Hans Rystedt | University of Gothenburg (original) (raw)
Papers by Hans Rystedt
Clinical Simulation in Nursing
ABSTRACT Background An important condition for serving the educational objectives of simulation i... more ABSTRACT Background An important condition for serving the educational objectives of simulation in nursing education is that the facilitator’s instructions during the briefing bridge the gap between the simulation and the real situation it simulates. This study aims to explicate instructional problems in the briefing, focusing both on how students understand that tasks should be performed in resuscitation teams and how these tasks should be adapted to the specific conditions of the simulation.
Simulation in healthcare: journal of the Society for Simulation in Healthcare
Introduction: Simulation-based education is a learner-active method that may enhance teamwork ski... more Introduction: Simulation-based education is a learner-active method that may enhance teamwork skills such as leadership and communication. The importance of postsimulation debriefing to promote reflection is well accepted, but many questions concerning whether and how faculty promote reflection remain largely unanswered in the research literature. The aim of this study was therefore to explore the depth of reflection expressed in questions by facilitators and responses from nursing students during postsimulation debriefings. Methods: Eighty-one nursing students and 4 facilitators participated. The data were collected in February and March 2008, the analysis being conducted on 24 videorecorded debriefings from simulated resuscitation teamwork involving nursing students only. Using Gibbs' reflective cycle, we graded the facilitators' questions and nursing students' responses into stages of reflection and then correlated these. Results: Facilitators asked most evaluative and fewest emotional questions, whereas nursing students answered most evaluative and analytic responses and fewest emotional responses. The greatest difference between facilitators and nursing students was in the analytic stage. Only 23 (20%) of 117 questions asked by the facilitators were analytic, whereas 45 (35%) of 130 students' responses were rated as analytic. Nevertheless, the facilitators' descriptive questions also elicited student responses in other stages such as evaluative and analytic responses. Conclusion: We found that postsimulation debriefings provide students with the opportunity to reflect on their simulation experience. Still, if the debriefing is going to pave the way for student reflection, it is necessary to work further on structuring the debriefing to facilitate deeper reflection. Furthermore, it is important that facilitators consider what kind of questions they ask to promote reflection. We think future research on debriefing should focus on developing an analytical framework for grading reflective questions. Such research will inform and support facilitators in devising strategies for the promotion of learning through reflection in postsimulation debriefings. (Sim Healthcare 8:135Y142, 2013)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2012
Background: Although nurses must be able to respond quickly and effectively to cardiac arrest, nu... more Background: Although nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR) in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance. Methods: We studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14) performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14) performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance. Results: Overall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio. We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables. Conclusion: We found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team-training of nursing students.
Journal of Advanced Nursing, 2011
Aim. The overarching aim was to explore and describe the communicative modes students employ to c... more Aim. The overarching aim was to explore and describe the communicative modes students employ to coordinate the team in a simulation-based environment designed for resuscitation team training. Background. Verbal communication is often considered essential for effective coordination in resuscitation teams and enhancing patient safety. Although simulation is a promising method for improving coordination skills, previous studies have overlooked the necessity of addressing the multifaceted interplay between verbal and non-verbal forms of communication.
Journal of Radiological Protection, 2013
Optimisation of radiological protection for operators working with fluoroscopically guided proced... more Optimisation of radiological protection for operators working with fluoroscopically guided procedures has to be performed during the procedure, under varying and difficult conditions. The aim of the present study was to evaluate the impact of a system for real-time visualisation of radiation dose rate on optimisation of occupational radiological protection in fluoroscopically guided procedures. Individual radiation dose measurements, using a system for real-time visualisation, were performed in a cardiology laboratory for three cardiologists and ten assisting nurses. Radiation doses collected when the radiation dose rates were not displayed to the staff were compared to radiation doses collected when the radiation dose rates were displayed. When the radiation dose rates were displayed to the staff, one cardiologist and the assisting nurses (as a group) significantly reduced their personal radiation doses. The median radiation dose (H p (10)) per procedure decreased from 68 to 28 µSv (p = 0.003) for this cardiologist and from 4.3 to 2.5 µSv (p = 0.001) for the assisting nurses. The results of the present study indicate that a system for real-time visualisation of radiation dose rate may have a positive impact on optimisation of occupational radiological protection. In particular, this may affect the behaviour of staff members practising inadequate personal radiological protection.
Medical Imaging 2011: Image Perception, Observer Performance, and Technology Assessment, 2011
abstract In chest tomosynthesis, low-dose projections collected over a limited angular range are ... more abstract In chest tomosynthesis, low-dose projections collected over a limited angular range are used for reconstruction of section images of the chest, resulting in a reduction of disturbing anatomy at a moderate increase in radiation dose compared to chest radiography. In a previous study, we investigated the effects of learning with feedback on the detection of pulmonary nodules in chest tomosynthesis. Six observers with varying degrees of experience of chest tomosynthesis analyzed tomosynthesis cases for presence of ...
Medical Imaging 2013: Image Perception, Observer Performance, and Technology Assessment, 2013
ABSTRACT In the monitoring of progression of lung disease in patients with cystic fibrosis (CF), ... more ABSTRACT In the monitoring of progression of lung disease in patients with cystic fibrosis (CF), recurrent computed tomography (CT) examinations are often used. The relatively new imaging technique chest tomosynthesis (CTS) may be an interesting alternative in the follow-up of these patients due to its visualization of the chest in slices at radiation doses and costs significantly lower than is the case with CT. A first step towards introducing CTS imaging in the diagnostics of CF patients is to establish a scoring system appropriate for evaluating the severity of CF pulmonary disease based on findings in CTS images. Previously, several such CF scoring systems based on CT imaging have been published. The purpose of the present study was to develop a CF scoring system for CTS, by starting from an existing scoring system dedicated for CT images and making modifications regarded necessary to make it appropriate for use with CTS images. In order to determine any necessary changes, three thoracic radiologists independently used a scoring system dedicated for CT on both CT and CTS images from CF patients. The results of the scoring were jointly evaluated by all the observers, which lead to suggestions for changes to the scoring system. Suggested modifications include excluding the scoring of air trapping and doing the scoring of the findings in quadrants of the image instead of in each lung lobe.
In chest tomosynthesis, low-dose projections collected over a limited angular range are used for ... more In chest tomosynthesis, low-dose projections collected over a limited angular range are used for reconstruction of section images of the chest, resulting in a reduction of disturbing anatomy at a moderate increase in radiation dose compared to chest radiography. In a previous study, we investigated the effects of learning with feedback on the detection of pulmonary nodules in chest tomosynthesis. Six observers with varying degrees of experience of chest tomosynthesis analyzed tomosynthesis cases for presence of pulmonary nodules. The cases were analyzed before and after learning with feedback. Multidetector computed tomography (MDCT) was used as reference. The differences in performance between the two readings were calculated using the jackknife alternative free-response receiver operating characteristics (JAFROC-2) as primary measure of detectability. Significant differences between the readings were found only for observers inexperienced in chest tomosynthesis. The purpose of the present study was to extend the statistical analysis of the results of the previous study, including JAFROC-1 analysis and FROC curves in the analysis. The results are consistent with the results of the previous study and, furthermore, JAFROC-1 gave lower p-values than JAFROC-2 for the observers who improved their performance after learning with feedback.
Discourse Studies, 2014
The present study examines the work of a group of medical scientists as they identify interpretat... more The present study examines the work of a group of medical scientists as they identify interpretative ‘pitfalls’ – recurrent sources of error – in the use of a new radiographic technique, formulate suggestions on how these pitfalls can be avoided and communicate their findings in the form of a scientific publication. The analysis focuses on a session in which previously diagnosed cases are discussed, and demonstrates the ways in which a certain source of diagnostic error gradually emerges as a taken-for-granted in the interaction. An increased sense of recognition, recurrence and typicality is discernible in the treatment of the cases. Talk characterized by expansions and elaborations, displays of understanding in the form of reformulations, understanding checks, and so on, leave room for brief typifications and reifications of interpretative difficulties in characteristics of the imaging technique. Topical treatment of perception and interpretation, as well as embodied engagement, become decreasingly salient. It is argued that the abstracted formulations in the published text rely on the case-by-case working up of generality from particularity; from individualized accounts of why ‘I’ interpreted the image in a certain way to proffered generalizations achieved through articulated perceptions of a generalized ‘one’. If these proffers are ratified, a potential ground is established for the consensual formulation of a pitfall. The formulation of novel instructions is consequently made relevant, projecting a re-instructed diagnostic practice.
Symposia paper presented at the EARLI SIG 14 meeting on Diversity in vocational and professional education and training, München, Germany., 2010
The current study draws on data from a radiology department working to improve diagnostic accurac... more The current study draws on data from a radiology department working to improve diagnostic accuracy with the use of a newly introduced technologytomosynthesis. In contrast to traditional chest radiography, tomosynthesis visualizes the anatomy of the lungs through a set of ...
Social Studies of Science, Oct 10, 2011
This study contributes to social studies of imaging and visualization practices within scientific... more This study contributes to social studies of imaging and visualization practices within scientific and medical settings. The focus is on practices in radiology, which are bound up with visual records known as radiographs. The study addresses work following the introduction of a new imaging technology, tomosynthesis. Since it was a novel technology, there was limited knowledge of how et al.Social Studies of Science Social Studies of Science 41 to correctly analyse tomosynthesis images. To address this problem, a collective review session was arranged. The purpose of the present study was to uncover the practical work that took place during that session and to show how, and on what basis, new methods, interpretations and understandings were being generated. The analysis displays how the diagnostic work on patients' bodies was grounded in two sets of technologically produced renderings. This shows how expertise is not simply a matter of providing correct explanations, but also involves discovery work in which visual renderings are made transparent. Furthermore, the results point to how the disciplinary knowledge is intertwined with timely actions, which in turn, partly rely on established practices of manipulating and comparing images. The embodied and situated reasoning that enabled radiologists to discern objects in the images thus display expertise as inherently practical and domain-specific.
Acta Radiologica, Jun 1, 2011
In chest tomosynthesis, low-dose projections collected over a limited angular range are used for ... more In chest tomosynthesis, low-dose projections collected over a limited angular range are used for reconstruction of an arbitrary number of section images of the chest, resulting in a moderately increased radiation dose compared to chest radiography. To investigate the effects of learning with feedback on the detection of pulmonary nodules for observers with varying experience of chest tomosynthesis, to identify pitfalls regarding detection of pulmonary nodules, and present suggestions for how to avoid them, and to adapt the European quality criteria for chest radiography and computed tomography (CT) to chest tomosynthesis. Six observers analyzed tomosynthesis cases for presence of nodules in a jackknife alternative free-response receiver-operating characteristics (JAFROC) study. CT was used as reference. The same tomosynthesis cases were analyzed before and after learning with feedback, which included a collective learning session. The difference in performance between the two readings was calculated using the JAFROC figure of merit as principal measure of detectability. Significant improvement in performance after learning with feedback was found only for observers inexperienced in tomosynthesis. At the collective learning session, localization of pleural and subpleural nodules or structures was identified as the main difficulty in analyzing tomosynthesis images. The results indicate that inexperienced observers can reach a high level of performance regarding nodule detection in tomosynthesis after learning with feedback and that the main problem with chest tomosynthesis is related to the limited depth resolution.
Psychnology Journal, 2004
The dynamic and interactive character of computer simulations is often thought to be advantageous... more The dynamic and interactive character of computer simulations is often thought to be advantageous in vocational education. In the present study, video-recorded data from a course in anaesthesia care are analysed in order to explore the conditions for students to understand and act in simulation-based case scenarios. The results show that the students orient themselves to the simulation in three different ways, thereby constituting three different learning foci. Sometimes, when students use resources from their education, the properties of pharmacological preparations are in focus. On other occasions routines at work organise their approach, whilst at other times, they focus on the specific characteristics of the simulation's user interface. In the discussion of the constitution of this hybrid activity, two aspects are presented as especially relevant: first, the students' previous experiences from their education and of nurses' work and, secondly, how the teacher guides the students' orientations toward different resources. Finally, we argue that the simulation could function as a unique learning environment since it provides opportunities for linking experiences from work with more theoretical forms of reasoning in distinctive ways.
Health and Technology, 2012
ABSTRACT The electronic patient record (EPR) is a constitutive element of medical practice and ca... more ABSTRACT The electronic patient record (EPR) is a constitutive element of medical practice and can be conceived of as a multi-purpose tool that is intended to support a range of activities such as planning, decision-making and evaluation. Each of these activities is quite complex in its own right. The aim of the present study is to explore how the standardized format of EPRs intervenes in the work of sustaining continuity in patients’ care. In doing this we analyse how this standardized format contributes to structure the production and use of information concerning patients’ mundane problems in the context of rehabilitation. Data consists of observations, informal interviews and video-recordings from a ward for patients affected by stroke. The results show that there is a tension between the highly uniform structures and standards for documentation in EPRs, on the one hand, and, on the other, how information is designed and put into use by care providers. When staff members use EPRs, they constantly have to contextualize what is written in relation to what they know about patients and/or the current situation. On the local level, the increasing standardization that follows the introduction of EPRs will make it even more necessary for professionals to engage in such interpretative work to close the gap between the standardized categories of the EPR and contextually relevant health care interventions. In spite of requests for increasing standardization there will always be a need to adapt to specific needs for more flexible information structures. Otherwise, there may be the risk that non-standard features the initial standardization was intended to reduce may be re-introduced.
The general aim of the present study is to further understand how electronic patient records (EPR... more The general aim of the present study is to further understand how electronic patient records (EPR) contributes to the ways information about patients care is constituted and maintained in a healthcare practice. In addressing this broad issue the focus is put on how nurses define and communicate patients' problems and needs in shift reports by means of an EPR. Working
The work of nurse anaesthetists is carried out in a highly technological environment, where patie... more The work of nurse anaesthetists is carried out in a highly technological environment, where patient care is provided in close collaboration with other members of hospital staff. The expertise of these nurses and how this is developed is of vital importance. Furthermore, the use of computerised pedagogical tools to support learning within an educational setting is of special interest. The main aim of this paper is to investigate how the use of one of these tools, a simulation based learning environment, can contribute to learning in the domain of anaesthesia care. The study is carried out within the framework of socio-cultural theory. From this perspective, learning is viewed as being situated in communities of practice, where interaction between individuals, and between artefacts and individuals, is considered as central in the learning process. Here, we will present results from a study of how trainee nurse anaesthetists use computer simulations and discuss issues concerning their learning processes. The planning, implementation and debriefing phases of one training session are scrutinised with respect to the framing of problems and implications for learning. The results support the assumption that work in computer based learning environments can influence assessment procedures and decisionmaking skills in significant ways, and that computer-based learning environments provide productive means for goal directed collaborative learning activities.
ReCALL, 2010
For language learning, online environments allowing for user generated content are becoming incre... more For language learning, online environments allowing for user generated content are becoming increasingly important since they offer possibilities for learners to elaborate on assignments and projects. This study investigates what wikis can do as a means to enhance group interaction, when students are encouraged to participate in constructing text and exchanging peer response. The research focus is on exploring what interaction unfolds in the wiki and how it promotes language learning, from a sociocultural perspective. This interaction is framed both by affordances in the wiki but also by what is expected from students as language learners in an English for Specific Purposes class environment. The analysis has a multilevel approach, focusing on patterns of interaction and the nature of feedback. The study shows that collaboration becomes specifically interesting from a language learning perspective. In the findings, on the student wiki pages there are numerous contributions relating to both local language and global content. Revising co-constructed text opens up possibilities for the students to evaluate existing contributions and it also provides opportunities for them to suggest constructive changes. In addition, with the environment being web based, we discuss certain benefits arising from the fact that it allows for user-generated content.
Nurse Education in Practice, 2001
Computer simulations have been widely used for training purposes and proliferate in nursing and m... more Computer simulations have been widely used for training purposes and proliferate in nursing and medicine. To take account of the multifaceted nature of nursing, a participatory design approach was applied in which nursing practice was utilized as a point of departure for exploring the educational value of the new technologies. In an empirical study, nurses with different degrees of experience were interviewed about those tasks within nursing that they perceived as difficult to learn, and how simulation technologies might contribute to learning the management of these. Six aspects of expertise emerged:judging the patient's health status; monitoring care interventions; prioritizing and carrying out interventions efficiently; communicating with patients and their relatives; cooperating with other members of the staff; and managing complexity. Most aspects include dynamic and complex features, and simulations were judged to be useful for capturing these and, subsequently, for training. Other aspects, such as focusing on human interaction, were assessed to be less prolific. Compared to traditio nal teaching media, the dynamic featuresof simulations were judged to be most useful. Training with simulations was regarded as complementary to other forms of instruction, and the curricular integration of simulations decisive in determining their cont ribution to learning in nurse education.
International Journal of Computer-Supported Collaborative Learning, 2012
Abstract The growing importance of medical imaging in everyday diagnostic practices poses challen... more Abstract The growing importance of medical imaging in everyday diagnostic practices poses challenges for medical education. While the emergence of novel imaging technologies offers new opportunities, many pedagogical questions remain. In the present study, we ...
Instructional Science, 2012
Because simulators offer the possibility of functioning as authentic representations of real-worl... more Because simulators offer the possibility of functioning as authentic representations of real-world tasks, these tools are regarded as efficient for developing expertise. The users' experience of realism is recognised as crucial, and is often regarded as an effect of the similarity between reality and the simulator itself. In this study, it is argued that simulation as a realistic and relevant activity cannot be predesigned but emerges in the interaction between the participants, the simulator, and the context. The study draws on interaction analysis of video data from medical training. The aim is to contrast the use of two different simulators to explore the requirements needed to establish and maintain simulations as authentic representations of clinical practice. Irrespective of the realism of the simulator, glitches in the understanding of the simulation as work-related activity appear and are bridged by participants. This regularly involves an orientation to the relevant similarities with work and, simultaneously, the ruling out of irrelevant dissimilarities. In doing so, the participants rely on established professional practices to construe the situation. Moreover, the realism of the simulation is maintained through the participants' mutual orientation to the moral order of good clinical practice and a proper simulation. It is concluded that the design of simulation activities needs to account for the possibilities of participants understanding the specific conditions of the simulation and the work practices that the simulation represents. Learning to simulate is thus something that needs further attention in its own right.
Clinical Simulation in Nursing
ABSTRACT Background An important condition for serving the educational objectives of simulation i... more ABSTRACT Background An important condition for serving the educational objectives of simulation in nursing education is that the facilitator’s instructions during the briefing bridge the gap between the simulation and the real situation it simulates. This study aims to explicate instructional problems in the briefing, focusing both on how students understand that tasks should be performed in resuscitation teams and how these tasks should be adapted to the specific conditions of the simulation.
Simulation in healthcare: journal of the Society for Simulation in Healthcare
Introduction: Simulation-based education is a learner-active method that may enhance teamwork ski... more Introduction: Simulation-based education is a learner-active method that may enhance teamwork skills such as leadership and communication. The importance of postsimulation debriefing to promote reflection is well accepted, but many questions concerning whether and how faculty promote reflection remain largely unanswered in the research literature. The aim of this study was therefore to explore the depth of reflection expressed in questions by facilitators and responses from nursing students during postsimulation debriefings. Methods: Eighty-one nursing students and 4 facilitators participated. The data were collected in February and March 2008, the analysis being conducted on 24 videorecorded debriefings from simulated resuscitation teamwork involving nursing students only. Using Gibbs' reflective cycle, we graded the facilitators' questions and nursing students' responses into stages of reflection and then correlated these. Results: Facilitators asked most evaluative and fewest emotional questions, whereas nursing students answered most evaluative and analytic responses and fewest emotional responses. The greatest difference between facilitators and nursing students was in the analytic stage. Only 23 (20%) of 117 questions asked by the facilitators were analytic, whereas 45 (35%) of 130 students' responses were rated as analytic. Nevertheless, the facilitators' descriptive questions also elicited student responses in other stages such as evaluative and analytic responses. Conclusion: We found that postsimulation debriefings provide students with the opportunity to reflect on their simulation experience. Still, if the debriefing is going to pave the way for student reflection, it is necessary to work further on structuring the debriefing to facilitate deeper reflection. Furthermore, it is important that facilitators consider what kind of questions they ask to promote reflection. We think future research on debriefing should focus on developing an analytical framework for grading reflective questions. Such research will inform and support facilitators in devising strategies for the promotion of learning through reflection in postsimulation debriefings. (Sim Healthcare 8:135Y142, 2013)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2012
Background: Although nurses must be able to respond quickly and effectively to cardiac arrest, nu... more Background: Although nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR) in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance. Methods: We studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14) performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14) performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance. Results: Overall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio. We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables. Conclusion: We found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team-training of nursing students.
Journal of Advanced Nursing, 2011
Aim. The overarching aim was to explore and describe the communicative modes students employ to c... more Aim. The overarching aim was to explore and describe the communicative modes students employ to coordinate the team in a simulation-based environment designed for resuscitation team training. Background. Verbal communication is often considered essential for effective coordination in resuscitation teams and enhancing patient safety. Although simulation is a promising method for improving coordination skills, previous studies have overlooked the necessity of addressing the multifaceted interplay between verbal and non-verbal forms of communication.
Journal of Radiological Protection, 2013
Optimisation of radiological protection for operators working with fluoroscopically guided proced... more Optimisation of radiological protection for operators working with fluoroscopically guided procedures has to be performed during the procedure, under varying and difficult conditions. The aim of the present study was to evaluate the impact of a system for real-time visualisation of radiation dose rate on optimisation of occupational radiological protection in fluoroscopically guided procedures. Individual radiation dose measurements, using a system for real-time visualisation, were performed in a cardiology laboratory for three cardiologists and ten assisting nurses. Radiation doses collected when the radiation dose rates were not displayed to the staff were compared to radiation doses collected when the radiation dose rates were displayed. When the radiation dose rates were displayed to the staff, one cardiologist and the assisting nurses (as a group) significantly reduced their personal radiation doses. The median radiation dose (H p (10)) per procedure decreased from 68 to 28 µSv (p = 0.003) for this cardiologist and from 4.3 to 2.5 µSv (p = 0.001) for the assisting nurses. The results of the present study indicate that a system for real-time visualisation of radiation dose rate may have a positive impact on optimisation of occupational radiological protection. In particular, this may affect the behaviour of staff members practising inadequate personal radiological protection.
Medical Imaging 2011: Image Perception, Observer Performance, and Technology Assessment, 2011
abstract In chest tomosynthesis, low-dose projections collected over a limited angular range are ... more abstract In chest tomosynthesis, low-dose projections collected over a limited angular range are used for reconstruction of section images of the chest, resulting in a reduction of disturbing anatomy at a moderate increase in radiation dose compared to chest radiography. In a previous study, we investigated the effects of learning with feedback on the detection of pulmonary nodules in chest tomosynthesis. Six observers with varying degrees of experience of chest tomosynthesis analyzed tomosynthesis cases for presence of ...
Medical Imaging 2013: Image Perception, Observer Performance, and Technology Assessment, 2013
ABSTRACT In the monitoring of progression of lung disease in patients with cystic fibrosis (CF), ... more ABSTRACT In the monitoring of progression of lung disease in patients with cystic fibrosis (CF), recurrent computed tomography (CT) examinations are often used. The relatively new imaging technique chest tomosynthesis (CTS) may be an interesting alternative in the follow-up of these patients due to its visualization of the chest in slices at radiation doses and costs significantly lower than is the case with CT. A first step towards introducing CTS imaging in the diagnostics of CF patients is to establish a scoring system appropriate for evaluating the severity of CF pulmonary disease based on findings in CTS images. Previously, several such CF scoring systems based on CT imaging have been published. The purpose of the present study was to develop a CF scoring system for CTS, by starting from an existing scoring system dedicated for CT images and making modifications regarded necessary to make it appropriate for use with CTS images. In order to determine any necessary changes, three thoracic radiologists independently used a scoring system dedicated for CT on both CT and CTS images from CF patients. The results of the scoring were jointly evaluated by all the observers, which lead to suggestions for changes to the scoring system. Suggested modifications include excluding the scoring of air trapping and doing the scoring of the findings in quadrants of the image instead of in each lung lobe.
In chest tomosynthesis, low-dose projections collected over a limited angular range are used for ... more In chest tomosynthesis, low-dose projections collected over a limited angular range are used for reconstruction of section images of the chest, resulting in a reduction of disturbing anatomy at a moderate increase in radiation dose compared to chest radiography. In a previous study, we investigated the effects of learning with feedback on the detection of pulmonary nodules in chest tomosynthesis. Six observers with varying degrees of experience of chest tomosynthesis analyzed tomosynthesis cases for presence of pulmonary nodules. The cases were analyzed before and after learning with feedback. Multidetector computed tomography (MDCT) was used as reference. The differences in performance between the two readings were calculated using the jackknife alternative free-response receiver operating characteristics (JAFROC-2) as primary measure of detectability. Significant differences between the readings were found only for observers inexperienced in chest tomosynthesis. The purpose of the present study was to extend the statistical analysis of the results of the previous study, including JAFROC-1 analysis and FROC curves in the analysis. The results are consistent with the results of the previous study and, furthermore, JAFROC-1 gave lower p-values than JAFROC-2 for the observers who improved their performance after learning with feedback.
Discourse Studies, 2014
The present study examines the work of a group of medical scientists as they identify interpretat... more The present study examines the work of a group of medical scientists as they identify interpretative ‘pitfalls’ – recurrent sources of error – in the use of a new radiographic technique, formulate suggestions on how these pitfalls can be avoided and communicate their findings in the form of a scientific publication. The analysis focuses on a session in which previously diagnosed cases are discussed, and demonstrates the ways in which a certain source of diagnostic error gradually emerges as a taken-for-granted in the interaction. An increased sense of recognition, recurrence and typicality is discernible in the treatment of the cases. Talk characterized by expansions and elaborations, displays of understanding in the form of reformulations, understanding checks, and so on, leave room for brief typifications and reifications of interpretative difficulties in characteristics of the imaging technique. Topical treatment of perception and interpretation, as well as embodied engagement, become decreasingly salient. It is argued that the abstracted formulations in the published text rely on the case-by-case working up of generality from particularity; from individualized accounts of why ‘I’ interpreted the image in a certain way to proffered generalizations achieved through articulated perceptions of a generalized ‘one’. If these proffers are ratified, a potential ground is established for the consensual formulation of a pitfall. The formulation of novel instructions is consequently made relevant, projecting a re-instructed diagnostic practice.
Symposia paper presented at the EARLI SIG 14 meeting on Diversity in vocational and professional education and training, München, Germany., 2010
The current study draws on data from a radiology department working to improve diagnostic accurac... more The current study draws on data from a radiology department working to improve diagnostic accuracy with the use of a newly introduced technologytomosynthesis. In contrast to traditional chest radiography, tomosynthesis visualizes the anatomy of the lungs through a set of ...
Social Studies of Science, Oct 10, 2011
This study contributes to social studies of imaging and visualization practices within scientific... more This study contributes to social studies of imaging and visualization practices within scientific and medical settings. The focus is on practices in radiology, which are bound up with visual records known as radiographs. The study addresses work following the introduction of a new imaging technology, tomosynthesis. Since it was a novel technology, there was limited knowledge of how et al.Social Studies of Science Social Studies of Science 41 to correctly analyse tomosynthesis images. To address this problem, a collective review session was arranged. The purpose of the present study was to uncover the practical work that took place during that session and to show how, and on what basis, new methods, interpretations and understandings were being generated. The analysis displays how the diagnostic work on patients' bodies was grounded in two sets of technologically produced renderings. This shows how expertise is not simply a matter of providing correct explanations, but also involves discovery work in which visual renderings are made transparent. Furthermore, the results point to how the disciplinary knowledge is intertwined with timely actions, which in turn, partly rely on established practices of manipulating and comparing images. The embodied and situated reasoning that enabled radiologists to discern objects in the images thus display expertise as inherently practical and domain-specific.
Acta Radiologica, Jun 1, 2011
In chest tomosynthesis, low-dose projections collected over a limited angular range are used for ... more In chest tomosynthesis, low-dose projections collected over a limited angular range are used for reconstruction of an arbitrary number of section images of the chest, resulting in a moderately increased radiation dose compared to chest radiography. To investigate the effects of learning with feedback on the detection of pulmonary nodules for observers with varying experience of chest tomosynthesis, to identify pitfalls regarding detection of pulmonary nodules, and present suggestions for how to avoid them, and to adapt the European quality criteria for chest radiography and computed tomography (CT) to chest tomosynthesis. Six observers analyzed tomosynthesis cases for presence of nodules in a jackknife alternative free-response receiver-operating characteristics (JAFROC) study. CT was used as reference. The same tomosynthesis cases were analyzed before and after learning with feedback, which included a collective learning session. The difference in performance between the two readings was calculated using the JAFROC figure of merit as principal measure of detectability. Significant improvement in performance after learning with feedback was found only for observers inexperienced in tomosynthesis. At the collective learning session, localization of pleural and subpleural nodules or structures was identified as the main difficulty in analyzing tomosynthesis images. The results indicate that inexperienced observers can reach a high level of performance regarding nodule detection in tomosynthesis after learning with feedback and that the main problem with chest tomosynthesis is related to the limited depth resolution.
Psychnology Journal, 2004
The dynamic and interactive character of computer simulations is often thought to be advantageous... more The dynamic and interactive character of computer simulations is often thought to be advantageous in vocational education. In the present study, video-recorded data from a course in anaesthesia care are analysed in order to explore the conditions for students to understand and act in simulation-based case scenarios. The results show that the students orient themselves to the simulation in three different ways, thereby constituting three different learning foci. Sometimes, when students use resources from their education, the properties of pharmacological preparations are in focus. On other occasions routines at work organise their approach, whilst at other times, they focus on the specific characteristics of the simulation's user interface. In the discussion of the constitution of this hybrid activity, two aspects are presented as especially relevant: first, the students' previous experiences from their education and of nurses' work and, secondly, how the teacher guides the students' orientations toward different resources. Finally, we argue that the simulation could function as a unique learning environment since it provides opportunities for linking experiences from work with more theoretical forms of reasoning in distinctive ways.
Health and Technology, 2012
ABSTRACT The electronic patient record (EPR) is a constitutive element of medical practice and ca... more ABSTRACT The electronic patient record (EPR) is a constitutive element of medical practice and can be conceived of as a multi-purpose tool that is intended to support a range of activities such as planning, decision-making and evaluation. Each of these activities is quite complex in its own right. The aim of the present study is to explore how the standardized format of EPRs intervenes in the work of sustaining continuity in patients’ care. In doing this we analyse how this standardized format contributes to structure the production and use of information concerning patients’ mundane problems in the context of rehabilitation. Data consists of observations, informal interviews and video-recordings from a ward for patients affected by stroke. The results show that there is a tension between the highly uniform structures and standards for documentation in EPRs, on the one hand, and, on the other, how information is designed and put into use by care providers. When staff members use EPRs, they constantly have to contextualize what is written in relation to what they know about patients and/or the current situation. On the local level, the increasing standardization that follows the introduction of EPRs will make it even more necessary for professionals to engage in such interpretative work to close the gap between the standardized categories of the EPR and contextually relevant health care interventions. In spite of requests for increasing standardization there will always be a need to adapt to specific needs for more flexible information structures. Otherwise, there may be the risk that non-standard features the initial standardization was intended to reduce may be re-introduced.
The general aim of the present study is to further understand how electronic patient records (EPR... more The general aim of the present study is to further understand how electronic patient records (EPR) contributes to the ways information about patients care is constituted and maintained in a healthcare practice. In addressing this broad issue the focus is put on how nurses define and communicate patients' problems and needs in shift reports by means of an EPR. Working
The work of nurse anaesthetists is carried out in a highly technological environment, where patie... more The work of nurse anaesthetists is carried out in a highly technological environment, where patient care is provided in close collaboration with other members of hospital staff. The expertise of these nurses and how this is developed is of vital importance. Furthermore, the use of computerised pedagogical tools to support learning within an educational setting is of special interest. The main aim of this paper is to investigate how the use of one of these tools, a simulation based learning environment, can contribute to learning in the domain of anaesthesia care. The study is carried out within the framework of socio-cultural theory. From this perspective, learning is viewed as being situated in communities of practice, where interaction between individuals, and between artefacts and individuals, is considered as central in the learning process. Here, we will present results from a study of how trainee nurse anaesthetists use computer simulations and discuss issues concerning their learning processes. The planning, implementation and debriefing phases of one training session are scrutinised with respect to the framing of problems and implications for learning. The results support the assumption that work in computer based learning environments can influence assessment procedures and decisionmaking skills in significant ways, and that computer-based learning environments provide productive means for goal directed collaborative learning activities.
ReCALL, 2010
For language learning, online environments allowing for user generated content are becoming incre... more For language learning, online environments allowing for user generated content are becoming increasingly important since they offer possibilities for learners to elaborate on assignments and projects. This study investigates what wikis can do as a means to enhance group interaction, when students are encouraged to participate in constructing text and exchanging peer response. The research focus is on exploring what interaction unfolds in the wiki and how it promotes language learning, from a sociocultural perspective. This interaction is framed both by affordances in the wiki but also by what is expected from students as language learners in an English for Specific Purposes class environment. The analysis has a multilevel approach, focusing on patterns of interaction and the nature of feedback. The study shows that collaboration becomes specifically interesting from a language learning perspective. In the findings, on the student wiki pages there are numerous contributions relating to both local language and global content. Revising co-constructed text opens up possibilities for the students to evaluate existing contributions and it also provides opportunities for them to suggest constructive changes. In addition, with the environment being web based, we discuss certain benefits arising from the fact that it allows for user-generated content.
Nurse Education in Practice, 2001
Computer simulations have been widely used for training purposes and proliferate in nursing and m... more Computer simulations have been widely used for training purposes and proliferate in nursing and medicine. To take account of the multifaceted nature of nursing, a participatory design approach was applied in which nursing practice was utilized as a point of departure for exploring the educational value of the new technologies. In an empirical study, nurses with different degrees of experience were interviewed about those tasks within nursing that they perceived as difficult to learn, and how simulation technologies might contribute to learning the management of these. Six aspects of expertise emerged:judging the patient's health status; monitoring care interventions; prioritizing and carrying out interventions efficiently; communicating with patients and their relatives; cooperating with other members of the staff; and managing complexity. Most aspects include dynamic and complex features, and simulations were judged to be useful for capturing these and, subsequently, for training. Other aspects, such as focusing on human interaction, were assessed to be less prolific. Compared to traditio nal teaching media, the dynamic featuresof simulations were judged to be most useful. Training with simulations was regarded as complementary to other forms of instruction, and the curricular integration of simulations decisive in determining their cont ribution to learning in nurse education.
International Journal of Computer-Supported Collaborative Learning, 2012
Abstract The growing importance of medical imaging in everyday diagnostic practices poses challen... more Abstract The growing importance of medical imaging in everyday diagnostic practices poses challenges for medical education. While the emergence of novel imaging technologies offers new opportunities, many pedagogical questions remain. In the present study, we ...
Instructional Science, 2012
Because simulators offer the possibility of functioning as authentic representations of real-worl... more Because simulators offer the possibility of functioning as authentic representations of real-world tasks, these tools are regarded as efficient for developing expertise. The users' experience of realism is recognised as crucial, and is often regarded as an effect of the similarity between reality and the simulator itself. In this study, it is argued that simulation as a realistic and relevant activity cannot be predesigned but emerges in the interaction between the participants, the simulator, and the context. The study draws on interaction analysis of video data from medical training. The aim is to contrast the use of two different simulators to explore the requirements needed to establish and maintain simulations as authentic representations of clinical practice. Irrespective of the realism of the simulator, glitches in the understanding of the simulation as work-related activity appear and are bridged by participants. This regularly involves an orientation to the relevant similarities with work and, simultaneously, the ruling out of irrelevant dissimilarities. In doing so, the participants rely on established professional practices to construe the situation. Moreover, the realism of the simulation is maintained through the participants' mutual orientation to the moral order of good clinical practice and a proper simulation. It is concluded that the design of simulation activities needs to account for the possibilities of participants understanding the specific conditions of the simulation and the work practices that the simulation represents. Learning to simulate is thus something that needs further attention in its own right.