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  • 1.
    Aamodt, Ina Thon
    et al.
    Oslo Univ Hosp Ulleval, Norway; Univ Oslo, Norway.
    Lycholip, Edita
    Vilnius Univ, Lithuania.
    Celutkiene, Jelena
    Vilnius Univ, Lithuania.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Atar, Dan
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Falk, Ragnhild Sorum
    Oslo Univ Hosp, Norway.
    von Lueder, Thomas
    Oslo Univ Hosp, Norway.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lie, Irene
    Oslo Univ Hosp Ulleval, Norway.
    Health Care Professionals Perceptions of Home Telemonitoring in Heart Failure Care: Cross-Sectional Survey2019In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 21, no 2, article id e10362Article in journal (Refereed)
    Abstract [en]

    Background: Noninvasive telemonitoring (TM) can be used in heart failure (HF) patients to perform early detection of decompensation at home, prevent unnecessary health care utilization, and decrease health care costs. However, the evidence is not sufficient to be part of HF guidelines for follow-up care, and we have no knowledge of how TM is used in the Nordic Baltic region. Objective: The aim of this study was to describe health care professionals (HCPs) perception of and presumed experience with noninvasive TM in daily HF patient care, perspectives of the relevance of and reasons for applying noninvasive TM, and barriers to the use of noninvasive TM. Methods: A cross-sectional survey was performed between September and December 2016 in Norway and Lithuania with physicians and nurses treating HF patients at either a hospital ward or an outpatient clinic. A total of 784 questionnaires were sent nationwide by postal mail to 107 hospitals. The questionnaire consisted of 43 items with close- and open-ended questions. In Norway, the response rate was 68.7% (226/329), with 57 of 60 hospitals participating, whereas the response rate was 68.1% (310/455) in Lithuania, with 41 of 47 hospitals participating. Responses to the closed questions were analyzed using descriptive statistics, and the open-ended questions were analyzed using summative content analysis. Results: This study showed that noninvasive TM is not part of the current daily clinical practice in Norway or Lithuania. A minority of HCPs responded to be familiar with noninvasive TM in HF care in Norway (48/226, 21.2%) and Lithuania (64/310, 20.6%). Approximately half of the HCPs in both countries perceived noninvasive TM to be relevant in follow-up of HF patients in Norway (131/226, 58.0%) and Lithuania (172/310, 55.5%). For physicians in both countries and nurses in Norway, the 3 most mentioned reasons for introducing noninvasive TM were to improve self-care, to reduce hospitalizations, and to provide high-quality care, whereas the Lithuanian nurses described ability to treat more patients and to reduce their workload as reasons for introducing noninvasive TM. The main barriers to implement noninvasive TM were lack of funding from health care authorities or the Territorial Patient Fund. Moreover, HCPs perceive that HF patients themselves could represent barriers because of their physical or mental condition in addition to a lack of internet access. Conclusions: HCPs in Norway and Lithuania are currently nonusers of TM in daily HF care. However, they perceive a future with TM to improve the quality of care for HF patients. Financial barriers and HF patients condition may have an impact on the use of TM, whereas sufficient funding from health care authorities and improved knowledge may encourage the more widespread use of TM in the Nordic Baltic region and beyond.

  • 2.
    Abbott, Allan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Schröder, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 4, article id e019906Article in journal (Refereed)
    Abstract [en]

    Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP.

    Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context.

    Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated.

    Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and implementation in Sweden and associated national quality register data collection are potential future developments of the project.

  • 3.
    Abdelrahman, Islam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Validation of the burn intervention score in a National Burn Centre2018In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, no 5, p. 1159-1166Article in journal (Refereed)
    Abstract [en]

    The Linköping burn score has been used for two decades to calculate the cost to the hospital of each burned patient. Our aim was to validate the Burn Score in a dedicated Burn Centre by analysing the associations with burn-specific factors: percentage of total body surface area burned (TBSA%), cause of injury, patients referred from other (non-specialist) centres, and survival, to find out which of these factors resulted in higher scores. Our second aim was to analyse the variation in scores of each category of care (surveillance, respiration, circulation, wound care, mobilisation, laboratory tests, infusions, and operation).

    We made a retrospective analysis of all burned patients admitted during the period 2000–15. Multivariable regression models were used to analyse predictive factors for an increased daily burn score, the cumulative burn score (the sum of the daily burn scores for each patient) and the total burn score (total sum of burn scores for the whole group throughout the study period) in addition to sub-analysis of the different categories of care that make up the burn score.

    We retrieved 22 301 daily recordings for inpatients. Mobilisation and care of the wound accounted for more than half of the total burn score during the study. Increased TBSA% and age over 45 years were associated with increased cumulative (model R2 0.43, p < 0.001) and daily (model R2 0.61, p < 0.001) burn scores. Patients who died had higher daily burn scores, while the cumulative burn score decreased with shorter duration of hospital stay (p < 0.001).

    To our knowledge this is the first long term analysis and validation of a system for scoring burn interventions in patients with burns that explores its association with the factors important for outcome. Calculations of costs are based on the score, and it provides an indicator of the nurses’ workload. It also gives important information about the different dimensions of the care provided from thorough investigation of the scores for each category.

  • 4. Abdon, Nils Johan
    et al.
    Bergfeldt, Lennart
    Herlitz, Johan
    University of Borås, School of Health Science.
    Hjärtstopp utlöst av läkemedel kanske vanligare än vi tror2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 8, p. 521-525Article in journal (Refereed)
  • 5. Abraha, Atakelti
    et al.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Kahsay, Asmelash
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
    The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case-control study2019In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Services that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.

  • 6. Abrahamsson, Birgitta
    et al.
    Berg, Marie-Louise U.
    Jutengren, Göran
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Annikki
    To recommend the local primary health-care centre or not: What importance do patients attach to initial contact quality, staff continuity and responsive staff encounters?2015In: International Journal for Quality in Health Care, ISSN 1353-4505, Vol. 27, no 3, p. 196-200Article in journal (Other academic)
    Abstract [en]

    Objective: This study aims to examine the circumstances associated with patients’ tendencies to recommend a primary care centre, based on four hypotheses, the initial contact’s quality, care relationship continuity, treatment encounter responsiveness and whether the significance of encounter responsiveness differs depending on whether the patient has been seeing a nurse or physician. Design: The study is based on the patient’ self-reported responses, retrieved from the Swedish National Patient Survey. The design is cross-sectional, and data were analysed using a binary logistic regression. Setting: Data were collected from three primary healthcare centres in the region of Västra Götaland, Sweden. Participants: A total of 362 patients (62% females) having visited any of three publicly run healthcare centres in September 2010 constitute the analytical sample. Participants were fairly evenly distributed across all age groups. Main Outcome Measures: Recommendation was captured by patients’ binary responses to the question: Would you recommend the visited primary healthcare centre? Results: The hypotheses involving initial contact quality, care relationship continuity and treatment encounter responsiveness were supported by the analyses. The latter was strongly associated with patient tendency to recommend the primary healthcare centre. However, the profession (nurse or physician) involved in the treatment encounter made no difference for the predictive significance of encounter responsiveness for a patient’s tendency to recommend the healthcare centre. Conclusions: Striving for stable and responsive patient/staff relationships and an open approach towards patients are potentially successful strategies for primary healthcare centres seeking to attract new patients and maintain current ones. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)

  • 7.
    Acheampong, Faustina
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Innovating healthcare through remote monitoring: Effects and business model2017In: Health Care Delivery and Clinical Science: Concepts, Methodologies, Tools, and Applications, IGI Global, 2017, p. 247-268Chapter in book (Other academic)
    Abstract [en]

    Information technology has been suggested to improve patient health outcomes and reduce healthcare cost. This study explored the business model and effects of collaborative innovation between caregivers and patients on healthcare delivery through remote patient monitoring by interviewing caregivers and surveying atrial fibrillation patients. Findings indicate that remote monitoring enhanced early detection of potential risks and quality of clinical decision-making with patients feeling more empowered and involved in their own care. The remote monitoring system which consisted of a home-based ECG and a web-based service and was offered free to patients, brought together caregivers, patients, service provider and the government as actors. The introduction of remote monitoring increased the workload of caregivers and facilitation of timely diagnostics and decision-making were not realized. IT is an enabler of innovation in healthcare, but it must be integrated into work processes with a viable business model to realize potential benefits and sustain it. 

  • 8.
    Achit, Hamza
    et al.
    Université Paris-Est, IFSTTAR.
    Carnis, Laurent
    Université Paris-Est, IFSTTAR.
    Physical Impairment and Medical Care Spending by Road Accident Victims2013In: Proceedings of the 16th International Conference Road Safety on Four Continents: Beijing, China. 15-17 May 2013, Linköping: Statens väg- och transportforskningsinstitut, 2013Conference paper (Other academic)
    Abstract [en]

    In addition to the immediate physical injuries they suffer, road accident victims may also be subject to ongoing deterioration of their state of health in terms of permanent physical and mental problems, disabilities, etc. These various health shocks entail recourse to care and treatment, the upshot being increases in health expenses. In France little is known about the financial impact of accidents on victims. This paper uses data from a sample of 777 individuals suffering from road accident-induced physical impairment. Information about these individuals includes details of their personal and socioprofessional characteristics, together with data provided by their health insurance offices regarding their use of treatment and their medical expenses. The analysis of these data reveals that the costs incurred by road accident victims are significantly associated with such factors as age, seriousness of impairment, and marital status. Interaction effects are also noted between these explanatory factors: for example, the effect of the seriousness of impairment on the costs involved differs according to the age of the victim.

  • 9.
    Adamiak, Grazyna Teresa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Påverkan av organisatoriska och miljömässiga faktorer på tillgänglighet till akutsjukvården2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The settings investigated were departments of internal medicine (IM), orthopaedics and surgery in acute care hospitals in Sweden. The objective was to identify exogenous and endogenous determinants of accessibility of health care. Both qualitative and quantitative analysis of utilisation was performed on national and regional level of data aggregation. The study proposes that accessibility to acute health services is influenced by exogenous factors, partly outside the control of health care professionals, such as season, physical proximity and overall supply. Organisational properties such as availability of inpatient beds, hospital and physician specialisation and the degree of system integration between provides of emergency care have effects on the quality of care. The novel finding is the strong association between acute readmissions and remaining inpatient utilisation indicating effects of bed supply on global use within IM. These conclusions follow:

    § structural changes on system level work as a method of prioritisation between patient groups by changes in criteria of accessibility;

    § the natural and organisational environments determine waiting times in EDs in hospitals by fluctuations of demand;

    § geographical accessibility coincides with the supply in terms of over- or underutilisation mirrored in the outcome of medical care;

    § effective access is determined by the divide of resources between inpatient and outpatient care and the total supply of inpatient care;

    § increasing demands on inpatient care in IM may be derived from deficiencies in the care of chronically ill, elderly patients;

    § transition of information and communication among care givers and patients varies in efficiency depending on vehicles for coordination and system integration;

    § the level of training of the admitting physician has effects on effective accessibility to inpatient care.

    There are conflicts between accessibility, efficiency and appropriateness of settings calling for attention to capacity to benefit in addition to needs as priority criteria.

  • 10.
    Adams, Mary
    et al.
    King’s College London, UK.
    Maben, Jill
    King’s College London, UK.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). King’s College London, UK.
    ‘It’s sometimes hard to tell what patients are playing at’: How healthcare professionals make sense of why patients and families complain about care2018In: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 22, no 6, p. 603-623Article in journal (Refereed)
    Abstract [en]

    This article draws from sociological and socio-legal studies of dispute between patients and doctors to examine how healthcare professionals made sense of patients’ complaints about healthcare. We analyse 41 discursive interviews with professional healthcare staff working in eight different English National Health Service settings to explore how they made sense of events of complaint and of patients’ (including families’) motives for complaining. We find that for our interviewees, events of patients’ complaining about care were perceived as a breach in fundamental relationships involving patients’ trust or patients’ recognition of their work efforts. We find that interviewees rationalised patients’ motives for complaining in ways that marginalised the content of their concerns. Complaints were most often discussed as coming from patients who were inexpert, distressed or advantage-seeking; accordingly, care professionals hearing their concerns about care positioned themselves as informed decision-makers, empathic listeners or service gate-keepers. We find differences in our interviewees’ rationalisation of patients’ complaining about care to be related to local service contingences rather than to fixed professional differences. We note that it was rare for interviewees to describe complaints raised by patients as grounds for improving the quality of care. Our findings indicate that recent health policy directives promoting a view of complaints as learning opportunities from critical patient/consumers must account for sociological factors that inform both how the agency of patients is envisaged and how professionalism exercised contemporary healthcare work.

  • 11. Adriansson, C
    et al.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Bergbom, I
    The use of topical anaesthesia at children's minor lacerations: an experimental study2004In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 12, no 2, p. 74-84Article in journal (Refereed)
    Abstract [en]

    Background: In a great many situations within health care and treatment, children are subjected to unnecessary pain and suffering. When local anaesthetics is to be administered the child can experience this as incomprehensible especially when the nursing staff assures the child that no pain would be felt, only to discover soon after, that it actually did hurt at the moment of anaesthetic infiltration. The soothing of pain during the suturing of wounds in emergency wards can be reduced, ensuring that unnecessary pain in the cafe-and-treatment process is mot meted out to children. In order to prevent this (subjection to unnecessary pain), and by improving accepted practice, it was interesting to investigate whether children felt pain at the time of infiltration anaesthesia following the initial topical anaesthesia. Aim: The aim of the present study was to investigate the effects of introductory topical anaesthesia using Xylocain solution dropped in the wound prior to a definitive infiltration-anaesthesia. An experimental, prospective design was used where children were included in either an experimental group or a control group. The experimental group (n=10) were given a Xylocain solution while the control group (n=10) received physiological Sodium solution. Data collection for the study was made by making VAS estimates and by interviews. Result: The study shows that a certain alleviation of pain does occur when using Xylocain but no statistically significant difference exists between the two groups. Irrespective of whether the children received an introductory topical anaesthesia with Xylocain or Sodium solution at the time of infiltration anaesthesia, they expressed pain in connection with infiltration. The study also shows that many children express fear and anxiety. Conclusion: Current research highlights the difficulties involved in offering children a really satisfactory form of pain relief in connection with infiltration anaesthesia and suturing of wounds. It is urgent to throw more light on children’s pain, both from a nursing and from a medical point of view. No statistically significant difference was found in children’s reported pain, after treatment with Xylocain but the solution can have a positive effect at the time of the infiltration jab, but a larger study needs to be done in order to establish this firmly.

  • 12.
    Agevall, Lena
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Social Sciences. Statsvetenskap.
    Jonnergård, Karin
    Växjö University, Faculty of Humanities and Social Sciences, School of Management and Economics. Ekonomistyrning.
    Management by documents - a risk of de-professionalizing?2007In: In tension between Organization and Profession: Professionals in Nordic Public Service, Nordic Academic Presss, Lund , 2007, p. 33-56Chapter in book (Other (popular science, discussion, etc.))
    Abstract [en]

    If we have to document our professional action, will we then only perform the actions that we are supposed to document? This question reflects the content of this chapter. The chapter includes a frame of reference for studying control of professionals in organizations and illustration on different types of professional controls.

  • 13.
    Ahl, Caroline
    et al.
    University of Borås, School of Health Science.
    Hjälte, L
    Johansson, C
    Wireklint-Sundström, Birgitta
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Culture and care in the Swedish ambulance services2005In: Emergency Nurse, ISSN 1354-5752, E-ISSN 2047-8984, Vol. 13, no 8, p. 30-36Article in journal (Refereed)
  • 14.
    Ahl, Caroline
    et al.
    University of Borås, School of Health Science.
    Nyström, Maria
    University of Borås, School of Health Science.
    Jansson, L
    Making up one’s mind: Patients Experiences of Calling an Ambulance2006In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 14, no 1, p. 11-19Article in journal (Refereed)
    Abstract [en]

    The issue of the inappropriate use of ambulance transport and care has mainly been studied from the professionals’ and caregivers’ perspective, with few studies focusing on the patient and his/her experiences. To further understand whether patients use ambulance care in an inappropriate manner and, if so, why, it is important to obtain an overall picture of the patients’ existential situation at the time they call an ambulance. The aim of this study was to analyse and describe patients’ experiences related to the decision to call an ambulance and the wait for it to arrive. The design was explorative, and twenty informants aged between 34 and 82 years were interviewed. Qualitative content analyses were performed. The findings showed that calling for an ambulance is a major decision that is preceded by hesitation and attempts to handle the situation by oneself. Our conclusion is that the definition of inappropriate use of valuable health care resources should not be based solely on the professionals’ point of view but also take account of the patients’ reactions when they experience a threat to their life and health.

  • 15.
    Ahl, Johannes
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Karlsmo, Martin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    SJUKSKÖTERSKANS STRESS RELATERAD TILL ARBETSBELASTNING: En enkätsstudie2017Independent thesis Basic level (degree of Bachelor), 15 credits / 22,5 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Negativ arbetsrelaterad stress är ett ständigt problem i flera samhällssektorer, även så i stor utsträckning inom vårdsektorn. Forskning visar att arbetsrelaterad stress inom vården kan utlösas av flera olika faktorer, bland annat en för hög arbetsbelastning. Långvarig negativ stress kan orsaka utmattningssymtom och utbrändhet.

    Syfte: Syftet med studien var att undersöka stress relaterad till arbetsbelastningen hos allmänsjuksköterskor som arbetar på sjukhusavdelningar.

    Metod: En kvantitativ enkätstudie utfördes på fyra sjukhusavdelningar på ett sjukhus i Södra Sverige. Instrumentet Maslach Burnout Inventory- HSS användes för att mäta respondenternas stress. Resultatet redovisades och analyserades med deskriptiv statistik, regressionsanalys och Spearmans rangkorrelationskoefficient.

    Resultat: Resultatet visar att det hos allmänsjuksköterskor finns ett samband mellan arbetsbelastning och stress. Samband uppmättes mellan antal övertidstimmar och utbrändhetsfaktorn ”Otillräcklighet” (p < 0,05), samt mellan känslan av att vara överarbetad och utbrändhetsfaktorn ”Emotionell utmattning” (p < 0,01).  Resultatet visar också att bakgrundsfaktorer som kan kopplas  till privatlivet spelar en mindre roll för sjuksköterskornas upplevda arbetsstress och att det huvudsakligen är arbetsrelaterade faktorer som påverkar upplevelsen av stress.

    Slutsats: Den undersökta populationen lider av stressfaktorer kopplade till arbetsbelastning och låg arbetstillfredsställelse och majoriteten av den undersökta populationen löper en risk att drabbas av utbrändhet. För att bibehålla god vårdkvalité, eller förbättra den ytterligare, bör åtgärder för att sänka arbetsbelastningen och öka arbetstillfredställelsen ses över.

  • 16.
    Ahlgren, Asa
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Mid Sweden University, Östersund, Sweden.
    Broman, Lisbet
    Karolinska Institutet, Stockholm, Sweden.
    Bergroth, Alf
    Mid Sweden University, Östersund, Sweden.
    Ekholm, Jan
    Mid Sweden University, Östersund, Sweden.
    Disability pension despite vocational rehabilitation?: A study from six social insurance offices of a county2005In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 28, no 1, p. 33-42Article in journal (Refereed)
    Abstract [en]

    Many long-term sick-listed individuals move from vocational rehabilitation to pension, rather than reaching the goal of return to work. There is thus reason to consider whether rehabilitation resources are being used optimally. Individuals receiving disability pensions are consuming financial and personnel resources at the insurance offices and also consume a large amount of health care. The general objective of the study was to evaluate the proportion of individuals granted vocational rehabilitation but then obtaining temporary or permanent disability pensions. All persons receiving any kind of rehabilitation and attending one of six local national insurance offices in a county in Sweden in 1998 and 1999 were studied. A 2-year follow-up was carried out to assess changes in status among those who had received temporary disability pensions. Of all individuals receiving rehabilitation, 46.2% ended up with a disability pension allowance. In addition, a large portion of the temporary disability pensions was transformed to permanent disability pensions within 2 years. For clients with a temporary disability pension, the rate of resuming work was close to nil. Among rehabilitation measures, investigation showed the lowest figures of work resumption while job training showed the best outcome in this respect. The study concluded that a large portion of the financial and personnel resources allocated by the national insurance offices to rehabilitation resulted in disability pensions.

  • 17.
    Ahlstedt, C.
    et al.
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Eriksson Lindvall, C.
    Department of Business Studies Uppsala University, Uppsala, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Muntlin Athlin, Å.
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    What makes registered nurses remain in work?: An ethnographic study2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89, p. 32-38Article in journal (Refereed)
    Abstract [en]

    Background: Registered nurses’ work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. Objectives: The aim of the study was to explore registered nurses’ workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. Design: A qualitative explorative study with an ethnographic approach. Methods: Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. Results: Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses’ work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses’ development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. Conclusion: This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation. 

  • 18.
    Ahlstrom, Gerd
    et al.
    Lund Univ, Sweden.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Benzein, Eva
    Linnaeus Univ, Sweden.
    Behm, Lina
    Lund Univ, Sweden.
    Wallerstedt, Birgitta
    Linnaeus Univ, Sweden.
    Persson, Magnus
    Lund Univ, Sweden.
    Sandgren, Anna
    Linnaeus Univ, Sweden.
    Implementation of knowledge-based palliative care in nursing homes and pre-post post evaluation by cross-over design: a study protocol2018In: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 17, article id 52Article in journal (Refereed)
    Abstract [en]

    Background: The demography of the world is changing as the population is ageing. Because of this change to a higher proportion of older people, the WHO has called for improved palliative care for older persons. A large number of all deaths in the industrialised world occur while older people are living in nursing homes and therefore a key question becomes how the principles of palliative care can be implemented in that context. The aims of this study are: a) to describe a model of an educational intervention with the goal of implementing knowledge-based palliative care in nursing homes, and b) to describe the design of the evaluation of the effectiveness regarding the implementation of knowledge-based palliative care. Methods/design: A complex intervention is evaluated by means of a cross-over design. An educational intervention concerning palliative care consisting of five seminars during 6 months for staff and managers has been developed and conducted in 20 nursing homes in two counties. Before the intervention started, the feasibility was tested in a pilot study conducted in nursing homes not included in the main study. The intervention is evaluated through a non-randomized experimental design with intervention and control groups and pre- and post-assessments. The evaluation includes older persons living in nursing homes, next-of-kin, staff and managers. Data collection consists of quantitative methods such as questionnaires and register data and qualitative methods in the form of individual interviews, focus-group interviews and participant observations. Discussion: The research will contribute to new knowledge about how to implement knowledge-based palliative care in a nursing home setting. A strength of this project is that the Medical Research Council framework of complex intervention is applied. The four recommended stages, Development, Feasibility and piloting, Evaluation and Implementation, are combined for the educational intervention, which functions as a strategy to achieve knowledge-based palliative care in the nursing homes. Implementation is always a question of change and a good theoretical understanding is needed for drawing valid conclusions about the causal mechanisms of change. The topic is highly relevant considering the worlds ageing population. The data collection is completed and the analysis is ongoing.

  • 19. Ahlstrom, Linda
    et al.
    Hagberg, Mats
    Dellve, Lotta
    University of Borås, School of Health Science.
    Workplace Rehabilitation and Supportive Conditions at Work: A Prospective Study2013In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 2, p. 248-260Article in journal (Refereed)
    Abstract [en]

    Purpose To investigate the impact of rehabilitation measures on work ability and return to work (RTW), specifically the association between workplace rehabilitation/supportive conditions at work and work ability and RTW over time, among women on long-term sick leave. Methods Questionnaire data were collected (baseline, 6 and 12 months) from a cohort of women (n = 324). Linear mixed models were used for longitudinal analysis of the repeated measurements of work ability index (WAI), work ability score and working degree. These analyses were performed with different models; the explanatory variables for each model were workplace rehabilitation, supportive conditions at work and time. Results The individuals provided with workplace rehabilitation and supportive conditions (e.g. influence at work, possibilities for development, degree of freedom at work, meaning of work, quality of leadership, social support, sense of community and work satisfaction) had significantly increased WAI and work ability score over time. These individuals scored higher work ability compared to those individuals having workplace rehabilitation without supportive conditions, or neither. Additionally, among the individuals provided with workplace rehabilitation and supportive conditions, working degree increased significantly more over time compared to those individuals with no workplace rehabilitation and no supportive conditions. Conclusion The results highlight the importance of integrating workplace rehabilitation with supportive conditions at work in order to increase work ability and improve the RTW process for women on long-term sick leave.

  • 20.
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science.
    Integrating improvement learning into health professional educational curricula2008In: International Forum on Quality Improvement in Healthcare, France, April 24 2008: International Forum on QI , 2008, p. 1-Conference paper (Refereed)
    Abstract [en]

    We all need to start where we are and also wanting to go further all the time. This is the essence in quality improvement. The leader and the teachers must own this attitude themselves in order to have the ability to be trustworthy for the students. There is evidence in the literature about the impact of education on the professional attitude and role. This means that it is important to work with better professional development for better outcomes in the faculty.

    One starting point for us in the planning of our different programs are that improvement knowledge will be a streak through the whole education in order to establish a professional attitude of daily inspiration to produce the best practise. We have applied all curricula to Boologna declaration and in this system progression in learning is a key point. We have four levels in the basic education (3-years education which lead to Bachelor degree) where we start to introduce 1) Concepts and models in health improvement. Then let our students make a 2) Personal improvement in their everyday life. Later in the education we teach about 3) Evidence practise and systematic literature reviews. Finally the students are 4) Making health improvements in collaboration with the staff during one clinical education.

    All educational programmes on basic level since 2007 include aim descriptions about quality improvement. The aim of the learning is to have the competence to initiate and participate in work about health care improvements.

    Finally, besides the mentions aspects in improvement education there are some other factors that needs for better system performance.

  • 21.
    Ahmady, Soleiman
    et al.
    Shahid Beheshti University of Medical Sciences, Iran;Karolinska Institutet, Sweden.
    Changiz, Tahereh
    Isfahan University of Medical Sciences, Iran.
    Masiello, Italo
    Karolinska Institutet, Sweden.
    Hamadanchi, Arya
    University of Social and Rehabilitation Sciences, Iran.
    Development and psychometrics properties of an instrument for assessing faculty development programs from a broader perspective2016In: Biosciences Biotechnology Research Asia, ISSN 0973-1245, Vol. 13, no 1, p. 319-325Article in journal (Refereed)
    Abstract [en]

    The present study proposed a new instrument for the assessment of the current faculty development programs at Iranian medical universities. Although the literature concerning the subject of faculty development activities has already identified strengths and weakness of such programs, it is still questionable whether these activities can be assessed using a pedagogical and managerial comprehensive approach. Therefore, it was determined to develop an instrument to examine faculty development activities that address all components of programs from planning and implementing to evaluating phases, with the possibility of utilizing this instrument as a tool to assess faculty development activities.

  • 22. Ahmed, Sayem
    et al.
    Hasan, Md. Zahid
    Laokri, Samia
    Jannat, Zerin
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Ahmed, Mohammad Wahid
    Dorin, Farzana
    Vargas, Veronica
    Khan, Jahangir A. M.
    Technical efficiency of public district hospitals in Bangladesh: a data envelopment analysis2019In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 17, article id 15Article in journal (Refereed)
    Abstract [en]

    Background: District hospitals (DHs) provide secondary level of healthcare to a wide range of population in Bangladesh. Efficient utilization of resources in these secondary hospitals is essential for delivering health services at a lower cost. Therefore, we aimed to estimate the technical efficiency of the DHs in Bangladesh. Methods: We used input-oriented data envelopment analysis method to estimate the variable returns to scale (VRS) and constant returns to scale (CRS) technical efficiency of the DHs using data from Local Health Bulletin, 2015. In this model, we considered workforce as well as number of inpatient beds as input variables and number of inpatient, outpatient, and maternal services provided by the DHs as output variables. A Tobit regression model was applied for assessing the association of institutional and environmental characteristics with the technical efficiency scores. Results: The average scale, VRS, and CRS technical efficiency of the DHs were estimated to 85%, 92%, and 79% respectively. Population size, poverty headcount, bed occupancy ratio, administrative divisions were significantly associated with the technical efficiency of the DHs. The mean VRS and CRS technical efficiency demonstrated that the DHs, on an average, could reduce their input mix by 8% and 21% respectively while maintaining the same level of output. Conclusion: Since the average technical efficiency of the DHs was 79%, there is little scope for overall improvements in these facilities by adjusting inputs. Therefore, we recommend to invest further in the DHs for improvement of services. The Ministry of Health and Family Welfare (MoHFW) should improve the efficiency in resource allocation by setting an input-mix formula for DHs considering health and socio-economic indicators (e.g., population density, poverty, bed occupancy ratio). The formula can be designed by learning from the input mix in the more efficient DHs. The MoHFW should conduct this kind of benchmarking study regularly to assess the efficiency level of health facilities which may contribute to reduce the wastage of resources and consequently to provide more affordable and accessible public hospital care.

  • 23.
    Aidemark, Jan
    et al.
    Linnaeus University.
    Askenäs, Linda
    Linnaeus University.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Strömberg, Anna
    Linköping University.
    User involvement in the co-design of self-care support systems for heart failure patients2015In: Procedia Computer Science, ISSN 1877-0509, E-ISSN 1877-0509, Vol. 64, p. 118-124Article in journal (Refereed)
    Abstract [en]

    In this paper the nature of user involvement in a co-design process will be explored. The outlines of a research project aiming at developing support systems for self-care inpatients suffering from chronic heart failure will be presented. The project is planned to perform a co-design effort where users (patients and healthcare professionals) will be given the opportunity to influence the development of support systems. We will discuss a number of possibilities and challenges that lie in the design of this kind of project and also some findings from its early stages. This report presents the experiences of users’ input, which are discussed in the context of previous research on benefits of user contributions in systems development.

  • 24. Ajroud-Driss, Senda
    et al.
    Adams, David
    Coelho, Teresa
    Polydefkis, Michael
    Gonzalez-Duarte, Alejandra
    Quan, Dianna
    Kristen, Arnt
    Berk, John L.
    Partisano, Angela M.
    Gollob, Jared
    Sweetser, Marianne T.
    Chen, Jihong
    Agarwal, Sonalee
    Suhr, Ole B.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Impact of Patisiran on Overall Health Status in hATTR Amyloidosis: Results from the APOLLO Trial2019In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 92, no 15Article in journal (Other academic)
  • 25.
    Akay, Altug
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Dragomir, Andrei
    Erlandsson, Björn-Erik
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    A Novel-Data Mining Platform to Monitor the Outcomes of Erlontinib (Tarceva) using Social Media2014In: XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013, Springer, 2014, p. 1394-1397Conference paper (Refereed)
    Abstract [en]

    A novel data-mining method was developed to gauge the experiences of the oncology drug Tarceva. Self-organizing maps were used to analyze forum posts numerically to infer user opinion of drug Tarceva. The result is a word list compilation correlating positive and negative word cluster groups and a web of influential users on Tarceva. The implica-tions could open new research avenues into rapid data collec-tion, feedback, and analysis that would enable improved solu-tions for public health.

  • 26.
    Akhavan, Sharareh
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Blev det ett genombrott?: Utvärdering av det nationella lärandeprojektet – Vård på lika villkor2014Report (Other academic)
    Abstract [sv]

    Sjukvården i Sverige är i dag inte jämlik, har brister i tillgänglighet och erbjuds inte på likvärdiga villkor trots Hälso- och sjukvårdslagens mål om en god hälsa och en vård på lika villkor för hela befolkningen.

    För att bryta den pågående trenden och öka jämlikheten gjordes en överenskommelse mellan regeringen och SKL om lärandeprojektet Vård på lika villkor (under åren 2011–2014). Syftet med projektets har varit att inom socioekonomiskt resurssvaga bostadsområden öka jämlikheten i första linjens vård. Detta genom att testa, utveckla och identifiera effektiva arbetssätt och metoder vid sju primärvårdsverksamheter från fem landsting i Sverige.

    Mälardalens högskola, Akademin för hälsa, vård och välfärd, fick av SKL i uppdrag att svara för forskarstöd och att genomföra en utvärdering av de metoder och arbetssätt som utvecklades och testades i lärandeprojektet.

    Resultatet från den genomförda utvärderingen som belyser den genomförda processen, mål- och resultat samt hälsoekonomiska aspekter beskrivs närmare i denna rapport.

  • 27.
    Akhavan, Sharareh
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Temaledare: Vård på lika villkor – Vad kan vi lära av Lärandeprojektet?2015In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, no 2, p. 103-106Article in journal (Other academic)
  • 28.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Kunskapsstyrning genom checklistor kan bli farlig sjukvård.2017Other (Other (popular science, discussion, etc.))
  • 29.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Socialstyrelsens kritik beror på bristande uppföljning av äldre personer2017Other (Other (popular science, discussion, etc.))
  • 30.
    Akner, Gunnar
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Sverige ledande på värdebaserad vård2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, article id ELSPArticle in journal (Other academic)
    Abstract [sv]

    Sverige ligger högst i en internationell jämförande studie om värdebaserad vård. Rapporten visar tydligt ambitionerna från ett flertal internationella organ att införa värdebaserad vård för styrningen av sjukvården globalt.

  • 31.
    Akner, Gunnar
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Andersson, Christer
    Umeå University.
    Ekerstad, Niklas
    NU-sjukvården.
    Eliasson, Mats
    Umeå University.
    Gustafson, Yngve
    Umeå University.
    Järhult, Bengt
    Region Östergötland.
    Petersson, Christer
    Region Kronoberg.
    Tjärnström, Johan
    NU-sjukvården.
    von Zur-Mühlen, Bengt
    Uppsala University Hospital.
    Wingstrand, Hans
    Lund University.
    Styrningen har blivit ett hot2016In: Svenska Dagbladet, ISSN 1101-2412, Vol. 25 jul, p. 1Article in journal (Other (popular science, discussion, etc.))
  • 32.
    Akner, Gunnar
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Andersson, Christer
    Umeå universitet.
    Hallén, Ola
    Karlstads lasarett.
    Järhult, Bengt
    Vårdcentralen Ryd.
    Järhult, Johannes
    Professor em. Jönköping.
    Lind, Helena
    Spec onkologi och palliativ medicin, Stockholm.
    Löfmark, Rurik
    Med dr Gävle.
    Petersson, Christer
    Allmänmedicinare, Växjö.
    Rutegård, Jörgen
    Docent kirurgi, Umeå.
    Sandberg, CG
    Spec psykiatri och företagshälsovård, Stockholm.
    Schmitt, Christian
    Spec allmänmedicin, Sätila.
    Sjögren, Jonas
    Spec allmänmedicin, Västerås.
    Cizinsky, Stella
    Specialist i kardiologi, Örebro.
    Styrud, Johan
    Specialist i kirurgi, Stockholm.
    Svenberg, Torgny
    Specialist i kirurgi, Stockholm.
    Tjärnström, Johan
    Specialist i kirurgi, Trollhättan.
    Westergren, Hans
    Öl, med dr, Smärtrehab, Lund.
    Wingstrand, Hans
    Professor i ortopedi, Lund.
    Zur-Mühlen B, Bengt
    Med dr, öl neurologi, Uppsala.
    Ekerstad, Niklas
    Med dr, spec kardiologi Trollhättan.
    Elisasson, Mats
    Professor, spec internmedicin, Umeå.
    Engström, Sven
    Spec allmänmedicin, Örnsköldsvik.
    Ervander, Cecilia
    Spec allmänmedicin Lund.
    Flordal, Per Anders
    Spec kirurgi, Stockholm.
    Hagström, Bertil
    Spec allmänmedicin, Horred.
    Halldin, Jan
    Specialist i psykiatri och socialmedicin, Stockholm.
    Värdebaserad vård strider sannolikt mot lagen2017In: Dagens Samhälle, ISSN 1652-6511, article id 170315Article in journal (Other (popular science, discussion, etc.))
  • 33.
    Akner, Gunnar
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Andersson, Christer
    Umeå universitet.
    Hallén, Ola
    Karlstads lasarett.
    Järhult, Bengt
    Vårdcentralen Ryd.
    Järhult, Johannes
    Professor em. Jönköping.
    Löfmark, Rurik
    Med dr Gävle.
    Petetrsson, Christer
    Allmänmedicinare, Växjö.
    Sandberg, CG
    Spec psykiatri och företagshälsovård, Stockholm.
    Schmitt, Christian
    Spec allmänmedicin, Sätila.
    Sjögren, Jonas
    Spec allmänmedicin, Västerås.
    Styrud, Johan
    Specialist i kirurgi, Stockholm.
    Svenberg, Torgny
    Specialist i kirurgi, Stockholm.
    Cizinsky, Stella
    Specialist i kardiologi, Örebro.
    Tjärnström, Johan
    Specialist i kirurgi, Trollhättan.
    Wingstrand, Hans
    Professor i ortopedi, Lund.
    Ekerstad, Niklas
    Med dr, spec kardiologi Trollhättan.
    Elisasson, Mats
    Professor, spec internmedicin, Umeå.
    Engström, Sven
    Spec allmänmedicin, Örnsköldsvik.
    Ervander, Cecilia
    Spec allmänmedicin Lund.
    Flordal, Per Anders
    Spec kirurgi, Stockholm.
    Hagström, Bertil
    Spec allmänmedicin, Horred.
    Halldin, Jan
    Specialist i psykiatri och socialmedicin, Stockholm.
    Vårdkrisen är egentligen en onödig artefakt.2017In: Dagens Medicin, E-ISSN 1402-1943, no 17, 26 April, p. 23-, article id 170428Article in journal (Other (popular science, discussion, etc.))
  • 34.
    Akner, Gunnar
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ekerstad, Niklas
    Med dr, spec kardiologi Trollhättan.
    Elisasson, Mats
    Professor, spec internmedicin, Umeå.
    Engström, Sven
    Spec allmänmedicin, Örnsköldsvik.
    Ervander, Cecilia
    Spec allmänmedicin Lund.
    Flordal, Per Anders
    Spec kirurgi, Stockholm.
    Hagström, Bertil
    Spec allmänmedicin, Horred.
    Halldin, Jan
    Specialist i psykiatri och socialmedicin, Stockholm.
    Hallén, Ola
    Medicinkliniken, Karlstads lasarett.
    Järhult, Bengt
    Vårdcentralen Ryd.
    Järhult, Johannes
    Professor em. Jönköping.
    Lind, Helena
    Spec onkologi och palliativ medicin, Stockholm.
    Löfmark, Rurik
    Med dr Gävle.
    Petersson, Christer
    Allmänmedicinare, Växjö.
    Rutegård, Jörgen
    Docent kirurgi, Umeå.
    Sandberg, CG
    Spec psykiatri och företagshälsovård, Stockholm.
    Schmitt, Christian
    Spec allmänmedicin, Sätila.
    Sjögren, Jonas
    Spec allmänmedicin, Västerås.
    Styrud, Johan
    Specialist i kirurgi, Stockholm.
    Svenberg, Torgny
    Specialist i kirurgi, Stockholm.
    Tjärnström, Johan
    Specialist i kirurgi, Trollhättan.
    Westergren, Hans
    Öl, med dr, Smärtrehab, Lund.
    Wingstrand, Hans
    Professor i ortopedi, Lund.
    von Zur-Mühlen, Bengt
    Med dr, öl nefrologi, Uppsala.
    Vi står gärna bakom en utfallsbaserad vård2017In: Dagens Samhälle, ISSN 1652-6511, article id 170328Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Jörgen Nordenström försöker få det till att vår kritik av värdebaserad vård egentligen handlar om att vi vill ha mer resurser. Han har helt missuppfattat oss, skriver 26 specialistläkare i en replik.

  • 35.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Kalmar, Sweden.
    Järhult, Bengt
    Ekonomiska incitament ska inte kopplas till den enskilde patienten2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, article id D4TPArticle in journal (Refereed)
  • 36.
    Akner, Gunnar
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Järhult, Bengt
    Region Östergötland.
    Ekonomiska incitament ska inte kopplas till den enskilde patienten: Replik till Magnus Lind om värdebaserad vård2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, article id D4TPArticle in journal (Other academic)
  • 37.
    Akner, Gunnar
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Järhult, Bengt
    Region Östergötland, Sweden.
    Värdebaserad vård införs snabbt: värdig efterträdare till NPM?2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, no 20, p. 1-3, article id DXUTArticle in journal (Refereed)
  • 38.
    Akner, Gunnar
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Järhult, Bengt
    Vårdcentralen Ryd.
    Värdebaserad vård utan underlag: Apropå!2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, no 21, article id DZFHArticle in journal (Other academic)
  • 39.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Al Mandhari, Ahmed
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, article id 18Article in journal (Refereed)
    Abstract [en]

    BackgroundThe literature has described several challenges related to the quality of diabetes management clinics in public primary health care centres in Oman. These clinics continue to face challenges due to the continuous growth of individuals diagnosed with type 2 diabetes. We sought to explore the challenges faced in these clinics and discuss opportunities for improvement in Oman.MethodsThis qualitative study was designed to include non-participant observations of diabetic patients and care providers during service provision at diabetes management clinics, as well as semi-structured interviews with care providers, at five purposively selected public primary health care centres. Care providers included physicians, nurses, dieticians, health educators, pharmacists, an assistant pharmacist, a psychologist, and a medical orderly. The data were analysed using qualitative content analysis.ResultsThe study disclosed three different models of service delivery at diabetes management clinics, which, to varying degrees, face challenges related to health centre infrastructure, technical and pharmaceutical support, and care providers' interests, knowledge, and skills. Challenges related to the community were also found in terms of cultural beliefs, traditions, health awareness, and public transportation.ConclusionThe challenges encountered in diabetes management clinics fall within two contexts: health care centres and community. Although many challenges exist, opportunities for improvement are available. However, improvements in the quality of diabetic clinics in primary health care centres might take time and require extensive involvement, shared responsibilities, and implications from the government, health care centres, and community.

  • 40.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Perceptions of type-two diabetes patients towards diabetes management visits at public primary health care centres with diverse opinions towards nurse-led clinics in Muscat, Oman: a pilot qualitative studyManuscript (preprint) (Other academic)
  • 41.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The question is not what we want; the question is, are we ready?: a qualitative study exploring primary health care providers`perceptions towards different human resources for health management mechanisms at diabetes management clinics in primary health care centres in Muscat, OmanManuscript (preprint) (Other academic)
  • 42.
    Albinsson, Gunilla
    et al.
    Blekinge Institute of Technology.
    Arnesson, Kerstin
    Blekinge Institute of Technology.
    Sustainable gender equality within the Swedish healthcare2013In: FALF-konferens - Arbetslivets föränderlighet, 2013, p. 3-Conference paper (Refereed)
    Abstract [en]

    The aim of the presentation is to discuss whether or not a methodological approach can promote a process of making visible gender equality within the health and medical care.

    Although Sweden has come a long way in making sure that women and men are treated equally in the workplace there are few countries with so obvious gender based occupational segregation. Within Swedish health- and medical care for example 81 per cent of the employees are women. The majority of these work in a hierarchical structure where the lower and intermediate levels primarily are comprised of women. With this point of departure we have studied the construction of gender equality in every day meetings between women and men working in health- and medical care.

    Aim

    The overarching purpose of the study was to describe and problematize the perspective of gender equality within the health- and medical care. Two main questions were posed:

    • How is the aspect of gender equality expressed in work related meetings between women and men working in health care?
    • Which opportunities and hindrances exist for creating sustainable gender equality within the health- and medical care?

    Method

    The empirical material comprised 23 women and men studying health care or public health at Blekinge Institute of Technology. The informants were also working as professional nurses. The study was carried through in two steps. Firstly four introductory lectures were conducted. Two of them were about qualitative methods with a particular emphasis on focus groups as an interview technique. The other two focused on current gender equality research. The informants also deepened their knowledge by reading articles about gender equality. In the second step qualitative interviews in focus groups were conducted. Before these occasions the interviewees had prepared themselves by reading a research report which made it possible to relate the text to personal experiences from working life.

    Result

    The empirical material showed that the knowledge about gender equality differed within the studied group. Most informants considered the problem area of vital importance and stressed the necessity of continual discussions in the workplace. However some of the interviewed had never thought of the issue as they regarded gender equality being a question without any interest. All our informants were aware of the plan of action for equality which is required at the workplace but only few of them had read it or worked actively with the implementation. When the interviewees reflected upon the hierarchical structure in their workplaces a common view was that an obvious difference between women’s and men’s opportunities to influence and exercise domination could be seen.

  • 43.
    Alexanderson, Kristina
    et al.
    Karolinska Institutet, Försäkringsmedicin.
    von Knorring, Mia
    Karolinska Institutet, Försäkringsmedicin.
    Keller, Christina
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Impact of a nationwide government program in Sweden on how healthcare managers, in their organisations, manage the work with sickness certification of patients2014In: The European journal of public health, Vol. 24, Supplement 2, 2014, p. 90-Conference paper (Refereed)
  • 44.
    Algurén, Beatrix
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. University of Gothenburg, Faculty of Education, Department of Food and Nutrition, and Sport Science, Sweden.
    Andersson Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Region Jönköping County, Futurum, Sweden.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Quality indicators and their regular use in clinical practice – results from a survey among users of two cardiovascular National Registries in Sweden2018In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, no 10, p. 786-792Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the regular use of quality indicators from Swedish cardiovascular National Quality Registries (NQRs) by clinical staff; particularly differences in use between the two NQRs and between nurses and physicians.

    Design: Cross-sectional online survey study.

    Setting: Two Swedish cardiovascular NQRs: a) Swedish Heart Failure Registry and b) Swedeheart.

    Participants: Clinicians (n=185; 70% nurses, 26% physicians) via the NQRs’ email networks.

    Main outcome measures: Frequency of NQR use for a) producing healthcare activity statistics; b) comparing results between similar departments; c) sharing results with colleagues; d) identifying areas for quality improvement (QI); e) surveilling the impact of QI efforts; f) monitoring effects of implementation of new treatment methods; g) doing research; h) educating and informing healthcare professionals and patients.

    Results: Median use of NQRs was ten times a year (25th and 75th percentiles range: 3 – 23 times/year). Quality indicators from the NQRs were used mainly for producing healthcare activity statistics. Median use of Swedeheart was six times greater than SwedeHF (p<0.000). Physicians used the NQRs more than twice as often as nurses (18 vs. 7.5 times/year; p<0.000) and perceived NQR work more often as meaningful. Around twice as many Swedeheart users had the role to participate in data analysis and in QI efforts compared to SwedeHF users.

    Conclusions: Most respondents used quality indicators from the two cardiovascular NQRs infrequently (< 3 times/year). The results indicate that linking registration of quality indicators to using them for QI activities increases their routine use and makes them meaningful tools for professionals.

  • 45.
    Algurén, Beatrix
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Food and Nutrition and Sport Science, University of Gothenburg, Faculty of Education, Gothenburg, Sweden.
    Nordin, Annika
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum, Region Jönköping County, Jönköping, Sweden.
    Peterson, Anette
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum, Region Jönköping County, Jönköping, Sweden.
    In-depth comparison of two quality improvement collaboratives from different healthcare areas based on registry data - Possible factors contributing to sustained improvement in outcomes beyond the project time2019In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, no 1, article id 74Article in journal (Refereed)
    Abstract [en]

    Background: Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years.

    Methods: Final reports of two QICs - one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC's team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics.

    Results: The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013.

    Conclusions: Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries' functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular. 

  • 46.
    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)2011In: Ocean and Coastal Management, ISSN 0964-5691, E-ISSN 1873-524X, Vol. 54, no 3, p. 250-255Article in journal (Refereed)
    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.

  • 47. Al-Janabi, Hareth
    et al.
    Coast, Joanna
    Flynn, Terry N
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    What do people value when they provide unpaid care for an older person? A meta-ethnography with interview follow-up.2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, no 1, p. 111-21Article in journal (Refereed)
    Abstract [en]

    Government policies to shift care into the community and demographic changes mean that unpaid (informal) carers will increasingly be relied on to deliver care, particularly to older people. As a result, careful consideration needs to be given to informal care in economic evaluations. Current methods for economic evaluations may neglect important aspects of informal care. This paper reports the development of a simple measure of the caring experience for use in economic evaluations. A meta-ethnography was used to reduce qualitative research to six conceptual attributes of caring. Sixteen semi-structured interviews were then conducted with carers of older people, to check the attributes and develop them into the measure. Six attributes of the caring experience comprise the final measure: getting on, organisational assistance, social support, activities, control, and fulfilment. The final measure (the Carer Experience Scale) focuses on the process of providing care, rather than health outcomes from caring. Arguably this provides a more direct assessment of carers' welfare. Following work to test and scale the measure, it may offer a promising way of incorporating the impact on carers in economic evaluations.

  • 48. Aljuaid, Mohammed
    et al.
    Elmontsri, Mustafa
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Rawaf, Salman
    Majeed, Azeem
    Psychometric evaluation of the Arabic language person-centred climate questionnairestaff version2018In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 26, no 4, p. 449-456Article in journal (Refereed)
    Abstract [en]

    AimTo evaluate the psychometric properties of the Arabic language person-centred climate questionnairestaff version. BackgroundThere have been increasing calls for a person-centred rather than a disease-centred approach to health care. A limited number of tools measure the extent to which care is delivered in a person-centred manner, and none of these tools have been validated for us in Arab settings. MethodThe validated form of the person-centred climate questionnairestaff version was translated into Arabic and distributed to 152 health care staff in teaching and non-teaching hospitals in Saudi Arabia. Statistical estimates of validity and reliability were used for psychometric evaluation. ResultsItems on the Arabic form of the person-centred climate questionnairestaff version had high reliability (Cronbach's alpha .98). Cronbach's alpha values for the three sub-scales (safety, everydayness and community), were .96, .97 and .95 respectively. Internal consistency was also high and measures of validity were very good. ConclusionArabic form of the person-centred climate questionnairestaff version provides a valid and reliable way to measure the degree of perceived person-centredness. Implications for nursing managementThe tool can be used for comparing levels of person-centredness between wards, units, and public and private hospitals. The tool can also be used to measure the extent of person-centredness in health care settings in other Arab countries.

  • 49. Allander, E
    et al.
    Bjurulf, P
    Isacsson, SO
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Svanström, L
    Westrin, CG
    Skilj mellan besluts- och forskningsregister!1985In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 82, p. 4383-84Article in journal (Refereed)
  • 50.
    Almblad, Ann-Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Engvall, Gunn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology.
    From skepticism to assurance and control: Implementation of a patient safety system at a pediatric hospital in Sweden2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0207744Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of evidence-based practice among healthcare professionals directly correlates to better outcomes for patients and higher professional satisfaction. Translating knowledge in practice and mobilizing evidence-based clinical care remains a continuing challenge in healthcare systems across the world.

    PURPOSE: To describe experiences from the implementation of an Early Detection and Treatment Program for Children (EDT-C) among health care professionals at a pediatric hospital in Sweden.

    DESIGN AND METHODS: Sixteen individual interviews were conducted with physicians, nurses and nurse assistants, which of five were instructors. Data were analyzed with qualitative content analysis.

    RESULTS: An overarching theme was created: From uncertainty and skepticism towards assurance and control. The theme was based on the content of eight categories: An innovation suitable for clinical practice, Differing conditions for change, Lack of organizational slack, Complex situations, A pragmatic implementation strategy, Delegated responsibility, Experiences of control and Successful implementation.

    CONCLUSIONS: Successful implementation was achieved when initial skepticism among staff was changed into acceptance and using EDT-C had become routine in their daily work. Inter-professional education including material from authentic patient cases promotes knowledge about different professions and can strengthen teamwork. EDT-C with evidenced-based material adapted to the context can give healthcare professionals a structured and objective tool with which to assess and treat patients, giving them a sense of control and assurance.

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