Örebro University

Linnanen C., Hemberg J., Bjerga G.H., Ueland V., Bergdahl E.

ABSTRACTBackgroundFor cancer care to be high‐quality, a shift is needed from a healthcare system that is designed around disease and institutions to one devised with a holistic perspective on human beings.AimTo gain a deeper understanding of healthcare professionals' experiences of the possibilities and limitations for providing person‐centred care to alleviate suffering among patients within cancer care.Method and MaterialA qualitative and explorative design was used. The data material consisted of texts from four focus group interviews with 15 nurses and physicians from a cancer clinic in Finland during January and February 2024. A qualitative content analysis was applied as a method. The COREQ checklist was used.FindingsContinuity, multidisciplinary collaboration, supporting collegial relationships, work ethics, and competence were seen as factors promoting person‐centred care. The organisation's various boundaries, failure demand, and emotional limitations were seen as factors that limited person‐centred care.DiscussionThe organisational management and healthcare professionals' ability to collaborate with the patient can promote opportunities and limit barriers in the unpredictable reality of cancer care and so lead to increased person‐centred care.ConclusionsHealthcare professionals' internal abilities are comprehensive. If the healthcare organisation were more integrated through better collaboration and flexibility between different instances, cancer care could alleviate patient suffering and simultaneously reduce failure demand.Relevance to Clinical PracticeFactors such as failure demand slow down care work, and by gaining a deeper understanding of the problems, leaders, together with healthcare professionals in healthcare organisations, can find solutions to address the problems and save time and resources for the benefit of both patients and healthcare professionals.

Urberg L.

Asakawa D., Lin H., Ruan Y., Taniyasu S., Yeung L.W., Tojo T., Ichihara M., Yamazaki E., Hanari N., Lam P.K., Yamashita N.

Germuskova Z., Westerholt M., Ocias L.F.

ABSTRACT Background Capnocytophaga canimorsus , a Gram-negative rod found in the commensal oral microflora of dogs, is a rare cause of infection following a dog bite, with severe infections more commonly occurring in asplenic or immunocompromised patients. This is a rare case of septic shock and meningitis with a serovar B strain in an immunocompetent patient who passed away due to the infection. Case Summary A previously healthy man in his late 50s with no known immunodeficiencies was admitted to the hospital with fever and cognitive deficits after being bitten by a dog. Capnocytophaga canimorsus grew in his cerebrospinal fluid and blood cultures. Despite aggressive fluid therapy, antibiotics, and intensive care, the patient succumbed to the infection. The strain was later characterized as serovar B using whole genome sequencing. Conclusion Even immunocompetent patients are at risk of severe infection caused by Capnocytophaga canimorsus . These infections are an important differential diagnosis in patients presenting with fever following recent dog exposure with serovars A–C being the most common in human clinical isolates.

Shanei M., Wang G., Johansson P., Volpe G., Käll M.

Gomez A., Walhelm T., Loeff F.C., Jönsen A., Nikolopoulos D., van den Broek B., Bengtsson A.A., de Vries A., Rispens T., Sjöwall C., Parodis I.

Abstract Objective Studies supporting therapeutic drug monitoring to biopharmaceuticals in systemic lupus erythematosus (SLE) are scarce. We aimed to assess anti-drug antibody (ADA) occurrence in belimumab-treated SLE patients and associations between belimumab concentrations and clinical response, serological outcomes, and adverse events. Methods We included 100 patients treated with intravenous belimumab. Clinical data and biological samples were collected at baseline and months 3, 6, 12, and 24. Belimumab levels were determined by quantitative sandwich ELISA, and ADA by an acid-dissociation radioimmunoassay. Clinical activity was evaluated with the SLE disease activity index 2000 (SLEDAI-2K), revised SLE activity measure (SLAM-R), and physician’s global assessment (PhGA). Serological markers included C3, C4, and anti-dsDNA. We performed cross-sectional Spearman’s rank correlation analyses, and longitudinal analyses using generalised estimating equations. Results Belimumab concentrations varied widely (median: 25.8; IQR: 20.9–43.5 μg/ml) but were stable over time at the group level. Pre-existing ADA were detected in 2 patients, but no patient developed ADA during follow-up. Belimumab levels moderately correlated with SLEDAI-2K (ρ: -0.37; p= 0.003) and PhGA (ρ: -0.41; p= 0.005) at month 6, while longitudinal analysis revealed a very weak association with SLEDAI-2K (β: -0.10; SE: 0.05; p= 0.031) and a weak association with SLAM-R (β: -0.32; SE: 0.13; p= 0.014). Despite moderate correlations between belimumab levels and serological markers at month 6, there were no associations in longitudinal analysis. There was no relationship between belimumab levels and adverse events. Conclusion Belimumab yielded no immunogenicity. Belimumab levels were modestly associated with clinical activity but not with serological activity or adverse events.

Wiels W.A., Oomens J.E., Engelborghs S., Baeken C., von Arnim C.A., Boada M., Didic M., Dubois B., Fladby T., van der Flier W.M., Frisoni G.B., Fröhlich L., Gill K.D., Grimmer T., Hildebrandt H., et. al.

ImportanceDepressive symptoms are associated with cognitive decline in older individuals. Uncertainty about underlying mechanisms hampers diagnostic and therapeutic efforts. This large-scale study aimed to elucidate the association between depressive symptoms and amyloid pathology.ObjectiveTo examine the association between depressive symptoms and amyloid pathology and its dependency on age, sex, education, and APOE genotype in older individuals without dementia.Design, Setting, and ParticipantsCross-sectional analyses were performed using data from the Amyloid Biomarker Study data pooling initiative. Data from 49 research, population-based, and memory clinic studies were pooled and harmonized. The Amyloid Biomarker Study has been collecting data since 2012 and data collection is ongoing. At the time of analysis, 95 centers were included in the Amyloid Biomarker Study. The study included 9746 individuals with normal cognition (NC) and 3023 participants with mild cognitive impairment (MCI) aged between 34 and 100 years for whom data on amyloid biomarkers, presence of depressive symptoms, and age were available. Data were analyzed from December 2022 to February 2024.Main Outcomes and MeasuresAmyloid-β1-42 levels in cerebrospinal fluid or amyloid positron emission tomography scans were used to determine presence or absence of amyloid pathology. Presence of depressive symptoms was determined on the basis of validated depression rating scale scores, evidence of a current clinical diagnosis of depression, or self-reported depressive symptoms.ResultsIn individuals with NC (mean [SD] age, 68.6 [8.9] years; 5664 [58.2%] female; 3002 [34.0%] APOE ε4 carriers; 937 [9.6%] had depressive symptoms; 2648 [27.2%] had amyloid pathology), the presence of depressive symptoms was not associated with amyloid pathology (odds ratio [OR], 1.13; 95% CI, 0.90-1.40; P = .29). In individuals with MCI (mean [SD] age, 70.2 [8.7] years; 1481 [49.0%] female; 1046 [44.8%] APOE ε4 carriers; 824 [27.3%] had depressive symptoms; 1668 [55.8%] had amyloid pathology), the presence of depressive symptoms was associated with a lower likelihood of amyloid pathology (OR, 0.73; 95% CI 0.61-0.89; P = .001). When considering subgroup effects, in individuals with NC, the presence of depressive symptoms was associated with a higher frequency of amyloid pathology in APOE ε4 noncarriers (mean difference, 5.0%; 95% CI 1.0-9.0; P = .02) but not in APOE ε4 carriers. This was not the case in individuals with MCI.Conclusions and RelevanceDepressive symptoms were not consistently associated with a higher frequency of amyloid pathology in participants with NC and were associated with a lower likelihood of amyloid pathology in participants with MCI. These findings were not influenced by age, sex, or education level. Mechanisms other than amyloid accumulation may commonly underlie depressive symptoms in late life.

Flewwelling L.D., Hannaian S.J., Cao V., Chaillou T., Churchward-Venne T.A., Cheng A.J.

High-load resistance exercise (>60% of 1-repetition maximum) is a well-known stimulus to enhance skeletal muscle hypertrophy with chronic training. However, studies have intriguingly shown that low-load resistance exercise training (RET) (≤60% of 1-repetition maximum) can lead to similar increases in skeletal muscle hypertrophy as compared with high-load RET. This has raised questions about the underlying mechanisms for eliciting the hypertrophic response with low-load RET. A key characteristic of low-load RET is performing resistance exercise to, or close to, task failure, thereby inducing muscle fatigue. The primary aim of this evidence-based narrative review is to explore whether muscle fatigue may act as an indirect or direct mechanism contributing to skeletal muscle hypertrophy during low-load RET. It has been proposed that muscle fatigue could indirectly stimulate muscle hypertrophy through increased muscle fiber recruitment, mechanical tension, ultrastructural muscle damage, the secretion of anabolic hormones, and/or alterations in the expression of specific proteins involved in muscle mass regulation (e.g., myostatin). Alternatively, it has been proposed that fatigue could directly stimulate muscle hypertrophy through the accumulation of metabolic by-products (e.g., lactate), and/or inflammation and oxidative stress. This review summarizes the existing literature eluding to the role of muscle fatigue as a stimulus for low-load RET-induced muscle hypertrophy and provides suggested avenues for future research to elucidate how muscle fatigue could mediate skeletal muscle hypertrophy.

Rizeq J., Ojala M.

Hellquist F., El-Hajj V.G., Buwaider A., Edström E., Elmi-Terander A.

Background/Objectives: Hypoglossal nerve palsy (HNP) is a rare complication after cervical spine surgery and is reported after both anterior and posterior approaches. It often presents with dysarthria, dysphagia, and hoarseness. We present a systematic review of the literature and two cases of patients presenting with confirmed HNP after anterior cervical spine surgery. Methods: Two retrospective case reports and a systematic review of the literature were presented. The electronic databases PubMed and Web of Science were systematically searched from inception. Results: In total, 17 cases of HNP were reported in the literature, including the two hereby presented. Ten cases involved the anterior approach and seven the posterior approach. The reported risk of HNP following cervical spine surgery varied between 0.01% and 2.5% depending on the procedure. The main etiology was mechanical compression of the nerve. Most of the cases recovered within a few months with conservative treatment. In some cases, permanent hypoglossal injury with persistent symptoms was reported. In both of the current cases, the symptoms gradually improved and completely resolved after a few months. Conclusions: HNP is a rare complication after cervical spine surgery. The causes of hypoglossal palsy are multifactorial, but mechanical injury is the most common. A thorough understanding of the nerve’s anatomy is essential to minimize the risk of injury during anesthesia, patient positioning, and surgery. Understanding the underlying mechanisms contributing to HNP post-cervical spine surgery enables the implementation of preventive measures to mitigate its occurrence.

Wettermark A., Berglund K.

Entrepreneurship is often understood as acting boldly on the market, broadcasting one’s endeavours in persuasive success stories. We, in contrast, seek to understand less flamboyant entrepreneurial practices by examining the creativity and innovations pursued by a gendered and marginalized professional group in the public sector. Through an ethnographic study of hospital pharmacists during the COVID-19 pandemic, we seek to understand how pharmacists ‘do’ entrepreneuring at work, what practices they engage in, and how they act creatively, sometimes breaking with role expectations, and seldom receiving recognition for what they are doing. In the article, we refer to this as silent entrepreneuring – a form of entrepreneuring that simultaneously complies with and refuses entrepreneurial ideals. By adopting two contrasting but complementary analytical positions, we examine the often unspoken activities of pharmacists and how they form practices that both support and contradict each other. We conclude by suggesting that the concept of silent entrepreneuring enables a broadened understanding of organizational entrepreneurship that calls for greater sensitivity towards the different forms that entrepreneuring may take.

Fiorino G., Ananthakrishnan A., Cohen R.D., Cross R.K., Deepak P., Farraye F.A., Halfvarson J., Steinhart A.H.

Data indicate that earlier initiation of anti-tumor necrosis factor alpha (anti-TNF-α) biologic medicines may prevent progression to irreversible bowel damage and improve outcomes for patients with inflammatory bowel disease (IBD), particularly Crohn’s disease. However, the high cost of such therapies may restrict access and prevent timely treatment of IBD. Biosimilar anti-TNF-α medicines may represent a valuable opportunity for cost savings and optimized patient outcomes by improving access to advanced therapies and allowing earlier anti-TNF-α treatment initiation. Biosimilar anti-TNF-α medicines have been shown to offer consistent therapeutic outcomes to their reference medicines, yet despite entering the IBD treatment armamentarium over 10 years ago, their implementation in clinical practice remains suboptimal. Factors limiting the ‘real’ use of biosimilar anti-TNF-α medicines may include an ongoing lack of understanding and acceptance of biosimilars by both healthcare professionals (HCPs) and patients, as well as systemic factors such as formulary decisions outside of the control of the prescriber. In this review, an expert panel of gastroenterologists discusses HCP-level considerations to improve biosimilar anti-TNF-α utilization in IBD in order to support early anti-TNF-α initiation and maximize patient outcomes.

Leissner P., Olsson E.M., Rondung E., Sundelin R., Spaak J., Ulvenstam A., Nordenskjöld A., Kövamees L., Lyngå P., Held C., Tornvall P., Humphries S.

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) and takotsubo syndrome (TS) are both characterised by lack of significant coronary artery stenoses and a higher prevalence of mental health disorders preceding the event. Currently, little is known about their pathological aetiologies and subsequent treatment plans, giving cause for concern among those affected. The objective of this review is to provide a comprehensive overview of mental health status and quality of life (QoL) in MINOCA- and TS-patients after the acute event, compared to both cardiac and non-cardiac populations, and over time. Methods A systematic search was conducted via Cochrane Library, CINAHL, PyschINFO, PubMed, ASSIA, Web of Science, Scopus and Embase from inception to May 2024. The review was registered in PROSPERO and methods, and results were reported in accordance with the PRISMA guidelines. Quality assessment and risk of bias were evaluated using the Newcastle-Ottawa Scale for cross-sectional and cohort studies. Results Sample sizes ranged from 13 to 5,322 participants. The risk of bias was high in 18/28, medium in 7/28, and low in 3/28 studies. Across the symptoms assessed, MINOCA- and TS-patients reported worse mental health status or QoL than non-cardiac groups in 10/13 studies, and cardiac groups in 10/20 studies. Investigating change over time, 1/5 studies found deteriorating mental health status, 3/5 reported improved mental health status or QoL and 1/5 reported no change in MINOCA- and TS-patients. Conclusions Patients with MINOCA or TS seem to have worse mental health status and QoL after the acute event than non-cardiac individuals, but it is yet difficult to conclude whether mental distress and QoL are equal or worse compared to CHD-patients. There is no convincing evidence that mental health status or QoL of MINOCA- and TS- patients naturally improve over time after the acute event. Among the studies evaluated, risk of bias was high. More high-quality studies are needed, investigating mental health status and QoL among MINOCA- and TS-patients.

Miranda I.P., Pankratova M., Weißenhofer M., Klautau A.B., Thonig D., Pereiro M., Sjöqvist E., Delin A., Katsnelson M.I., Eriksson O., Bergman A.

Magnetoelasticity plays a crucial role in numerous magnetic phenomena, including magnetocalorics, magnon excitation via acoustic waves, and ultrafast demagnetization, or the Einstein–de Haas effect. Despite a long-standing discussion on anisotropy-mediated magnetoelastic interactions of relativistic origin, the exchange-mediated magnetoelastic parameters within an atomistic framework have only recently begun to be investigated. As a result, many of their behaviors and values for real materials remain poorly understood. Therefore, by using a proposed simple modification of the embedded cluster approach that reduces the computational complexity, we critically analyze the properties of exchange-mediated spin-lattice coupling parameters for elemental 3d ferromagnets (bcc Fe, fcc Ni, and fcc Co), comparing methods used for their extraction and relating their realistic values to symmetry considerations and orbitally decomposed contributions. Additionally, we investigate the effects of noncollinearity (spin temperature) and applied pressure on these parameters. For Fe, we find that single-site rotations, associated with spin temperatures around 100 K, induce significant modifications, particularly in Dzyaloshinskii-Moriya-type couplings; in contrast, such interactions in Co and Ni remain almost configuration independent. Moreover, we demonstrate a notable change in the exchange-mediated magnetoelastic constants for Fe under isotropic contraction. Finally, the conversion between atomistic, quantum-mechanically derived parameters and the phenomenological magnetoelastic theory is discussed, which can be a useful tool towards larger and more realistic dynamics simulations involving coupled subsystems. Published by the American Physical Society 2025

Gomez A., Lindblom J., Parodis I., Bertsias G.

Abstract Objectives DORIS remission, based on clinical activity, and lupus low disease activity state (LLDAS), which includes serological markers, are protective targets in SLE. However, it remains unclear whether their prognostic impact is influenced by serum anti-dsDNA and complement levels Methods We analysed data from five phase III trials (BLISS-52, BLISS-76, BLISS-SC, BLISS-NEA, EMBRACE) totalling 45 254 monthly visits. Generalized linear models evaluated the effects of DORIS/LLDAS—with or without active serology—on the risk for severe (BILAG ≥1A/2B) and renal (BILAG A/B) flares. Organ damage was also assessed. Results Normal serology occurred in 544/1871 (29.1%) DORIS and 1879/4760 (39.5%) LLDAS visits. Using no-DORIS as reference, DORIS with anti-dsDNA(−) or normal/high C3/C4 demonstrated stronger protection against severe flares (odds ratio [OR] 0.042 [95% CI: 0.005, 0.331] and 0.216 [95% CI: 0.094, 0.494], respectively) compared with DORIS with anti-dsDNA(+) or low C3/C4 (OR 0.511 [95% CI: 0.284, 0.919] and 0.528 [95% CI: 0.261, 1.067]). Similarly, LLDAS with normal serology showed greater risk-reduction in severe flares compared with LLDAS with active serology, especially low C3/C4. For renal flares, DORIS with serological activity carried ∼6-fold higher risk compared with combined clinical/serological remission (OR 5.94 [95% CI: 1.26, 28.04]). Damage accrual was lowest in patients with sustained DORIS and ≥1 visit showing anti-dsDNA(−) (0.8%) or normal C3/C4 (1.8%). Conclusion Normal serology enhances the protection of DORIS and LLDAS against severe and renal SLE flares, possible reflecting deeper states of disease control. Patients with recently active disease who meet clinical targets but have persistently abnormal serology may require close monitoring to minimize flare-risk.