulation of the isolated caveolae fraction increased tyrosine phosphorylation of the insulin receptor in caveolae, demonstrating that insulin receptors in caveolae are functional. Our results indicate that insulin receptors are localized to caveolae in the plasma membrane of adipocytes, are signaling in caveolae, and are dependent on caveolae for signaling.

  • 17.
    Karlsson, Margareta
    et al.
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Thorn, Hans
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Danielsson, Anna
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Karin G., Stenkula
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Gustavsson, Johanna
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik H.
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    In human adipocytes the insulin receptor and IRS1 are localized in caveolae, and caveolae destruction makes cells resistant to insulin signaling for metabolic and mitogenic controlManuscript (preprint) (Other academic)
    Abstract [en]

    Caveolae are plasma membrane invaginations with several functions, one of which appears to be to organize receptor mediated sigoaling. Here we show that in human adipocytes the iosulin receptor is localized in caveolae: by electron microscopy and immunogold detection and by isolating caveolae from plasma membranes. We similarly demonstrate that significant part of the immediate downstream signal mediator IRS1 is localized at the plasma membrane and caveolae. A detailed image shows the caveola as a bulb, protroding into the cell interior, with a neck attaching it to the plasma membrane. The caveolar structural protein caveolin is localized in the neck aod not in the bulb of the caveola. The receptor is active in caveolae since insulin stimulation caused tyrosine specific phosphorylation of the receptor recovered in isolated caveolae. Caveolae contain a major part of the free cholesterol in the plasma membrane and cholesterol is a stroctural component of caveolae. Depletion of cholesterol from the cells using B-cyclodextrio blocks insulin stimulation of glucose uptake, insulin inhibition of perilipin phosphorylation in response to isoproterenol, and insulio stimulation of protein kinase B and Map-kinases ERK1/2 phosphorylation- in effect making the human adipocytes insulin resistant. The insulin-stimulated phosphorylation of the insulin receptor and IRS1 are, however, not affected, indicating that caveolae integrity is required downstream of IRS1, consistent with its colocalization with the insulin receptor io caveolae in human adipocytes.

  • 18.
    Karlsson, Margareta
    et al.
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Thorn, Hans
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Danielsson, Anna
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Stenkula, Karin
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Öst, Anita
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Gustavsson, Johanna
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Colocalization of insulin receptor and insulin receptor substrate-1 to caveolae in primary human adipocytes2004In: European Journal of Biochemistry, ISSN 0014-2956, E-ISSN 1432-1033, Vol. 271, no 12, p. 2471-2479Article in journal (Refereed)
    Abstract [en]

    Caveolae are plasma membrane invaginations with several functions, one of which appears to be to organize receptor mediated signalling. Here we report that in primary human subcutaneous adipocytes the insulin receptor was localized to caveolae by electron microscopy/immunogold detection and by isolating caveolae from plasma membranes. Part of insulin receptor substrate 1 (IRS1), the immediate downstream signal mediator, was colocalized with the insulin receptor in the plasma membrane and caveolae, as demonstrated by immunofluorescence microscopy, immunogold electron microscopy, and immunogold electron microscopy of transfected recombinant HA-IRS1. In contrast, rat epididymal adipocytes lacked IRS1 at the plasma membrane. Depletion of cholesterol from the cells using β-cyclodextrin blocked insulin stimulation of glucose uptake, insulin inhibition of perilipin phosphorylation in response to isoproterenol, and insulin stimulation of protein kinase B and Map-kinases extracellular signal-related kinase (ERK)1/2 phosphorylation. Insulin-stimulated phosphorylation of the insulin receptor and IRS1 was not affected, indicating that caveolae integrity is required downstream of IRS1. In conclusion we show that insulin receptor and IRS1 are both caveolar proteins and that caveolae are required for both metabolic and mitogenic control in human adipocytes. Our results establish caveolae as foci of insulin action and stress the importance of examining human cells in addition to animal cells and cell lines.

  • 19.
    Karlsson, Margareta
    et al.
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Thorn, Hans
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Parpal, Santiago
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Gustavsson, Johanna
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Insulin induces translocation of glucose transporter GLUT4 to plasma membrane caveolae in adipocytes2002In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 16, no 2, p. 249-251Article in journal (Refereed)
    Abstract [en]

    Insulin-stimulated glucose uptake in muscle and adipose tissue is the result of translocation of insulin-regulated glucose transporters (GLUT4) from intracellular vesicles to the plasma membrane. Here we report that GLUT4 in the plasma membrane of 3T3-L1 adipocytes were located predominantly in caveolae invaginations: by immunogold electron microscopy of plasma membranes, 88% of GLUT4 were localized to caveolae structures and this distribution within the plasma membrane was not affected by insulin. By immunofluorescence microscopy, a major part of GLUT 4 was colocalized with caveolin. The total amount of GLUT4 in the plasma membrane increased 2.2-fold in response to insulin as determined by immunogold electron or immunofluorescence microscopy. GLUT4 were enriched in caveolae fractions isolated without detergents from plasma membranes of rat adipocytes. In these fractions, GLUT4 were largely confined to caveolin-containing membranes of the caveolae preparation isolated from insulin-stimulated cells, determined by electron microscopy. Insulin increased the amount of GLUT4 2.7-fold in this caveolae fraction. Caveolae were purified further by immunoisolation with antibodies against caveolin. The amount of GLUT4 increased to the same extent in the immunopurified caveolae as in the cruder caveolae fractions from insulin-stimulated cells. We conclude that insulin induces translocation of GLUT4 to caveolae.

  • 20.
    Karlsson, Margareta
    et al.
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Örtegren, Unn
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Blomqvist, Maria
    Department of Clinical Neuroscience, Sahlgrenska University Hospital/Mölndal, Göteborg University, Mölndal, Sweden.
    Blazic, Natascha
    Department of Clinical Neuroscience, Sahlgrenska University Hospital/Mölndal, Göteborg University, Mölndal, Sweden.
    Nyström, Fredrik H.
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Gustavsson, Johanna
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Fredman, Pam
    Department of Clinical Neuroscience, Sahlgrenska University Hospital/Mölndal, Göteborg University, Mölndal, Sweden.
    Strålfors, Peter
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Lipid composition of caveolae and of surrounding plasma membrane in rat adipocytesManuscript (preprint) (Other academic)
    Abstract [en]

    Caveolae are invaginations of the plasma membrane that may arise from so called rafts in the presence of the structural protein caveolin. We have isolated caveolae from purified plasma membrane of primary rat adipocytes using ultrasonication to disrupt the membrane followed by density gradient ultracentrifugation. This caveolae fraction was further purified by adsorption to antibodies against caveolin. As a comparison we also isolated a detergent-insoluble fraction of the plasma membrane, utilizing the detergent insolubility of caveolae and rafts. Caveolae were strongly enriched in cholesterol and sphingomyelin, the concentration was 3.5 and 2.8-fold, respectively, higher in the caveolar membrane than in the surrounding plasma membrane. Phosphoacylglycerols were also concentrated in caveolae, while proteins were depleted compared to the surrounding plasma membrane. We have calculated that an average adipocyte caveola contains 18000 molecules of cholesterol, 6000 of sphingomyelin, 18000 of phosphoacylglycerol, 350 protein molecules, and about I 00 glycolipid molecules.

    We analyzed for a range of glycolipids and especially gangliosides. Of these GM3 and GD3 are the most prevalent and both were enriched in caveolae, together with GM1 and GDla. GDlb and GTib were present in the plasma membrane at low levels, while GM2, GD2, GQ1b, sulphatide, and lactosylceramide sulphate were not detected. None of them were detected in caveolae. As a first comprehensive and quantitative analysis of purified caveolae from primary cells, our results provide a firm basis for the examination of caveolae formation using artificial membranes.

  • 21.
    Lindh Falk, Annika
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ekstedt, Mattias
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
    Heslyk, Annika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Whiss, Per
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Creating spaces for interprofessional learning: Strategic revision of a common IPL curriculum in undergraduate programs2015In: Interprofessional Education in Europe: Policy and Practice / [ed] Andre Vyt, Majda Pahor, Tiina Tervaskanto-Maentausta, Antwerpen: Garant Publishers Limited , 2015, p. 49-66Chapter in book (Refereed)
  • 22.
    Lystedt, Erika
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care.
    Westergren, Hanna
    Brynhildsen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Lindh-Åstrand, Lotta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Gustavsson, Johanna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of cell biology.
    Nyström, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Strålfors, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of cell biology.
    Subcutaneous adipocytes from obese hyperinsulinemic women with polycystic ovary syndrome exhibit normal insulin sensitivity but reduced maximal insulin responsiveness2005In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 153, no 6, p. 831-835Article in journal (Refereed)
    Abstract [en]

    Background: Polycystic ovary syndrome (PCOS) has a high prevalence in women and is often associated with insulin resistance and hence with aspects of the so-called metabolic syndrome. Methods: Ten women diagnosed with PCOS were consecutively included (aged 21-39 years, average 30.2±1.9 years, body mass index 28.4-42.5 kg/m2, average 37.5±1.7 kg/m2 (mean±S.E.)). Adipocytes were isolated from the subcutaneous fat and, after overnight incubation to recover from insulin resistance due to the surgical cell isolation procedures, they were analyzed for insulin sensitivity. Results: The patients with PCOS exhibited marked clinical hyperinsulinemia with 3.6-fold higher blood levels of C-peptide than a healthy lean control group (1.7±0.2 and 0.5±0.02 nmol/l respectively, P < 0.0001). The patients with PCOS also exhibited 2.4-fold higher concentrations of serum triacylglycerol (2.1±0.3 and 0.9±0.06 mmol/l respectively, P < 0.0001), but only slightly elevated blood pressure (118±12/76±6 and 113±7/72±6 mmHg respectively, P = 0.055/0.046). However, insulin sensitivity for stimulation of glucose transport in the isolated adipocytes was indistinguishable from a non-PCOS, non-diabetic control group, while the maximal insulin effect on glucose uptake was significantly lower (2.2±0.2- and 3.8±0.8-fold respectively, P = 0.02). Conclusions: Subcutaneous adipocytes from patients with PCOS do not display reduced insulin sensitivity. The findings show that the insulin resistance of PCOS is qualitatively different from that of type 2 diabetes. © 2005 Society of the European Journal of Endocrinology.

  • 23.
    Nyström, Sofia
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Continuing professional development: pedagogical practices of interprofessional simulation in health care2017In: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 39, no 3, p. 303-319Article in journal (Refereed)
    Abstract [en]

    The increasing complexity of health care practice makes continuing professional development (CPD) essential for health care professionals. Simulation-based training is a CPD activity that is often applied to improve interprofessional collaboration and the quality of care. The aim of this study is to explore simulation as a pedagogical practice for the CPD of health care professionals. Specifically, the study focuses on how a professional development activity, the simulation, is enacted to support interprofessional collaboration and learning. A practice theory perspective is used as the theoretical framework. In this, the professional practice is conceptualised as being embodied, relational and situated in sociomaterial arrangements. Ten introduction and reflection sessions following interprofessional full-scale manikin-based simulations with professionals were video-recorded. The recordings were analysed following a stepwise qualitative collaborative approach developed for the purpose. The key findings suggest that the professional competence activity is enacted and interconnected with and governed by historical traditions of institutional teaching practices as well as simulation practices. Despite the intentions of team and interprofessional training, the institutional teaching and simulation practices constrain and hinder the intended outcomes of professional development in interprofessional collaboration.

    The full text will be freely available from 2018-12-06 14:53
  • 24.
    Nyström, Sofia
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Debriefing practices in interprofessional simulation with students: A sociomaterial perspective2016In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, no 148, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background: The debriefing phase is an important feature of simulation activities for learning. This study applies a sociomaterial perspective on debriefing in interprofessional simulation with medical and nursing students. Sociomaterial perspectives are increasingly being used in order to understand professional practice and learning in new ways, conceptualising professional practice as being embodied, relational and situated in sociomaterial relations. The aim of the study is to explore how debriefing is carried out as a practice supporting students’ interprofessional learning.

    Methods: Eighteen debriefing sessions following interprofessional full-scale manikin-based simulation with nursing and medical students from two different universities were video-recorded and analysed collaboratively by a team of researchers, applying a structured scheme for constant comparative analysis.

    Results: The findings show how debriefing is intertwined with, and shaped by social and material relationships. Two patterns of enacting debriefing emerged. Debriefing as algorithm was enacted as a protocol-based, closed inquiry approach. Debriefing as laissez-faire was enacted as a loosely structured collegial conversation with an open inquiry approach.

    Conclusion: The findings indicate that neither an imposed structure of the debriefing, nor the lack of structure assured interprofessional collaboration to emerge as a salient topic for reflection, even though that was an explicit learning objective for the simulation. 

  • 25.
    Nyström, Sofia
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hult, Håkan
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Enacting simulation: A sociomaterial perspective on students’ interprofessional collaboration2016In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 30, no 4, p. 441-447Article in journal (Refereed)
    Abstract [en]

    Full-scale simulation exercises are becoming more common as an educational feature of the under- graduate training of health professionals. This study explores how interprofessional collaboration is enacted by the participating students. Practice theory is used as the theoretical framework for a field study of two naturalistic educational settings, when medical and nursing students come together to practice in a simulated emergency situation, where a manikin is replacing the patient. Eighteen sessions of simulations were observed, and data were collected through standardised video recordings that were analysed collaboratively. To ensure transparency and scientific rigour, a stepwise constant comparative analysis was conducted, in which individual observations within and across single video recordings were compared, negotiated and eventually merged. The findings show that the student teams relate to the manikin as a technical, medical, and human body, and that interprofessional knowings and enactments emerge as a fluid movement between bodily positioning in synchrony and bodily positioning out of synchrony in relation to the sociomaterial arrangements. The findings are related to contemporary theorisations of practice comprising an integrated view of body and mind, and it is discussed how the findings can be used in simulation exercises to support participants’ learning in new ways. 

  • 26.
    Nyström, Sofia
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Educational Sciences.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hult, Håkan
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Observing of interprofessional collaboration in simulation: A socio-material approach2016In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 30, no 6, p. 710-716Article in journal (Refereed)
    Abstract [en]

    Simulation exercises are becoming more common as an educational feature of the undergraduate training of health professionals. Not all students participate in these activities, but are assigned as observers of the actual simulation. This article presents a study that explored how social-material arrangements for observation of interprofessional collaboration in a simulated situation are enacted and how these observations are thematised and made relevant for learning. The empirical data consisted of 18 standardised video recordings of medical and nursing students observing their peer students simulate. Practice theory is used to show how observation is embodied, relational, and situated in social-material relations. The findings show two emerging ways of enacting observation—proximate observation and distant observation. The enactments are characterised by different socio-material arrangements concerning the location where the simulation took place and its material set-up as well as embodied “doings” and “relatings” between the observing students and instructors. The observing students are participating in a passive, normative position as an audience and as judges of what is correct professional behaviour.

  • 27.
    Stenkula, Karin G.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Said Suma, Lilian
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Karlsson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Cell Biology.
    Thorn, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Gustavsson, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Söderström, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik H
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Expression of a mutant IRS inhibits metabolic and mitogenic signalling of insulin in human adipocytes2004In: Molecular and Cellular Endocrinology, ISSN 0303-7207, Vol. 221, no 1-2, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Adipose tissue is a primary target of insulin, but knowledge about insulin signalling in human adipocytes is limited. We developed an electroporation technique for transfection of primary human adipocytes with a transfection efficiency of 15% ± 5 (mean ± S.D.). Human adipocytes were co-transfected with a mutant of IRS-3 (all four potential PI3-kinase binding motifs mutated: IRS-3F4) and HA-tagged protein kinase B (HA-PKB/Akt). HA-PKB/Akt was immunoprecipitated from cell lysates with anti-HA antibodies, resolved with SDS-PAGE, and immunoblotted with phospho-specific antibodies. We found that IRS-3F4 blocked insulin stimulation of HA-PKB/Akt phosphorylation and in further analyses also translocation of recombinant HA-tagged glucose transporter to the plasma membrane. IRS-3F4 also blocked insulin-induced activation of the transcription factor Elk-1. Our results demonstrate the critical importance of IRS for metabolic as well as mitogenic signalling by insulin. This method for transfection of primary human adipocytes will be useful for studying insulin signalling in human adipocytes with molecular biological techniques.

  • 28.
    Thorn, Hans
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Stenkula, Karin G.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Karlsson, Margareta
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Örtegren Kugelberg, Unn
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Gustavsson, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Cell surface orifices of caveolae and localization of caveolin to the necks of caveolae in adipocytes2003In: Molecular Biology of the Cell, ISSN 1059-1524, E-ISSN 1939-4586, Vol. 14, no 10, p. 3967-3976Article in journal (Refereed)
    Abstract [en]

    Caveolae are noncoated invaginations of the plasma membrane that form in the presence of the protein caveolin. Caveolae are found in most cells, but are especially abundant in adipocytes. By high-resolution electron microscopy of plasma membrane sheets the detailed structure of individual caveolae of primary rat adipocytes was examined. Caveolin-1 and -2 binding was restricted to the membrane proximal region, such as the ducts or necks attaching the caveolar bulb to the membrane. This was confirmed by transfection with myc-tagged caveolin-1 and -2. Essentially the same results were obtained with human fibroblasts. Hence caveolin does not form the caveolar bulb in these cells, but rather the neck and may thus act to retain the caveolar constituents, indicating how caveolin participates in the formation of caveolae. Caveolae, randomly distributed over the plasma membrane, were very heterogeneous, varying in size between 25 and 150 nm. There was about one million caveolae in an adipocyte, which increased the surface area of the plasma membrane by 50%. Half of the caveolae, those larger than 50 nm, had access to the outside of the cell via ducts and 20-nm orifices at the cell surface. The rest of the caveolae, those smaller than 50 nm, were not open to the cell exterior. Cholesterol depletion destroyed both caveolae and the cell surface orifices.

  • 29.
    Törnkvist, Åsa
    et al.
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Parpal, Santiago
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Gustavsson, Johanna
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Inhibition of Raf-1 kinase expression abolishes insulin stimulation of DNA synthesis in H4IIE hepatoma cells1994In: Journal of Biological Chemistry, ISSN 0021-9258, E-ISSN 1083-351X, Vol. 269, no 19, p. 13919-13921Article in journal (Refereed)
    Abstract [en]

    The involvement of Raf-1 kinase in the insulin signal transduction chain leading to control of cell proliferation was studied in the H4IIE rat hepatoma cell line by inhibiting expression of the kinase with antisense oligodeoxyribonucleotide directed against Raf-1 mRNA. Antisense oligonucleotide was found to reduce (at 2 microM) or completely block (at 15 microM) the stimulation by insulin of DNA synthesis, measured as thymidine incorporation. The residual DNA synthesis seen in the absence of insulin stimulation was also inhibited by the Raf-1 kinase antisense oligonucleotide.

  • 30.
    Örtegren, Unn
    et al.
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Karlsson, Margareta
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Blazic, Natascha
    Department of Clinical Neuroscience, Sahlgrenska University Hospital/Mölndal, Göteborg University, Mölndal, Sweden.
    Blomqvist, Maria
    Department of Clinical Neuroscience, Sahlgrenska University Hospital/Mölndal, Göteborg University, Mölndal, Sweden.
    Nyström, Fredrik
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Gustavsson, Johanna
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Fredman, Pam
    Department of Clinical Neuroscience, Sahlgrenska University Hospital/Mölndal, Göteborg University, Mölndal, Sweden.
    Strålfors, Peter
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Lipids and glycosphingolipids in caveolae and surrounding plasma membrane of primary rat adipocytes2004In: European Journal of Biochemistry, ISSN 0014-2956, E-ISSN 1432-1033, Vol. 271, no 10, p. 2028-2036Article in journal (Refereed)
    Abstract [en]

    We have made a comprehensive and quantitative analysis of the lipid composition of caveolae from primary rat fat cells and compared the composition of plasma membrane inside and outside caveolae. We isolated caveolae from purified plasma membranes using ultrasonication in carbonate buffer to disrupt the membrane, or extraction with nonionic detergent, followed by density gradient ultracentrifugation. The carbonate-isolated caveolae fraction was further immunopurified using caveolin antibodies. Carbonate-isolated caveolae were enriched in cholesterol and sphingomyelin, and the concentration was three- and twofold higher, respectively, in caveolae compared to the surrounding plasma membrane. The concentration of glycerophospholipids was similar suggesting that glycerophospholipids constitute a constant core throughout the plasma membrane. The composition of detergent-insoluble fractions of the plasma membrane was very variable between preparations, but strongly enriched in sphingomyelin and depleted of glycerophospholipids compared to carbonate-isolated caveolae; indicating that detergent extraction is not a suitable technique for caveolae preparation. An average adipocyte caveola contained about 22 × 103 molecules of cholesterol, 7.5 × 103 of sphingomyelin and 23 × 103 of glycerophospholipid. The glycosphingolipid GD3 was highly enriched in caveolae, whereas GM3, GM1 and GD1a were present inside as well as outside the caveolae membrane. GD1b, GT1b, GM2, GQ1b, sulfatide and lactosylceramide sulfate were not detected in caveolae.

  • 31.
    Öst, Anita
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Örtegren, Unn
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Gustavsson, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik H
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Triacylglycerol is synthesized in a specific subclass of caveolae in primary adipocytes2005In: Journal of Biological Chemistry, ISSN 0021-9258, E-ISSN 1083-351X, Vol. 280, no 1, p. 5-8Article in journal (Refereed)
    Abstract [en]

    A principal metabolic function of adipocytes is to synthesize triacylglycerol (TG) from exogenous fatty acids. The level of fatty acids has to be tightly controlled in the adipocyte, as they can act as detergents that rapidly dissolve the plasma membrane, causing cell lysis if allowed to accumulate. Fatty acids therefore have to be efficiently converted to TG and stored in the central lipid droplet. We report that in intact primary adipocytes exogenous oleic acid was taken up and directly converted to TG in the plasma membrane, in a novel subclass of caveolae that specifically contains the protein perilipin. Isolated caveolae catalyzed de novo TG synthesis from oleic acid and glycerol 3-phosphate. Electron microscopy revealed the presence of caveolin and perilipin in caveolae and in lipid-laden bulbs in the plasma membrane, and fluorescence microscopy demonstrated colocalization of fatty acids/TG with caveolin and perilipin at the plasma membrane. A second caveolae fraction was isolated, which lacked perilipin and the triacylglycerol synthesizing enzymes. Both caveolae fractions contained caveolin-1 and the insulin receptor. The findings demonstrate that specific subclasses of caveolae carry out specific functions in cell metabolism. In particular, triacylglycerol is synthesized at the site of fatty acid entry in one of these caveolae classes.

1 - 31 of 31
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