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  • 1.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Kalmar, Sweden.
    Järhult, Bengt
    Ekonomiska incitament ska inte kopplas till den enskilde patienten2016Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, artikel-id D4TPArtikel i tidskrift (Refereegranskat)
  • 2.
    Ali, DK
    et al.
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Yousefzade-Chabok, S
    Trauma Research Center, Guilan University of Medical Science, Rasht, Iran.
    Jansson, B
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Mohammadi, R
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Costs related to drowning and near drowning in northern Iran (Guilan province)2011Ingår i: Ocean and Coastal Management, ISSN 0964-5691, E-ISSN 1873-524X, Vol. 54, nr 3, s. 250-255Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In Iran and many other low- and middle-income countries, few  studies have been carried out in order to assess which cost analysis methods should be  undertaken at the household and community level in relation to incidences of drowning. In this study, we have attempted to develop a model for  estimating the impact of the economic burden that drowning and near drowning events incur for victims’ families in the Guilan province in the north of  Iran by  using an  incidence approach. During the financial year of March 2007 to 2008,  the following cost-related aspects of  drowning episodes were evaluated: (note: main cost elements were income adjusted by family and years) medical costs, productivity loss  costs and death costs. A total of 137 drowning fatalities and 104 near drowning incidents were recorded. Males in the age  span of  10e29  years constitute a  majority of  the epidemiology and economy data. When the number of variables included in cost analysis was expanded, the estimated burden of economic duress increased dramatically; however, drowning cost for  one drowned victim was equivalent to 17  times the country’s  gross domestic product(GDP) per capital. Identification of  injured person-based costs in  this study will  enable development of  more effective prevention programs and provide indicators of  other costs related to drowning episodes such as  property damage and the impact of  these accidents on community services and the public health care system.

  • 3.
    Almén, Niclas
    et al.
    Mid Sweden University, Sundsvall, Sweden.
    Lekander, Mats
    Karolinska Institutet, Stockholm, Sweden; Stockholm University, Stockholm, Sweden.
    Öst, Lars-Göran
    Stockholm University, Stockholm, Sweden.
    Sundin, Örjan
    Mid Sweden University, Sundsvall, Sweden.
    Ekdahl, Johanna
    Mid Sweden University, Sundsvall, Sweden.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Hedenstedt, Eva
    Sveriges kliniska psykologers förening, Sweden.
    Norlund, Fredrika
    Uppsala University, Uppsala, Sweden.
    Lindskog, Marie
    Västerbottens läns landsting, Sweden.
    Hjärtström, Lotten
    Västerbottens läns landsting, Sweden.
    Keskiniva, Sinella
    Västerbottens läns landsting, Sweden.
    Sinervo, Kirsti
    Landstinget Sörmland, Sweden.
    Många är undantagna rätten till effektiv sjukvård2018Ingår i: Dagens medisin, ISSN 1501-4290, E-ISSN 1501-4304, nr 16 juliArtikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 4.
    Alsabri, Mohamed
    et al.
    Emergency Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Harvard Medical School, Boston Massachusetts, USA.
    Boudi, Zoubir
    Department of Emergency Medicine, Dr Sulaiman Alhabib Hospital, Dubai, United Arab Emirates.
    Lauque, Dominique
    Emergency Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Harvard Medical School, Boston Massachusetts, USA; Department of Emergency Medicine, Purpan Hospital and Toulouse III University, Toulouse, France.
    Dias, Roger Daglius
    STRATUS Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts.
    Whelan, Julia S.
    MS Knowledge Services, Beth Israel Deaconess Medical Center, Boston Massachusetts, USA.
    Östlundh, Linda
    The National Medical Library, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates.
    Alinier, Guillaume
    Hamad Medical Corporation Ambulance Service, Doha, Qatar; School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom; Weill Cornell Medicine-Qatar, Doha, Qatar.
    Onyeji, Churchill
    Emergency Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Harvard Medical School, Boston Massachusetts, USA.
    Michel, Philippe
    Department of Health Quality, University Hospital, Hospices Civils, Lyon, France; Health Services and Performance Research Laboratory, Lyon, France.
    Liu, Shan W.
    Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston Massachusetts, USA.
    Jr Camargo, Carlos A.
    Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston Massachusetts, USA.
    Lindner, Tobias
    Division of Emergency and Acute Medicine (CVK, CCM), Charité University Medicine, Berlin, Germany.
    Slagman, Anna
    Division of Emergency and Acute Medicine (CVK, CCM), Charité University Medicine, Berlin, Germany.
    Bates, David W.
    Department of Healthcare Quality, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts, USA.
    Tazarourte, Karim
    Health Services and Performance Research Laboratory, Lyon, France; Emergency Medicine Department, University Hospital, Hospices Civils, Lyon, University Lyon, Lyon, France .
    Singer, Sara J.
    Department of Medicine, Division of Primary Care, Stanford University School of Medicine, Stanford California, USA.
    Toussi, Anita
    Department of Emergency Medicine, Union Hospital Terre Haute and Clinton IN, Simulation Center for Health Care Education, Indiana State University, Terre Haute Indiana, USA.
    Grossman, Shamai
    Emergency Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Harvard Medical School, Boston Massachusetts, USA.
    Bellou, Abdelouahab
    Emergency Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Harvard Medical School, Boston Massachusetts, USA; Research Innovation Department, Global Health Care Network and Research Innovation Institute LLC, Brookline, Massachusetts, USA.
    Impact of Teamwork and Communication Training Interventions on Safety Culture and Patient Safety in Emergency Departments: A Systematic Review2022Ingår i: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425, Vol. 18, nr 1, s. E351-E361Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objectives: This study aimed to narratively summarize the literature reporting on the effect of teamwork and communication training interventions on culture and patient safety in emergency department (ED) settings.

    Methods: We searched PubMed, EMBASE, Psych Info CINAHL, Cochrane, Science Citation Inc, the Web of Science, and Educational Resources Information Centre for peer-reviewed journal articles published from January 1, 1988, to June 8, 2018, that assessed teamwork and communication interventions focusing on how they influence patient safety in the ED. One additional search update was performed in July 2019.

    Results: Sixteen studies were included from 8700 screened publications. The studies' design, interventions, and evaluation methods varied widely. The most impactful ED training interventions were End-of-Course Critique, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), and crisis resource management (CRM)-based training. Crisis resource management and TeamSTEPPS CRM-based training curriculum were used in most of the studies. Multiple tools, including the Kirkpatrick evaluation model, the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture, the TeamSTEPPS Teamwork Attitudes Questionnaire, the Safety Attitudes Questionnaire, and the Communication and Teamwork Skills Assessment, were used to assess the impact of such interventions. Improvements in one of the domains of safety culture and related domains were found in all studies. Four empirical studies established improvements in patient health outcomes that occurred after simulation CRM training (Kirkpatrick 4), but there was no effect on mortality.

    Conclusions: Overall, teamwork and communication training interventions improve the safety culture in ED settings and may positively affect patient outcome. The implementation of safety culture programs may be considered to reduce incidence of medical errors and adverse events.

  • 5.
    Andersson, Henrik
    et al.
    Toulouse School of Economics (LERNA, UT1C, CNRS), Toulouse, France.
    Hole, Arne Risa
    University of Sheffield, Sheffield, United Kingdom.
    Svensson, Mikael
    Örebro universitet, Handelshögskolan vid Örebro Universitet. Karlstad University, Karlstad, Sweden; Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Valuation of small and multiple health risks: A critical analysis of SP data applied to food and water safety2016Ingår i: Journal of Environmental Economics and Management, ISSN 0095-0696, E-ISSN 1096-0449, Vol. 75, s. 41-53Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study elicits individual risk preferences in the context of an infectious disease using choice experiments. A main objective is to examine scope sensitivity using a novel approach. Our results suggest that the value of a mortality risk reduction (VSL) is highly sensitive to the survey design. Our results cast doubt on the standard scope sensitivity tests in choice experiments, but also on the validity and reliability of VSL estimates based on stated-preference studies in general. This is important due to the large empirical literature on non-market evaluation and the elicited values' central role in policy making.

  • 6.
    Andersson, Åsa
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Geriatrics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Dahlkvist, Lisabet
    Centre of Clinical Research, Region Värmland, Karlstad, Sweden.
    Kurland, Lisa
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Emergency, School of Medical Sciences, Faculty of Medicineand , Health Örebro University, Örebro, Sweden.
    Patient-centered outcomes and outcome measurements for people aged 65 years and older-a scoping review2024Ingår i: BMC Geriatrics, E-ISSN 1471-2318, Vol. 24, nr 1, s. 528-, artikel-id 528Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    INTRODUCTION: The aging population is a challenge for the healthcare system that must identify strategies that meet their needs. Practicing patient-centered care has been shown beneficial for this patient-group. The effect of patient-centered care is called patient-centered outcomes and can be appraised using outcomes measurements.

    OBJECTIVES: The main aim was to review and map existing knowledge related to patient-centered outcomes and patient-centered outcomes measurements for older people, as well as identify key-concepts and knowledge-gaps. The research questions were: How can patient-centered outcomes for older people be measured, and which patient-centered outcomes matters the most for the older people? STUDY DESIGN: Scoping review.

    METHODS: Search for relevant publications in electronical databases, grey literature databases and websites from year 2000 to 2021. Two reviewers independently screened titles and abstracts, followed by full text review and extraction of data using a data extraction framework.

    RESULTS: Eighteen studies were included, of which six with involvement of patients and/or experts in the process on determine the outcomes. Outcomes that matter the most to older people was interpreted as: access to- and experience of care, autonomy and control, cognition, daily living, emotional health, falls, general health, medications, overall survival, pain, participation in decision making, physical function, physical health, place of death, social role function, symptom burden, and time spent in hospital. The most frequently mentioned/used outcomes measurements tools were the Adult Social Care Outcomes Toolkit (ASCOT), EQ-5D, Gait Speed, Katz- ADL index, Patient Health Questionnaire (PHQ9), SF/RAND-36 and 4-Item Screening Zarit Burden Interview.

    CONCLUSIONS: Few studies have investigated the older people's opinion of what matters the most to them, which forms a knowledge-gap in the field. Future research should focus on providing older people a stronger voice in what they think matters the most to them.

  • 7.
    Andrén, Daniela
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Wellbeing and healthcare priority settings in Sweden at the beginning of the COVID-19 omicron wave2022Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction: The COVID pandemic proves that a sustainable healthcare system is dependent both on resources and a consensus about which values should guide the decision makers to appropriately set priorities for resource allocation. There is not clear how exactly the decision makers choose the priorities for spending, but there were differences between and within countries. For example, in Sweden, where healthcare system has a pronounced public characterand a declared emphasis on equity and solidarity, there was a high variation between and within regions with respect to how resources were used for treatment, prevention, and vaccination. This article is an explorative analysis of the respondents’ wellbeing and their preferences regarding priority-setting in healthcare in Sweden during December 2021, when the extremely high infection risk of the Omicron sparked significant concern among global experts andpoliticians.

    Methods: Our web-survey was answered by 1000 respondents from the web panel Userneeds. The sample is representative with respect age, gender, and geographical region for the adult population of Sweden. The respondents are invited to imagine that they are decision-makers in the health care system and decide for six hypothetical choice situations, where the resources are allocated to save the life of patients at risk of dying due to suicide, pancreatic cancer, breast cancer and acute heart attack. In addition to the choices, the survey also includes questions about the individual’s demographic and socio-economic characteristics, their well-being, their risk for and experience (their own and/or someone near them) with suicide, pancreatic cancer, breast cancer and acute heart attack.

    Results: Our preliminary results show that regardless of their age, people with a high value of life-satisfaction and with no experience related to suicide, pancreatic cancer, breast cancer and acute heart attack tend to allocate resources for relatively young patients suffering do to suicide and breast cancer.

    Ladda ner (pdf)
    Abstract
  • 8.
    Angelis, Jannis
    et al.
    Royal Institute of Technology, Stockholm, Sweden; Research Institute of Industrial Economics (IFN), Stockholm, Sweden.
    Glenngård, Anna Häger
    Lund University School of Economics and Management, Lund, Sweden; Research Institute of Industrial Economics (IFN), Stockholm, Sweden.
    Jordahl, Henrik
    Örebro universitet, Handelshögskolan vid Örebro Universitet. Research Institute of Industrial Economics, Stockholm, Sweden.
    Management practices and the quality of primary care2021Ingår i: Public Money & Management, ISSN 0954-0962, E-ISSN 1467-9302, Vol. 41, nr 3, s. 264-271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Using the World Management Survey method, the authors mapped and analysed management quality in Swedish primary care centres. On average, private sector providers were better managed than public providers. Centres with a high overall social deprivation among enrolled patients also tended to have higher management quality. Management quality was positively associated with accessibility (length of waiting times), but not with patient-reported experience.

    IMPACT: The authors explored the use of management practices at the operational (care centre) level in Swedish primary care. The paper relates management quality to provider characteristics (public or private) and to the quality of care. An expansion of private care centres seems to have increased the average level of management quality in Swedish primary care. The findings suggest that suitable applications of management practices, especially in the area of people management, can produce a higher quality of care.

  • 9.
    Anrys, Charlotte
    et al.
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
    Van Tiggelen, Hanne
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
    Verhaeghe, Sofie
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department Health Care, VIVES University College, Roeselare, Belgium.
    Van Hecke, Ann
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Nursing Department, Ghent University Hospital, Ghent, Belgium.
    Beeckman, Dimitri
    Örebro universitet, Institutionen för hälsovetenskaper. Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
    Independent risk factors for pressure ulcer development in a high-risk nursing home population receiving evidence-based pressure ulcer prevention: Results from a study in 26 nursing homes in Belgium2019Ingår i: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 16, nr 2, s. 325-333Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to identify independent risk factors for pressure ulcer (PU) development in a high-risk nursing home population receiving evidence-based PU prevention. This study was part of a randomised controlled trial examining the (cost-)effectiveness of static air support surfaces compared with alternating pressure air mattresses. The sample consisted of 308 residents at a high risk of PU development (presence of non-blanchable erythema, Braden score ≤ 12 or Braden subscale "mobility" ≤ 2). PU incidence was monitored for 14 days. Demographic variables; functional, physical, and psychological characteristics; and data on skin assessment were collected. Independent risk factors were identified using multiple logistic regression analysis. The overall PU incidence (category II-IV) was 8.4% (n = 26), and 1.9% (n = 6) of the residents developed a deep PU (category III-IV). PUs (category II-IV) were significantly associated with non-blanchable erythema, a lower Braden score, and pressure area-related pain in high-risk residents even if preventive care was provided. These results highlight the need of a systematic risk assessment, including pain assessment and skin observations, in order to determine and tailor preventive care to the needs of high-risk individuals.

  • 10.
    Appelros, Peter
    et al.
    Region Örebro län. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Jonsson, Fredrik
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Åsberg, Signild
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Asplund, Kjell
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Glader, Eva-Lotta
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Åsberg, Kerstin Hulter
    Department of Medicine, Enköping Hospital, Enköping, Sweden.
    Norrving, Bo
    Department of Neurology, Lund University Hospital, Lund, Sweden.
    Stegmayr, Birgitta
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Terént, Andreas
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Trends in stroke treatment and outcome between 1995 and 2010: observations from Riks-Stroke, the Swedish stroke register2014Ingår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 37, nr 1, s. 22-29Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Continuous changes in stroke treatment and care, as well as changes in stroke characteristics, may alter stroke outcome over time. The aim of this paper is to describe time trends for treatment and outcome data, and to discuss if any such changes could be attributed to quality changes in stroke care.

    METHODS: Data from Riks-Stroke, the Swedish stroke register, were analyzed for the time period of 1995 through 2010. The total number of patients included was 320,181. The following parameters were included: use of computed tomography (CT), stroke unit care, thrombolysis, medication before and after the stroke, length of stay in hospital, and discharge destination. Three months after stroke, data regarding walking, toileting and dressing ability, as well social situation, were gathered. Survival status after 7, 27 and 90 days was registered.

    RESULTS: In 1995, 53.9% of stroke patients were treated in stroke units. In 2010 this proportion had increased to 87.5%. Fewer patients were discharged to geriatric or rehabilitation departments in later years (23.6% in 2001 compared with 13.4% in 2010), but more were discharged directly home (44.2 vs. 52.4%) or home with home rehabilitation (0 vs. 10.7%). The need for home help service increased from 18.2% in 1995 to 22.1% in 2010. Regarding prevention, more patients were on warfarin, antihypertensives and statins both before and after the stroke. The functional outcome measures after 3 months did improve from 2001 to 2010. In 2001, 83.8% of patients were walking independently, while 85.6% were independent in 2010. For toileting, independence increased from 81.2 to 84.1%, and for dressing from 78.0 to 80.4%. Case fatality (CF) rates after 3 months increased from 18.7% (2001) to 20.0% (2010). This trend is driven by patients with severe strokes.

    CONCLUSIONS: Stroke outcomes may change over a relatively short time period. In some ways, the quality of care has improved. More stroke patients have CT, more patients are treated in stroke units and more have secondary prevention. Patients with milder strokes may have benefited more from these measures than patients with severe strokes. Increased CF rates for patients with severe stroke may be caused by shorter hospital stays, shorter in-hospital rehabilitation periods and lack of suitable care after discharge from hospital.

  • 11.
    Arnell, Susann
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Center, Örebro University, Örebro, Sweden; The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden.
    Jerlinder, Kajsa
    The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden; Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Geidne, Susanna
    Örebro universitet, Institutionen för hälsovetenskaper.
    Lundqvist, Lars-Olov
    Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Center, Örebro University, Örebro, Sweden; The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden.
    Experiences of stakeholder collaboration when promoting participation in physical activity among adolescents with autism spectrum disorder2022Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, nr 9, s. 1728-1736Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Various stakeholders contribute to the development of healthy physical activity habits in adolescents with autism spectrum disorder (ASD). Parents and stakeholders seek collaborative actions but little is still known about such efforts. The purpose of this study was thus to explore how professionals from different services experience stakeholder collaboration when promoting participation in physical activity for these adolescents.

    METHOD: Five focus group discussions were held with 17 professionals from education, health care, community, and sports organizations, engaged in the promotion of physical activity in adolescents with ASD. The data were analyzed with qualitative content analysis.

    RESULTS: . The professionals though experienced that this collaboration was hampered by the low priority given to physical activity issues within different organizations, by limited resources, lack of knowledge, and unclear roles.

    CONCLUSIONS: Notwithstanding the professionals' different roles, all agreed that physical activity issues need to be prioritized and that each stakeholder needs to acknowledge the shared responsibility of collaboration. However, more clear routines for collaboration that include joined efforts but also highlight the organization-specific responsibilities might enhance the collaborative efforts.

    • In-depth understanding of both the adolescents' needs and the environments in which physical activity is promoted is required if participation in physical activity among adolescents with ASD is to be enhanced.
    • Families and professionals within different organizations need to be supported to collaborate when mapping and meeting the adolescents' physical activity needs.
    • Issues regarding developing physical activity habits need to be prioritized.
    • Professionals, such as education, health, and community professionals who are important for the promotion of healthy physical activity habits need to be included in multi-stakeholder meetings.
  • 12.
    Axén, Iben
    et al.
    Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    The Nordic maintenance care program: the clinical use of identified indications for preventive care2013Ingår i: Chiropractic and Manual Therapies, E-ISSN 2045-709X, Vol. 21, nr 1, artikel-id 10Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Low back pain (LBP) is a prevalent condition and has been found to be recurrent and persistent in a majority of cases. Chiropractors have a preventive strategy, maintenance care (MC), aimed towards minimizing recurrence and progression of such conditions. The indications for recommending MC have been identified in the Nordic countries from hypothetical cases. This study aims to investigate whether these indications are indeed used in the clinical encounter.

    Methods: Data were collected in a multi-center observational study in which patients consulted a chiropractor for their non-specific LBP. Patient baseline information was a) previous duration of the LBP, b) the presence of previous episodes of LBP and c) early improvement with treatment. The chiropractors were asked if they deemed each individual patient an MC candidate. Logistic regression analyses (uni– and multi-level) were used to investigate the association of the patient variables with the chiropractor’s decision.

    Results: The results showed that “previous episodes” with LBP was the strongest predictor for recommending MC, and that the presence of all predictors strengthens the frequency of this recommendation. However, there was considerable heterogeneity among the participating chiropractors concerning the recommendation of MC.

    Conclusions: The study largely confirms the clinical use of the previously identified indications for recommending MC for recurrent and persistent LBP. Previous episodes of LBP was the strongest indicator.

  • 13.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Halasz, Laszlo
    Private practise, Lund, Sweden.
    Lange, Fredrik
    Private practise, Stockholm, Sweden.
    Lövgren, Peter W.
    Private practise, Stockholm, Sweden.
    Rosenbaum, Annika
    Private practise, Linköping, Sweden.
    Leboeuf-Yde, Charlotte
    Institute of Regional Health Research, Spine Centre of Southern Denmark, Hospital Lillebælt, University of Southern Denmark, Kolding, Denmark.
    Jensen, Irene
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, The Karolinska Institutet, Stockholm, Sweden.
    Clustering patients on the basis of their individual course of low back pain over a six month period2011Ingår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 12, artikel-id 99Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Several researchers have searched for subgroups in the heterogeneous population of patients with non-specific low back pain (LBP). To date, subgroups have been identified based on psychological profiles and the variation of pain.

    Methods: This multicentre prospective observational study explored the 6- month clinical course with measurements of bothersomeness that were collected from weekly text messages that were sent by 176 patients with LBP. A hierarchical cluster analysis, Ward's method, was used to cluster patients according to the development of their pain.

    Results: Four clusters with distinctly different clinical courses were described and further validated against clinical baseline variables and outcomes. Cluster 1, a "stable" cluster, where the course was relatively unchanged over time, contained young patients with good self- rated health. Cluster 2, a group of "fast improvers" who were very bothered initially but rapidly improved, consisted of patients who rated their health as relatively poor but experienced the fewest number of days with bothersome pain of all the clusters. Cluster 3 was the "typical patient" group, with medium bothersomeness at baseline and an average improvement over the first 4-5 weeks. Finally, cluster 4 contained the "slow improvers", a group of patients who improved over 12 weeks. This group contained older individuals who had more LBP the previous year and who also experienced most days with bothersome pain of all the clusters.

    Conclusions: It is possible to define clinically meaningful clusters of patients based on their individual course of LBP over time. Future research should aim to reproduce these clusters in different populations, add further clinical variables to distinguish the clusters and test different treatment strategies for them.

  • 14.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Halasz, Laszlo
    Lange, Fredrik
    Lövgren, Peter W.
    Rosenbaum, Annika
    Leboeuf-Yde, Charlotte
    Spine Centre of Southern Denmark, Hospital Lillebalt, University of Southern Denmark, Odense, Denmark.
    Jensen, Irene
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    The use of weekly text messaging over 6 months was a feasible method for monitoring the clinical course of low back pain in patients seeking chiropractic care2012Ingår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 65, nr 4, s. 454-461Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This study critically evaluates a new method of collecting frequent data using mobile phones and text messages. Fluctuating conditions such as low back pain (LBP) need frequent monitoring to describe the clinical course in detail and to account for individual and subgroup variations.

    Study Design and Setting: In this multicentre prospective observational study, 262 subjects with nonspecific LBP were followed with weekly text messages for 6 months, with the question “How many days this previous week has your low back pain been bothersome?” The text replies were instantly recorded in a data file to be merged with baseline and follow up data (age, gender, pain intensity, duration, and self- rated health) collected through ordinary questionnaires. The response rate, user-friendliness, and compliance of this method were evaluated.

    Results: The mean response rate for the text messages throughout the study was 82.5% and was unaffected by season. The method was found to be user friendly. Dropout was not affected by age and gender, but compliance was possibly somewhat affected by outcome.

    Conclusion: Weekly text messages are a useful method of data collection to examine the clinical course of LBP in the primary care sector.

  • 15.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Kongsted, Alice
    Clinical Locomotion Network, Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
    Wedderkopp, Niels
    Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark.
    Jensen, Irene
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Analyzing repeated data collected by mobile phones and frequent text messages: An example of Low back pain measured weekly for 18 weeks2012Ingår i: BMC Medical Research Methodology, E-ISSN 1471-2288, Vol. 12, artikel-id 105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Repeated data collection is desirable when monitoring fluctuating conditions. Mobile phones can be used to gather such data from large groups of respondents by sending and receiving frequently repeated short questions and answers as text messages.

    The analysis of repeated data involves some challenges. Vital issues to consider are the within-subject correlation, the between measurement occasion correlation and the presence of missing values.

    The overall aim of this commentary is to describe different methods of analyzing repeated data. It is meant to give an overview for the clinical researcher in order for complex outcome measures to be interpreted in a clinically meaningful way.

    Methods: A model data set was formed using data from two clinical studies, where patients with low back pain were followed with weekly text messages for 18 weeks. Different research questions and analytic approaches were illustrated and discussed, as well as the handling of missing data. In the applications the weekly outcome “number of days with pain” was analyzed in relation to the patients’ “previous duration of pain” (categorized as more or less than 30 days in the previous year).

    Research questions with appropriate analytical methods

    1: How many days with pain do patients experience? This question was answered with data summaries.

    2: What is the proportion of participants “recovered” at a specific time point? This question was answered using logistic regression analysis.

    3: What is the time to recovery? This question was answered using survival analysis, illustrated in Kaplan-Meier curves, Proportional Hazard regression analyses and spline regression analyses.

    4: How is the repeatedly measured data associated with baseline (predictor) variables? This question was answered using generalized Estimating Equations, Poisson regression and Mixed linear models analyses.

    5: Are there subgroups of patients with similar courses of pain within the studied population?A visual approach and hierarchical cluster analyses revealed different subgroups using subsets of the model data.

    Conclusions: We have illustrated several ways of analysing repeated measures with both traditional analytic approaches using standard statistical packages, as well as recently developed statistical methods that will utilize all the vital features inherent in the data.

  • 16.
    Bassford, Christopher R.
    et al.
    Warwick Medical School, University of Warwick, Coventry, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom.
    Krucien, Nicolas
    Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
    Ryan, Mandy
    Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
    Griffiths, Frances E.
    Warwick Medical School, University of Warwick, Coventry, United Kingdom.
    Svantesson, Mia
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Fritz, Zoe
    Warwick Medical School, University of Warwick, Coventry, United Kingdom; The Healthcare Improvement Studies (THIS) Institute, Cambridge University, Cambridge, United Kingdom.
    Perkins, Gavin D.
    Warwick Medical School, University of Warwick, Coventry, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, United Kingdom.
    Quinton, Sarah
    University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, United Kingdom.
    Slowther, Anne-Marie
    Warwick Medical School, University of Warwick, Coventry, United Kingdom.
    U.K. Intensivists' Preferences for Patient Admission to ICU: Evidence From a Choice Experiment2019Ingår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 47, nr 11, s. 1522-1530Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Deciding whether to admit a patient to the ICU requires considering several clinical and nonclinical factors. Studies have investigated factors associated with the decision but have not explored the relative importance of different factors, nor the interaction between factors on decision-making. We examined how ICU consultants prioritize specific factors when deciding whether to admit a patient to ICU.

    DESIGN: Informed by a literature review and data from observation and interviews with ICU clinicians, we designed a choice experiment. Senior intensive care doctors (consultants) were presented with pairs of patient profiles and asked to prioritize one of the patients in each task for admission to ICU. A multinomial logit and a latent class logit model was used for the data analyses.

    SETTING: Online survey across U.K. intensive care.

    SUBJECTS: Intensive care consultants working in NHS hospitals.

    MEASUREMENTS AND MAIN RESULTS: Of the factors investigated, patient's age had the largest impact at admission followed by the views of their family, and severity of their main comorbidity. Physiologic measures indicating severity of illness had less impact than the gestalt assessment by the ICU registrar. We identified four distinct decision-making patterns, defined by the relative importance given to different factors.

    CONCLUSIONS: ICU consultants vary in the importance they give to different factors in deciding who to prioritize for ICU admission. Transparency regarding which factors have been considered in the decision-making process could reduce variability and potential inequity for patients.

  • 17.
    Baxter, Rebecca
    et al.
    Department of Nursing, Umeå University, Sweden.
    Jemberie, Wossenseged Birhane
    Department of Social Work, Umeå University, Sweden; Centre for Demographic and Ageing Research (CEDAR), Umeå University, Sweden.
    Li, Xia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
    Naseer, Mahwish
    School of Education, Health and Social Studies, Dalarna University, Sweden; Ageing Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Pauelsen, Mascha
    Department of Health Sciences, Luleå University of Technology, Sweden.
    Shebehe, Jacques
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Viklund, Emilia W.E.
    Department of Health Sciences, Faculty of Education and Welfare Studies, Åbo Akademi University, Finland.
    Xia, Xin
    Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Sweden.
    Zulka, Linn Elena
    Department of Psychology, Centre for Ageing and Health (AgeCap), University of Gothenburg, Sweden.
    Badache, Andreea
    Örebro universitet, Institutionen för hälsovetenskaper. Swedish Institute of Disability Research.
    COVID-19: Opportunities for interdisciplinary research to improve care for older people in Sweden2021Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, nr 1, s. 29-32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The emergence of COVID-19 has changed the world as we know it, arguably none more so than for older people. In Sweden, the majority of COVID-19-related fatalities have been among people aged ⩾70 years, many of whom were receiving health and social care services. The pandemic has illuminated aspects within the care continuum requiring evaluative research, such as decision-making processes, the structure and organisation of care, and interventions within the complex public-health system. This short communication highlights several key areas for future interdisciplinary and multi-sectorial collaboration to improve health and social care services in Sweden. It also underlines that a valid, reliable and experiential evidence base is the sine qua non for evaluative research and effective public-health systems.

  • 18.
    Beeckman, Dimitri
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Örebro University, Örebro, Sweden.
    Cooper, Matthew
    3M Health Care, St. Paul, Minnesota, USA.
    Greenstein, Emily
    Sanford Health, Fargo, North Dakota, USA.
    Idensohn, Patricia
    CliniCare Medical Centre, Ballito, South Africa.
    Klein, Robert J.
    Department of Surgery, University of South Carolina School of Medicine, Greenville, South Carolina, USA.
    Kolbig, Norbert
    University Hospital Düsseldorf, Düsseldorf, Germany.
    LeBlanc, Kimberly
    KDS Professional Consulting, Ottawa, Ontario, Canada.
    Milne, Catherine
    Connecticut Clinical Nursing Associates, LLC, Bristol, Connecticut, USA.
    Treadwell, Terry
    Wound Care Solutions, Montgomery, Alabama, USA.
    Weir, Dot
    Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, New York, USA.
    White, Wendy
    Wendy White WoundCare, Murwillumbah, New South Wales, Australia.
    The role community-based healthcare providers play in managing hard-to-heal wounds2024Ingår i: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 21, nr 1, artikel-id e14402Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is common for community-based healthcare providers (CHPs)-many of whom have not received specialised training in wound care-to deliver initial and ongoing management for various wound types and diverse populations. Wounds in any setting can rapidly transition to a stalled, hard-to-heal wound (HTHW) that is not following a normal healing trajectory. Failure to recognise or address issues that cause delayed healing can lead to increased costs, healthcare utilisation and suffering. To encourage early intervention by CHPs, a panel of wound care experts developed actionable evidence-based recommendations for CHPs delineating characteristics and appropriate care in identifying and treating HTHWs. A HTHW is a wound that fails to progress towards healing with standard therapy in an orderly and timely manner and should be referred to a qualified wound care provider (QWCP) for advanced assessment and diagnosis if not healed or reduced in size by 40%-50% within 4 weeks. HTHWs occur in patients with multiple comorbidities, and display increases in exudate, infection, devitalised tissue, maceration or pain, or no change in wound size. CHPs can play an important initial role by seeing the individual's HTHW risk, addressing local infection and providing an optimal wound environment. An easy-to-follow one-page table was developed for the CHP to systematically identify, evaluate and treat HTHWs, incorporating a basic toolkit with items easily obtainable in common office/clinic practice settings. A flow chart using visual HTHW clinical cues is also presented to address CHPs with different learning styles. These tools encourage delivery of appropriate early interventions that can improve overall healthcare efficiency and cost.

  • 19.
    Bejerot, Eva
    et al.
    Psykologiska institutionen, Stockholms universitet, Stockholm, Sweden.
    Aronsson, Gunnar
    Psykologiska institutionen, Stockholms universitet, Stockholm, Sweden.
    Hasselbladh, Hans
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Bejerot, Susanne
    Karolinska institutet, Stockholm, Sweden.
    Läkarkåren - en profession med allt mindre stöd och inflytande. Enkätstudie av svenska läkares arbetsmiljö 1992 och 2010: [The medical profession, a profession with less and less support and influence. A questionnaire study the occupational environment of Swedish physicians in 1992 and 2010]2011Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, nr 50, s. 2652-2656Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [sv]

    Syftet med studien var att undersöka förändringar i läkares arbetsvillkor med särskild inriktning på ledning, styrning och stöd. Jämförelser gjordes av enkätdata från två slumpmässiga urval 1992 (n = 390) och 2010 (n = 1 937). Stora förändringar framkom i flera avseenden. Andelen läkare som upplever sig ha något verksamhetsansvar har minskat med 45 procentandelar, från 76 till 31 procent. Mycket stora försämringar framkom vad gäller stöd i arbetet. Tiden som läggs på fortbildning/inläsning och forskning har minskat. Utnyttjandet av läkarnas högsta kompetens har minskat.

  • 20. Bejerot, Susanne
    ST-handledare - ett omöjligt uppdrag?: [Internship supervisor--an impossible mission?]2010Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 29-31, s. 1785-1786Artikel i tidskrift (Refereegranskat)
  • 21.
    Bejerot, Susanne
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län, Örebro.
    Glans, Martin
    Örebro universitet, Institutionen för medicinska vetenskaper. Psykiatri sydväst, Region Stockholm.
    Fördelar och nackdelar med en legalisering av cannabis i Sverige [Legalization of cannabis - A Swedish perspective]2021Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, artikel-id 20112Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    While no European country has legalized recreational use of cannabis, several countries, but not Sweden, have decriminalized it. Although we hitherto have a relatively low prevalence of users compared to other countries, Swedish policy is criticized. Strong voices advocate legalization. It is hypothesized that a legalization would minimize adolescent access, ensure quality control, make consumption safer and raise tax revenue. Furthermore, it is assumed to diminish the illicit drug market and drug related crimes. However, the legalization in the US and Canada has instead made cannabis more available to users by innovative marketing and product development, while the illegal market persists. Meanwhile the price of cannabis decreases and potency, which are related to many of the risks, increases. Cannabis-related harms include e.g. cognitive impairment, psychosis and psychosocial problems. The long-term effects from legalization is yet to be seen.

  • 22.
    Bellafronte, Natália Tomborelli
    et al.
    McGill University - MacDonald Campus, 151165, School of Dietetics and Human Nutrition, Sainte-Anne-de-Bellevue, Quebec, Canada.
    Nasser, Roseann
    Saskatchewan Health Authority, 7234, Clinical Nutrition Services, Regina, Saskatchewan, Canada.
    Gramlich, Leah
    University of Alberta Faculty of Medicine & Dentistry, 12357, Gastroenterology, Edmonton, Alberta, Canada.
    Carli, Francesco
    McGill University, 5620, Department of Anesthesia, Montreal, Quebec, Canada.
    Liberman, A. Sender
    McGill University Health Centre, 54473, Department of Surgery, Montreal, Quebec, Canada.
    Santa Mina, Daniel
    University of Toronto Faculty of Kinesiology and Physical Education, 177420, Kinesiology and Physical Education, Toronto, Ontario, Canada; University Health Network, 7989, Department of Anesthesia and Pain Management, Toronto, Ontario, Canada.
    Schierbeck, Geoff
    Doctors of BC, 50030, Portfolio Liaison Surgery , Vancouver, British Columbia, Canada.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University, Örebro, Sweden.
    Gillis, Chelsia
    McGill University - MacDonald Campus, 151165, School of Dietetics and Human Nutrition, Sainte-Anne-de-Bellevue, Quebec, Canada; McGill University, 5620, Department of Anesthesia, Montreal, Quebec, Canada; McGill University, 5620, Department of Surgery, Montreal, Quebec, Canada.
    A survey of preoperative surgical nutrition practices, opinions, and barriers across Canada2024Ingår i: Applied Physiology, Nutrition and Metabolism, ISSN 1715-5312, E-ISSN 1715-5320, Vol. 49, nr 5, s. 687-699Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Malnutrition is prevalent among surgical candidates and associated with adverse outcomes. Despite being potentially modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a cross-sectional survey to understand healthcare professionals' (HCP) opinions and barriers regarding screening and treatment of malnutrition. HCPs working with adult surgical patients in Canada were invited to complete an online survey. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using summative content analysis. Of the 225 HCPs surveyed (n=111 dietitians, n=72 physicians, n=42 allied healthcare professionals), 96%-100% agreed that preoperative malnutrition is a modifiable risk factor associated with worse surgical outcomes and is a treatment priority. Yet, 65% (n=142/220; dietitians: 88% vs. physicians: 40%) reported screening for malnutrition, mostly in the postoperative period (n=117) by dietitians (n=94), and just 42% (48/113) of non-dietitian respondents referred positively screened patients to a dietitian for further assessment and treatment. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n=121/212), time (40%, n=84/212) and support from others (38%, n=80/212). In conclusion, there is a gap between opinion and practice among surgical HCPs pertaining to malnutrition. Although HCPs agreed malnutrition is a surgical priority, the opportunity to screen for nutrition risk was a great barrier.

  • 23.
    Berg, Marie
    et al.
    Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Linden, Karolina
    Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro universitet, Institutionen för hälsovetenskaper.
    Sparud Lundin, Carina
    Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ranerup, Agneta
    Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden.
    Web-Based Intervention for Women With Type 1 Diabetes in Pregnancy and Early Motherhood: Critical Analysis of Adherence to Technological Elements and Study Design2018Ingår i: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 20, nr 5, artikel-id el60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Numerous Web-based interventions have been implemented to promote health and health-related behaviors in persons with chronic conditions. Using randomized controlled trials to evaluate such interventions creates a range of challenges, which in turn can influence the study outcome. Applying a critical perspective when evaluating Web-based health interventions is important.

    Objective: The objective of this study was to critically analyze and discuss the challenges of conducting a Web-based health intervention as a randomized controlled trial.

    Method: The MODIAB-Web study was critically examined using an exploratory case study methodology and the framework for analysis offered through the Persuasive Systems Design model. Focus was on technology, study design, and Web-based support usage, with special focus on the forum for peer support. Descriptive statistics and qualitative content analysis were used.

    Results: The persuasive content and technological elements in the design of the randomized controlled trial included all four categories of the Persuasive Systems Design model, but not all design principles were implemented. The study duration was extended to a period of four and a half years. Of 81 active participants in the intervention group, a maximum of 36 women were simultaneously active. User adherence varied greatly with a median of 91 individual log-ins. The forum for peer support was used by 63 participants. Although only about one-third of the participants interacted in the forum, there was a fairly rich exchange of experiences and advice between them. Thus, adherence in terms of social interactions was negatively affected by limited active participation due to prolonged recruitment process and randomization effects. Lessons learned from this critical analysis are that technology and study design matter and might mutually influence each other. In Web-based interventions, the use of design theories enables utilization of the full potential of technology and promotes adherence. The randomization element in a randomized controlled trial design can become a barrier to achieving a critical mass of user interactions in Web-based interventions, especially when social support is included. For extended study periods, the technology used may need to be adapted in line with newly available technical options to avoid the risk of becoming outdated in the user realm, which in turn might jeopardize study validity in terms of randomized controlled trial designs. Conclusions: On the basis of lessons learned in this randomized controlled trial, we give recommendations to consider when designing and evaluating Web-based health interventions.

  • 24.
    Bergdahl, Elisabeth
    et al.
    Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
    Ternestedt, Britt-Marie
    Department of Health Care Science/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Berterö, Carina
    Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Andershed, Birgitta
    Department of Health Care Science/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden; Faculty of Health, Care and Nursing, Norwegian University of Science and Technology, Gjøvik, Norway.
    The theory of a co-creative process in advanced palliative home care nursing encounters: A qualitative deductive approach over time2019Ingår i: Nursing Open, E-ISSN 2054-1058, Vol. 6, nr 1, s. 175-188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives: The aim of this study was to test the theoretical conceptualization of the co-creative process in home care nursing encounters over time.

    Method and design: This was a multiple case study with a deductive analysis of qualitative data over time, using interviews and observations collected from three cases.

    Results: The co-creative process was complex and contained main, sub- and micro-processes. Time was important and valuable, giving the patient and relatives space to adjust the process to their own pace. Some processes were worked on more intensively in accordance with the patients' and relatives' needs, and these are considered the main-process. The further developed theory of the co-creative process and its main, sub- and microprocesses can be understood as a concretization of how good nursing care can be performed within caring relationships in the context of advanced palliative home care.

  • 25.
    Bergman, Stefan
    et al.
    Spenshult sjukhus Halmstad, Landstinget Halland, Sweden.
    Gerdle, Björn
    Linköpings universitet, Universitetssjukhuset i Linköping, Sweden.
    Hagberg, Mats
    Göteborgs universitet, Sahlgrenska universitetssjukhuset, Göteborg, Sweden.
    Jacobsson, Ulf
    Lunds universitet, Lund, Sweden.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Strender, Lars-Erik
    Karolinska institutet, Huddinge, Sweden.
    Stålnacke, Britt-Marie
    Umeå universitet, Norrlands universitetssjukhus, Umeå, Sweden.
    Söderlund, Anne
    Mälardalens högskola, Hälsa och välfärd, Västerås, Sweden.
    Långvarig smärta i nacke, skuldror och rygg i Nationella riktlinjer för rörelseorganens sjukdomar 2010 – stöd för styrning och ledning: Preliminär version2010Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Nationella riktlinjer för rörelseorganens sjukdomar belyser områden där behovet av vägledning är stort på grund av att det finns praxisskillnader, kontroversiella frågor eller behov av kvalitetsutveckling.

    De här riktlinjerna berör åtgärder som utförs inom hälso- och sjukvården och utgår från diagnostik, behandling och rehabilitering. Nationella riktlinjer för rörelseorganens sjukdomar omfattar:

    • reumatoid artrit
    • ankyloserande spondylit
    • psoriasisartrit
    • artros i höft och knä
    • osteoporos (benskörhet)
    • långvarig smärta i nacke, skuldror och rygg
  • 26.
    Bergman, Stefan
    et al.
    Spenshult sjukhus i Halmstad, Landstinget Halland, Sweden.
    Gerdle, Björn
    Linköpings universitet, Universitetssjukhuset i Linköping; Sweden.
    Hagberg, Mats
    Göteborgs universitet, Sahlgrenska Universitetssjukhuset i Göteborg, Sweden.
    Jakobsson, Ulf
    Lunds universitet, Lund, Sweden.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Strender, Lars-Erik
    Karolinska Institutet i Huddinge, Sweden.
    Stålnacke, Britt-Marie
    Umeå universitet, Norrlands universitetssjukhus i Umeå, Sweden.
    Söderlund, Anne
    Mälardalens högskola i Västerås, Sweden.
    Långvarig smärta i nacke, skuldror och rygg i Nationella riktlinjer för rörelseorganens sjukdomar 2012: Osteoporos, artros, inflammatorisk ryggsjukdom och ankyloserande spondylit ,psoriasisartrit och reumatoid artrit - Stöd för styrning och ledning2012Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Dessa riktlinjer innehåller rekommendationer om åtgärder vid sjukdomar i rörelseorganen. De innehåller också bedömningar av rekommendatio-nernas ekonomiska och organisatoriska konsekvenser och indikatorer för uppföljning. Riktlinjerna omfattar följande diagnosområden:

    • osteoporos (benskörhet)
    • artros i knä och höft (nedbrytning av ledbrosk)
    • inflammatorisk ryggsjukdom (axial spondylartrit) och ankylose-rande spondylit
    • psoriasisartrit (en kombination av psoriasis och ledinflammationer)
    • reumatoid artrit (ledgångsreumatism)
  • 27.
    Bergström, Gunnar
    et al.
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Lohela-Karlsson, M.
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Kwak, L.
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Jensen, I.
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Torgén, Margareta
    Department of Medical Science, Uppsala University, Uppsala, Sweden.
    Nybergh, L.
    Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden..
    Preventing sickness absenteeism among employees with common mental disorders or stress-related symptoms at work: Design of a cluster randomized controlled trial of a problem-solving based intervention versus care-as-usual conducted at the Occupational Health Services2017Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 17, nr 1, artikel-id 436Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Common mental disorders (CMDs) are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS) can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis.

    Methods: The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention's cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out.

    Discussion: The study includes analyses of the effectiveness of the intervention (clinical and economic) as well as an analysis of its implementation at the participating OHSs. Possible methodological challenges such as selection bias and risk of contamination between OHS consultants delivering the experimental condition and consultants giving usual care are discussed.

    Ladda ner fulltext (pdf)
    Preventing sickness absenteeism among employees with common mental disorders or stress-related symptoms at work: Design of a cluster randomized controlled trial of a problem-solving based intervention versus care-as-usual conducted at the Occupational Health Services
  • 28.
    Bergthorsdottir, R
    et al.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Nilsson, A G
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gillberg, P
    Shire, Danderyd, Sweden.
    Ekman, Bertil
    Linköping University, Linköping, Sweden.
    Wahlberg, Jeanette
    Linköping University, Linköping, Sweden.
    Health-Related Quality of Life In Patients With Adrenal Insufficiency Receiving Plenadren Compared With Immediate-Release Hydrocortisone2015Ingår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 18, nr 7, artikel-id A616Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Previous studies in patients with primary adrenal insufficiency (PAI) on conventional replacement therapy suggest decreased health-related quality of life (HRQoL), and that patients report more frequently fatigue, increased anxiety and inability to work compared to background population.

    Objectives

    To study self-reported health status with EQ-5D in patients with PAI. Patients treated with Plenadren (modified-release hydrocortisone) were compared with patients treated with immediate release hydrocortisone (IRHC) replacement therapy.

    Methods

    This was a cross-sectional, multi-centre, non-interventional survey of patients with PAI receiving Plenadren or immediate release hydrocortisone (IRHC) replacement.

    Subjects

    One hundred thirty-four adult patients with PAI of whom 36 (19 females [53%]) were treated with Plenadren and 98 (77 females [79%]) were treated with IRHC, were included.

    MAIN OUTCOME MEASURE

    HRQoL described by the EQ-5D, a generic preference-based measure of health.

    RESULTS

    Patients on Plenadren and on IRHC had a mean ± SD age of 53.1 ± 12.7 years and 48.0 ± 13.1 years, respectively (P=0.043). The majority of the patients were diagnosed more than 5 years ago (69%). The mean ± SD daily Plenadren and IRHC doses were 27.0 ± 6.8 mg and 26.6 ± 10.9 mg, respectively (P=0.807). 47% of the Plenadren patients had been receiving Plenadren and 82% of the IRHC patients had been receiving IRHC for more than 3 years. Patients receiving Plenadren had better HRQoL measured by the EQ-5D questionnaire compared to patients replaced with IRHC (0.76 ± 0.18 vs 0.68 ± 0.18, respectively [P=0.040]).

    CONCLUSIONS

    Replacement therapy with Plenadren in patients with PAI confers measurable benefit on HRQoL relative to IRHC as estimated by the EQ-5D questionnaire, and may therefore be advantageous when compared to IRHC substitution.

  • 29.
    Biswas, Animesh
    et al.
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh.
    Abdullah, Abu Sayeed Md
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Public Health Science.
    Deave, Toity
    Centre for Child and Adolescent Health, Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom.
    Rahman, Fazlur
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh; Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.
    Mashreky, Saidur Rahman
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh; Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.
    Exploring perceptions of common practices immediately following burn injuries in rural communities of Bangladesh2018Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 18, artikel-id 467Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Burns can be the most devastating injuries in the world, they constitute a global public health problem and cause widespread public health concern. Every year in Bangladesh more than 365,000 people are injured by electrical, thermal and other causes of burn injuries. Among them 27,000 need hospital admission and over 5600 people die. Immediate treatment and medication has been found to be significant in the success of recovering from a burn. However, common practices used in the treatment of burn injuries in the community is not well documented in Bangladesh. This study was designed to explore the perception of local communities in Bangladesh the common practices used and health-seeking behaviors sought immediately after a burn injury has occurred.

    Methods: A qualitative study was conducted using Focus Group Discussions (FGD) as the data collection method. Six unions of three districts in rural Bangladesh were randomly selected and FGDs were conducted in these districts with six burn survivors and their relatives and neighbours. Data were analyzed manually, codes were identified and the grouped into themes.

    Results: The participants stated that burn injuries are common during the winter in Bangladesh. Inhabitants in the rural areas said that it was common practice, and correct, to apply the following to the injured area immediately after a burn: egg albumin, salty water, toothpaste, kerosene, coconut oil, cow dung or soil. Some also believed that applying water is harmful to a burn injury. Most participants did not know about any referral system for burn patients. They expressed their dissatisfaction about the lack of available health service facilities at the recommended health care centers at both the district level and above.

    Conclusions: In rural Bangladesh, the current first-aid practices for burn injuries are incorrect; there is a widely held belief that using water on burns is harmful.

  • 30. Björkelund, Cecilia
    et al.
    Hasselgren, Mikael
    Primary Care Research Centre, County Council of Värmland, Karlstad, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    [Psychiatry and primary health care have common responsibility]2011Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, nr 14, s. 786-786Artikel i tidskrift (Refereegranskat)
  • 31.
    Blomberg, Karin
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Hugelius, Karin
    Örebro universitet, Institutionen för hälsovetenskaper.
    Health and well-being after being deployed in a major incident; how do Swedish ambulance nurses perceive their health recover process? A qualitative study2023Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 7, artikel-id e071848Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To explore health problems and the recovery process after being deployed in a major incident.

    DESIGN: Qualitative, explorative design.

    SETTING: Ambulance services in Sweden.

    PARTICIPANTS AND METHODS: Semistructured, individual two-session interviews with 15 ambulance nurses with the experience of being deployed to major incidents were conducted. Data were analysed with thematic analysis.

    RESULTS: Being deployed in major incidents was perceived to be straining and led to both physical health problems and distress. To recover, the ambulance nurses strived to use strategies to distance themselves from the situation and created supportive conditions for their recovery, and if successful, the experiences led to both professional and personal growth and self-awareness. However, being deployed in major incidents without significant preparedness or experience could harm individuals and, in the worst case, end their career.

    CONCLUSIONS: A successful recovery from the physical and mental exhaustion experienced after being deployed in a major incident required both individual abilities and self-care strategies as well as a supportive working environment. Supporting individual recovery strategies and following up on physical and mental well-being over time should be part of all ambulance services procedures after major incidents.

  • 32.
    Blomqvist, Suzanne
    et al.
    Psychiatric Research Centre, Örebro County Council, Örebro, Sweden.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Interprofessional psychiatric teams: is multidimensionality evident in treatment conferences?2012Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 26, nr 4, s. 289-296Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Interprofessional teamwork is practised when the care needs of patients are complex. Little is known about the extent to which team competence really determines patient interventions. The aim of the study was to examine the degree of multidimensionality in patient discussions in psychiatry, and to how different professions contribute. Psychiatric teams were observed during 30 team meetings. A content analysis was used to examine the amount of attention given to medical, psychological and social aspects. The results indicated difficulties in achieving multidimensionality in patient discussions during team meetings. The descriptive element of the discussion was dominated by the social aspect, to which all professions contributed. The analytical element was dominated by the psychological aspect, also to which all the professions contributed. In suggesting interventions, medical interventions were emphasized, principally by the physicians. Decisions on interventions concerned equally medical, social and psychological aspects. An interprofessional composition of teams offers no guarantee that interventions will be of a multidimensional nature. The results are discussed in relation to previous research and practical implications.

  • 33. Blusi, Madeleine
    et al.
    Dalin, Rolf
    Näslund, Pär
    Palmgren, Katarina
    Scandurra, Isabella
    Department of information technology, Uppsala university, Uppsala, Sweden.
    Test av användbarheten hos innovationen SenseSoft i äldreomsorgen i Sundsvalls kommun2014Rapport (Övrigt vetenskapligt)
  • 34.
    Blusi, Madeleine
    et al.
    R&D Department, The Association of Local Authorities in Västernorrland County, Härnösand, Sweden.
    Dalin, Rolf
    R&D Department, The Association of Local Authorities in Västernorrland County, Härnösand, Sweden.
    Näslund, Pär
    Palmgren, Katarina
    Scandurra, Isabella
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Test av användbarheten hos innovationen TENA Identifi på Viktoriagården i Kramfors2015Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Norrlandicus är ett ”Living Lab” med syfte att i en verklig testmiljö inom äldreomsorgen testa innovationer i form av produkter, tjänster och arbetssätt för att se om de tillför ett ökat värde i en vård- och omsorgsprocess och om innovationen möter slutanvändarens faktiska behov. En utgångspunkt för Norrlandicus testmetod är Socialstyrelsens riktlinjer om värdegrunder i omsorgen av äldre, om äldres värdighet och välbefinnande.

    På ett äldreboende i Kramfors kommun har SCA Hygiene Products innovation för inkontinensutredning testats. Under tre dygn deltog ett antal utvalda äldre personer i en inkontinensutredning där man använde ny teknik med sensorer i inkontinensskyddet för att samla in information kring tidpunkt och ungefärlig urinmängd av läckage.

    I testet ingår först och främst att utvärdera innovationens användbarhet. Detta sker utifrån personalens användning och uppfattning kring verktyget. Det resultatet kan i viss mån även belysa nyttoeffekter av verktyget i en vård- och omsorgsprocess. Vilka effekter kan innovationen få för den äldre och vilken nytta kan den ge personalen? Enkäter och strukturerade intervjuer har utförts med personal och intervjuer har efter samtycke utförts med de berörda äldre. Användningen har även observerats och Norrlandicus-teamet har deltagit praktiskt i alla testets faser.

    Vårdpersonalens analys av data tillsammans med deras kännedom om personen underlättar för personalen att individanpassa de äldres inkontinensskydd bättre, och att bättre planera in assistans vid toalettbesök. Det ger i detta avseende möjligheter att öka de äldres välbefinnande och värdighet, vilket är i linje med äldreomsorgens nationella riktlinjer. Verktyget har även visat sig kunna förbättra inkontinensvården ur personalens synvinkel. Den information som verktyget ger är mer utförlig än den som fås från dagens utredningsmetod där inkontinensskydden vägs. Det ger stöd i besluten för vilka insatser som personen bör ha samt vilka typer av inkontinensskydd som bör användas. Dessutom slipper personalen momentet med vägning, vilket ökar de hygieniska aspekterna.

    Personalen som deltagit i testet är nöjda med utfallet och skulle gärna använda detta verktyg på rutinbasis vid inkontinensutredningar.

  • 35.
    Bodin Danielsson, Christina
    et al.
    Royal Institute of Technology, Stockholm, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Office type in relation to health, well-being, and job satisfaction among employees: Erratum2010Ingår i: Environment and Behavior, ISSN 0013-9165, E-ISSN 1552-390X, Vol. 42, nr 6, s. 887-887Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Reports an error in "Office type in relation to health, well-being, and job satisfaction among employees" by Christina Bodin Danielsson and Lennart Bodin (Environment and Behavior, 2008[Sep], Vol 40[5], 636-668). In the original article, a symbol was missing from Table 7 on p. 654. In that table, an open circle ("o") should have been present to show that the odds ratio indicated low risk for having poor quality of sleep among those who worked in the flex office. The corrected table is present in the erratum. (The following abstract of the original article appeared in record 2008-12036-003). This article investigates the hypothesis that office type has an influence on workers' health status and job satisfaction and 469 employees in seven different types, defined by their unique setup of architectural and functional features, have rated their health status and job satisfaction. Multivariate regression models were used for analysis of these outcomes, with adjustment for age, gender, job rank, and line of business. Both health status and job satisfaction differed between the seven office types. Lowest health status was found in medium-sized and small open plan offices. Best health was among employees in cell offices and flex offices. Workers in these types of offices and in shared room offices also rated the highest job satisfaction. Lowest job satisfaction was in combi offices, followed by medium-sized open plan offices. The differences between employees could possibly be ascribed to variations in architectural and functional features of the office types. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

  • 36.
    Bohm, Katarina
    et al.
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Kurland, Lisa
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Bartholdson, Sofia
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
    Castrèn, Maaret
    Karolinska Institutet, Institution of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    Descriptions and presentations of sepsis: A qualitative content analysis of emergency calls2015Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, nr 4, s. 294-298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Sepsis is a serious condition which requires early treatment. We often fail to recognize sepsis patients in the chain of prehospital care. Knowledge of how sepsis is expressed in calls to the emergency medical communication centre (EMCC) is limited. An increased understanding could lead to earlier identification of patients with sepsis.

    OBJECTIVE: The aim of this study was to describe the descriptions of sepsis used during communication between the caller and the emergency medical dispatcher (EMD).

    METHODS: To achieve the aim of the study, an inductive approach of qualitative content analysis was used. In total, 29 consecutive patients, who arrived at the emergency department by ambulance and received a diagnosis of sepsis according to the International Classification of Diseases (ICD)-10, were included in the study. For each case, the corresponding emergency call recording from the EMCC was transcribed verbatim. Main categories and subcategories from the text were abstracted.

    RESULTS: From fifteen subcategories, three main categories were abstracted: "Deterioration", "Physical signs and symptoms" and "Difficulties establishing satisfactory contact with the patient." The way laymen and professionals expressed themselves seemed to differ.

    CONCLUSIONS: Sepsis was described in terms of the physical symptoms, changes of condition and communication abilities of the patient. This knowledge could lead to the identification of keywords which could be incorporated in the decision tool used by the EMD to increase sepsis identification, but further research is required.

  • 37.
    Borg, S.
    et al.
    The Swedish Institute for Health Economics (IHE), Lund, Sweden.
    Näslund, Ingmar
    Surgical department, Örebro University Hospital, Region Örebro län, Örebro, Sweden.
    Persson, U.
    The Swedish Institute for Health Economics (IHE), Lund, Sweden.
    Ödegaard, K.
    The Swedish Institute for Health Economics (IHE), Lund, Sweden.
    Budget impact analysis of surgical treatment for obesity in Sweden2012Ingår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 101, nr 3, s. 190-197Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The recent substantial increase in the number of obese surgeries performed in Sweden has raised concerns about the budget impact.

    Objective: Our aim in this paper is to present an assessment of the budgetary impact of different policies for surgical intervention for obese and overweight subjects from a healthcare perspective in Sweden.

    Methods: The model simulates the annual expected treatment costs of obesity related diseases and surgery in patients of different sex, age and Body Mass Index (BMI). Costs evaluated are costs of surgery plus the excess treatment costs that an obese patient has over and above the treatment costs of a normal-weight patient. The diagnoses that are included for costs assessment are diabetes and cardiovascular disease since these diagnoses are the principal diagnoses associated with obesity. Four different scenarios over the number of surgical operations performed each year are simulated and compared: (1) no surgical operation, (2) 3 000 surgical operations in persons with BMI > 40, (3) 4 000 (BMI > 40), and (4) 5 000 (expanded to BMI > 38).

    Results: Comparing Scenario 2 with Scenario 1 results in a net budget impact of on average SEK 121 million per annum or SEK 40 000 per patient. This implies that 55 percent of the cost of surgery, set equal to SEK 90 000 for each patient, has been offset by a reduction in the excess treatment costs of obesity related diseases. Expanding annual surgery from 3000 to 4000 the cost-offset increased to 58%. By expanding annual surgery further from 4000 to 5000 and at the same time expanding the indication for surgery from BMI > 40 to BMI > 38, no cost-offset is obtained.

    Conclusion: A cost-minimization strategy for bariatric surgery in Sweden should not expand indication, but rather increase the number of surgeries within the currently accepted indication.

  • 38.
    Borgström, Ellinor
    et al.
    Örebro universitet, Hälsoakademin.
    Holma, Therese
    Örebro universitet, Hälsoakademin.
    Hörselrehabilitering för patienter med Alzheimers sjukdom - är det meningsfullt?: En litteraturstudie2008Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Sammanfattning

    Åldrandet kan innebära ökade svårigheter att klara det dagliga livet. Kroppen genomgår fysiska förändringar som kan orsaka ökade funktionshinder, bland annat i kommunikationssituationer. Med stigande ålder följer en naturlig degeneration av hörselsystemet och presbyacusis (åldershörselnedsättning) drabbar många äldre. Demens tillhör inte det naturliga åldrandet, men risken att drabbas av Alzheimers sjukdom (den vanligaste demensformen), ökar med stigande ålder. Den kognitiva förmågan påverkas exempelvis genom minnesstörningar och tal- och språksvårigheter, vilket innebär att den drabbade får kommunikationssvårigheter. Syftet med vår uppsats var att undersöka om forskningen funnit samband mellan Alzheimers sjukdom och hörselnedsättning, samt om hörselrehabilitering har någon betydelse för den äldre som drabbas av hörselnedsättning och Alzheimers sjukdom. Denna undersökning genomfördes som en litteraturstudie för att ta reda på kunskapsläget. Resultatet uppvisade ett visst biologiskt samband mellan Alzheimers sjukdom och hörselnedsättning i det centrala hörselsystemet, men ej i det perifera hörselsystemet. Alzheimerdrabbade patienter med hörselnedsättning blev hjälpta av hörapparatanpassning, vilket upplevdes av både patient och dess omgivning. Denna litteraturstudie uppmuntrar till vidare forskning kring hörselrehabiliteringens betydelse för personer med Alzheimers sjukdom och med hörselnedsättning samt kring samband mellan dessa två diagnoser, då forskning kring dessa frågeställningar var mycket begränsad.

    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 39.
    Bosma, A. L.
    et al.
    Department of Dermatology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands.
    Musters, A. H.
    Department of Dermatology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands.
    Bloem, M.
    Department of Dermatology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands.
    Gerbens, L. A. A.
    Department of Dermatology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands.
    Middelkamp-Hup, M. A.
    Department of Dermatology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands.
    Haufe, E.
    Center for Evidence-based Health Care (ZEGV), Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
    Schmitt, J.
    Center for Evidence-based Health Care (ZEGV), Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
    Barbarot, S.
    Nantes Université, Department of Dermatology, CHU Nantes, UMR 1280 PhAN, INRAE, Nantes, France.
    Seneschal, J.
    Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Diseases, University Hospital of Bordeaux, France.
    Staumont-Sallé, D.
    Department of Dermatology, University Hospital of Lille, INFINITE (Institute for Translational Research in Inflammation) Inserm, Lille, France.
    Johansson, E. K.
    Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden; Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Bradley, M.
    Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden; Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    von Kobyletzki, Laura B.
    Örebro universitet, Institutionen för medicinska vetenskaper. Occupational and Environmental Dermatology, Malmö, Lund University, Sweden; Centrum for clinical research, Örebro University, Örebro, Sweden.
    Vittrup, I.
    Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Department of Dermatology and Venereology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
    Ruge, I. Frier
    Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Department of Dermatology and Venereology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
    Thyssen, Jacob P.
    Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
    Vestergaard, C.
    Department of Dermatology Aarhus University hospital, Aarhus, Denmark.
    de Vega, M.
    Research Unit, Academia Española de Dermatologia y Venereologia, Madrid, Spain.
    García-Doval, I.
    Research Unit, Academia Española de Dermatologia y Venereologia, Madrid, Spain.
    Chiricozzi, A.
    Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy.
    Stingeni, Luca
    Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
    Calzavara-Pinton, Piergiacomo
    Department of Dermatology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
    Ardern-Jones, M. R.
    Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Department of Dermatology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
    Reynolds, N. J.
    Institute of Translational and Clinical Medicine, Faculty of Medical Sciences, Framlington Place, Newcastle University, Newcastle upon Tyne, UK; Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
    Flohr, C.
    Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
    Spuls, P. I.
    Department of Dermatology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands.
    Mapping exercise and status update of eight established registries within the TREatment of ATopic eczema (TREAT) Registry Taskforce2023Ingår i: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 37, nr 1, s. 123-136Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: the TREatment of ATopic eczema (TREAT) Registry Taskforce is a collaborative international network of registries collecting data of atopic eczema (AE) patients receiving systemic and phototherapy with the common goal to provide long-term real-world data on the effectiveness, safety and cost-effectiveness of therapies. A core dataset, consisting of domains and domain items with corresponding measurement instruments, has been developed to harmonize data collection.

    OBJECTIVES: we aimed to give an overview of the status and characteristics of the eight established TREAT registries, and to perform a mapping exercise to examine the degree of overlap and pooling ability between the national registry datasets. This will allow us to determine which research questions can be answered in the future by pooling data.

    METHODS: all eight registries were asked to share their dataset and information on the current status and characteristics. The overlap between the core dataset and each registry dataset was identified (according to the domains, domain items and measurement instruments of the TREAT core dataset).

    RESULTS AND CONCLUSIONS: a total of 4,702 participants have been recruited in the 8 registries as of 1st of May 2022. Of the 69 core dataset domain items, data pooling was possible for 69 domain item outcomes in TREAT NL (the Netherlands), 61 items in A-STAR (UK and Ireland), 38 items in TREATgermany (Germany), 36 items in FIRST (France), 33 items in AtopyReg (Italy), 29 items in Biobadatop (Spain), 28 items in SCRATCH (Denmark) and 20 items in SwedAD (Sweden). Pooled analyses across all registries can be performed on multiple important domain items, covering the main aims of analyzing data on the (cost-)effectiveness and safety of AE therapies. These results will facilitate future comparative or joint analyses.

  • 40.
    Brunnberg, Elinor
    et al.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Cedersund, ElisabetHälsohögskolan, Högskolan i Jönköping.
    Välfärdspolitik i praktiken: om perspektiv och metoder i forskning2007Samlingsverk (redaktörskap) (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Förändringar av människors villkor i samhället kräver nya sätt att forska. I den här antologin presenteras olika redskap för kvalitativ forskning om välfärd. I antologin utgår forskarna från redan välkända traditioner inom samhällsvetenskaplig forskning, men argumenterar inte bara för etablerade forskningsmetoder och teoretiska perspektiv inom välfärdsforskningen utan också för nya. Antologin har arbetats fram inom ramen för Nordiska Sommaruniversitetet och därmed influerats av olika forskningstraditioner som förekommer vid universitet och högskolor i Norden.

    Nya forskningsmetoder där människornas egna utsagor och upplevelser tillvaratas kan tolkas utifrån redan etablerade teoretiska perspektiv som fenomenologi, hermeneutik och interaktionism. De forskningsansatser som presenteras möjliggör att människor även själva är med och formulerar bilden av sina livsvillkor. I antologin visas hur forskning med dessa ansatser kan ske tillsammans med människor i olika åldrar och livssituationer. I antologin visas också att komparativa ansatser kan öppna för nya insikter om olika dimensioner i välfärdsystemet som en kulturell praktik.

  • 41.
    Brynhildsen, Jan
    et al.
    Division of Obstetrics & Gynaecology, Faculty of Health Sciences, Linköping University Hospital, Linköping, Sweden.
    Dahle, L. O.
    Division of Obstetrics & Gynaecology, Faculty of Health Sciences, Linköping University Hospital, Linköping, Sweden.
    Behrbohm Fallsberg, M.
    Medical Education Consultant Service, Faculty of Health Sciences, Linköping University Hospital, Linköping, Sweden.
    Rundquist, I.
    Department of Cell Biology, Faculty of Health Sciences, Linköping University Hospital, Linköping, Sweden.
    Hammar, M.
    Division of Obstetrics & Gynaecology, Faculty of Health Sciences, Linköping University Hospital, Linköping, Sweden.
    Attitudes among students and teachers on vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum2002Ingår i: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 24, nr 3, s. 286-288Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Important elements in the curriculum at the Faculty of Health Sciences in Link ping are vertical integration, i.e. integration between the clinical and basic science sections of the curriculum, and horizontal integration between different subject areas. Integration throughout the whole curriculum is time-consuming for both teachers and students and hard work is required for planning, organization and execution. The aim was to assess the importance of vertical and horizontal integration in an undergraduate medical curriculum, according to opinions among students and teachers. In a questionnaire 102 faculty teachers and 106 students were asked about the importance of 14 different components of the undergraduate medical curriculum including vertical and horizontal integration. They were asked to assign between one and six points to each component (6 points = extremely important for the quality of the curriculum; 1 point = unimportant). Students as well as teachers appreciated highly both forms of integration. Students scored horizontal integration slightly but significantly higher than the teachers (median 6 vs 5 points; p=0.009, Mann-Whitney U-test), whereas teachers scored vertical integration higher than students (6 vs 5; p=0.019, Mann-Whitney U-test). Both students and teachers considered horizontal and vertical integration to be highly important components of the undergraduate medical programme. We believe both kinds of integration support problem-based learning and stimulate deep and lifelong learning and suggest that integration should always be considered deeply when a new curriculum is planned for undergraduate medical education.

  • 42.
    Busch, Hillevi
    et al.
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Bergström, Gunnar
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Jensen, Irene B.
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Patterns of sickness absence a decade after pain-related multidisciplinary rehabilitation2011Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 152, nr 8, s. 1727-1733Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Multidisciplinary programmes using a vocational approach can enhance work return in chronic pain patients, but little is known about the long-term effects of rehabilitation. The current study examined the patterns of sickness absence 10 years after participation in 3 treatment groups (physiotherapy, cognitive behavioural therapy, and vocational multidisciplinary rehabilitation) in comparison to a control group receiving treatment-as-usual. Cost-effectiveness was also assessed. Two hundred fourteen patients participated in a randomized controlled trial and were followed-up via register data 10 years after the interventions. On average, persons in multidisciplinary rehabilitation had 42.98 fewer days on sickness absence per year compared to those treated-as-usual (95% confidence interval −82.45 to −3.52, P=0.03). The corresponding reduction of sickness absence after physiotherapy and cognitive behavioural therapy was not significantly different from the control group. The effect of rehabilitation seems to be more pronounced for disability pension than for sick leave. The economic analyses showed substantial cost savings for individuals in the multidisciplinary group compared to the control group.

  • 43.
    Bärkås, Annika
    et al.
    Department of Women's and Children's Health, Uppsala University, Sweden.
    Hägglund, Maria
    Department of Women's and Children's Health, Uppsala University, Sweden.
    Moll, Jonas
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Cajander, Åsa
    Department of Information Technology, Uppsala University, Sweden.
    Rexhepi, Hanife
    School of Informatics, Skövde University, Sweden.
    Hörhammer, Iiris
    Department of Industrial Engineering and Management, Aalto University, Finland.
    Blease, Charlotte
    General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
    Scandurra, Isabella
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Patients' Access to Their Psychiatric Records: A Comparison of Four Countries2022Ingår i: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 294, s. 510-514Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Several Nordic and Baltic countries are forerunners in the digitalization of patient ehealth services and have since long implemented psychiatric records as parts of the ehealth services. There are country-specific differences in what clinical information is offered to patients concerning their online patient accessible psychiatric records. This study explores national differences in Sweden, Norway, Finland, and Estonia in patient access to their psychiatric records. Data was collected through a socio-technical data collection template developed during a workshop series and then analyzed in a cross-country comparison focusing on items related to psychiatry records online. The results show that psychiatric records online are offered to patients in all four countries, and provide the same functionality and similar psychiatry information. Overall, the conclusion is that experiences of various functionalities should be scrutinized to promote transparency of psychiatric records as part of the national eHealth services to increase equality of care and patient empowerment.

  • 44.
    Bärkås, Annika
    et al.
    Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden.
    Kharko, Anna
    Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden; Faculty of Health, University of Plymouth, Plymouth, United Kingdom.
    Blease, Charlotte
    Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden; Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
    Cajander, Åsa
    Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Johansen Fagerlund, Asbjørn
    Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway.
    Huvila, Isto
    Department of ALM, Uppsala University, Uppsala, Sweden.
    Johansen, Monika Alise
    Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, Telemedicine and E-health Research Group, Arctic University of Norway, Tromsø, Norway.
    Kane, Bridget
    Business School, Karlstad University, Karlstad, Sweden.
    Kujala, Sari
    Department of Computer Science, Aalto University, Espoo, Finland.
    Moll, Jonas
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Rexhepi, Hanife
    School of Informatics, University of Skövde, Skövde, Sweden.
    Scandurra, Isabella
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Wang, Bo
    Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway.
    Hägglund, Maria
    Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden.
    Errors, Omissions, and Offenses in the Health Record of Mental Health Care Patients: Results from a Nationwide Survey in Sweden2023Ingår i: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 25, artikel-id e47841Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous research reports that patients with mental health conditions experience benefits, for example, increased empowerment and validation, from reading their patient-accessible electronic health records (PAEHRs). In mental health care (MHC), PAEHRs remain controversial, as health care professionals are concerned that patients may feel worried or offended by the content of the notes. Moreover, existing research has focused on specific mental health diagnoses, excluding the larger PAEHR userbase with experience in MHC.

    OBJECTIVE: The objective of this study is to establish if and how the experiences of patients with and those without MHC differ in using their PAEHRs by (1) comparing patient characteristics and differences in using the national patient portal between the 2 groups and (2) establishing group differences in the prevalence of negative experiences, for example, rates of errors, omissions, and offenses between the 2 groups.

    METHODS: Our analysis was performed on data from an online patient survey distributed through the Swedish national patient portal as part of our international research project, NORDeHEALTH. The respondents were patient users of the national patient portal 1177, aged 15 years or older, and categorized either as those with MHC experience or with any other health care experience (nonmental health care [non-MHC]). Patient characteristics such as gender, age, education, employment, and health status were gathered. Portal use characteristics included frequency of access, encouragement to read the record, and instances of positive and negative experiences. Negative experiences were further explored through rates of error, omission, and offense. The data were summarized through descriptive statistics. Group differences were analyzed through Pearson chi-square.

    RESULTS: Of the total sample (N=12,334), MHC respondents (n=3131) experienced errors (1586/3131, 50.65%, and non-MHC 3311/9203, 35.98%), omissions (1089/3131, 34.78%, and non-MHC 2427/9203, 26.37%) and offenses (1183/3131, 37.78%, and non-MHC 1616/9203, 17.56%) in the electronic health record at a higher rate than non-MHC respondents (n=9203). Respondents reported that the identified error (MHC 795/3131, 50.13%, and non-MHC 1366/9203, 41.26%) and omission (MHC 622/3131, 57.12%, and non-MHC 1329/9203, 54.76%) were "very important," but most did nothing to correct them (MHC 792/3131, 41.29%, and non-MHC 1838/9203, 42.17%). Most of the respondents identified as women in both groups.

    CONCLUSIONS: About 1 in 2 MHC patients identified an error in the record, and about 1 in 3 identified an omission, both at a much higher rate than in the non-MHC group. Patients with MHC also felt offended by the content of the notes more commonly (1 in 3 vs 1 in 6). These findings validate some of the worries expressed by health care professionals about providing patients with MHC with PAEHRs and highlight challenges with the documentation quality in the records.

  • 45.
    Bärkås, Annika
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Scandurra, Isabella
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Rexhepi, Hanife
    School of Informatics, Skövde University, Skövde, Sweden.
    Blease, Charlotte
    General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
    Cajander, Åsa
    Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Patients' Access to Their Psychiatric Notes: Current Policies and Practices in Sweden2021Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, nr 17, artikel-id 9140Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Patients' access to electronic health records (EHRs) is debated worldwide, and access to psychiatry records is even more criticized. There is a nationwide service in Sweden which offers all citizens the opportunity to read their EHR, including clinical notes. This study aims to explore Swedish national and local policy regulations regarding patients' access to their psychiatric notes and describe to what extent patients currently are offered access to them. The rationale behind the study is that current policies and current practices may differ between the 21 self-governing regions, although there is a national regulation. We gathered web-based information from policy documents and regulations from each region's website. We also conducted key stakeholder interviews with respondents from the regions and cross-regional private care providers, using a qualitative approach. The results show that 17 of 21 regions share psychiatric notes with patients, where forensic psychiatric care was the most excluded psychiatric care setting. All private care providers reported that they mainly follow the regions' guidelines. Our findings show that regional differences concerning sharing psychiatric notes persist, despite Swedish regulations and a national policy that stipulates equal care for everyone. The differences, however, appear to have decreased over time, and we report evidence that the regions are moving toward increased transparency for psychiatry patients.

  • 46.
    Cajander, Åsa
    et al.
    Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Huvila, Isto
    Department of Archive, Library and Museum Studies, Uppsala University, Uppsala, Sweden.
    Salminen-Karlsson, Minna
    Centre for Gender Studies, Uppsala University, Uppsala, Sweden.
    Lind, Thomas
    Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Scandurra, Isabella
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Effects of patient accessible electronic health records on nurses' work environment: a survey study on expectations in Sweden2022Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 11, artikel-id e059188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The introduction of information and communication technology influences the work environment of large groups of employees in healthcare. In Sweden, a national healthcare service providing patient accessible electronic health records (PAEHR) has been deployed, and this paper investigates nurses' expected effects of this implementation.

    SETTING: Nurses associated with the Swedish Association of Health Professionals working in healthcare such as primary care, hospitals and midwives in Sweden. Before a full-scale national implementation of PAEHR, a web survey study was distributed nationally. The respondents represented all 21 Swedish regions. Questions included five-point Likert scale questions and open questions.

    PARTICIPANTS: A survey link was distributed via email to 8460 registered nurses, midwives and union representatives in Sweden. The response rate was 35.4% (2867 respondents: registered nurses 84%; midwives 6%; chief position 5%; in projects 2% and other 3%). Three reminders were sent out, all of them increasing the response rate. A majority of the respondents were female (89.9%), 8.4% male, whereas 1.7% did not indicate their gender. 31.4% were under 40 years old, 53.8% 40-59 and 13.7% over 60.

    RESULTS: Data were analysed using exploratory factor analysis with principal component analysis as the extraction method. The analysis revealed three distinct factors related to nurses' expectations of PAEHR: (1) PAEHR improves the quality of care, (2) PAEHR improves the quality of the work environment and (3) risk and fears concerning patients' well-being. Some interesting results include that more experienced nurses are more favourable to PAEHR. Our analysis also shows that the view of the nurse-patient relationship is an essential underlying factor related to positive or negative expectations.

    CONCLUSIONS: Results show that the expectations and perceptions of PAEHR vary depending on the nurse's view of who the electronic record belongs to. Younger nurses are somewhat more negative towards PAEHR than older nurses.

  • 47.
    Carlfjord, Siw
    et al.
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden.
    Nilsing-Strid, Emma
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Centre.
    Johansson, Kajsa
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden.
    Holmgren, Theresa
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden; Department of Orthopaedics, Region Östergötland, Linköping, Sweden.
    Öberg, Birgitta
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study2019Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, nr 4, s. 622-629Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    RATIONALE, AIMS, AND OBJECTIVES: To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence-based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence-based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation.

    METHODS: A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis.

    RESULTS: The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient- and provider-related challenges to the implementation were mentioned.

    CONCLUSIONS: The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.

  • 48.
    Carling, Anna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Centre; Department of Physiotherapy.
    Nilsagård, Ylva
    Health Care Management, Region Örebro County, Örebro, Sweden.
    Forsberg, Anette
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Making it work: experience of living with a person who falls due to multiple sclerosis2020Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 42, nr 7, s. 940-947Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The purpose of this study was to describe how everyday life is experienced by next of kin sharing residence with a person who falls due to multiple sclerosis (MS).

    METHODS: Twenty face-to-face interviews were analysed using a qualitative content analysis.

    RESULTS: The overall theme "Making it work" represents the next of kin's struggle to make life work. It comprises three themes: "Taking responsibility", "Making adjustments", and "Standing aside for someone else". The two first themes reflect what relatives do to make the situation work, and the last theme represents what they give up.

    CONCLUSION: Next of kin who share residence and everyday life with a person with MS are affected by that person's occasional falls. They often take on the responsibility of preventing such falls and adapt their lives practically and emotionally. However, adaptation is neither always enough or always possible. In these cases, relatives often deprioritize their own needs and free time to make everyday life in the home work.

    Implications for rehabilitation

    • By highlighting that next of kin also are affected by the falls of their cohabiting person with multiple sclerosis enhances the importance of fall prevention activities that should include the next of kin.
    • Next of kin to people who occasionally fall due to multiple sclerosis can be in need of both practical and emotional support from the health care system.
    • Enhanced information from the health care system can empower and help them to take care of themselves while managing to live with, care for, and protect the person with multiple sclerosis from falls.
  • 49.
    Carlsson, Gunilla
    et al.
    Centre for Ageing and Supportive Environments (CASE), Lund University, Lund, Sweden.
    Pettersson, Cecilia
    Centre for Ageing and Supportive Environments (CASE), Lund University, Lund, Sweden.
    Kylberg, Marianne
    Centre for Ageing and Supportive Environments (CASE), Lund University, Lund, Sweden.
    Iwarsson, Susanne
    Centre for Ageing and Supportive Environments (CASE), Lund University, Lund, Sweden.
    Patientprocesser inom projektet Hälsostaden Ängelholm: Erfarenheter frånmultisjuka äldre, närstående och personal2016Rapport (Övrigt vetenskapligt)
  • 50.
    Carlsson, H.
    et al.
    International Medical Program, Centre for Teaching and Research in Disaster Medicine, Linköping, Sweden.
    Blaku, V.
    Qendra e Mjekesise Urgjente, Qendra e Mjekesise Urgjente, Pristine, Kosovo.
    Lidberg, H.
    International Medical Program, Centre for Teaching and Research in Disaster Medicine, Linköping, Sweden.
    Hodza-Beganovic, Ruhija
    Örebro universitet, Institutionen för hälsovetenskaper. International Medical Program, Centre for Teaching and Research in Disaster Medicine, Linköping, Sweden.
    Berggren, P.
    International Medical Program, Centre for Teaching and Research in Disaster Medicine, Linköping, Sweden; Linköping University, Linköping, Sweden.
    Implementing treatment guidelines for ambulance services in a low- and middle income setting2019Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr Suppl. 4, s. 515-515Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: The use of clinical practice guidelines in clinical and organizational decision-making improves the care of patients and patient safety. Guidelines make healthcare consistent and efficient. In many low- and middle income countries healthcare workers depend on guidelines developed in higher income countries. For these to be useful and accepted they need to be adapted to the local setting. The aim of the study was to implement pre-hospital treatment guidelines into an organization that was not currently using guidelines. The study was partnership between a Swedish pre-hospital training organization and local ambulance service organizations in Kosovo.

    Methods: An iterative process of implementing the guidelines was used:

    • Identify guidelines appropriate for the local organization.
    • In sets of five, have the guidelines translated into Albanian.
    • Adapt the guidelines to the local conditions and context.
    • Approval of guidelines by an expert group.
    • Begin using the guidelines within the target organization.

    Results: The first set of five guidelines was translated, approved, and implemented into the organizations. To improve acceptance, both practitioners and decision-makers were involved in the process. Seven workshops were held, with a total of 104 participants. In follow-up discussions participants said they accepted the guidelines and that they would be useful in their daily work.

    Conclusions: It is important to evaluate to what extent the guidelines have been accepted, understood, and used. The success and acceptance is due to the flexible procedure managing the full implementation process. Adapting guidelines to fit with local needs and requirements using local experts made the guide-lines accessible and useful. The workshop discussions established justification and approval.

    Key messages:

    • Involve local experts in contextualising guidelines to increase acceptance from the start.
    • Support building a robust local implementation organization to assist and administer change.
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