Sterilcentralen som finns på nya Karolinska Universitetssjukhuset är inte modern. Den är dessutom inte tillfredsställande ur ett arbetsmiljömässigt perspektiv.  Det finns redan ett antal beprövade automationsmetoder som är implementerade på olika sjukhus, men inte på NKS. Det finns ett antal olika processer som ett material måste genomgå för att det ska bli sterilt. De flesta sköts manuellt. Kan automation förverkligas för att minska mängden manuellt arbete samt förbättra arbetsmiljön för avdelningens personal? Ett frågeformulär användes för att ta reda på hur personalen som arbetar på avdelningen uppfattar arbetet som utförs. Formuläret var också till för att ta reda på hur de tror att arbetet och arbetsmiljön kan förbättras genom automation. Fältstudier samt besök på andra sjukhus gjordes för att undersöka hur arbetet på sterilcentralen går till i praktiken. / The central sterile department that is located at the new Karolinska Hospital is not up to date. It is not satisfying from a work environmental perspective. There are however a number of proven methods of automation that are implemented at different hospitals but not at NKS. There are a number of different processes that have to be executed on an instrument to be able to classify it as sterile. Most of the work is done manually. Could automation be implemented to reduce the number of work done manually and to improve the work environment for the employees of the department? A questionnaire was used to figure out how the staff that works at the department perceives the work that is being done. The questionnaire was also used to figure out the staff's point of view on how the work processes and work environment can be improved due to automation. Field studies and visiting other hospitals were executed to study how the work at the central sterile department is done in reality.

In November 2016 a brand new and highly technological hospital called New Karolinska Solna opened in Stockholm. In connection with the planning of the hospital, new medical devices were procured, including a new infusion system that is now in use. Previously, each ward at the hospital had their own pumps and was responsible for updates and maintenance. Now, the hospital will instead have a floating pump system, which means that the hospital will own the pumps. The infusion pumps will be floating between the wards without being linked to a specific ward or department. The updates that were previously done when the need arose at the ward will now be a common process for the entire hospital. The aim of the project was to develop new guidelines for how the update process should be done on New Karolinska Solna's new infusion pump system. Through interviews with key personnel during the procurement process, the medical technicians department and caseworkers, new guidelines have been written, given the already existing technical conditions. During the course of the project it has been found that there are major shortcomings of information and communication within the hospital. The guidelines presented in the result are an important part to ensure that information related to the update comes to the caregivers at New Karolinska Solna, thus simplifying and streamlining the update of the infusion pumps.

Karolinska Institutet (KI) är en kunskapsintensiv organisation som bedriver världsledande medicinsk forskning. Här blir frågor kring ägande och makt centrala då produktion av vetenskap är en bransch där det finns mycket prestige och ekonomiskt kapital att vinna. Utifrån läsning av kandidatuppsatser som gjorts på KI bildades ett intresse för att lyfta betydelsen av maktens påverkan på det vetenskapliga arbetet. Syftet med studien har varit att utöka förståelsen för hur makt manifesteras inom och mellan forskargrupper på KI. Detta har gjorts genom en kortvarig etnografisk studie under en veckas tid, då vi följt en forskargrupp i deras dagliga arbete. För att kunna styrka våra observationer har även material från tidigare studier gjorda inom samma fält, tillgodogjorts i samråd med handledaren. Forskningsfrågorna som studien utgått från är hur manifesteras makt inom och mellan forskargrupper samt vilken roll spelar kapital som valuta och medlare vid manifestation av makt. För att besvara våra forskningsfrågor har vi tillämpat Bruno Latours Actor-Network Theory (ANT) samt Pierre Bourdieus koncept kring olika kapitalformer. Genom vår observation kunde vi se hur teorierna kunde sammanföras för att förklara hur makt manifesteras och vilka aktörer som kom att spela stor roll i detta avseende. Resultatet av studien visar på att hur makt manifesteras mellan människor, till stor del formas av de så kallade icke-mänskliga aktörerna som finns inom det specifika fältet som studeras. Dessa aktörer menar vi främst är byggnadens utformning, den vetenskapliga och tekniska utrustningen, hyror och publikationer. Avslutningsvis har vi kunnat se att makt manifesteras genom att analysera den cykliska återinvesteringen av kapital.

FN har tagit fram regler kring främjandet av rättigheterna för personer med funktionsnedsättning. Detta innebär att allmänna platser och utemiljöer ska vara tillgängliga och användbara för alla. Målet med detta examensarbete är att ta fram typlösningar som är anpassade för personer med nedsatt orienteringsförmåga, med fokus på synnedsättning. Den geografiska avgränsningen är Östra Sjukhuset i Göteborg, men resultatets lösningar skall även vara applicerbara på andra allmänna utemiljöer. Lagar och rekommendationer har jämförts med brukarnas subjektiva upplevelser av utemiljöer för att se om eventuella glapp uppkommer. Av platsobservationerna och studier av lagar och bestämmelser kan det konstateras att strängare krav måste ställas vad gäller tillgänglighet. Att skapa en fungerande tillgänglig och användbar miljö kräver dock inte enbart att regler efterföljs, även kunskap om verklig behov och hur lösningar fungerar i praktiken har en betydande roll.

Syftet med uppsatsen är att kartlägga behovet av en testbädd för telemedicinska produkter och att analysera krav som medicintekniska företag ställer på en testbäddsmiljö för samverkan med sjukvården. Målet har varit att konkretisera resultatet i en kommersialiseringsplan för Karolinska Testbädd för Telemedicin och eHälsa, vid Medicinsk Teknik på Karolinska Universitetssjukhuset. Vid genomförandet av undersökningen har totalt 19 intervjuer och ytterligare 6 telefonintervjuer genomförts med dels representanter från medicintekniska företag och sjukvården och dels med samarbetsstrukturer för medicinsk teknik och möjliga finansiärer. En enkätundersökning har genomförts för att kvantifiera resultatet från intervjuerna. Webbutskick har gjorts till 279 företag med verksamhet inom områdena medicinsk teknik, IT och telekom. Uppsatsen beskriver hur den kliniska forskningen inom området medicinsk teknik har förändrats de senaste decennierna och hur situationen ser ut idag. Utmaningar som den svenska hälso- och sjukvården står inför presenteras, som demografiska förändringar, ökade sjukvårdskostnader, dyrare behandlingsmetoder och färre kommersialiserade innovationer inom medicinsk teknik.  Omständigheter som påverkar produktutveckling för hälso- och sjukvården belyses, dels genom den regulatoriska gränsdragningen mellan IT-produkter och medicintekniska produkter och dels utifrån en genomgång av forskning inom produkt- och tjänsteutveckling och utifrån de frågor kring hur företag bedriver produktutveckling som ställts i intervjuerna och i webbenkäten. Resultatet visar att företagen i högsta grad är beroende av samarbete med sjukvården i olika faser av sin produktutvecklingsprocess och att flera företag uttrycker ett behov av en testbäddsstruktur. Företagen samarbetar med vården framförallt för att det möjliggör att utveckla mer vårdanpassade produkter. Samarbete med vården ger kortare utvecklingstider och därmed minskade utvecklingskostnader. Det förenklar även arbetet med validering av produkters funktionalitet. Flera företag har utarbetade samarbeten direkt in på vårdavdelningar, medan andra i dagsläget saknar nödvändiga samarbetsstrukturer. Studien har identifierat ett flertal företag som visat intresse för ett samarbete med Testbädden och ytterligare ett antal som har önskat att få mer information om vad Testbädden kan erbjuda. I kommersialiseringsplanen föreslås Karolinska Testbädd för Telemedicin och eHälsa fokusera på sin nisch samt vidareutveckla den kompetens som företagen saknar. Testbädden bör arbeta vidare med att utveckla både externa kontakter och den interna samverkansorganisationen på Karolinska för att möjliggöra effektiva, smidiga och kvalitativa samarbeten mellan företag och sjukhusets avdelningar. / The purpose is to study the demand for a testbed for telemedicine and to analyze the medical device-developing companies’ requirements on the testbed’s facilities when collaborating with the healthcare sector in their product development. The study’s aim is to result in a commercialization plan for Karolinska Testbed for telemedicine and eHealth, at the department of Biomedical Engineering at Karolinska University Hospital. During the study, 19 interviews and 6 telephone-interviews has been held with people from the medical device industry, hospitals, potential funders and collaboration structures which foster medical device development. A web-survey has been sent to 279 companies within the fields of medical technologies, IT and telecom, to quantify the results from the interviews. The study describes how the clinical research on medical technologies has changed over the last decades and what the situation is like today. Present and forthcoming challenges to the Swedish health care system is presented, like demographic changes, increasing healthcare-costs, expensive treatments and the scarcity of medical device innovations being commercialized. Obstacles affecting the medical device development are studied, including the regulatory differences between IT and medical devices. An analysis of the research on product and service development is also looked at from the perspectives on how the medical device companies develop their products, which is derived from both interviews and the web-survey. The result shows that medical device companies rely upon the ability to collaborate with the hospitals in different phases of their product development process and that there is an extensive need for a testbed structure amongst companies. The companies that collaborate with hospitals do it primarily because it makes their products more adaptive to functioning in the settings of healthcare, time to market and development costs can be decreased and it facilitates the process when validating the functionality of their products. Several companies have their ways of collaborating with hospital wards whilst others explicitly lack indispensable collaboration structures. The study has identified some companies which have shown interest in collaborating with Testbed Karolinska for telemedicine and eHealth and other ones whom wish to receive more information on what the testbed can offer them. In the commercialization plan it is suggested that Karolinska Testbed for telemedicine and eHealth shall focus on their niche and elaborate the competency which the companies doesn’t have. It is also suggested that the Testbed continues the work with developing the internal organization within Karolinska to enable efficient, flexible and qualitative collaboration between companies and the clinics at Karolinska University Hospital.

The purpose of the study was to explore how property management companies view of Building Information Modeling (BIM) as a working method in property management process, and to explore the companies efforts at BIM in terms of the level of detail on BIM object implementation in property management. The study includes both companies that have and do not have contributions in BIM. The exploration was aimed at two companies and their varying ways of working to inform the needs of BIM in property management. The purpose of the study was also to give a clear picture of how BIM tools should be defined in the management process. The work was used of qualitative methods to answer the questions first consisted of a literature review, interviews and case study. The case study was about BIM implementation in New Karolinska Solna. The result showed that the definition of BIM in property management companies is not clear yet. The companies have intended to use BIM, but they are not there yet, there should be a type of requirements list that works with planning and production and benefit from using BIM in the property management. According to respondents, most of the common reasons why BIM was not used were because the approach of the tool. There is no proper structure or common working method of how the tool would be applied. Many literature sources including respondents claimed that BIM seemed good and have a good potential to be the future work process. BIM leads to improved work environment, improved sustainability development, good marketing, increased quality in work, time savings, and improved project management. As a suggestion as to how BIM could be implemented, it can be described in a few steps, which is status analysis, identify the benefits of BIM, start implementing on a smaller scale, follow up continuously, improve and expand the work and last but not least Integrate information. The conclusions that can be drawn from the results and literature study were that BIM can improve the quality management of the properties, but it is important to find a reasonable level of BIM implementation as well as a suitable detail level of BIM-model.

Medicinteknisk utrustning (MT) har en stor och avgörande roll i dagens samhälle för att kunna utföra en patientsäker sjukvård. De senaste tekniska framstegen har försett sjukvården med otaliga skräddarsydda MT-produkter för olika behov som uppstår vid behandling av patienterna. Trots detta har vissa hälso- och sjukvårdssektorer särskilda behov som inte kan tillgodoses genom marknadens utbud. När en sådan situation uppstår, tillåter regelverket sjukvårdsverksamheter att utveckla egentillverkade produkter eller modifiera befintlig MT-utrustning för att lösa det specifika sjukvårdsproblemet. Egentillverkning av en MT-produkt är en reglerad process i enlighet med EU-förordning om MT-produkter MDR (EU 2017/745) artikel 5.5. Detta regelverk säkerställer en patientsäker och kvalitetssäkrad MT-utrustning för intern användning inom sjukvårdsverksamheten.  Karolinska Universitetssjukhuset (Karolinska) som är Nordens största sjukhus har, i enlighet med regelverket, tagit fram egna interna riktlinjer för egentillverkning av MT-produkter. Covid-19-pandemin har aktualiserat att tillämpa dessa rutiner i praktiken. Karolinska har vårdat ett stort antal Covid-19-patienter med svåra respiratoriska symptom som har krävt ett särskilt omhändertagande bland annat på intensivvårdsavdelningen (IVA).  Ett av de mest förekommande kirurgiska ingreppen på IVA-patienter under denna period har varit trakeotomi. På grund av de stora svårigheter som uppstår med att flytta patienten till vanlig operationssal har öron-näsa-halsenheten (ÖNH) på Karolinska, som ansvarar för alla kirurgiska trakeotomier på sjukhuset, behövt utföra operationen på patienten i IVA-sängen. För att utföra en mer patientsäker på-plats-operation och förbättra denna ohållbara arbetsmiljö har ÖNH-kirurger önskat och sökt ett mobilt operationsbord som kan dockas till de olika IVA-sängtyperna som finns på sjukhuset. Eftersom detta operationsbord inte fanns att köpa på marknaden har MT-mekaniska verkstaden på Karolinska utvecklat en prototyp av trakeotomibordet som uppfyller ÖNH-kirurgernas specifika behov.  I detta arbete undersöktes egentillverkning av MT-produkter inom Karolinska i samband med utveckling av trakeotomibordet. I detta avseende studerades hela processen som krävs av regelverket och Karolinskas interna föreskrifter, från behovsanalys och definition av MT-produkten till kvalitetssäkring och riskhanteringen som garanterar en godkänd MT-utrustning för intern användning inom Karolinska Universitetssjukhuset. / Medical devices have a crucial role in performing a high-quality healthcare with patient safety in focus. Recent technological advances have provided healthcare systems with countless customized medical products for the various needs that arise in the treatment of patients. Despite this, some health care sectors have special needs that cannot be met by the market supply. In such circumstances, the regulations allow healthcare providers to develop in-house production or modify existing medical equipment to solve the specific need of the medical staff. In-house production of a medical device is a detailed regulated process defined in accordance with MDR (EU 2017/745) Article 5 (5). This regulatory framework ensures a patient-safe and quality-assured medical equipment for internal use within the healthcare.  Karolinska University Hospital (Karolinska), which is the Nordic region's largest hospital, follows the regulatory praxis for in-house production of medical devices. These praxes were put into use during the Covid-19 pandemic. Karolinska had to take care of many Covid-19 patients with severe respiratory symptoms who required special care, including intensive care unit (ICU).  One of the most common surgical procedures on ICU patients during this period was tracheotomy. Due to the complications that occur in moving patients to regular operating theatre, the ear-nose-throat unit (ENT) at Karolinska, which is responsible for all surgical tracheotomies at the hospital, has had to perform operations directly on ICU beds.  To improve the quality of the operations and the surgeon's work condition, the Karolinska ENT have sought a mobile operating table with ability to be docked to various ICU beds, available at the hospital. Since this medical equipment was not available on the market, the medical engineering workshop at Karolinska has developed a prototype of the tracheotomy table that meets the specific needs of ENT surgeons. This project studies the in-house production of a medical device at Karolinska through examining the development of tracheostomy table’s prototype by medical engineering workshop. In this respect, the regulatory requirements that approve the tracheostomy table for internal use within Karolinska University Hospital, are studied.

The purpose of this study was to investigate breast cancer patients’ experiences of their illness and of traditional nursing care (TNC) or supportive nursing care (SNC) respectively, as well as nurses' experiences of support and of caring for cancer patients. An intervention including extended co-operation between the surgical ward and primary health care, shorter waiting times, and changed routines concerning the information about the diagnosis, as well as training and systematic clinical supervision for the nurses, was implemented. Newly diagnosed breast cancer patients (n=47) from two county councils in the south-east of Sweden were interviewed (IV, V). Thirty-four of them completed scales about well-being, burnout, hopelessness, anxiety and depression (VII). The women who had TNC reported lack of professional support during the initial phase of the disease and suggested changes in the care similar to those implemented in the SNC. In the SNC group the women expressed feelings of safety and security after the professional support and the organizational changes in the care. There were significantly more single women and women who had had breast conserving surgery in the SNC group than in the TNC (VII). The hopelessness scores in the SNC group were significantly higher than in the TNC group. Thirty-nine district nurses (DNs) were interviewed at baseline (I), and thirty-three of them completed scales about burnout, empathy, and sense of coherence (SOC) before and after systematic clinical supervision (VI). Twenty-three of the 39 DNs, as well as 9 hospital nurses (HNs) who participated in the clinical supervision, were interviewed about their experiences of this intervention (III). Twenty-nine tape-recorded supervision sessions in three groups of DNs (n=23) were analysed (II). Baseline interviews and analyses of the content of the supervisory sessions strongly emphasized that DNs experienced problems in the home care of seriously ill cancer patients. Deep human contacts were a source of both strain and enrichment. The clinical supervision was said to provide relief from undesirable thoughts and feelings, confirmation of themselves both as individuals and in their professional role, a broader and deeper knowledge and increased self-confidence. There were no significant differences in the burnout, empathy, and SOC scores between the supervisory group (n=21) and a comparison group (n=12) at the first and second measures, nor over time within the groups. There were some correlations between these phenomena and the Karolinska scales of personality, as well as cor­relations between burnout, empathy and SOC. The groups of women were not entirely similar as regards demographic and medical characteristics, and the sample size of patients and nurses was small. It is obvious that patients in the TNC missed those factors that were implemented in the SNC, at the same time the latter women expressed hopelessness more often than those who had received TNC. This result may be due to the fact that support from nurses had made the women more prepared to express their feelings, that support had not been provided to an adequate extent or in the right way, or that the applied scales were not appropriate. The finding that the nurses experienced the clinical supervision as very positive but that, despite this, there were no significant differences in attitudes measured by scales within or between the groups, can be interpreted in a similar way. Consequently, further research is needed to judge the effects of intervention. The study has, above all, produced qualitative descriptions of patients' experiences of the nursing care after discharge from hospital, and of DNs’ experiences of the care of cancer patients in their homes, and of systematic clinical supervision. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 7 uppsatser.</p> / digitalisering@umu

The thesis concerns the artworks by Johan Sylvius in the staircase, upper vestibule, upper north guard room and upper gallery of the Drottningholm Palace, as painted performances. They are studied as performative cultural encounters with a historically situated beholder but will also be regarded in relation to their spatial and artistic surrounding. From the theoretical framework of performativity and reception aesthetics, the results indicate that the images have the potential to inscribe the beholder within certain postulates on power relations and politics of identity, through working with splendour, naturalism, narrative and the function of the rooms they are located in. The results further point to the images’ manners of effecting the beholder on several levels through an employed pluralism and lastly, that they both build upon and re-produce the relation between monarch/nobility, where the former is the sole figure who both grants status and can remove it in an instance.

Karolinska University Hospital's problem regarding the CAR-T cells' journey has been impacting thetreatment of patients and therefore a solution was in dire need to be presented. Visual mappingmethods have been used to review and map the journey with the aim of identifying factors that seemto be impacted. Previous research concerns user journey mapping, mapping methods andcollaboration theories. To carry out the mapping of the cells' journey, semi-structured interviews werecarried out with selected experts within the research area. These experts consisted of the unit managerat the apheresis clinic at Karolinska, a medically responsible researcher at the apheresis clinic atKarolinska and a senior patient operation manager at Bristol Myers Squibb. Their expertise andexperiences were the basis for the visual mapping, and this provided deep insights into the researcharea where the problem has been identified. Lastly, the data was mapped to create a visual map oftheir current management approach regarding CAR-T cell therapy where their experiences around theproblems could be identified. As a result, a solution to the identified factors that expose the cells tothe risks is presented with several visual maps and a proposed solution for a redesign withinKarolinska.