The Unit for Clinical Caring Research Focusing on Immune Diseases and Immunotherapies and on Quality and Safety in Health-care

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Dr Ann Gardulf is a clinical researcher with her research focus on primary immunodeficiencies (PID). She investigates the clinical effects of the patients' IgG replacement therapy, e.g. susceptibility to inections, the patients’ therapy- and life situation, quality of life, and the costs of the different therapy alternatives (health economics). She is also active as a researcher within different research areas focusing on quality and safety in Health-care.

Dr Gardulf was the one to develop the rapid subcutaneous IgG replacement therapy, which today is commonly used worldwide. The 1st article about the method was published in The Lancet in 1991. She is one of the founders of both the National (SISSI, Sveriges Immunbristsjuksköterskors Intresseförening) and the International (INGID, International Nursing Group for Immunodeficiencies) Nurse PID Organisations.

The Nurse Professional Competence (NPC) Scale
Dr Gardulf is also active as a researcher within different research areas focusing on quality and safety in the Health-care. As an ongoing example, a national research group consisting of researcher from seven Universities/University Colleges has developed a new instrument to measures self-reported competence among registered nurses in clinical care -  “The Nurse Professional Competence (NPC) Scale” (2013). The research group is now setting up a model to facilitate the implementation of the NPC Scale within the Swedish health-care system to make it possible to measure nurses’ competence over time, i.e. from newly graduated registered nurses to highly specialized nurses. 

Primary immunodeficiencies (PID)
Primary immunodeficiencies (PID) ( > 200 types summarised) are recognized having about the same prevalence as diabetes. It has been estimated that about 40-50,000 individuals in Sweden are suffering from some form of PID. Although Sweden must be considered to hold a position in the frontline regarding research and clinical care of patients with PID, only 2,000 individuals have so far been diagnosed. Thus, many patients are still suffering from increased frequency and severity of infections due to lack of awareness of PID among Swedish health care staff. The most common PID is some form of primary antibody deficiency leading to an increased susceptibility to bacterial infections in the lungs, sinus and ears. Once diagnosed, it is possible to help the patients to a much healthier life and a better quality of life if the patients are given IgG on a regular basis (normally weekly). IgG (gammaglobulin) is a concentrate of ready-to-use-antibodies from healthy blood donors. In Sweden about 80% of both the children and the adult PID patients self-infuse at home. They then use a small portable pump to infuse the IgG subcutaneously. The remaining 20% of the patients receive their IgG replacement as intravenous IgG infusions at out-patient clinics at specialist clinics at the hospitals.

Well-trained and competent nurses are a prerequisite for a high-quality and safe care. Already in 2005, the National Board of Health and Welfare in Sweden set up formal competence requirements for registered nurses. Although these formal requirements have been in force for 8 years it has not been possible to evaluate nurses’ competence in relations to the national formal requirements until the NPC Scale was developed. 


Name Title
Ann Gardulf RN, PhD, Associate professor
Research collaboration with researchers at
seven Swedish Universities/University Colleges and
international PID research collaboration with several European and North-American Universities.

Current external assignments

Member of the scientific group “Vinn-Verifiering”  within the Governmental body “VINNOVA” for supporting business plans based on research results. The scientific group seeks and financially supports the best strategies for commercialization

External funding

Founding from national organisations.

Teaching assignments

Teaching assignments comprise basic and clinical immunology for >100 nursing students at Karolinska Institutet and also teaching primary immunodeficencies to nursing students participating in the special course ”Pathophysiology of communicable and non-communicable diseases and the prevention of these diseases”. 


Living with Primary Immunodeficiency - Reports

1/2007 Adult Report (in Swedish)

2/2007 Parental Report (in Swedish)

3/2007 Child/Teenage Report (in Swedish)

Selected publications

Primary immunodeficiencies/lgG treatment

Does IgG therapy prevent Alzheimer's disease?
Hammarström L, Hansen S, Gardulf A
J. Neuroimmunol. 2009 Oct;215(1-2):122-4

Efficacy and safety of home-based subcutaneous immunoglobulin replacement therapy in paediatric patients with primary immunodeficiencies.
Borte M, Bernatowska E, Ochs H, Roifman C,
Clin. Exp. Immunol. 2011 Jun;164(3):357-64

Clinical symptoms in adults with selective IgA deficiency: a case-control study.
Jorgensen G, Gardulf A, Sigurdsson M, Sigurdardottir S, Thorsteinsdottir I, Gudmundsson S, et al
J. Clin. Immunol. 2013 May;33(4):742-7

Subcutaneous immunoglobulin replacement therapy: the European experience.
Chapel H, Gardulf A
Curr Opin Allergy Clin Immunol 2013 Dec;13(6):623-9

Health-related quality of life (HRQL) in immunodeficient adults with selective IgA deficiency compared with age- and gender-matched controls and identification of risk factors for poor HRQL.
Jörgensen G, Gardulf A, Sigurdsson M, Arnlaugsson S, Hammarström L, Ludviksson B
Qual Life Res 2014 Mar;23(2):645-58

Quality and Safety in Health-care

Standardized care plans in Swedish health care: their quality and the extent to which they are used.
Olsson P, Petersson H, Willman A, Gardulf A
Scand J Caring Sci 2009 Dec;23(4):820-5

Documented assessments and treatments of patients seeking emergency care because of pain.
Lewén H, Gardulf A, Nilsson J
Scand J Caring Sci 2010 Dec;24(4):764-71

Education for dialysis patients lowers long-term phosphate levels and maintains health-related quality of life.
Gardulf A, Pålsson M, Nicolay U,
Clin. Nephrol. 2011 Apr;75(4):319-27

Validation of a disease-specific questionnaire for measuring parent-reported health-related quality of life in children with allergies.
Uwe N, Eva , Ann-Charlotte E, Gun N, Ann G
Scand J Caring Sci 2012 Dec;26(4):679-87

Development and validation of a new tool measuring nurses self-reported professional competence--the nurse professional competence (NPC) Scale.
Nilsson J, Johansson E, Egmar A, Florin J, Leksell J, Lepp M, et al
Nurse Educ Today 2014 Apr;34(4):574-80

Health careImmunology