Produkt: Läkare eller socialisering av en medicine kandidat

PROBLEM: Läkaryrket är ett komplext yrke där verklighetens obestämbarhet gör att enbart de med stor kunskap, erfarenhet och färdigheter, i förhållande till lekmannen, kan ta kvalificerade beslut. Yrken med denna beskrivning kallas professioner. Skapar professioner en viss sorts människor? Efter avslutade civilingenjörsstudier samt en nästan färdig fil.kand. i företagsekonomi, kände jag under mina läkarstudier att mitt tankesätt påverkades i en helt annan grad än vid de tidigare studierna. Höll jag på att förändras, höll jag på att socialiseras och i så fall till vad? SYFTE: Att belysa och diskutera den speciella insocialiseringen i läkarprofessionen. METOD: Att med hjälp av en fallstudie i form av en deltagande observation samla in data om en läkarstudents vardag på en kirurgklinik. Att via litteraturstudier om socialisering, profession samt socialiseringsstudier om läkarstudenter nå förståelse för dessa. Vidare att utifrån litteraturstudierna skapa en analysmodell för de insamlade data från observationen, för att avgöra om en socialiseringsprocess pågick under fallstudien, samt skapa en analysmodell för socialiseringsstudierna, för att därmed jämföra dessa studier och föreliggande observation. SLUTSATS: Litteraturstudien gav vid hand att värderingar överförs under den professionella socialiseringen av läkarstuderande på ett komplext sätt liknande den socialisering barn utsätts för. Uppsatsförfattaren förändrade själv motvilligt sitt beteende under observationstiden, vilket kan tyda på en värderingsförändring i form av en aktiv identifiering. Vidare såg jag tecken på en interaktionistisk studentkultur och rollspel. Blir läkarstudenten en standardläkare? Funktionalister anser det. Interaktionister och rollspelsanhängare kan inte med sina studier besvara frågan. Företrädare för den affektiva neutraliteten (att objektivifiera patienten, vilket inte är det samma som känslokyla) menar att den affektiva neutraliteten kvarstannar som en del av läkarrollen efter examen. Andra slutligen anser att läkarens mål är att bli specialistläkare och att den tidigare rollen som läkarstudent inte är adekvat för den roll läkaren senare skall spela. Ingen av de refererade socialiseringsstudierna har ett definitivt svar vem läkarstudenten blir efter examen, då ingen av dem studerat de yrkesverksamma läkarna efter sin examen, utan enbart studerat dem som läkarstudenter och jämfört deras värderingar med då yrkesverksamma läkare, där bl a. en generationseffekt mellan läkarstudenter och läkare inte alltid kan uteslutas som orsak till skillnader

Survival of full-thickness retinal xenotransplants without immunosuppression

Background: A study was carried out to explore the survival of xenogeneic full-thickness retinal transplants in the subretinal space of hosts without immunosuppression. Methods: Nine adult rabbits received a complete immature rat neuroretina in the subretinal space. No immunosuppression was given, and the animals were followed up for 15 or 34 days. The eyes were then examined histologically with hematoxylin and eosin staining as well as with antibodies against major histocompatibility complex (MHC) classes I and II, and the retinal pigment antigen RPE-65. Results. Surviving grafts were found in five out of nine eyes. Three grafts displayed the laminated appearance of a normal retina, and two had developed into rosettes. In four of the five specimens with surviving grafts, the host retinal pigment epithelium (RPE) was continuous, and MHC labeling showed no or minimal upregulation. In four specimens, no graft was found. Three of these displayed RPE defects and an increase in MHC class I- and II-labeled cells in the host choroid, subretinal space and host neuroretina. Conclusions: Full-thickness xenogeneic neuroretinal grafts can survive for at least 34 days in an adult host without immunosuppression. Immature grafts can develop the laminated appearance of a normal retina. The integrity of the host RPE seems to correlate with graft survival. We conclude that xenogeneic retinal grafts can survive and develop if the integrity of the donor tissue is intact and if damage to the RPE is minimal

Neuroretinal xenotransplantation to immunocompetent hosts in a discordant species combination.

In spite of its immune privileged state, xenotransplantation within the CNS is associated with rapid graft destruction in immunocompetent hosts. Efforts to enhance graft survival have mostly focused on host immune response, whereas relatively little attention has been paid to donor tissue characteristics. In the present paper, we explore long-term survival of xenogeneic full-thickness neuroretinal transplants in immunocompetent hosts and investigate the significance of tissue integrity in relation to graft survival. Adult rabbits receiving no immunosuppression were used as hosts and fetal Sprague-Dawley rat neuroretina as donors. Using vitreoretinal surgical techniques, rabbits received either a full thickness or a fragmented neuroretinal graft to the subretinal space of one eye. Eyes receiving full-thickness grafts were examined morphologically after 91 days and fragmented grafts after 7-14 days. Surviving full thickness grafts were found in six of eight eyes, four of which displayed the normal laminated appearance. Major histocompatibility complex (MHC) up-regulation in surviving grafts was minimal and they contained a well-organized photoreceptor layer, protein kinase C (PKC) labeled rod bipolar cells, parvalbumin labeled AII amacrine cells and glial fibrillary acidic protein (GFAP) labeled Müller cells. Fragmented grafts (n=6) were all destroyed or showed severe signs of rejection. A mass of inflammatory cells derived from the choroid was evident in these specimens, and no labeling of retina-specific cells was seen. We conclude that full-thickness rat neuroretina can survive for several months after subretinal transplantation to the subretinal space of immunocompetent rabbits, while fragmented counterparts are rapidly rejected. Surviving full-thickness grafts can develop many of the normal retinal morphological characteristics, indicating a thriving relationship between the initially immature donor tissue and its foreign host. Our results strongly indicate that donor tissue integrity is a crucial factor for graft survival in CNS xenotransplantation

Immune privilege of allogeneic neuroretinal transplants in the subconjunctival space.

BACKGROUND: The extent of site and tissue-associated immune privilege is of great interest in transplantation experiments involving the CNS. In the present paper we have explored neuroretinal immune privilege by transplantation to a non-immune privileged site. METHODS: Fetal and adult full-thickness rabbit neuroretinal grafts were placed in the subconjunctival space of immunocompetent rabbit hosts. Morphological examination was performed after 2-31 days (fetal grafts, n = 46), and after 8 days (adult grafts, n = 4). RESULTS: Hematoxylin and eosin-stained sections and immunohistochemistry directed against microtubule-associated protein 2 (MAP2) revealed surviving grafts containing retinal neurons in the majority of eyes with fetal grafts. In all specimens, a mild inflammatory reaction was evident as seen with major histocompatibility complex class II (MHC-II) labeling. Short-term grafts survived well and displayed lamination and rosette formation whereas older grafts appeared more disorganized and were more often rejected. Müller cell fibers labeled with glial fibrillary acidic protein (GFAP) were present in grafts from 15 days and onwards. Adult grafts were destroyed after 8 days. CONCLUSIONS: Allogeneic fetal full-thickness neuroretinal transplants can survive for several weeks in a non-immune privileged environment in which adult grafts are rapidly rejected. Fetal grafts gradually shrink, lose their architecture and go through a glial transformation accompanied by low-grade inflammation. The rabbit neuroretina thus appears to enjoy partial immune privilege, the extent of which depends on the development state of the tissue. The characterization of neuroretinal immune privilege will hopefully influence future clinical trials of retinal transplantation

Uveitis associated with juvenile arthritis : a continued cohort study 40 years after uveitis onset

BACKGROUND: A third follow-up study, mean 40.7 years after uveitis onset, of a cohort originally consisting of 55 Swedish patients with uveitis associated with juvenile arthritis.METHOD: A retrospective study of the patients' ophthalmic medical records. The results were compared to those of the same cohort previously studied at mean 7.2 and 24.0 years after uveitis onset. In the present follow-up study, 30 of the original 55 patients consented to participate. Of these, 26 had ophthalmic medical records that were reviewed.RESULTS: In the 30 participants, active uveitis was seen in 43.4%, cataracts in 66.6% and glaucoma in 40.0%. When comparing data from previous follow-ups of the same cohort, a total of 61.8% were reported to have had cataracts at any of the three follow-ups, 29.0% had glaucoma or ocular hypertension and 12.7% had severe visual impairment in both eyes. At mean 40.7 years after uveitis onset 20% of patients in the original uveitis cohort were deceased. In 4 of the 11 deceased individuals, rheumatic disease was stated as the main cause of death, and in 3 it was considered a contributory factor in the patients deaths.CONCLUSIONS: Uveitis associated with juvenile arthritis can be active into midlife and possibly longer. Ocular complications and visual loss increased up to 40 years after uveitis diagnosis. The mortality rate of this cohort was higher than that of a corresponding Swedish population. Lifelong ophthalmic check-ups are probably necessary for patients diagnosed with this type of uveitis

Current practice in the management of ocular toxoplasmosis

Background Ocular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice. Methods 192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy. Results For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing-usually PCR-in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim-sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim-sulfamethoxazole was prescribed to selected patients by 69.8%. Conclusion Our report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists