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  • 151.
    Sahlin Åkerstedt, Ulrika
    et al.
    Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Cajander, Åsa
    Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Moll, Jonas
    Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Ålander, Ture
    Department of Public Health and Caring Sciences, Uppsala University Hospital, Uppsala, Sweden.
    On threats and violence for staff and patient accessible electronic health records2018In: Cogent Psychology, E-ISSN 2331-1908, Vol. 5, no 1, article id 1518967Article in journal (Refereed)
    Abstract [en]

    Does patient accessible electronic health records (PAEHR) result in increased risk of threats and violence? This study was conducted one year after launching PAEHR in Uppsala to examine whether staff whose patients had gained access to the patient portal perceived greater risks of threats and violence, and were exposed to more threats and violence, than those whose patients had not yet gained access. A total of 174 (35%) professionals responded to a web survey. 83 were from the emergency department, whose patients had online electronic health record access, and 91 were from the psychiatric department, whose patients had not. 40% of all participating professionals believed that risks of threats and violence increase after launch. The results did not support a correlation with more incidents of threats and violence, and only one respondent reported that patient access had played any significant negative role in relation to an incident.

  • 152.
    Scandurra, Isabella
    FoU Seniorium, Danderyd, Sweden.
    Hållbara och kvalitetssäkrade kommunikationstjänster i äldreomsorgen2011Report (Other academic)
    Abstract [sv]

    Denna  slutrapport  innehåller  två  delprojekt  i  ett  Vinnova‐finansierat  samverkansprojekt där problemägare,  företag  och  forskare  medverkar  i  skärningspunkten mellan vård och teknik, äldre användare och utvecklare.  Projektet  syftar  till  att  gemensamt  utveckla  och  kvalitetssäkra  hållbara kommunikationstjänster i äldreomsorgen  och  har  beviljats  anslag  från  VINNOVA,  Verket  för  Innovationssystem.  Arbetet  kan  beskrivas  som  en  slags  innovationsupphandling  där  kommuner  och  FoU‐enheter  höjer  sin  beställarkompetens  och  där  företaget  genom  detta  Forska&väx‐projekt  ökar sin kunskap om slutanvändaren i kommunen och genom forskarna får  en  chans  att  stärka  sitt metodologiska  angreppssätt. Syftet med  det  är  att  företaget  InView  AB  tack  vare  ökad  kunskap  om  användarcentrerad utveckling och olika kommuners lokala behov kan öka sin konkurrenskraft.

    Målet var att ta fram ett tjänsteutbud som svarar upp till samhällets behov  av  nya  hållbara  och  kvalitetssäkrade  kommunikationstjänster  i  äldreomsorgen. I detta arbete har användarcentrerade utvecklingsmetoder  varit  centralt,  där  presumtiva  kunder  och  slutanvändare  är  delaktiga  i  processen. Däri består  kvalitetssäkringen, att användaren av  tjänsten görs  delaktig och att de arbetssätt som utvecklats är dynamiska så att lärdomar  byggs in i systemet som görs hållbart med öppna standarder. 

    InView  AB  var  projektägare  i  samverkan  med  representanter  från  FoU  Seniorium,  FoU  Jämt,  Swedish  Institute  of  Computer  Science  (SICS)  med  fallstudier  i  fyra  referens‐kommuner.  Projektarbetet  har  bedrivits  i  åtta  delprojekt; 

    ‐ Metodprojektet, användarcentrerade utvecklingsmetoder och socio‐ tekniska införandemetoder,   ‐ Informationsstrukturprojektet, utveckling av en användbar och  skalbar informationsstruktur,   ‐ Affärsmodellsprojektet, med kommunen som kund till ippi‐tjänsten,   ‐ Jämtlandsprojektet i Berg, service i glesbygd,   ‐ Södertäljeprojektet, hemtjänstverksamhet,   ‐ Täbyprojektet, en träffpunkt för seniora invånare,   ‐ Vallentunaprojektet, ett vård‐ och omsorgsboende, och slutligen   ‐ Teknikprojektet, bestående av utveckling och test av ippi‐systemet.

    Genom ett verksamhetsnära samarbete i de fyra kommunerna med skilda behov och användargrupper har InView och forskarorganisationen i projektet lyft ippi‐plattformens funktionalitet och erhållit värdefulla erfarenheter kring införande av ippi som teknikstöd. Under projektet har ippi vidareutvecklats med sociala kommunikations‐tjänster, vård‐ och omsorgsriktade tjänster och tjänster med fokus på friskvård och hälsa, samt informationstjänster om lokalt aktivitetsutbud. De användarcentrerade utvecklingsmetoderna och socio‐tekniska införandemetoder har varit centrala i projektet och i stort bidragit till projektets lyckade utgång. Affärsmodellen för ippi‐tjänsten med kommunen som kund har utvecklats med argument baserade i Socialtjänstlagstiftningen och bekräftats genom att tre av fyra medverkande kommuner har beslutat att fortsätta i någon form. Dessa kommuner har även agerat referenskommuner och InView har sedan hösten 2009 utökat sitt kundsamarbete till att våren 2011 arbeta med 22 kommuner.

  • 153.
    Scandurra, Isabella
    APRI eHealth, Själevad, Sweden.
    Störande eller stödjande?: Om eHälsosystemens användbarhet 20132013Report (Other academic)
  • 154.
    Scandurra, Isabella
    Department of Medical Sciences, Biomedical Informatics and Engineering, Uppsala University, University Hospital, Uppsala, Sweden.
    Visualization and Interaction Design for Ubiquitous Access to Shared Medical Information2005In: Human-computer interaction: INTERACT 2005: IFIP TC13 international conference on Human-computer interaction, 12th-16th September 2005, Rome, Italy: adjunct proceedings / [ed] Buono, Costabile, Paternò & Santoro, Bari: Laterza, Giuseppe , 2005, p. 39-40Conference paper (Refereed)
    Abstract [en]

    The goal of the research work is to develop prototypes for visualization of and interaction with medical information for some specific clinical work situations and to conduct usability tests in order to ensure future guidelines’ validity and reliability. For prototype development user centred system design (UCSD) is used and so far, the specific requirements for applying UCSD in the health care area have been identified. New demands for visualization and interaction design in mobile and shared care considering both the users and the context of use are described.

  • 155.
    Scandurra, Isabella
    et al.
    Centre for EHealth, Uppsala University, University Hospital, Uppsala, Sweden; Dept of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Dept of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    Dept of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Koch, Sabine
    Centre for EHealth, Uppsala University, University Hospital, Uppsala, Sweden; Dept of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Heuristic Evaluation Performed by Usability-educated Clinicians: Education and Attitudes2007In: Information Technology in Health Care 2007: Proceedings of the 3rd International Conference on Information Technology in Health Care: Socio-technical Approaches / [ed] E. Coiera, J.I. Westbrook, J.L. Callen, and Jos Aarts, IOS Press, 2007, p. 205-216Chapter in book (Refereed)
    Abstract [en]

    Heuristic evaluation is a usability testing method aiming to improve the user interface design. Traditionally, a panel of experts in usability and human factor issues evaluate and judge the compliance of computer software according to recognized usability principles, the heuristics. In this paper, we investigate clinicians' attitudes towards learning and performing a heuristic evaluation and present the procedure of educating the healthcare staff and their accomplishment of the evaluation. 18 clinicians were recruited for a 2-hours education and filled in a post-education questionnaire regarding their opinions of the evaluation method when applied by clinicians. Six of the clinicians participated later in a heuristic evaluation of a web-based virtual health record,Their time spent for evaluation and analysis of results was approximately four hours each. Opinions from the six "clinical evaluators" were gathered in an post-evaluation form and compared to the post-education questionnaire. The results of 18 clinicians indicate that there is an interest in learning and participating in such evaluations. Our interpretation is that it is feasible to educate healthcare staff to perform rapid usability inspections to locate usability defects and additionally emphasize the domain specific problems residing in health information systems.

  • 156.
    Scandurra, Isabella
    et al.
    Örebro University, Örebro University School of Business.
    Hägglund, Maria
    Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden.
    Johansen, Monika
    Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, the Artic University of Norway (UIT), Tromsø, Norway.
    Bergmo, Trine
    Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.
    Zanaboni, Paolo
    Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.
    Impact of Patient Accessible EHRs: An Interactive Workshop to Share Experiences and Explore Evaluation Approaches2017Conference paper (Other academic)
  • 157.
    Scandurra, Isabella
    et al.
    Department of Medical Sciences, Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Department of Medical Sciences, Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Johansson, Niklas
    Department of Information Technology, Human Computer Interaction, Uppsala University, Uppsala, Sweden.
    Sandblad, Bengt
    Department of Information Technology, Human Computer Interaction, Uppsala University, Uppsala, Sweden.
    Koch, Sabine
    Department of Medical Sciences, Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    User needs for development of context dependent devices in mobile home care2003In: Human-Computer Interaction with Mobile Devices and Services: 5th International Symposium, Mobile HCI 2003, Udine, Italy, September 2003. Proceedings / [ed] Luca Chittaro, Springer-Verlag , 2003, p. 446-450Chapter in book (Refereed)
    Abstract [en]

    Mobile work situations within home care of the elderly require immediate and ubiquitous access to patient-oriented data. We intend to develop a mobile information system that provides correct information in a proper way to the right person in the appropriate occasion of care. This requires a thorough user needs analysis that so far often has been neglected during systems development in health care. We conducted the user needs analysis in interdisciplinary working groups in order to achieve a holistic view of the entire work process. This allows for the development of not only patient-oriented but care process oriented systems. In this paper, we describe how the user needs analysis was conducted, the impact of this work on the user group and some of the requirements found to be specific for mobile IT-support for home care of the elderly.

  • 158.
    Scandurra, Isabella
    et al.
    Department of Medical Sciences, Uppsala University, University Hospital, Uppsala, Sweden; Center for eHealth, Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Department of Medical Sciences, Uppsala University, University Hospital, Uppsala, Sweden; Center for eHealth, Uppsala University, Uppsala, Sweden.
    Koch, Sabine
    Department of Medical Sciences, Uppsala University, University Hospital, Uppsala, Sweden; Center for eHealth, Uppsala University, Uppsala, Sweden.
    Clinicians’ opinions towards learning and performing Heuristic Evaluations of Health Information Systems2007In: Proceedings of 5th Scandinavian Conference on Health Informatics (SHI 2007) (Skandinaviska hälsoinformatik- och termkonferensen 2007) / [ed] Göran Petersson et. al., Kalmar: eHealth Institute , 2007, p. 62-62Conference paper (Refereed)
  • 159.
    Scandurra, Isabella
    et al.
    Department of Medical Sciences, Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Department of Medical Sciences, Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Koch, Sabine
    Department of Medical Sciences, Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Integrated care plan and documentation on handheld devices in mobile home care2004In: Mobile Human-Computer Interaction - MobileHCI 2004: 6th International Symposium, MobileHCI, Glasgow, UK, September 13 - 16, 2004. Proceedings / [ed] Stephen Brewster, Mark Dunlop, Springer-Verlag , 2004, p. 496-500Chapter in book (Refereed)
    Abstract [en]

    Mobile work situations within home care of the elderly require immediate and ubiquitous access to patient-oriented data. We have developed a PDA based prototype that provides both access to the current care plan and an intuitive way for home help personnel to document the performed measures during mobile work. System development was conducted according to a user centered design approach in interdisciplinary working groups consisting of home help personnel, nurses, physicians, medical informaticians, system developers and usability experts. In this paper, we describe how the development of the prototype was performed and present our design considerations as well as the resulting prototype.

  • 160.
    Scandurra, Isabella
    et al.
    Medical Informatics and Engineering, Uppsala University, University Hospital, Uppsala, Sweden.
    Hägglund, Maria
    Medical Informatics and Engineering, Uppsala University, University Hospital, Uppsala, Sweden.
    Koch, Sabine
    Medical Informatics and Engineering, Uppsala University, University Hospital, Uppsala, Sweden.
    Specific demands for developing ICT systems for shared home care: a user centred approach2005In: Journal on Information Technology in Healthcare, ISSN 1479-649X, Vol. 3, no 5, p. 279-285Article in journal (Refereed)
    Abstract [en]

    When different care professionals are involved in patient care without proper coordination, the care process may not be meaningfully integrated. To address this issue we have analysed the specific demands for shared home care employing a user-centred system development method and working in close cooperation with district nurses, home helpers and general practitioners. Through this experience we have gained insight into the specific demands that should be taken into consideration when developing information communication technology (ICT) systems for shared home care. This paper describes these requirements and also how a user-centred system engineering approach can assist in improving cooperation in shared home care.

  • 161.
    Scandurra, Isabella
    et al.
    Medical Informatics and Engineering, Uppsala University, University Hospital, Uppsala, Sweden.
    Hägglund, Maria
    Medical Informatics and Engineering, Uppsala University, University Hospital, Uppsala, Sweden.
    Koch, Sabine
    Medical Informatics and Engineering, Uppsala University, University Hospital, Uppsala, Sweden.
    Specific Demands for Developing IT Systems for Shared Home Care: A User Centred Approach2005In: Telemedicine and eHealth in Recent Years: Meeting the Challenges / [ed] Kioulafas K, Katharaki M, National and Kapodistrian University of Athens , 2005, no 2, p. 371-376Conference paper (Refereed)
  • 162.
    Scandurra, Isabella
    et al.
    Department of Medical Sciences, Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Department of Medical Sciences, Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Koch, Sabine
    Department of Medical Sciences, Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Visualization and Interaction Techniques for Mobile CloseCare2003In: Physics and engineering in evidence-based medicine: World Congress on Medical Physics and Biomedical Engineering, August 24-29, 2003, Sydney Convention and Exhibition Centre. Congress proceedings, IFMBE , 2003Chapter in book (Refereed)
  • 163.
    Scandurra, Isabella
    et al.
    Department of Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Department of Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Moström, Dennis
    XLENT technology.
    Koch, Sabine
    Department of Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Heuristic Evaluation Extended by User Analysis: A fast and efficient method to identify Potential Usability Problems in Health Information Systems2006In: Journal on Information Technology in Healthcare, ISSN 1479-649X, Vol. 4, no 5, p. 317-325Article in journal (Refereed)
    Abstract [en]

    Heuristic evaluation is a usability testing method for computer software that helps to identify usability problems in the user interface (UI) design. It specifically involves evaluators examining the interface and judging its compliance with recognised usability principles (the "heuristics"). Despite the benefits of this practice, to our knowledge formal heuristic evaluation is rarely performed for healthcare software applications, and particularly for those used in home care. In this paper we present a heuristic evaluation aimed at improving the usability of a virtual health record used by district nurses in home care. A user analysis was added to the conventional evaluation, defining specific characteristics of district nurses in home care, e.g. expertise, skills, knowledge, cognitive capacities and frequency of system use. The evaluation was performed by 6 people, half of which had both heuristic evaluation experience and medical domain knowledge. The evaluators used 10 heuristics to categorise heuristic violations and usability problems. Fifty-eight heuristic violations and 44 usability problems were identified. Based on a scale of 1 (cosmetic) to 4 (catastrophic) the average severity ratings of all heuristic violations identified was 1.78. The most frequently violated were "Consistency and Standards" for novice users and "Flexibility and efficiency of use" for Experienced users. The most severe violations were found in "Visibility of system status". The results of our study indicate that heuristic evaluation combined with user analysis provides a richer assessment than heuristic evaluation alone for the development of Health Information Systems where heterogeneous user groups are common.

  • 164.
    Scandurra, Isabella
    et al.
    Department of Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Department of Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Moström, Dennis
    XLENT technology.
    Koch, Sabine
    Department of Medical Informatics and Engineering, Uppsala University, Uppsala, Sweden.
    Heuristic Evaluation extended by User Analysis: A fast and efficient method to identify potential usability problems in Health Information Systems2006In: Proceedings of ICICTH 2006 / [ed] Kioulafas, K.; Katharaki, M., 2006, no 5, p. 171-177Conference paper (Refereed)
  • 165.
    Scandurra, Isabella
    et al.
    Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden.
    Åhlfeldt, Rose-Mharie
    School of Humanities and Informatics, University of Skövde, Skövde, Sweden.
    Experiences of Novel e-Health Services for Patients: Pros, Cons and Future Challenges2013In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 192, p. 1254-1254Article in journal (Refereed)
    Abstract [en]

    It is crucial to involve the patient in the development of patient accessible eHealth systems. But who, how and when? Patientinvolvement in development of e-health services for citizens has gained little attention to date. It is important to highlight theexperiences, pros and cons, and explore new issues and future challenges that arise for all different stakeholders involved in e-healthdevelopment. One source of inspiration for this workshop is the European funded SUSTAINS project which aims to deploy e-healthservices with the patient as an important actor. Another is the Swedish research project My Care Pathways where focus is ondevelopment of new e-health services that enable the patient to follow and interact with their care processes. This workshop aims todiscuss the experiences made in ongoing European deployment projects of online e-health services as well as methods to improvepatient participation in such development based on current evaluations and future needs. The objective is to collect and disseminatevarious experiences from novel e-health service deployment in Europe; during the workshop active participation is desired via twitterand other eLearning tools, and afterwards the results of the workshop are published on easily accessible web sites.

  • 166.
    Scandurra, Isabella
    et al.
    Örebro University, Örebro University School of Business.
    Jansson, Anette
    Region Örebro County, Örebro, Sweden.
    Forsberg-Fransson, Marie-Louise
    Region Örebro County, Örebro, Sweden.
    Ålander, Ture
    Department of Public Health and Caring Sciences (IFV), Uppsala University, Uppsala, Sweden.
    Patient Accessible EHR is Controversial: Lack of Knowledge and Diverse Perceptions Among Professions2017In: International Journal of Reliable and Quality E-Healthcare, ISSN 2160-9551, E-ISSN 2160-956X, Vol. 6, no 1, p. 29-46Article in journal (Refereed)
    Abstract [en]

    In Sweden, a national eHealth service providing Patient Accessible Electronic Health Records is now being widely deployed, with 400 000 users in January 2016. Although the Patient Data Act states that patients have a right to take part of their health records, the introduction has been controversial. Results from a pre-deployment questionnaire to record-keeping care professions in a healthcare region indicate that perceptions and knowledge differ not only between the professions but, more importantly, that knowledge about current eHealth development and action plans needs to increase as implementation will affect their work processes. Staff perceptions and knowledge are considered being some of the most important issues to handle during the implementation of eHealth services aiming to provide healthcare information and communication tools for patients and relatives. To cover the gaps, specific training is needed, and all record-keeping professionals need to be more involved in the implementation of such eHealth services.

  • 167.
    Scandurra, Isabella
    et al.
    Örebro University, Örebro University School of Business.
    Pettersson, Maria
    Department of Journalen, Inera AB, Stockholm, Sweden .
    Eklund, Benny
    Uppsala County Council, Uppsala, Sweden.
    Lyttkens, Leif
    Uppsala County Council, Uppsala, Sweden.
    Analysis of the Updated Swedish Regulatory Framework of the Patient Accessible Electronic Health Record in Relation to Usage Experience2017In: MEDINFO 2017: Precision Healthcare through Informatics / [ed] Adi V. Gundlapalli, Marie-Christine Jaulent, Dongsheng Zhao, IOS Press, 2017, Vol. 245, p. 798-802Conference paper (Refereed)
    Abstract [en]

    In Sweden, all citizens can (in 2017) access their health data online from all county councils using one national eHealth service. However, depending on where the patient lives, different information is provided as care providers have assessed differently how to apply the National Regulatory Framework (NRF). The NRF recently was updated and this paper analyses version 2.0 should now serve as the guideline for all county councils. Potential improvements are analyzed in relation to patient experiences of using the service, and the rationale for each change in the NRF is discussed. Two real case quotations are used to illustrate potential implications for the patient when the new version is placed into operation. Results indicate that this NRF allows for opportunities to create a national eHealth service that better supports patient-centered care and improves health information outcome.

  • 168.
    Scandurra, Isabella
    et al.
    Örebro University, Örebro University School of Business.
    Pettersson, Maria
    Inera AB, Stockholm, Sweden.
    Hägglund, Maria
    Karolinska Institutet, Stockholm, Sweden.
    When do people read their health record?: analysis of usage data of a national eHealth service giving patients access to their electronic health record2017Conference paper (Other academic)
    Abstract [en]

    Introduction: eHealth services for citizens provide support for patients and families, as well as for healthcare professionals. In Sweden different eHealth services have been developed since the late 1990s and they are now used by millions of users. One of the national eHealth services that provides opportunities for increased participation in care is the Patient Accessible Electronic Health Record (PAEHR). To date (February 2017) over one million citizens (of 10 million inhabitants) have accessed their own electronic health record (EHR). In this study, we describe current usage by analysing log-data from the service. Who are the users, and how and when do they use the service?

    Method: Data collection of routinely captured usage data was administered by Inera AB, owner of all Swedish national eHealth services. Data was analyzed through IBM SPSS in accordance with the declaration of Helsinki. Queries for this quantitative study were created based on previously published results regarding concerns often expressed by healthcare professionals (HCP) as well as routinely captured log-data. Descriptive usage statistics were analysed towards such HCP concerns, e.g. increased workload due to worried patients reading but not understanding the PAEHR content.

    Results: Current status of the Swedish PAEHR is presented, e.g. number of users, demographic data (age, gender) in relation to log-in statistics. Regarding log-ins, first-time users and unique hits show that attention by national media has an impact a news cast resulted in 31,000 logged in compared to a week day average of 20,000. To date more than 1 million citizens have chosen to log in and the numbers are increasing. A newly connected region (Örebro) has an average of 500 new users a day. This can be compared to the first region (Uppsala) which during the first year (2012- 2013) had approx. 100 new users a day, although the strategy then was not to advertise the service. In total 10,000 to 13,000 new users log in every day nationally. More women than men log in and their mean age are 23-32 years. The older the users get the less they use the PAEHR, however some users are older than 93 years. During weekends the activity decreases, as opposed to HCP expectations. More often, users log in on week days, e.g. on Monday morning.

    Discussion: Usage statistics were related to concerns of HCP, which seem to have little resemblance to reality. One concern was that the service would not provide benefit for patients, here contradicted by the increasing number of both first-time and recurrent users. However, such indicators need to be further analysed. Paper records and PAEHR usage are difficult to compare, due to lack of statistics regarding printout reading. Usage comparisons between PAEHR solutions of different counties would however be interesting.

    Conclusion: Recurrent concerns of mainly HCP seem to be contradicted by actual usage by patients. This may lead to a decreased controversy of how PAEHR is experienced by patients and HCP. Knowledge about how users actually use PAEHR may also improve the service as such.

  • 169.
    Schollin, Jens
    et al.
    Örebro University, School of Medical Sciences.
    Lindgren, Stefan
    Lund University, Malmö, Sweden .
    Starten på det yrkeslivslånga lärandet som läkare [A new internationally harmonized Swedish basic medical education]2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, no 35-36, article id FR4SArticle in journal (Refereed)
    Abstract [sv]

    The Swedish Parliament and Government has recently sanctioned a new 6 year undergraduate medical degree leading directly to license, followed by a 12 month introduction to work as a certified doctor. The undergraduate education is internationally harmonized and the 23 learning outcomes address competence needs in future Swedish and international health-care. Particular attention is given to professional competence, critical thinking, team-work and health promotion. All 23 learning outcomes must be documented before the University can issue a MD degree. After license, the doctor applies for a 12 month introduction to employment as doctor in the Swedish health-care system. This introduction is mandatory for all, regardless of the country where the license was issued. The introduction comprises clinical service in general medicine, emergency medicine and elective disciplines. Assessment of 10 learning outcomes is carried out in a formative wav by experienced and trained clinicians during the clinical service. After the introduction, the doctor is duly qualified to apply for specialist training.

  • 170.
    Schröder, Agneta
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Health Science, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), Gjövik, Norway.
    Lundqvist, Lars-Olov
    Örebro University, School of Law, Psychology and Social Work.
    International comparisons of patients and staff views of quality in psychiatric care with the QPC instrument2017Conference paper (Other academic)
  • 171.
    Schröder, Agneta
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Lundqvist, Lars-Olov
    Örebro University, School of Health Sciences.
    Patients' and staff's experiences of quality of psychiatric care: An international comparison2018Conference paper (Refereed)
  • 172.
    Shebehe, Jacques
    et al.
    The University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hansson, Anders
    Örebro University, School of Medical Sciences. The University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Academy of Sahlgrenska, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    High hospital readmission rates for patients aged ≥65 years associated with low socioeconomic status in a Swedish region: a cross-sectional study in primary care2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 3, p. 300-307Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: There is a presumption that hospital readmission rates amongst persons aged ≥65 years are mainly dependent on the quality of care. In this study, our primary aim was to explore the association between 30-day hospital readmission for patients aged ≥65 years and socioeconomic characteristics of the studied population. A secondary aim was to explore the association between self-reported lack of strategies for working with older patients at primary health care centres and early readmission.

    DESIGN: A cross-sectional ecological study and an online questionnaire sent to the heads of the primary health care centres. We performed correlation and regression analyses.

    SETTING AND SUBJECTS: Register data of 283,063 patients in 29 primary health care centres in the Region Örebro County (Sweden) in 2014.

    MAIN OUTCOME MEASURE: Thirty-day hospital readmission rates for patients aged ≥65 years. Covariates were socioeconomic characteristics among patients registered at the primary health care centre and eldercare workload.

    RESULTS: Early hospital readmission was found to be associated with low socioeconomic status of the studied population: proportion foreign-born (r = 0.74; p < 0.001), proportion unemployed (r = 0.73; p < 0.001), Care Need Index (r = 0.74; p < 0.001), sick leave rate (r = 0.51; p < 0.01) and average income (r = -0.40; p = 0.03). The proportion of unemployed alone could explain up to 71.4% of the variability in hospital readmission (p < 0.001). Primary health care centres reporting lack of strategies to prevent readmissions in older patients did not have higher hospital readmission rates than those reporting they had such strategies.

    CONCLUSION: Primary health care centres localized in neighbourhoods with low socioeconomic status had higher rates of hospital readmission for patients aged ≥65. Interventions aimed at reducing hospital readmissions for older patients should also consider socioeconomic disparities.

    Key Points

    • In Sweden, hospital readmission within 30 days among patients aged ≥65 has been used as a measure of quality of primary care for the elderly.
    • However, in our study, elderly 30-day readmission was associated with low neighbourhood socioeconomic status.
    • A simple survey in one Swedish region showed that the primary health care centres that lacked active strategies for working with aged patients did not have higher hospital readmission rates than those that reported having strategies.
    • Interventions aimed at reducing elderly hospital readmissions should therefore also consider the socioeconomic disparities in the elderly.
  • 173.
    Solbakken, Rita
    et al.
    Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
    Bergdahl, Elisabeth
    Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
    Rudolfsson, Gudrun
    Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway; Department of Health Sciences, Division of Nursing, University West, Trollhättan, Sweden.
    Bondas, Terese
    Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
    International Nursing: Caring in Nursing Leadership – A Meta-ethnography From the Nurse Leader's Perspective2018In: Nursing Administration Quarterly, ISSN 0363-9568, E-ISSN 1550-5103, Vol. 42, no 4, p. E1-E19Article in journal (Refereed)
    Abstract [en]

    To explore and derive new conceptual understanding of nurse leaders' experiences and perceptions of caring in nursing.

    RESEARCH QUESTION: What is caring in nursing leadership from the nurse leaders' perspectives? There is a paucity of theoretical studies of caring in nursing leadership. Noblit and Hares interpretative meta-ethnography was chosen because of its interpretative potential for theory development. Caring in nursing leadership is a conscious movement between different "rooms" in the leader's "house" of leadership. This emerged as the metaphor that illustrates the core of caring in nursing leadership, presented in a tentative model. There are 5 relation-based rooms: The "patient room," where nurse leaders try to avoid patient suffering through their clinical presence; the "staff room," where nurse leaders trust and respect each other and facilitate dialogue; the "superior's room," where nurse leaders confirm peer relationships; the "secret room," where the leaders' strength to hang on and persist is nurtured; and the "organizational room," where limited resources are continuously being balanced. Caring in nursing leadership means nurturing and growing relationships to safeguard the best nursing care. This presupposes that leaders possess a consciousness of the different "rooms." If rooms are not given equal attention, movement stops, symbolizing that caring in leadership stops as well. One room cannot be given so much attention that others are neglected. Leaders need solid competence in nursing leadership to balance multiple demands in organizations; otherwise, their perceptiveness and the priority of "ministering to the patients" can be blurred.

  • 174.
    Stassen, Willem
    et al.
    Department of Clinical Research and Education, Karolinska Institutet, Sweden; Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa.
    Wallis, Lee
    Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
    Castren, Maaret
    Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa.
    Vincent-Lambert, Craig
    Department of Emergency Medical Care, University of Johannesburg, Johannesburg, South Africa.
    Kurland, Lisa
    Örebro University, School of Medical Sciences.
    A Prehospital Randomised Controlled Trial in South Africa: Challenges and Lessons Learnt2019In: African Journal of Emergency Medicine, ISSN 2211-419X, Vol. 9, no 3, p. 145-149Article in journal (Refereed)
    Abstract [en]

    The incidence of cardiovascular disease and STEMI is on the rise in sub-Saharan Africa. Timely treatment is essential to reduce mortality. Internationally, prehospital 12 lead ECG telemetry has been proposed to reduce time to reperfusion. Its value in South Africa has not been established. The aim of this study was to determine the effect of prehospital 12 lead ECG telemetry on the PCI-times of STEMI patients in South Africa. A multicentre randomised controlled trial was attempted among adult patients with prehospital 12 lead ECG evidence of STEMI. Due to poor enrolment and small sample sizes, meaningful analyses could not be made. The challenges and lessons learnt from this attempt at Africa's first prehospital RCT are discussed. Challenges associated with conducting this RCT related to the healthcare landscape, resources, training of paramedics, rollout and randomisation, technology, consent and research culture. High quality evidence to guide prehospital emergency care practice is lacking both in Africa and the rest of the world. This is likely due to the difficulties with performing prehospital clinical trials. Every trial will be unique to the test intervention and setting of each study, but by considering some of the challenges and lessons learnt in the attempt at this trial, future studies might experience less difficulty. This may lead to a stronger evidence-base for prehospital emergency care.

  • 175.
    Sundell, Isa
    et al.
    Uppsala University, Uppsala, Sweden.
    Carbajal, Ricardo
    Université Pierre et Marie Curie, Paris, Frankrike.
    Anand, K.J.S.
    LeBonheur Children’s Hospital, Memphis TN, USA; University of Tennessee Health Science Center, Memphis TN, USA.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    National guidelines for neonatal pain management: occurance and content2013Conference paper (Refereed)
    Abstract [en]

    Introduction & Aims

    International evidence-based guidelines for preventing or treating neonatal pain were published in 2001(1). They describe sources of acute pain and recommend approaches for pain assessment, and pharmacological and non-pharmacological management. We investigated the occurance and content of national guidelines for neonatal pain management and their compliance with international recommendations. A secondary aim was to study how intubation premedication recommendations were followed in clinical practice.

    Methods

    A questionnaire was distributed to neonatal societies worldwide and to members of the e-mail-lists International Pediatric pain-list, NICU-net and Council of International Neonatal Nurses-network. Additionally a search in Pubmed was done, using pain, neonatal, newborn, guideline, government publication and pain management as searchwords. A web-based survey about premedication prior to intubation of newborn infants was sent to members of the same e-mail-lists.

    Results

    National guidelines from 14 countries were obtained, mostly issued by professional societies from 1995 to 2011. Guidelines from 13 countries contained suggestions concerning procedural pain. Other issues were pain assessment (14 countries), postoperative pain (12) and ongoing/prolonged pain (9). Pharmacological and non-pharmacological treatment recommendations were found in 13 national guidelines. Six countries had recommendations for premedication prior to intubation. Seventy-six individuals from 27 different countries responded to the web-based survey. Seventy-one percent used premedications routinely prior to intubation. The most commonly used drug was fentanyl followed by morphine and midazolam. Thirty-four percent reported using muscle relaxant routinely, with suxamethonium as the most commonly used drug. Thirty-six percent used atropine prior to intubation.

    Discussion & Conclusions

    Many countries have still not developed national guidelines for management of neonatal pain. The guidelines obtained in this study comply with the international guidelines concerning their recommendations for pain assessment, actions at procedural pain, and pharmacological and non-pharmacological pain treatment. Many national guidelines do not have specific suggestions concerning dosages of drugs, management of ongoing/prolonged pain, and premedications for intubation. The web-based survey indicates that the use of premedication is still not widely adopted and there is wide variability in the drugs and doses used. The lack of evidence-based recommendations for intubation premedication in many countries also implies that the international guidelines should be revised and updated.

    Reference

    1. Anand, K. J. S. & the International Evidence-Based Group for Neonatal Pain (2001). Consensus statement for the prevention and management of pain in the newborn. Archives of Pediatrics and Adolescent Medicine, 155(2), 173-180.

    The authors have no conflict of interest to declare.

  • 176.
    Sundström, Johan
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center (UCR), Uppsala, Sweden.
    Björkelund, Cecilia
    Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Giedraitis, Vilmantas
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Hansson, Per-Olof
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Högman, Marieann
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Koupil, Ilona
    Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Kristenson, Margareta
    Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden.
    Lagerros, Ylva Trolle
    Department of Medicine, Unit of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden; Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Huddinge, Sweden.
    Leppert, Jerzy
    Västerås Centre for Clinical Research, Uppsala University, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lissner, Lauren
    Department of Public Health and Community Medicine/Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Johansson, Ingegerd
    Department of Odontology, School of Dentistry, Umeå University, Umeå, Sweden.
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Nilsson, Peter M.
    Department of Clinical Sciences, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
    Olsson, Håkan
    Department of Clinical Sciences, Cancer Epidemiology, Lund University, Lund, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Rosenblad, Andreas
    Västerås Centre for Clinical Research, Uppsala University, Uppsala, Sweden.
    Rosengren, Annika
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sandin, Sven
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA; Seaver Autism Center for Research and Treatment at Mount Sinai, New York NY, USA.
    Snäckerström, Tomas
    Uppsala Clin Res Ctr UCR, Uppsala, Sweden..
    Stenbeck, Magnus
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Söderberg, Stefan
    Department of Public Health and Clinical Medicine, and Heart Center, Umeå University, Umeå, Sweden.
    Weiderpass, Elisabete
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, Helsinki University, Helsinki, Finland; Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
    Wanhainen, Ers
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Wennberg, Patrik
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Fortier, Isabel
    Research Institute of the McGill University Health Centre, Montreal, Canada.
    Heller, Susanne
    Uppsala Clinical Research Center (UCR), Uppsala, Sweden.
    Storgärds, Maria
    Uppsala Clinical Research Center (UCR), Uppsala, Sweden.
    Svennblad, Bodil
    Uppsala Clinical Research Center (UCR), Uppsala, Sweden.
    Rationale for a Swedish cohort consortium2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 21-28Article in journal (Refereed)
    Abstract [en]

    We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.

  • 177.
    Thanh, Nguyen X.
    et al.
    Institute of Health Economics, Edmonton AB, Canada.
    Chuck, Anderson W.
    Institute of Health Economics, Edmonton AB, Canada.
    Wasylak, Tracy
    Alberta Health Services, Calgary AB, Canada.
    Lawrence, Jeannette
    Alberta Health Services, Calgary AB, Canada.
    Faris, Peter
    Alberta Health Services, Calgary AB, Canada.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Nelson, Gregg
    Department of Oncology, University of Calgary, Calgary AB, Canada.
    Gramlich, Leah M.
    Department of Medicine, University of Alberta, Edmonton AB, Canada.
    An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta2016In: Canadian journal of surgery, ISSN 0008-428X, E-ISSN 1488-2310, Vol. 59, no 6, p. 415-421Article in journal (Refereed)
    Abstract [en]

    Background: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites.

    Methods: We assessed the impact of ERAS on patients' health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique.

    Results: We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000-$3 391 000), or $1768 (range $920-$2619) per patient. The probability for the program to be cost-saving was 73%-83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4-$5.1) in return.

    Conclusion: The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites.

  • 178.
    Tistad, Malin
    et al.
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden .
    Palmcrantz, Susanne
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Wallin, Lars
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ehrenberg, Anna
    Örebro University, School of Health Sciences. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Olsson, Christina B.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Mörby Academic Primary Healthcare Center, Stockholm County Council, Stockholm, Sweden.
    Tomson, Göran
    International Health Systems Research, Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institutet, Solna, Sweden.
    Holmqvist, Lotta Widen
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
    Gifford, Wendy
    Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa ON, Canada.
    Eldh, Ann Catrine
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness2016In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, no 8, p. 477-486Article in journal (Refereed)
    Abstract [en]

    Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation.

    Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention.

    Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation.

    Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

  • 179.
    Torlén, Klara
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Örebro University, School of Medical Sciences. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Castrén, Maaret
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
    Olanders, Knut
    Department of Anaesthesiology and ICU, Lund University Hospital, Lund, Sweden.
    Bohm, Katarina
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
    A comparison of two emergency medical dispatch protocols with respect to accuracy2017In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, no 1, article id 122Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Emergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols - the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A.

    METHODS: A simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13 + 13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study.

    RESULTS: A total of 1293 calls were included in the analysis. For priority level, n = 349 (54.0%) of the calls were assessed correctly with Medical Index and n = 309 (48.0%) with RETTS-A (p = 0.012). Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6-87.3%) in the Medical Index and 54.0% (44.3-63.4%) in RETTS-A. Overtriage was 37.9% (34.2-41.7%) in the Medical Index and 28.6% (25.2-32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7-8.5%) and 23.4% (20.3-26.9%) respectively.

    CONCLUSION: In this simulation study we demonstrate that Medical Index had a higher accuracy for priority level and less undertriage than the new prototype RETTS-A. The overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. The results suggest that in order to improve patient safety both protocols need revisions in order to guarantee safe emergency medical dispatching.

  • 180.
    Tschudin-Sutter, S.
    et al.
    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.
    Kuijper, E. J.
    Department of Medical Microbiology, Centre for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.
    Durovic, A.
    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.
    Vehreschild, M. J. G. T.
    Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany.
    Barbut, F.
    National Reference Laboratory for Clostridium difficile, Paris, France.
    Eckert, C.
    National Reference Laboratory for Clostridium difficile, Paris, France.
    Fitzpatrick, F.
    Departments of Clinical Microbiology, Royal College of Surgeons in Ireland and Beaumont Hospital, Ireland.
    Hell, M.
    Department of Medical Microbiology and Infection Control, Academic Teaching Laboratories-Medilab OG, Paracelsus Medizinische Privatuniversität (PMU), Salzburg, Austria.
    Norén, Torbjörn
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Clinical Microbiology.
    O'Driscoll, J.
    Department of Medical Microbiology, Stoke Mandeville Hospital, Aylesbury, UK.
    Coia, J.
    Scottish Microbiology Reference Laboratories, Glasgow, UK.
    Gastmeier, P.
    Institute of Hygiene and Environmental Medicine, Charité, Universitätsmedizin Berlin, Berlin, Germany.
    von Müller, L.
    Institute for Medical Microbiology and Hygiene, University of Saarland Medical Center, State Laboratory of Saarland, Consiliary Laboratory for Clostridium difficile, Homburg/Saar, Germany.
    Wilcox, M. H.
    Department of Microbiology, Leeds Teaching Hospitals, Leeds, UK; University of Leeds, Leeds, UK.
    Widmer, A. F.
    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.
    Guidance document for prevention of Clostridium difficile infection in acute healthcare settings2018In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 24, no 10, p. 1051-1054, article id S1198-743X(18)30195-2Article in journal (Refereed)
    Abstract [en]

    SCOPE: Clostridium difficile infection (CDI) is the most important infective cause of healthcare-associated diarrhoea in high income countries and one of the most important healthcare-associated pathogens in both Europe and the United States. It is associated with high morbidity and mortality resulting in both societal and financial burden. A significant proportion of this burden is potentially preventable by a combination of targeted infection prevention and control measures and antimicrobial stewardship. The aim of this guidance document is to provide an update on recommendations for prevention of CDI in acute care settings to provide guidance to those responsible for institutional infection prevention and control programmes.

    METHODS: An expert group was set up by the European society of clinical microbiology and infectious diseases (ESCMID) Study Group for C. difficile (ESGCD), which performed a systematic review of the literature on prevention of CDI in adults hospitalized in acute care settings and derived respective recommendations according to the GRADE approach. Recommendations are stratified for both outbreak and endemic settings.

    QUESTIONS ADDRESSED BY THE GUIDELINE AND RECOMMENDATIONS: This guidance document provides thirty-six statements on strategies to prevent CDI in acute care settings, including 18 strong recommendations. No recommendation was provided for three questions.

  • 181.
    Walby, Sylvia
    et al.
    Lancaster University, Lancaster, UK.
    Olive, Philippa
    Lancaster University, Lancaster, UK.
    Towers, Jude
    Lancaster University, Lancaster, UK.
    Francis, Brian
    Lancaster Univertsity, Lancaster, UK.
    Strid, Sofia
    Örebro University, School of Humanities, Education and Social Sciences.
    Krizsan, Andrea
    Central European University, Budapest, Slovakia.
    Lombardo, Emanuela
    Universidad Complutense, Madrid, Spain.
    May-Chahal, Corinne
    Lancaster University, Lancaster, UK.
    Franzway, Suzanne
    University of South Australia, Adelaide, Australia.
    Sugarman, David
    Lancaster University, Lancaster, UK.
    Agarwal, Bina
    University of Dehli, Dehli, India.
    Stopping rape: towards a comprehensive policy2015Book (Refereed)
  • 182.
    Wallin, Agneta
    et al.
    Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden; School of Health Sciences, Örebro University, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health Sciences.
    Anderzen Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Lundén, Maud
    Örebro University, School of Health Sciences. Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden.
    Radiographers' experience of risks for patient safety incidents in the radiology department2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 7-8, p. 1125-1134Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe potential risks for patient safety incidents in the radiology department from a radiographer's perspective.

    BACKGROUND: A radiology department is a high-tech environment with high communication activity between different health care systems in combination with a large patient flow. Risks for patient safety incidents exist in every phase of a radiological examination. Due to the nature of the activity, a radiology department needs to have its own range of measures to prevent risks linked to radiology.

    DESIGN: A qualitative descriptive design.

    METHODS: Semi-structured interviews were carried out with 17 radiographers during the period September 2015 to February 2016. The data was analyzed using conventional content analysis. This study followed the COREQ checklist criteria for the reporting of qualitative research.

    RESULTS: The analysis yielded 20 different patient safety incidents that could result in the following six types of health care-associated harm: Patients could; (1) be exposed to unnecessary radiation; (2) receive an inaccurate diagnosis; (3) incur drug-induced damage; (4) suffer direct physical injury; or (5) their examination and treatment could be delayed or not carried out; or (6) their general health condition could deteriorate.

    CONCLUSION: Lack of communication and knowledge, both internally and externally, can increase risks for patient safety incidents. The study describes a complex chain of activities that represent risks in the radiology department. It needs to be pointed out that it is not always the activities in the radiology department that cause the harm.

    RELEVANCE TO CLINICAL PRACTICE: To carry out preventive patient safety work, a comprehensive analysis of the entire care chain is required. Patient safety work should also focus on improvement of communication both internally, within the radiology department, and externally. Standardized methodological guidelines, consistent prescriptions of method from the radiologist, and a good working environment are internal success factors for patient safety at the radiology department.

  • 183.
    Wennberg, Pär
    et al.
    Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Andersson, Henrik
    PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Wireklint Sundström, Birgitta
    PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature2018In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 29, p. 16-31Article, review/survey (Refereed)
  • 184.
    Wenzel, Helmut
    et al.
    Health Economist, Konstanz, Germany.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Family Medicine, Brickebacken Primary Health Care Center, Örebro, Sweden.
    Landin-Olsson, Mona
    Department of Endocrinology, Lund University Hospital, Lund, Sweden.
    Integrated Diabetes Care in Sweden2017In: Integrated Diabetes Care: A Multidisciplinary Approach / [ed] David Simmons, Helmut Wenzel, Janice C. Zgibor, Springer, 2017, p. 201-214Chapter in book (Other academic)
    Abstract [en]

    The Swedish health-care system is a kind of “Beveridge model”, with a strong orientation towards subnational levels, i.e. municipalities and regions. The responsibility is shared between the central government, county councils and municipalities. Health care is mainly tax funded both at the Government level and the levels of the county councils and the municipalities. The latter also levy proportional income taxes on the population to cover the services that they provide. In addition, small user fees are paid at the point of use. The health system is highly decentralised and organised: this leads to variation in care provision. To overcome this, the government has created national guidelines for common diagnoses including diabetes. Primary and secondary care is funded and delivered at county level. Municipalities are responsible for nursing and residential homes as well as home care and other social services. The Swedish health-care system is trying to combine decentralisation, a high degree of specialisation, and professional organisation in a system where common health-care goals can be maintained. To avoid fragmentation, ‘chains of care’ have been identified to bridge different care givers. Diabetes is treated by multidisciplinary teams consisting of doctors and diabetes nurses in collaboration with other professionals at primary or secondary care level. This means that virtually all patients with type 1 diabetes have their care provided at hospitals, while patients with type 2 diabetes are managed in primary care. Electronic medical records (EMR) are used by the majority of care givers, and are linked to the National Diabetes Register (NDR) as well as to other national registers. EMR are also used for referrals within or between county councils. For patients without complications the level of care and allocated resources can be defined by national guidelines. For patients with complications the care involves specialist units at the hospital in collaboration with primary care and medical assistance in the home. These chains of care are more difficult to define but instead the government has defined quality indicators in order to keep the frequency of complications as low as possible.

  • 185.
    Wistrand, Camilla
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Cardiothoracic Surgery and Vascular Surgery.
    Söderquist, Bo
    Örebro University, School of Medical Sciences. Departments of Laboratory Medicine, Clinical Microbiology, and Infectious diseases, Örebro University Hospital, Örebro, Sweden.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Perioperative Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Exploring bacterial growth and recolonization after preoperative hand disinfection and surgery between operating room nurses and non-health care workers: a pilot study2018In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 18, no 1, article id 466Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To prevent cross infection the surgical team perform preoperative hand disinfection before dressed in surgical gowns and gloves. Preoperative hand disinfection does not make hands sterile and the surgical glove cuff end has been regarded as a weak link, since it is not a liquid-proof interface. The aims were to investigate if there were differences in bacterial growth and recolonization of hands between operating room nurses and non-health care workers as well as to investigate if bacterial growth existed at the surgical glove cuff end during surgery.

    METHODS: This pilot project was conducted as an exploratory comparative clinical trial. Bacterial cultures were taken from the glove and gown interface and at three sites of the hands of 12 operating room nurses and 13 non-health care workers controls directly after preoperative hand disinfection and again after wearing surgical gloves and gowns. Colony forming units were analysed with Mann-Whitney U test and Wilcoxon Sign Ranks test comparing repeated measurements. Categorical variables were evaluated with chi-square test or Fisher's exact test.

    RESULTS: Operating room nurses compared to non-health care workers had significant higher bacterial growth at two of three culture sites after surgical hand disinfection. Both groups had higher recolonization at one of the three culture sites after wearing surgical gloves. There were no differences between the groups in total colony forming units, that is, all sampling sites. Five out of 12 of the operating room nurses had bacterial growth at the glove cuff end and of those, four had the same bacteria at the glove cuff end as found in the cultures from the hands. Bacteria isolated from the glove cuff were P. acnes, S. warneri, S. epidermidis and Micrococcus species, the CFU/mL ranged from 10 to 40.

    CONCLUSIONS: There were differences in bacterial growth and re-colonization between the groups but this was inconclusive. However, bacterial growth exists at the glove cuff and gown interface, further investigation in larger study is needed, to build on these promising, but preliminary, findings.

    TRIAL REGISTRATION: Trial registration was performed prospectively at Research web (FOU in Sweden, 117,971) 14/01/2013, and retrospectively at ClinicalTrials.gov ( NCT02359708 ). 01/27/2015.

  • 186.
    Wångdahl, Josefin
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Psychometric validation of Swedish and Arabic versions of two Health literacy questionnaires, eHEALS and HLS-EU-Q16, for use in a Swedish context: A study protocol2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 9, article id e029668Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Equity in health and access to healthcare regardless of gender, ethnicity or social position is a major political issue worldwide. Regardless of an individual's knowledge, motivation and competence, individuals are expected to be engaged and take responsibility of their own care. Migrants have been identified as a vulnerable population in healthcare, and an explanation for the inequity in health and in healthcare is limited health literacy. Furthermore, with increasing digitalisation in healthcare, it also puts demand on the individual to have digital or electronic health (eHealth) literacy.

    The overall aim of this study is to conduct a psychometric evaluation of the Swedish and Arabic versions of HLS-EU-Q16 and eHEALS and to compare Arabic and Swedish speakers' Health literacy and eHealth literacy levels in Sweden.

    METHODS AND ANALYSIS: This is a prospective, psychometric evaluation study with the intent of including 300 Arabic-speaking and 300 Swedish-speaking participants. Questionnaires: The Health Literacy Survey European Questionnaire (HLS-EU-Q16) includes 16 items measuring perceived personal skills of finding, understanding, judging and applying health information to maintain and improve their health. The eHealth literacy scale (eHEALS) is an 8-item scale measuring health literacy skills in relation to online information and applications.

    This study will be conducted in four phases. Phase 1: Translation of HLS-EU-Q16 and eHEALS from English to Swedish and Arabic versions following the principles of translation of questionnaires. Phase 2: Content validity testing of eHEALS, including face validity and interpretability, conducted with five Arabic and five Swedish-speaking participants. Phase 3: Psychometric testing including construct validity, reliability, feasibility and floor ceiling effects. Phase 4: Distribution and comparison of eHealth and HLS-EU-Q16 analysed with χ2 and Fisher's exact test as appropriate. To assess associations between HLS-EU-Q16, eHEALS and demographic variables, binary logistic regression analyses will be performed.

    ETHICS AND DISSEMINATION: The project has been approved by the regional ethical review board in Stockholm, Sweden (2019/5:1) and will follow the principles outlined in the 1964 Helsinki Declaration and its later amendments. Results from this study will be disseminated in peer-reviewed journals, scientific conferences and social media.

  • 187.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of University Healthcare Research Centre.
    Arne, Mats
    Centre for clinical research, County Council of Värmland, Sweden; Department of Medical Sciences, Lung allergy and sleep research, Uppsala University, Uppsala, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Theander, Kersti
    Centre for clinical research, County Council of Värmland, Sweden.
    A complex intervention of self-management for patients with COPD or CHF in primary care improved performance and satisfaction with regard to own selected activities: a longitudinal follow-up2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 1, p. 175-186Article in journal (Refereed)
    Abstract [en]

    AIM: To test a self-management intervention in primary health care for patients with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure on self-efficacy, symptoms, functioning and health.

    BACKGROUND: Patients with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure experience often the same symptoms such as shortness of breath, cough, lack of energy, dry mouth, numbness or tingling in hands and feet, pain and sleeping problems.

    DESIGN: A multicentre randomized control trial.

    METHOD: The trial was conducted with one intervention group (n=73) and one control group (n=77). The trial was performed from September 2013 - September 2015 at nine primary health care centres in three county councils in Sweden. At baseline patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure experienced any symptom. Follow-ups were performed after three months and one year. The intervention was structured on Bandura's theory of self-efficacy in six meetings and individual action plans based on personal problems were performed and discussed.

    RESULTS: At baseline, there were no differences between the groups except for SF-36 social function. After three months, the intervention group improved performance and satisfaction with regard to own selected activities, otherwise no differences were found.

    CONCLUSION: When designing a program, the patient's own difficulties must be taken into consideration if person-centered care is to be established. It is feasible to include both patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure in the same group in primary health care. Health care professionals need supervision in pedagogics during intervention in self-management.

  • 188.
    Zhu, Egui
    et al.
    Faculty of Education, Hubei University, Wuhan, China.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    What Does the Chinese Public Care About with Regard to Primary Care Physicians: Trustworthiness or Competence?2019In: Medicina (Kaunas), ISSN 1010-660X, E-ISSN 1648-9144, Vol. 55, no 8, article id E455Article in journal (Refereed)
    Abstract [en]

    Background and Objective: China has launched a series of reforms to enhance primary care. The aims of these reforms are to strengthen the functionality of primary care to encourage patients to use primary care. Patients’ trust in physicians is important in clinical medicine; however, little is known about how Chinese patients’ preferences relate to their trust in primary care physicians. This study’s objectives are to measure the Chinese public’s trust in primary care physicians and to characterize reasons of their preferences for health care.

    Materials and Methods: This quantitative study comprises a face-to-face survey with a convenience sample (n = 273) of people visiting community health centers or stations (CHCSs) in Wuhan, China. We measured the patients’ preferences for the different level of hospitals and their trust in physicians, as well as the reasons of the patients’ preferences, using a Chinese version of the Wake Forest Physician Trust Scale and other variables (such as demographics, health status, and hospital preference).

    Results: Approximately two thirds (68.6%) of the participants had experienced a mild or chronic disease in the year before the survey, but only 26.4% preferred to visit CHCSs in such cases. The negative factors related to this lack of preference are the physicians’ competence (odds ratio [OR] = 0.250), the medical equipment (OR = 0.301), and the popularity of hospitals (OR = 0.172). The positive factors were ease of access (OR = 2.218) and affordability (OR = 1.900). The participants expressed a moderate trust in physicians in CHCSs (score of 3.02 out of 5). There is no association between the patients’ trust and their hospital preference (r = 0.019, p = 0.859). Of the participants, 92 suggested that the physicians in CHCSs should improve in terms of their competence (n = 53), attitude (n = 35), and/or medical ethics (n = 16).

    Conclusions: This study’s results suggest that patients consider improving physicians’ competence to be more important and urgent than improving those physicians’ trustworthiness in terms of reconstructing Chinese primary care. Improving the physicians’ competence would not only reduce the barriers that patients experience regarding CHCSs, but would also increase their trust in the physicians.

  • 189.
    Björklund, Lars (Contributor)
    Skånes universitetssjukvård.
    Eriksson, Mats (Contributor)
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Universitetssjukhuset Örebro, Örebro.
    Hellström Westas, Lena (Contributor)
    Uppsala universitet, Uppsala; Akademiska sjukhuset, Uppsala.
    Håkansson, Stellan (Contributor)
    Norrlands universitetssjukhus, Umeå.
    Norman, Mikael (Contributor)
    Karolinska Institutet, Stockholm; Astrid Lindgrens Barnsjukhus, Stockholm.
    Polberger, Staffan (Contributor)
    Skånes universitetssjukvård.
    Soop, Michael (Contributor)
    Socialstyrelsen, Stockholm.
    Wagner, Andor (Contributor)
    Socialstyrelsen, Stockholm.
    Fagerstedt, Charlotte (Contributor)
    Socialstyrelsen, Stockholm.
    Björkman, Eleonora (Contributor)
    Socialstyrelsen, Stockholm.
    Vård av extremt för tidigt födda barn: en vägledning för vård av barn födda före 28 fullgångna graviditetsveckor2014Report (Refereed)
    Abstract [sv]

    När ett barnföds extremt för tidigt, det vill säga före 28 fullgångna graviditetsveckor, krävs särskilda resurser och kompetenser. Vården av dessa barn är komplicerad och vårdpersonalen ställs ofta inför svåra medicinska bedömningar. Denna vägledning är tänkt att stödja vårdgivare och verksamhetschefer ansvariga för neonatalvård att ge en god vård till alla extremt för tidigt födda barn. Vägledningen innehåller rekommendationer inom områden där behovet av stöd har ansetts som störst.

    Extremt för tidigt födda barn som fötts på regionklinik har visats ha en väsentlig högre överlevnad än barn födda på andra sjukhus. Detta motiverar att omhändertagandet av mor och barn bör ske på sjukhus med stor erfarenhet av specialiserad obstetrik och neonatal intensivvård. Det bör även finnas tillgång till en väl fungerande transportorganisation med specialiserad personal både för mammor med hotande förtidsbörd och för de extremt för tidigt födda barn som är i behov av att flyttas efter födelsen.

    Barnen drabbas ofta av allvarliga komplikationer och sjukdomar som kan leda till både akuta och framtida problem. Nästan alla extremt för tidigt födda barn behöver någon form avandningsunderstöd och många behöver avancerad respiratorvård. Många barn har ett långvarigt behov av extra syrgas och alla måste övervakas noga för att undvika ögonskador (prematuritets-retinopati). Cirkulationsproblem är vanliga och över hälften av barnen får behandling för att stänga ductus arteriosus, vilket är en fosterförbindelse i cirkulationen och om den kvarstår öppen kan det få negativa effekter. Akut lungsjukdom och sviktande cirkulation bidrar till att extremt för tidigt födda barn ofta drabbas av blödningar och syrebrist i centrala nervsystemet. Barnens omogna hjärnor bör därför bedömas fortlöpande och faktorer som kan påverka hjärnans utveckling och funktion negativt bör minimeras.

    För att främja de omogna barnens hälsa och utveckling är det centralt att vården bedrivs på ett sådant sätt att vårdrelaterade infektioner förebyggs och att smärta och stress minimeras. Smärtbehandling bör i första hand ske genom icke-farmakologiska metoder, men vid behov även med läkemedel.

    För att optimera tillväxten bör utarbetade nutritionsrekommendationer följas. De extremt för tidigt födda barnen har ett näringsbehov som vida överstiger det hos fullgångna nyfödda, samtidigt som näringstillförseln ofta försvåras av omogna organfunktioner och komplikationer från magtarmkanalen.

    Att få ett extremt för tidigt fött barn innebär en stor påfrestning för familjen. Vården bör organiseras så att den är patient- och familjecentrerad, där barnets och familjens individuella behov respekteras så långt det är möjligt och där föräldrarna stödjs och kontinuerligt informeras om barnets tillstånd och prognos.

    Extremt för tidigt födda barn bör följas på kort och lång sikt för att öka vårdenskunskap om följderna av en extremt för tidig födelse. Ett strukturerat uppföljningssystem ger förutsättningar för att utvärdera och ständigt förbättra vården för dessa barn.

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