Rectal cancer is one of the three most common malignancies in Sweden with an annual incidence of about 2000 cases. Current treatment consists of surgical resection of the rectum including the loco-regional lymph nodes in the mesorectum. In advanced cases, neoadjuvant chemo-radiotherapy (CRT) prior to the operative treatment reduces local recurrences and enables surgery. The neoadjuvant treatment can also eradicate the tumour completely, i.e. complete response. This research project was designed to investigate the effects of preoperative radiotherapy/ CRT and analyze methods to predict response to CRT. Study I investigated the expression of the FXYD-3 protein with immunohistochemistry in rectal cancer, with or without preoperative radiotherapy. The results from the total cohort showed that, strong FXYD-3 expression was correlated to infiltrative tumour growth (p = 0.02). In the radiotherapy group, strong FXYD-3 expression was related to an unfavourable prognosis (p = 0.02). Tumours with strong FXYD-3 expression had less tumour necrosis (p = 0.02) after radiotherapy. FXYD-3 expression in the primary tumour was increased compared to normal mucosa (p=0.008). We concluded that FXYD-3 expression was a prognostic factor in patients receiving preoperative radiotherapy for rectal cancer. Study II investigated FXYD-3 expression in tumours that developed local recurrences following surgery and compared this with expression in tumours that did not develop local recurrences. There was no difference in the expression of FXYD-3 between the group that developed local recurrences and the group that did not develop local recurrences. There was no difference in survival between those with strong or weak FXYD-3 expression. We concluded that this study could not confirm the findings from study 1 i.e. that FXYD-3 expression has prognostic significance in rectal cancer. Study III was a register-based study on the incidence and effects of complete response to neoadjuvant treatment. Eight per cent of the patients with adequate CRT to achieve complete response also had a complete histological response of the luminal tumor in the resected bowel. Sixteen per cent of that group had remaining lymph node metastases in the operative specimen. Chemotherapy together with radiotherapy doubled the chance of complete response in the luminal tumour. Patients with remaining lymph node metastases had a lower survival rate compared to those without. We concluded that residual nodal involvement after neoadjuvant treatment was an important factor for reduced survival after complete response in the luminal tumour. Study IV followed up the results from the previous study by re-evaluating magnetic resonance imaging (MRI)- images in patients with complete tumour response. Two experienced MRI radiologists performed blinded re-staging of post CRT MR- images from patients with complete response in the luminal tumour. One group with lymph node metastases and another one without were studied and the results compared with the pathology reports. The sensitivity, specificity, and positive and negative predicted values for correct staging of positive lymph nodes was 37%, 84%, 70% and 57%. The size of the largest lymph node (4.5 mm, p=0.04) seemed to indicate presence of a tumour positive lymph node. We concluded that MRI couldn’t correctly stage patients for lymph node metastases in patients with complete response to CRT in the luminal tumour.

Kolesterol transporteras i blodet med hjälp av lipoproteinpartiklar. Höga nivåer av low-density lipoprotein (LDL)-kolesterol i blodet är en riskfaktor för kardiovaskulär sjukdom. Koncentrationen av LDL-kolesterol kan beräknas med hjälp av Friedewalds formel men det finns även metoder där LDL-kolesterol kan analyseras direkt. Syftet med arbetet var att verifiera metoden direkt LDL-kolesterol på analysinstrumentet Beckman Coulter AU680. Metodens inomserie- och totalimprecision analyserades. Två korrelationsstudier utfördes mellan direkt LDL-kolesterol och beräknat LDL-kolesterol, en med 43 patientprover med triglycerider < 4,5 mmol/L och en med 11 patientprover med triglycerider > 4,5 mmol/L. Friedewalds formel ska egentligen inte användas vid triglycerider > 4,5 mmol/L, men i detta fall användes formeln ändå för att utvärdera eventuella skillnader mellan metodernas resultat vid höga triglyceridkoncentrationer. Vid analys av metodens inomserieimprecision blev variationskoefficienten (CV) omkring 0,5 % vid analys av både den låga kontrollen (A1) och den höga kontrollen (A2). CV för totalimprecisionen blev 1,21 % vid analys av A1 och 1,11 % vid analys av A2. Korrelationsstudierna visade ett linjärt samband mellan metoderna men den direkta metoden gav något högre resultat vid lägre koncentrationer och något lägre resultat vid högre koncentrationer jämfört med beräknat LDL-kolesterol. Vid triglycerider > 4,5 mmol/L gav den direkta metoden betydligt högre resultat än beräknat LDL-kolesterol. Slutsatsen blev att metoden hade god precision. Överensstämmelsen mellan metodernas resultat var relativt bra för proverna med triglycerider < 4,5 mmol/L. Vid triglycerider > 4,5 mmol/L var differensen mellan metoderna stor, troligtvis på grund av falskt för låga resultat från beräknat LDL-kolesterol. / Cholesterol is transported in the blood by lipoproteins. High levels of low-density lipoprotein (LDL)-cholesterol in the blood is a risk factor for cardiovascular disease. The concentration of LDL-cholesterol can be calculated using the Friedewald formula but there are also methods that measure LDL-cholesterol directly. The aim of this study was to verify the method P-LDL-cholesterol on a Beckman Coulter AU680 analyzer. Within-run imprecision and total imprecision were analyzed. The correlation between direct LDL-cholesterol and calculated LDL-cholesterol was examined using 43 patient samples with triglyceride levels < 4,5 mmol/L and 11 patient samples with triglyceride levels > 4,5 mmol/L. The Friedewald formula is not supposed to be used on triglyceride levels > 4,5 mmol/L, but in this case the formula was used anyway to evaluate differences between the methods at high triglyceride concentrations. The coefficient of variation (CV) for the within-run imprecision was about 0,5 %, both for the low control (A1) and the high control (A2). Total imprecision had a CV of 1,21 % for A1 and 1,11 % for A2. There was a linear relationship between the methods, but the direct method gave slightly higher results at low concentrations and slightly lower results at high concentrations compared to calculated LDL-cholesterol. At triglyceride levels > 4,5 mmol/L the results from the direct method was considerably higher than calculated LDL-cholesterol. The conclusion is that the precision of the method was good. The correlation between the results from direct LDL-cholesterol and calculated LDL-cholesterol was relatively high for samples with triglyceride levels < 4,5 mmol/L. At triglyceride levels > 4,5 mmol/L there was a big difference between the methods, probably because of falsely low results from calculated LDL-cholesterol.

Este trabalho busca responder a pergunta de pesquisa: como ocorre a gestão da inovação em uma empresa de Medicina Diagnóstica? Para isso teve como objetivo aprofundar a compreensão sobre a gestão da inovação nesta empresa, entendendo as etapas do processo de inovação (ideação, conversão e difusão), entendendo como a estratégia da inovação se insere no processo de gestão da inovação, e entendendo como que pessoas e organização se inserem na gestão da inovação. Esta pesquisa fez uso de uma abordagem de natureza teórico-prática de enfoque qualitativo e objetivos de caráter exploratório por meio deum estudo de caso único em um centro de medicina diagnóstica de grande porte, reconhecido por práticas de gestão e inovação. Foram utilizadas as técnicas de entrevistas semiestruturadas, observação direta na empresa, e análise de documentos. Para a etapa de entrevista foi elaborado um protocolo semiestruturado com questões orientadoras conforme pesquisa bibliográfica a respeito de gestão da inovação, o setor de saúde e medicina diagnóstica.Foram entrevistados 12 líderes da empresa envolvidos com a gestão da inovação. Todas as fontes de dados foram analisadas e trianguladas chegando à apresentação e discussão de resultados do caso. Como resultados, a pesquisa evidenciou a importância da inovação em medicina diagnóstica, podendo reduzir custos e aumentar a qualidade, além de gerar valor para o restante da cadeia. A estratégia da inovação é alinhada à estratégia corporativa em diversos elementos e possui um processo de definição de drivers que direcionam a companhia no processo de inovação. O processo de inovação é influenciado por atores encontrados na literatura como órgãos reguladores, médicos, pacientes, fornecedores, universidades e operadoras. Além destes, outros foram citados, como órgãos representativos e o Ministério da Ciência e Tecnologia. Dois processos estruturados de inovação foram evidenciados: de novos produtos e de novos processos. O processo de novos produtos é alinhado ao modelo destagegates, enquanto que o processo de novos processos é mais amplo seguindo o modelo hegemônico. A etapa de ideação ocorre com geração de ideias tanto por fontes internas como externas, sendo as principais fontes os médicos e técnicos assessores, e os colaboradores. Técnicas como brainstorming, observação do comportamento dos clientes, e pesquisas acadêmicas são utilizadas. Na etapa de conversão, a seleção e avaliação é feita de maneira colegiada ou individual, por meio de fóruns presenciais ou virtuais. Os critérios de seleção são o alinhamento estratégico, as análises financeiras, técnicas e comerciais. No desenvolvimento e implantação, destaca-se a aplicação de pilotos e testes antes da efetiva implantação da inovação, treinamentos e acompanhamentos da implantação. Por fim, a etapa de difusão ocorre externamente, por meio da equipe comercial junto às operadoras, e com a equipe de médicos e técnicos assessores, junto aos clientes médicos, além dos canais de divulgação como eventos e congressos. A divulgação com clientes finais se dá por meio dos sites, redes sociais, e revistas. Já internamente, a comunicação ocorre principalmente na forma de murais e portais virtuais de comunicação, na atualização de documentos técnicos, e por meio de eventos internos de divulgação do conhecimento, premiação e reconhecimento. Em pessoas e organização, a pesquisa evidenciou que a cultura influencia o processo de gestão da inovação, sendo formada historicamente sobre os pilares de geração de conhecimento e relacionamento acadêmico nas universidades. Objetiva-se gerenciar os recursos humanos capturando pessoas alinhadas ao valor da inovação desde a fase de contratação, passando por treinamentos, avaliação anual de desempenho, premiação e reconhecimento. Não somente os colaboradores internos recebem incentivos e reconhecimentos, como também há incentivos a fornecedores, médicos e universitários por meio de programas específicos. / This master thesis seeks to answer the research question: how works the management of innovation in a case of Diagnostic Medicine? The purpose of this study was to deepen the understanding of innovation management in a diagnostic medicine company, understanding the stages of the innovation process (ideation, conversion and diffusion), understanding how the innovation strategy is embedded in the process of innovation management, and understanding how people and organizations are involved in managing innovation. This research made use of a theoretical-practical approach of qualitative approach and exploratory objectives through a case study in a large diagnostic medicine center, recognized by management and innovation practices. The techniques of semi-structured interviews, direct observation in the company, and document analysis were used. For the interview stage, a semistructured protocol was developed with orienting questions according to bibliographic research regarding innovation management, the health sector and diagnostic medicine. We interviewed 12 company leaders involved in innovation management. All data sources were analyzed and triangulated, arriving at the presentation and discussion of the results of the case. The research highlighted the importance of innovation in diagnostic medicine, which can reduce costs and increase quality, and generate value for the rest of the chain. The innovation strategy is aligned with the corporate strategy in several elements and has a process of definition of drivers that guide the company in the process of innovation. The innovation process is influenced by several stakeholders found in the literature. Besides these others were cited as representative bodies, and the ministry of science and technology. Two structured innovation processes were evidenced: process of new products and new processes. The process of new products is aligned with the stage gates model, while the process of new processes is broader following the hegemonic model. The stage of ideation occurs with the generation of ideas by both internal and external sources, the main sources being the doctors and technical advisors, and collaborators. Techniques such as brainstorming, customer behavior observation, and academic research are used. In the conversion stage, the selection and evaluation can be done collegially or individually, through forums that can be even virtual. The selection criteria are strategic alignment, financial, technical and commercial analysis. In the development and implementation, we highlight the application of pilots and tests before the effective implementation of the innovation, the training and follow-up of the implementation. Finally, the diffusion stage occurs externally, through the commercial team with the operators, and with the team of medical and technical advisors, with the medical clients, in addition to the channels of dissemination such as events, congresses. Publicity with end customers is through websites, social networks, and magazines. Already internally the communication occurs mainly in the form of virtual murals and portals of communication, in the updating of technical documents, and through internal events of dissemination of knowledge, awards and recognition. In people and organization, the research evidenced that culture influences the process of innovation management, being historically formed on the pillars of knowledge generation and academic relationship in universities. It aims to manage human resources by capturing people aligned with the value of innovation from the hiring stage, through training, annual performance evaluation, awards and recognition. Not only do internal collaborators receive incentives and recognition, but there are also incentives to suppliers, doctors and university students through specific programs.

Snabb och korrekt artidentifiering är avgörande för effektiv behandling av svampinfektioner, särskilt bland immunsupprimerade patienter. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) används rutinmässigt på kliniska laboratorier för identifiering av karaktäristiska proteinmönster hos bakterier och jästsvampar genom tolkning av proteinspektra i en masspektradatabas för korrekt artidentifiering. Mögelsvamparnas hårda cellvägg och heterogena växtsätt med varierande proteinuttryck beroende på mognadsstadie, försvårar identifiering med MALDI-TOF MS. Metodens tänkbara fördelar mot traditionella metoden mikroskopering är förkortade svarstider, säkrare artidentifiering av fler arter och mindre beroende av subjektiv morfologisk bedömning. Studiens syfte var att undersöka om MALDI-TOF MS kunde anpassas och användas för identifieringen av mögelsvamp i klinisk rutindiagnostik. Fyra referensstammar (Aspergillus niger, A. fumigatus, A.terreus, A.flavus) och ett kliniskt isolat (A.terreus) undersöktes. Preparationsmetoderna (I) fullständig myrsyraextraktion, (II) direktapplicering och (III) suspension i destillerat vatten användes för analys av sporer och frontmycel hos yngre och äldre mögelkulturer. Två olika masspektradatabaser för artidentifiering jämfördes; rutindatabasen BDAL och den specialiserade mögeldatabasen Filamentous Fungi Library. Även plocktekniken av mögelmaterial inför analys med MALDI-TOF MS utvärderades. Vid vissa tillfällen förbättrades artidentifieringen efter extraktion av mögelkulturerna, medan i andra fall var direktapplicering fullt tillräcklig. Mögelmaterial med mycket sporer tenderade ge något fler artidentifieringar i BDAL oavsett kulturernas ålder.  Filamentous Fungi Library tenderade i vissa fall ge bättre resultat jämfört med BDAL för yngre kulturer. Fler studier krävs för att utvärdera och optimera MALDI-TOF MS som metod för artidentifiering av mögelsvamp. / Rapid and accurate species identification is crucial for successful treatment of fungal infections, especially among immunosuppressed patients. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is used routinely at clinical laboratories to identify characteristic protein patterns of bacteria and yeast by the interpretation of protein spectra in a database for accurate species identification. The hard cell wall of the mold and the heterogeneous growth with varying protein expression due to maturation, complicates identification with MALDI-TOF MS. The potential benefits of this method compared to microscopy as traditional method are shortened turn-around times, safer species identification of more species that is independent on subjective morphological assessment. The purpose of the study was to investigate whether MALDI-TOF MS could be adapted and used for the identification of molds in clinical routine diagnostics. Four reference strains (Aspergillus niger, A.fumigatus, A.terreus, A.flavus) and a clinical isolate (A.terreus) were examined. The preparation methods (I) complete formic acid extraction, (II) direct application and (III) suspension in distilled water were used for analysis of spores and frontmycelium from younger and older mold cultures. Two different masspektradatabases for species identification were compared; routine database BDAL and the specialized mold database, Filamentous Fungi Library. Also the collecting technique of mold prior to analysis with MALDI-TOF MS was evaluated. Sometimes, the species identification improved after extraction of mold cultures, while in other cases direct application was sufficient. Cultures with a lot of spores tended to give slightly more species identifications in BDAL regardless of the age of cultures. Filamentous Fungi Library, in some cases, tended to improve the performance compared to BDAL for younger cultures. More studies are required to evaluate and optimize MALDI-TOF MS as a method of mold identification.

Trigger finger is one of the most common hand conditions, with a prevalence of almost 3%. The aetiology remains unclear even though many causes have been suggested. The prevailing paradigm is that the pathogenesis of trigger finger is ascribed to primary changes in the first fibrous condensation of the tendon sheath (A1-pulley). Several studies have investigated pathology in the pulley, but few have investigated the tendon. The general aim of this thesis was to find out if there is pathology in the trigger finger tendon and to define it. We first looked at trigger finger tendon biopsies in a light microscope, and found that they were histologically different from healthy tendons. They showed signs of micro-ruptures, collagen degradation, increased amounts of ground substance, both hyper- and hypo-cellular areas, round active cell nuclei and absence of inflammatory cells, all similar to tendinosis. The histological picture was further assessed by using a scoring system for Achilles tendinosis. The trigger finger tendons scored high, suggesting a similar histopathology. Next, we performed a quantitative real-time polymerase chain reaction (qPCR) on trigger finger tendons. We assessed the mRNA expression of 10 genes, which have been described to be differently expressed in Achilles tendinosis (collagen 1 and 3, versican, decorin, biglycan, aggrecan, MMP-2, MMP-3, ADAMTS-5, and TIMP-3). The overall expression pattern agreed with previous studies on Achilles tendinosis, suggesting that the cellular function in trigger finger tendons is disturbed in a similar way as in Achilles tendinosis. Recent experimental and observational research has suggested potential side effects of statin treatment on tendons, but firm evidence was lacking. We performed an epidemiological study on two large population-based cohorts. Statin use was found to increase the risk of both trigger finger and tendinosis in the shoulder and Achilles tendons, especially among men. This suggests a similar pathology in trigger finger and tendinosis. We have also studied the time to treatment effect after a single injection of glucocorticoid in trigger finger. Our results suggest that 60-80% of patients can expect resolution of the triggering within 14 days, and half of them within seven days. This result allows correct information to be given to the patient and proper planning of follow-ups. In conclusion, the pathology in trigger finger tendons is similar to tendinosis in other tendons.

Warfarin är ett läkemedel som används för att förhindra att högriskpatienter såsom de med förmaksflimmer får tromboembolism. Denna verkan uppnås genom att hämma de K-vitaminberoende faktorerna VII, X och protrombin och på så sätt minska blodets förmåga att koagulera. Att hitta rätt dosering av läkemedlet för warfarinbehandlade patienter har visat sig vara svårt eftersom det kräver regelbunden provtagning och påverkas av mat- och levnadsvanor. Det vanligaste sättet att mäta protrombinkomplexhalten är med venös plasma men det är även möjligt att använda sig av kapillär plasma. Helblod kan användas för mekaniska metoder som inte använder sig av optisk detektion. Fördelen är att helblod inte kräver centrifugering. Studiens syfte var att undersöka om det fanns en signifikant skillnad (p≤0,05) mellan helblod och plasma som används i den nuvarande metoden för kapillära prover och om det finns en skillnad i stabiliteten av dessa prov. Dubbla prover togs från 30 warfarinbehandlade patienter och 5 icke warfarinbehandlade individer. Ett av proven centrifugerades och analyserades på plasma, det andra analyserades på helblod. Resultaten visade att det fanns en signifikant skillnad (p≤0,05) mellan metoderna. Bland-Altman diagrammet visade att 95 % av helblodsproverna inte var högre än 0,25 INR och lägre än 0,14 INR. Detta har en låg klinisk inverkan. 4 Proverna förvarades i rumstemperatur i upp till 24 timmar och analyserades sedan om. Ingen förändring över 10 % kunde observeras i hållbarheten. Studien visade att trots att det finns en signifikant skillnad är det möjligt att ersätta den nuvarande metoden med plasma och använda helblod istället. / Warfarin is a drug used to prevent high-risk patients such as those with atrial fibrillation from thromboembolisms. This effect is achieved by suppressing vitamin-K dependent factors VII, X and prothrombin and therefore decreasing the bloods ability to clot. Finding the right dosage of the drug for warfarin treated patients has proven difficult, as it demands regular blood draws to monitor their prothrombin complex level, which is affected by dietary and living habits. The most common way to measure prothrombin complex levels is by using venous plasma but it is also possible to use capillary plasma. Whole blood can be used for mechanical methods, which don’t use optical detection. The benefit is that whole blood doesn’t require centrifugation. The aim of this study was to investigate if there was a significant difference (p≤0,05) between using whole blood and plasma which is the existing method for capillary sample and also if there is any differences between the stability of these samples. Double samples from 30 warfarin treated patients and 5 non-treated persons were taken. One of the samples were centrifuged and analyzed on plasma and the other analyzed on whole blood. The results showed that there was a significant difference (p≤0,05) between the methods. Bland-Altman plot comparison showed that 95 % of the whole blood samples would not be higher than 0,25 INR and lower than 0,14 INR. This has low clinical impact. The samples were stored at room temperature for up to 24 hours and reanalyzed. No changes over 10 % in INR values were observed. This study showed that even though there is a significant difference, it is possible to replace the existing method which using plasma with the whole blood instead.

Este trabalho busca responder a pergunta de pesquisa: como ocorre a gestão da inovação em uma empresa de Medicina Diagnóstica? Para isso teve como objetivo aprofundar a compreensão sobre a gestão da inovação nesta empresa, entendendo as etapas do processo de inovação (ideação, conversão e difusão), entendendo como a estratégia da inovação se insere no processo de gestão da inovação, e entendendo como que pessoas e organização se inserem na gestão da inovação. Esta pesquisa fez uso de uma abordagem de natureza teórico-prática de enfoque qualitativo e objetivos de caráter exploratório por meio deum estudo de caso único em um centro de medicina diagnóstica de grande porte, reconhecido por práticas de gestão e inovação. Foram utilizadas as técnicas de entrevistas semiestruturadas, observação direta na empresa, e análise de documentos. Para a etapa de entrevista foi elaborado um protocolo semiestruturado com questões orientadoras conforme pesquisa bibliográfica a respeito de gestão da inovação, o setor de saúde e medicina diagnóstica.Foram entrevistados 12 líderes da empresa envolvidos com a gestão da inovação. Todas as fontes de dados foram analisadas e trianguladas chegando à apresentação e discussão de resultados do caso. Como resultados, a pesquisa evidenciou a importância da inovação em medicina diagnóstica, podendo reduzir custos e aumentar a qualidade, além de gerar valor para o restante da cadeia. A estratégia da inovação é alinhada à estratégia corporativa em diversos elementos e possui um processo de definição de drivers que direcionam a companhia no processo de inovação. O processo de inovação é influenciado por atores encontrados na literatura como órgãos reguladores, médicos, pacientes, fornecedores, universidades e operadoras. Além destes, outros foram citados, como órgãos representativos e o Ministério da Ciência e Tecnologia. Dois processos estruturados de inovação foram evidenciados: de novos produtos e de novos processos. O processo de novos produtos é alinhado ao modelo destagegates, enquanto que o processo de novos processos é mais amplo seguindo o modelo hegemônico. A etapa de ideação ocorre com geração de ideias tanto por fontes internas como externas, sendo as principais fontes os médicos e técnicos assessores, e os colaboradores. Técnicas como brainstorming, observação do comportamento dos clientes, e pesquisas acadêmicas são utilizadas. Na etapa de conversão, a seleção e avaliação é feita de maneira colegiada ou individual, por meio de fóruns presenciais ou virtuais. Os critérios de seleção são o alinhamento estratégico, as análises financeiras, técnicas e comerciais. No desenvolvimento e implantação, destaca-se a aplicação de pilotos e testes antes da efetiva implantação da inovação, treinamentos e acompanhamentos da implantação. Por fim, a etapa de difusão ocorre externamente, por meio da equipe comercial junto às operadoras, e com a equipe de médicos e técnicos assessores, junto aos clientes médicos, além dos canais de divulgação como eventos e congressos. A divulgação com clientes finais se dá por meio dos sites, redes sociais, e revistas. Já internamente, a comunicação ocorre principalmente na forma de murais e portais virtuais de comunicação, na atualização de documentos técnicos, e por meio de eventos internos de divulgação do conhecimento, premiação e reconhecimento. Em pessoas e organização, a pesquisa evidenciou que a cultura influencia o processo de gestão da inovação, sendo formada historicamente sobre os pilares de geração de conhecimento e relacionamento acadêmico nas universidades. Objetiva-se gerenciar os recursos humanos capturando pessoas alinhadas ao valor da inovação desde a fase de contratação, passando por treinamentos, avaliação anual de desempenho, premiação e reconhecimento. Não somente os colaboradores internos recebem incentivos e reconhecimentos, como também há incentivos a fornecedores, médicos e universitários por meio de programas específicos. / This master thesis seeks to answer the research question: how works the management of innovation in a case of Diagnostic Medicine? The purpose of this study was to deepen the understanding of innovation management in a diagnostic medicine company, understanding the stages of the innovation process (ideation, conversion and diffusion), understanding how the innovation strategy is embedded in the process of innovation management, and understanding how people and organizations are involved in managing innovation. This research made use of a theoretical-practical approach of qualitative approach and exploratory objectives through a case study in a large diagnostic medicine center, recognized by management and innovation practices. The techniques of semi-structured interviews, direct observation in the company, and document analysis were used. For the interview stage, a semistructured protocol was developed with orienting questions according to bibliographic research regarding innovation management, the health sector and diagnostic medicine. We interviewed 12 company leaders involved in innovation management. All data sources were analyzed and triangulated, arriving at the presentation and discussion of the results of the case. The research highlighted the importance of innovation in diagnostic medicine, which can reduce costs and increase quality, and generate value for the rest of the chain. The innovation strategy is aligned with the corporate strategy in several elements and has a process of definition of drivers that guide the company in the process of innovation. The innovation process is influenced by several stakeholders found in the literature. Besides these others were cited as representative bodies, and the ministry of science and technology. Two structured innovation processes were evidenced: process of new products and new processes. The process of new products is aligned with the stage gates model, while the process of new processes is broader following the hegemonic model. The stage of ideation occurs with the generation of ideas by both internal and external sources, the main sources being the doctors and technical advisors, and collaborators. Techniques such as brainstorming, customer behavior observation, and academic research are used. In the conversion stage, the selection and evaluation can be done collegially or individually, through forums that can be even virtual. The selection criteria are strategic alignment, financial, technical and commercial analysis. In the development and implementation, we highlight the application of pilots and tests before the effective implementation of the innovation, the training and follow-up of the implementation. Finally, the diffusion stage occurs externally, through the commercial team with the operators, and with the team of medical and technical advisors, with the medical clients, in addition to the channels of dissemination such as events, congresses. Publicity with end customers is through websites, social networks, and magazines. Already internally the communication occurs mainly in the form of virtual murals and portals of communication, in the updating of technical documents, and through internal events of dissemination of knowledge, awards and recognition. In people and organization, the research evidenced that culture influences the process of innovation management, being historically formed on the pillars of knowledge generation and academic relationship in universities. It aims to manage human resources by capturing people aligned with the value of innovation from the hiring stage, through training, annual performance evaluation, awards and recognition. Not only do internal collaborators receive incentives and recognition, but there are also incentives to suppliers, doctors and university students through specific programs.

The pre-analytical phase is known for being the most important step in the laboratory process to reach reliable test results. If handling, transport or preparation of the sample is performed incorrectly the results can deviate from the true value. Today, sampling tubes contains various additives to stabilize concentration levels. The aim of this study was to test a new sampling tube containing fluoride/citrate for glucose, lactate and homocysteine. It was also of interest to evaluate the stability of those three analytes in lithium-heparin, sodium-fluoride/potassium oxalate and fluoride/citrate tubes. To perform the sustainability study, a method verification was done for homocysteine in plasma. The study was performed in a hospital laboratory on the routine instrument Roche Cobas 6000 analyzer. Blood was drawn from 20 patients and was analyzed at the hospital laboratory in Gävle. The blood samples were transported frozen to the laboratory in Hudiksvall and were used in the method verification. For the sustainability study, blood was drawn from 10 healthy volunteers in lithium-heparin, sodium-fluoride/potassium oxalate and fluoride/citrate tubes. The method verification was approved. The results showed that glucose was stable for up to 72 hours in Vacuette Glycaemia tube with fluoride/citrate and this tube also gave more accurate results. Lactate and homocysteine were also stable in fluoride/citrate, but needs further studies. All three analytes were more stable if the sample tubes were centrifuged as soon as possible after blood collection. Fluoride/citrate tubes were stable without centrifugation directly.

Neisseria gonorrhoeae (NG) har successivt utvecklat resistens mot många antimikrobiella medel och betraktas som ett av de tre reella hoten bland antibiotikaresistenta bakterier. Ciprofloxacin är ett bredspektrum-antibiotikum tillhörande gruppen kinoloner som, förutom att behandla urinvägsinfektioner, används mot NG och infektioner i mage och tarm. Dock har det rapporterats att ca 30 % av NG-isolat som samlats in genom gonokock-isolatövervakningsprojekt (GISP) under 2017 var resistenta mot ciprofloxacin. På molekylnivå är resistens mot ciprofloxacin starkt associerad med en enda mutation i kodon 91 i gyras-genen (gyrA). Detta projekt har undersökt om det går att använda molekylärbiologiska metoder för att detektera NG-isolat med gyrA mutationen. Analysen gjordes med två olika PCR-system, ”7500 Fast Real-Time PCR System” från Applied Biosystems (ABI) och Panther Fusion från Hologic. Proberna som användes designades för påvisning av vildtyp gyrA (ciprofloxacin-känslig) och mutant gyrA (ciprofloxacin-resistent) hos NG. I projektet analyserades 50 NG-positiva prov (analyserade med screeningtest APTIMA COMBO2 från Hologic), från 43 patienter som provtagits under januari-februari 2020 i Region Skåne. Några patienter testades flera gånger vid olika tillfällen. NG-odling hade utförts parallellt från motsvarande tagna prov från patienterna. ABI-metoden påvisade genen hos 90 % (45/50) av NG-positiva prover (APTIMA COMBO2) medan endast 24 av de 49 proven (49 %) kunde odlas med traditionell metodik för att därefter resistensbestämmas. Av de 45 prov där gyras-genen kunde detekteras med ABI-metoden, uppvisade 28 (62 %) av proven en muterad gen och därmed en potentiell resistens för ciprofloxacin. Panther Fusion-metoden påvisade genen hos 80 % (40/50) av NG-positiva prover (APTIMA COMBO2), och såsom tidigare nämnts, kunde endast 24 av de 49 proven (49 %) odlas med traditionell metodik för att därefter resistensbestämmas. Av de 40 prov där gyras-genen kunde detekteras med Panther Fusion-metoden, uppvisade 26 av proven (65 %) en muterad gen och därmed en potentiell resistens för ciprofloxacin. En jämförelse mellan resultaten från PCR-metoderna och odlingarna visar att av de 24 odlingarna som kunde resistensbestämmas fick ABI-metoden resultat för 23 och Panther Fusion för 22. PCR-metodernas resultat överensstämde perfekt med resultaten från odling med samma 8 känsliga och 15 respektive 14 resistenta NG-isolat som odling. De båda PCR-metoderna och traditionell odling uppvisade jämförbara resultat. Av de 24 prov som kunde odlas och därmed resistensbestämmas, detekterades med ABI-metoden gyras-genen i 23 av dessa prov och i 22 av proven med Panther Fusion-metoden. Resistens mot ciprofloxacin uppvisades genom odling i 16 av de 24 odlingsbara prov, och av dessa 24 odlingsbara prov uppvisade ABI-metoden en muterad gen i 15 av proven och Panther Fusion-metoden en muterad gen i 14 av proven. Traditionell odling kunde bara genomföras på 24 av proven och PCR-metoderna identifierade signifikant fler prov innehållande vildtyp eller muterad gyras-gen, 45 respektive 40 prov. Projektet visade tydligt att PCR-metoderna kan identifiera fler prov än genom traditionell odling och kan därmed upptäcka fler prov med förväntad ciprofloxacin-resistens än vad som kan bestämmas genom traditionell odling. / Neisseria gonorrhoeae (NG) has been developing a resistance towards several different antibiotics and is viewed as one of the three real threats among resistant bacteria. Ciprofloxacin is a broad-spectrum-antibiotic belonging to the group quinolone antibiotics which, in addition to being used to treat urinal infections, is used to treat NG and infections in the stomach and intestines. However, it has been reported that 30 % of NG-isolates that have been gathered through the Gonococcal Isolate Surveillance Project (GISP) throughout 2017 were resistant to ciprofloxacin. On a molecular level, resistance to ciprofloxacin is strongly associated with a single mutation in kodon 91 in the gyras-gene (gyrA). This project sought to examine if it is possible to use methods from molecular biology to detect which NG that have the gyrA-mutation. The test was done using two different PCR-systems, ”7500 Fast Real-Time PCR System” from Applied Biosystems (ABI) and Panther Fusion from Hologic. The probes used were designed to show wild type gyrA (ciprofloxacin sensitive), and mutated gyrA (ciprofloxacin resistant) in NG. In this project 50 NG-positive samples (analysed with screentest APTIMA COMBO2 from Hologic), from 43 patients that had been tested during January-February 2020 in Region Skåne, were analysed. Some patients were tested several times, within the time period. NG-cultivation had been done in parallel from corresponding samples taken from the patients. The ABI-method showed the gene in 90 % (45/50) of NG-positive samples (APTIMA COMBO2) while only 24 of the 49 samples (49 %) could be cultivated by traditional methodology, and then tested for resistance. Of the 45 samples where the gyras-gene could be detected with the ABI-method, 28 samples (62 %) exhibited a mutated gene and thus a potential resistance to ciprofloxacin. The Panther fusion-method showed the gene in 80 % (40/50) of NG-positive samples (APTIMA COMBO2), and as mentioned earlier, only 24 of the 49 samples (49 %) could be cultivated by traditional methodology to then be tested for resistance. Of the 40 samples where the gyras-gene could be detected with the Panther Fusion-method, 26 samples (65 %) exhibited a mutated gene and thus a potential resistance to ciprofloxacin. The two PCR-methods and traditional cultivation exhibited comparable results. Of the 24 samples that could be cultivated and thus tested for resistance, the ABI-method detected the gyras-gene in 23 of these samples and the Panther Fusion-method detected the gene in 22 of the samples. Cultivation exhibited resistance to ciprofloxacin in 16 of the 24 samples that could be cultivated, and of these 24 cultivatable samples the ABI method exhibited a mutated gene in 15 of the samples and the Panther Fusion-method exhibited a mutated gene in 14 of the samples. Traditional cultivation could only be done on 24 of the samples and the PCR-methods could identify significantly more samples containing either wild type or mutated gyras-gene, 45 and 40 samples, respectively. The project clearly showed that more samples can be identified with the PCR-methods than through traditional cultivation, and thereby discover more samples with expected ciprofloxacin-resistance, than can be determined through traditional cultivation.

Högerkammare (RV) har en komplex anatomi, spelar en viktig roll för blodsyresättning och kan påverkas av fler patofysiologiska tillstånd. Utvärdering av RV:s funktion är viktig för överlevnad och har prognostiskt värde vid hjärt-och lungsjukdomar. Transthorakal ekokardiografi (TTE) används för RV:s storlek- och funktionsbedömning. Tricuspid annular plane systolic excursion (TAPSE) och annulus tricuspid peak systolic velocity (RVs´) är två vanliga metoder för bedömning av RV:s funktion. Båda metoderna har bra reproducerbarhet och är enkla att utföra.  Syftet med detta arbete är att utreda interobservatörvariation, sambandet och överensstämmelse mellan TAPSE och RVs´. Studien är en tvärsnittsstudie av 53 friska testpersoner 18-60 åringar. Mätningen baserades på en blind dubbelbestämning av två biomedicinska analytiker studenter. Analysen genomfördes med programmet IBM SPSS Statistics.  Interobservatörvariationsanalys visade ingen signifikant skillnad i mätosäkerheten mellan studenterna, (PTAPSE=0,568 och PRVs´=0,548). Enligt regressionsanalysen hade RVs´ något mindre mätosäkerhet än TAPSE. Ett svagt positivt samband hittades mellan RVs´ och TAPSE och 100% överenstämmelse avseende utfall påvisades, Kappavärdet blev 1. Båda metoderna har bra interobservatörvariation hos oerfarna undersökare. Hos hjärt- och lungfriska ser sambandet svagt positivt ut mellan TAPSE och RVs´. Dock kunde tidigare studier identifiera starkare positivt samband. Skillnaden i resultatet kan bero på erfarenhetsbrist hos studenterna och lågt antal deltagare. / The Right ventricle (RV) has a complex anatomy, plays an important role in blood oxygenation and can be affected by several pathophysiological conditions. Evaluation of RV function has prognostic value in heart and lung diseases. Tricuspid annular plane systolic excursion (TAPSE) and annulus tricuspid peak systolic velocity (RVs´) are two common methods for assessing RV function in Transthoracic echocardiography.  The study aimed to investigate interobserver variation, the correlation and agreement between TAPSE and RVs´. The study is a cross-sectional study of 53 healthy participants aged 18-60. The measurement was based on a blind double determination by two biomedical analyst students. The analysis was implemented with the program IBM SPSS Statistics. Interobserver variation analysis showed no significant difference between the two students, (PTAPSE =0,568 and PRVs´=0,548). Regression analysis showed RVs´ had slightly less measurement uncertainty than TAPSE. A weak positive correlation was found between RVs´ and TAPSE and 100% agreement regarding outcome was demonstrated, Kappa value was 1. Both methods have good interobserver variation in inexperienced examiners. In people with healthy heart and lungs, the relationship between TAPSE and RVs looks weakly positive. Previous studies identified stronger positive association. Differences in the results may be due to a lack of experience on the part of the students and a low number of participants.