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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, 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.

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  • 2.
    Abazi, Doresa
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Vasilevski, Daniella
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Management Control in Swedish healthcare: A study of how cost control affects physicians' performance and their ability to maintain patient safety2022Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study is to gain insight into how cost control affects physicians’ performance in terms of motivation and dysfunctional behaviour, and their ability to maintain patient safety. In the study, a qualitative method was used and four participants from Danderyd hospital were interviewed with semi-structured questions to gain material to answer the research question. In order to analyse the data, transcriptions of the interviews were made, and a thematic analysis method was used. Based on the analysis, four main themes emerged; Cost control, Motivation, Change in Behaviour and Patient safety.

    Among the physicians, results showed that physicians’ performance is negatively affected by cost control, resulting in decreased patient safety. Motivation was found to be indirectly affected and dysfunctional behaviours were found to be negatively affected by cost control. Resulting of cost control, physicians cannot fulfil their ethical obligations and perform more poorly because resources are decreased, primarily due to lack of care beds. Furthermore, the findings indicate that patient safety is negatively affected by the influence of cost control on dysfunctional behaviour. There is no adverse effect of cost control on patient safety when it comes to motivation.

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  • 3.
    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, 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.

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  • 4.
    Abdel, Mariam
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sech Mousa, Sarmpel
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Chefers och ledarskapets utmaningar inom laboratoriemedicinverksamheten under pandemin2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Sveriges hälso- och sjukvården står inför stora förändringar det senaste decenniet med anledning av olika händelser såsom digitaliseringen och pandemier. Covid-19-pandemin har orsakat enorma omställningar de senaste två åren uppger Coronakomissionen (SOU 2021:89) i sin rapport. En av de verksamheter som stod inför stora utmaningar inom hälso- och sjukvården var laboratoriemedicin. Syftet med studien är att belysa första linjens chefers utmaningar inom laboratoriemedicinverksamheteten när det gäller ledarskapet och arbetsmiljöutmaningar och hur dessa hanterades under covid-19-pandemin. Metoden som användes var kvalitativ metod med induktiv ansats och datainsamlingen genomfördes i form av semistrukturerade intervjuer med sex första linjens chefer inom laboratoriemedicinverksamheten. Resultatet presenteras i form av kategorier som har kommit fram genom analys av datamaterialet och presenteras utifrån studiens frågeställningar. Studiens resultatvisar att första linjens chefer inom laboratoriemedicinverksamheteten hanterade flera utmaningar under pandemin som bland annat var det stort informationsflödet, bemanningsproblem, arbetsmiljöutmaningar och slitna medarbetarna som behövde stöttas mentalt. Olika strategier har använts av cheferna med stöd av deras chefskollegor samt medarbetarna för att kunna hantera de här utmaningarna. Vidare forskning behövs både för chefers arbetsmiljö i ovan nämnd verksamhet samt för medarbetarnas arbetsmiljö i syfte att kunna belysa ytterligare de problem som finns samt att hitta olika hållbara lösningar.

  • 5.
    Abdelaziz, Amr Abdelaziz Badrawy
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Troeller, Kenan Craig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Cost-Effectiveness Analysis of Endovascular versus Open Repair of Ruptured Abdominal Aortic Aneurysm in Sweden2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Approximately 600 people die from ruptured abdominal aortic aneurism annually in Sweden. Abdominal aortic aneurysm (AAA) is a widening of the abdominal aorta. If a ruptured aortic aneurysm occurs (RAAA), it is a medical emergency and it is a life-threatening condition. The two interventions used to treat RAAA patients are known as the endovascular strategy (EVAR) and the open repair method (OR). Given the life-threatening nature of RAAA, mortality rates are quite high especially considering that this medical condition affects predominantly the elderly. Determining whether a patient is more suitable for EVAR or OR depends on —among other clinical factors— whether technical expertise and resources are available to perform EVAR. The Swedish Agency for Health and Technology Assessment (SBU) explain that it is currently unclear as to which of the two intervention is the cost-effective alternative in treating RAAA in Sweden. 

    Objective: The aim of this study is to evaluate whether the non-invasive EVAR (endovascular) or traditional surgery known as OR (open repair) is more cost-effective in treating RAAA in Sweden.

    Methods: A Cost-effectiveness analysis with healthcare provider perspective using secondary data from relevant peer-reviewed literature from Sweden, other European countries, Swedvascs' and Socialstyrelsens' registries. The model of choice for this evaluation is a decision tree. The target population is males and females who suffer from RAAA in Sweden ranging from ages 50 – 90+, the majority of which were >65. Two subgroups were analyzed; RAAA patients treated with EVAR  and RAAA patients treated with OR. Total RAAA patients n=178. EVAR n= 73. OR n= 105. The time horizon in the base-case is 90 days. The outcome measures are incremental cost-effectiveness ratio (ICER), QALYs and cost/QALY. A one-way deterministic sensitivity analyses, in addition to a probabilistic sensitivity analysis were performed in order to assess the level of confidence that may be associated with the conclusion of this economic evaluation

    Results: Results from the base-case analysis shows that EVAR's cost per QALY gained is SEK 715,823.82 with an ICER of SEK 1,113,499.44 per QALY gained. Results of the base-case analysis shows that EVAR is not cost-effective when considering the commonly accepted threshold of SEK 500,000 per QALY gained. Results of the deterministic sensitivity analyses show that under all suggested scenarios EVAR was not cost-effective. However, results of the probabilistic sensitivity analysis result shows that there is a considerable uncertainty around the cost-effectiveness of EVAR.

    Conclusion: EVAR is not cost-effective with marginal clinical benefits compared to OR. Since it is a high cost intervention which lacks national guidelines from "Socialstyrelsen", individual county councils in Sweden will likely have to make the decision individually if they want to adopt EVAR as a treatment method for RAAA. While RAAA is a very severe health condition it also has a low prevalence in Sweden meaning county councils with larger population centers, budgets and availability of technical expertise/equipment can still introduce EVAR to treat RAAA even if the cost-effectiveness analysis results exceed the commonly accepted threshold value of SEK 500,000 per QALY gained. Due to uncertainties vis-à-vis a lack of more conclusive data in a Swedish context, further investigation is required before recommending EVAR for subsidization. It would however be worth pursuing this end given the promise of EVAR as a non-invasive and more benign treatment method for patients. 

  • 6.
    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.

  • 7. 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)
  • 8.
    Abougazar, Eman Silmy
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
      Barriers to equal access to eHealth in Stockholm  : A qualitative study2022Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    The aim behind this study was to observe and understand barriers to access the eHealth system equally. The study was conducted in Stockholm based on qualitative data in which semi- structured interviews were conducted among 15 interviewees from different localities of Stockholm. The findings from the collected data revealed that language barriers, lack of knowledge about digital literacy, unawareness of Swedish healthcare services, psychological and social barriers, safety and privacy concerns, and the lack of an e-identification are all major barriers to accessing the eHealth system. From the data, it has also been observed that the main causes of the aforementioned hurdles are based on varied socioeconomic levels, literacy conditions of an individual, cultural background, and age. Another important observation shows that highly qualified people with limited language abilities have a difficult time using eHealth services. 

    Keywords 

    Ehealth, Covid-19, nudge approach, digital literacy, linguistic skills, Bank ID, 1177.se, Alltid öppet. 

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  • 9.
    Abougazar, Eman Silmy
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Barriers to equal access to eHealth in Stockholm: A qualitative study2022Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The aim behind this study was to observe and understand barriers to access the eHealth system equally. The study was conducted in Stockholm based on qualitative data in which semi- structured interviews were conducted among 15 interviewees from different localities of Stockholm. The findings from the collected data revealed that language barriers, lack of knowledge about digital literacy, unawareness of Swedish healthcare services, psychological and social barriers, safety and privacy concerns, and the lack of an e-identification are all major barriers to accessing the eHealth system. From the data, it has also been observed that the main causes of the aforementioned hurdles are based on varied socioeconomic levels, literacy conditions of an individual, cultural background, and age. Another important observation shows that highly qualified people with limited language abilities have a difficult time using eHealth services. 

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  • 10.
    Abourraja, Mohamed Nezar
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Marzano, Luca
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Raghothama, Jayanth
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Boodaghian Asl, Arsineh
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Darwich, Adam S.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Meijer, Sebastiaan
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Lethvall, Sven
    Uppsala University Hospital,Uppsala,Sweden.
    Falk, Nina
    Uppsala University Hospital,Uppsala,Sweden.
    A Data-Driven Discrete Event Simulation Model to Improve Emergency Department Logistics2022In: Proceedings of the 2022 Winter Simulation Conference, Institute of Electrical and Electronics Engineers (IEEE) , 2022Conference paper (Refereed)
    Abstract [en]

    Demands for health care are becoming overwhelming for healthcare systems around the world regarding theavailability of resources, particularly, in emergency departments (EDs) that are continuously open and mustserve immediately any patient who comes in. Efficient management of EDs and their resources is requiredmore than ever. This could be achieved either by optimizing resource utilization or by the improvement ofhospital layout. This paper investigates, through data-driven simulation alternative designs of workflowsand layouts to operate the ED of the Uppsala University Hospital in Sweden. Results are analyzed tounderstand the requirements across the hospital for reduced waiting times in the ED. The main observationrevealed that introducing a new ward dedicated to patients having complex diagnoses with a capacity ofless than 20 beds leads to lower waiting times. Furthermore, the use of data-mining was of great help inreducing the efforts of building the simulation model.

  • 11.
    Abourraja, Mohamed Nezar
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Meijer, Sebastiaan
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Boukachour, Jaouad
    Normandie University, UNIHAVRE, 76600 Le Havre, France.
    A model-driven design approach for Ro-Ro and container terminals: from requirements analysis down to simulation model implementation2021In: 20th International Conference on Modeling and Applied Simulation, MAS 2021, Cal-Tek Srl , 2021, p. 9-20Conference paper (Refereed)
    Abstract [en]

    Modeling, one of the main pillars of good scientific research, is a long-standing multidisciplinary activity to understand and analyze complex systems. In this paper, the focus is directed toward conceptual modeling of multi-terminal seaports specialized in handling and treatment of intermodal transport units (ITU). These systems are complex with highly dynamic and stochastic behaviors and actors, therefore, studying them as a coherent whole or just analyzing one part by taking into account the high degree of integration among the different aspects and actors linked by a flow of activities, information, and interactions is a bet lost in advance without a well-defined design process. Several design approaches and methodologies have been proposed over the years, but nonetheless, there is still no agreement on how to conduct modeling of complex systems because they are of different kinds. In this line, this paper proposes a top-down approach for container and Ro-Ro terminals largely inspired by the Unified Process Methodology and refined through several research projects that we have been involved in. It gives some recommendations and guidelines as well as a helpful way to successfully build modular and consistent simulation models. To prove its efficiency, it was applied to a case study and the resulting models were validated by the subject matter's experts.

  • 12.
    Abraha, Atakelti
    et al.
    Tigray Health Bureau, Tigray, Ethiopia;Ethiopian Health Insurance Agency, Addis Ababa, Ethiopia.
    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, Vol. 31, no 10, p. 1271-1281Article 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.

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  • 13. 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)

  • 14.
    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. 

  • 15.
    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.

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  • 16.
    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.

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  • 17.
    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.

  • 18.
    Adelsjö, Igor
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Nilsson, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Amanda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Ekstedt, Mirjam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Karolinska Institutet, Sweden.
    Lehnbom, Elin C.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. UiT The Arctic University of Norway, Norway.
    Communication about medication management during patient–physician consultations in primary care: a participant observation study2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 11, article id e062148Article in journal (Refereed)
    Abstract [en]

    Objective To explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations.

    Setting Two primary care centres in southern Sweden.

    Participants Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis.

    Results Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further.

    Conclusion Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.No data are available.

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  • 19.
    Ademovic, Mevlida
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Cederlund, Anna
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Psykisk ohälsa hos första linjens chefer inom vård och omsorg: En litteraturöversikt2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    First-line managers have a demanding position. For exemple as they often need to convey the management's decisions that they themselves do not decide on and at the same time have a good relationship with their employees. Many first-line managers choose to resign. The purpose of the study is to describe nurse managers' experiences of what in the work creates mental strain. A general literature study. 10 qualitative studies were reviewed and compiled into a result of 1 main theme and 3 sub-themes. The result presents the main theme: Difficult role to shoulder, was mainly about the complexity of the role of first-line manager, which often means having to be accountable to both management and employees. It also emerged that first-line managers need increased support in administration and stronger support from management. First-line managers also felt that they needed more education, especially in finance. The first-line manager often lack mandate to implement changes, but frequently needs to convey decisions that they themselves have not made. First-line managers who have received more support resources have proven to be more satisfied in their work role. More education is something that nursing managers who have terminated their employment have wished they had received. 

  • 20. 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.

  • 21.
    af Ugglas, Bjorn
    et al.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Skyttberg, Niclas
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Wladis, Andreas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Djarv, Therese
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Holzmann, Martin J.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden2020In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 28, no 1, article id 107Article in journal (Refereed)
    Abstract [en]

    Objectives COVID-19 presents challenges to the emergency care system that could lead to emergency department (ED) crowding. The Huddinge site at the Karolinska university hospital (KH) responded through a rapid transformation of inpatient care capacity together with changing working methods in the ED. The aim is to describe the KH response to the COVID-19 crisis, and how ED crowding, and important input, throughput and output factors for ED crowding developed at KH during a 30-day baseline period followed by the first 60 days of the COVID-19 outbreak in Stockholm Region. Methods Different phases in the development of the crisis were described and identified retrospectively based on major events that changed the conditions for the ED. Results were presented for each phase separately. The outcome ED length of stay (ED LOS) was calculated with mean and 95% confidence intervals. Input, throughput, output and demographic factors were described using distributions, proportions and means. Pearson correlation between ED LOS and emergency ward occupancy by phase was estimated with 95% confidence interval. Results As new working methods were introduced between phase 2 and 3, ED LOS declined from mean (95% CI) 386 (373-399) minutes to 307 (297-317). Imaging proportion was reduced from 29 to 18% and admission rate increased from 34 to 43%. Correlation (95% CI) between emergency ward occupancy and ED LOS by phase was 0.94 (0.55-0.99). Conclusions It is possible to avoid ED crowding, even during extreme and quickly changing conditions by leveraging previously known input, throughput and output factors. One key factor was the change in working methods in the ED with higher competence, less diagnostics and increased focus on rapid clinical admission decisions. Another important factor was the reduction in bed occupancy in emergency wards that enabled a timely admission to inpatient care. A key limitation was the retrospective study design.

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  • 22.
    Agasteen Anantharaj, Kingsly Anand
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH).
    Improving management of patient flow at Radiology Department using Simulation Models2021Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The Swedish healthcare system is considered to have good healthcare productivity and efficiency with moderate cost but seems to have some future challenges. Sweden is moving towards the aging population as it requires development in medical care techniques and technologies to provide care to elderly patients. This increases the pressure on the healthcare system. Hence, the number of patients in the hospital increase, as a result, the flow of patients within the wards are increased. Furthermore, the pandemic has increased the number of people admitted to hospitals. As a consequence, even for high-priority cases, the wait times are rising.

    The Skaraborg Hospital Group, SHG, and other general hospitals, in particular, are focusing on how to handle patient flow at various levels within departments and clinics by improving patient flow quality. Production and capacity preparation (PCP) is a commonly used industry tool for resolving bottlenecks. Hence, this method needs to be adopted within the hospital and by the healthcare sector to a larger extent.

    Since many patients from different specialty departments use the Radiology department's facilities, it is often a "bottleneck" in inpatient traffic at hospitals. Furthermore, the influx of patients with covid-19 has increased the department's workload.

    This master's thesis aims to assist the Radiology department in improving their production and capacity planning to increase unit flow performance. The project involves supporting key staff in the department in estimating demand to align different patient movements with equipment and personnel services. Improving radiology department flow efficiency can lead to more even and healthy patient flows around the hospital, reducing "buffers" of patients and longer stays at different specialist clinics.

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  • 23.
    Agerholm, Janne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Burström, Bo
    Schön, Pär
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Liljas, Ann
    How did providers of home care for older adults manage the early phase of the Covid-19 pandemic? A qualitative case study of managers' experiences in Region Stockholm2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, article id 1173Article in journal (Refereed)
    Abstract [en]

    Background In the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care providers to follow and staff in home care organisations often had to tackle challenges posed by the pandemic as they appeared. The aim of this study was to understand how the spread of Covid-19 was managed in organisations providing home care to older adults in different municipalities in Region Stockholm, and what actions were taken to minimise the spread of the disease among clients and staff.

    Method A descriptive qualitative study was performed based on eight interviews with managers of home care providers for older adults in three different municipalities in Region Stockholm.Three of the eight providers operate within an integrated care system. Data were analysed using conventional content analysis.

    Results Three themes were identified covering actions taken to handle the spread of the virus, feelings of insecurity and anxiety, and internal and external factors influencing how the pandemic was tackled. There was no single strategy followed by all municipalities or organisations, however, there were similarities between the organisations. One such example was the introduction of cohort care and the experience of lacking personal protective equipment. Providers in the integrated care system emphasized some advantages with their system that was seen as facilitators for minimising the risk of spreading the virus, like the joint meetings with managers from both health and social care and the close contact with healthcare professionals in relation to dissemination of hygiene instructions.

    Conclusion Social care workers providing home care to older persons are an important group in preventing dissemination of infectious diseases like Covid-19. For better readiness and preparedness for future pandemics, municipal home care services would need larger stocks of personal protective equipment, clear guidelines and more training on how to reduce dissemination of disease. Ways to achieve closer communication between health and social care providers should also be investigated.

  • 24.
    Agerholm, Janne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    Koitzsch Jensen, Natasja
    Liljas, Ann
    Healthcare professionals' perception of barriers and facilitators for care coordination of older adults with complex care needs being discharged from hospital: A qualitative comparative study of two Nordic capitals2023In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 23, no 1, article id 32Article in journal (Refereed)
    Abstract [en]

    Background The handover of older adults with complex health and social care from hospital admissions to homebased healthcare requires coordination between multiple care providers. Providing insight to the care coordination from healthcare professionals’ views is crucial to show what efforts are needed to manage patient handovers from hospitals to home care, and to identify strengths and weaknesses of the care systems in which they operate.

    Objective This is a comparative study aiming to examine healthcare professionals’ perceptions on barriers and facilitators for care coordination for older patients with complex health and social care needs being discharged from hospital in two capital cities Copenhagen (DK) and Stockholm (SE).

    Method Semi-structured interviews were conducted with 25 nurses and 2 assistant nurses involved in the coordination of the discharge process at hospitals or in the home healthcare services (Copenhagen n = 11, Stockholm n = 16). The interview guide included questions on the participants’ contributions, responsibilities, and influence on decisions during the discharge process. They were also asked about collaboration and interaction with other professionals involved in the process. The data was analysed using thematic analysis.

    Results Main themes were communication ways, organisational structures, and supplementary work by staff. We found that there were differences in the organisational structure of the two care systems in relation to integration between different actors and differences in accessibility to patient information, which influenced the coordination. Municipal discharge coordinators visiting patients at the hospital before discharge and the follow-home nurse were seen as facilitators in Copenhagen. In Stockholm the shared information system with access to patient records were lifted as a facilitator for coordination. Difficulties accessing collaborators were experienced in both settings. We also found that participants in both settings to a high degree engage in work tasks outside of their responsibilities to ensure patient safety.

    Conclusions There are lessons to be learned from both care systems. The written e-communication between hospitals and home health care runs more smoothly in Stockholm, whereas it is perceived as a one-way communication in Copenhagen. In Copenhagen there are more sector-overlapping work which might secure a safer transition from hospital to home. Participants in both settings initiated own actions to weigh out imperfections of the system.

  • 25. Agerholm, Janne
    et al.
    Pulkki, Jutta
    Jensen, Natasja K.
    Keskimäki, Ilmo
    Andersen, Ingelise
    Burström, Bo
    Jämsen, Esa
    Tynkkynen, Liina-Kaisa
    Schön, Pär
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Liljas, Ann E. M.
    The organisation and responsibility for care for older people in Denmark, Finland and Sweden: outline and comparison of care systems2024In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 52, no 2, p. 119-122Article in journal (Refereed)
    Abstract [en]

    Aim: To outline the organisation and responsibility for health and social care provided to older people in Denmark, Finland and Sweden.

    Methods: Non-quantifiable data on the care systems were collated from the literature and expert consultations. The responsibilities for primary healthcare, specialised healthcare, prevention and health promotion, rehabilitation, and social care were presented in relation to policy guidance, funding and organisation.

    Results: In all three countries, the state issues policy and to some extent co-funds the largely decentralised systems; in Denmark and Sweden the regions and municipalities organise the provision of care services – a system that is also about to be implemented in Finland to improve care coordination and make access more equal. Care for older citizens focuses to a large extent on enabling them to live independently in their own homes.

    Conclusions: Decentralised care systems are challenged by considerable local variations, possibly jeopardising care equity. State-level decision and policy makers need to be aware of these challenges and monitor developments to prevent further health and social care disparities in the ageing population.

  • 26.
    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.

  • 27.
    Agic, Alma
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Norlander Ekberg, Erika
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Inget sitter i väggarna – Organisationskultur och ledarskap: Vägen till hållbart ledarskap inom vård och omsorg2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In Sweden, there is a collective goal of providing high-quality and equitable care on equal terms for all. The health and social care sector faces significant future challenges in the area of competence maintenance in order to be able to provide high-quality care. To attract and retain a workforce, it is of great importance to prioritize work environment management and strengthen leadership. An organization’s perspective on leadership impacts which managers are recruited and the conditions for how leadership is created and developed. Taking into consideration the size of work groups, mission statement, economic challenges and comparatively weak organizational support, first line managers within health and social care have complex assignments in comparison with managers in other sectors. Organizations within the health and social care sector have finalized values as a part of their marketing philosophy and the organizational culture desired by leadership, while workplaces have developed their own cultures and norms, which leads to first line managers being placed in the difficult position of balancing between these cultures. Previous research has demonstrated that sustainable leadership is of great importance for organizations, workplaces, and first line managers.   

    The purpose of this study was to, with a focus on health and social care, investigate to what extent the reciprocal relationship between leadership, psychological security, diverse organizational cultures and work cultures promotes sustainable leadership.  

    The method of this study is a qualitative one, based on interviews conducted with six first line managers from different areas within the health and social care sector, with the goal of investigating their experiences in order to gain an increased understanding of how organizational culture and workplace culture affect and are affected by leadership. We have analyzed and summarized these interviews in relation to the following categories: organizational culture, workplace culture, psychological security, leadership and sustainable leadership.  

    The results demonstrate a significant distinction between organizational culture and workplace culture, as well as their impact on first line managers and their leadership. Furthermore, they demonstrate that first line managers feel that leadership becomes less sustainable in relation to organizational culture, but more sustainable in relation to workplace culture. First line managers work extensively with the implementation of sustainable workplace cultures, where they stress the importance of a present and trustbased leadership.

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  • 28.
    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)
  • 29.
    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.

  • 30.
    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.

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    SJUKSKÖTERSKANS STRESS RELATERAD TILL ARBETSBELASTNING (Ahl & Karlsmo, 2017)
  • 31.
    Ahl, Josefin
    et al.
    Halmstad University, School of Information Technology.
    Djurklou, Julia
    Halmstad University, School of Information Technology.
    Ransomware-hotet mot svenska sjukhus: – en intervju- och litteraturstudie2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Statistics show an increase in ransomware activity in recent years. The increase is mainly due to the ongoing Covid-19 pandemic. Cybercriminals take advantage of the fact that hospitals worldwide are overloaded with caring for seriously ill patients in Covid-19 and perform ransomware attacks.

    This thesis examines how Swedish hospitals experience and handle the increased threat of ransomware. The bachelor’s thesis consists of a literature study and some in-depth interviews. The literature study is investigating ransomware as a phenomenon and finding out why it is a successful method for cybercriminals to use in digital extortion.

    The purpose is also to investigate how Swedish hospitals relate to the fact that the healthcare sector has become an attractive target for cyber-attacks. The interview study examines the hospitals' IT security to determine whether they are sufficiently resistant to ransomware attacks. The interview results are discussed and analyzed against the background of the literature. The conclusion of this analysis is the basis for the proposed countermeasure.

    The results show that the hospitals surveyed have suitable IT security. The most central security mechanisms for the hospitals are their backup and recovery routines in the fight against ransomware. The discussion in this work combines the results from the literature and interview studies carried out. Based on the discussion, the conclusion is that the hospitals surveyed have good security and meet most of the recommendations published by Swedish authorities. Still, there is room for some improvement which is indicated.

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  • 32.
    Ahl, Magnus
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Inst Postgrad Dent Educ, Sweden.
    Marcusson, Agneta
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Ulander, Martin
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Magnusson, Anders
    Inst Postgrad Dent Educ, Sweden; Jonkoping Univ, Sweden.
    Cardemil, Carina
    Karolinska Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Larsson, Pernilla
    Malmo Univ, Sweden; Folktandvarden Ostergotland, Sweden.
    Translation and validation of the English-language instrument Orthognathic Quality of Life Questionair into Swedish2021In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, no 1, p. 19-24Article in journal (Refereed)
    Abstract [en]

    Introduction: In orthognathic surgery, understanding the patients motives for treatment is a key factor for postoperative patient satisfaction and treatment success. In countries/systems where orthognathic surgery is funded by public means, patients are referred mainly due to functional problems, although studies of quality of life related changes after treatment indicate that psychosocial and aesthetic reasons might be equal or more important for the patient. There is no available validated condition specific instruments in the Swedish language for quality of life evaluation of patients with dentofacial deformities. Aims/objectives: Cross cultural translation and adaptation of the English-language instrument Orthognathic Quality of Life Questionnaire (OQLQ) into Swedish. Methods: OQLQ was translated into Swedish. A total of 121 patients in four groups were recruited and the Swedish version of the OQLQ (OQLQ-S) was tested by psychometric methods. Reliability was assessed by internal consistency and test-retest reliability. Validity was evaluated by face, convergent and discriminant validity. Results/findings and conclusions: OQLQ-S is reliable and showed good construct validity and internal consistency and can be used in a Swedish speaking population as a complement to clinical variables to evaluate patients with dentofacial deformity.

  • 33.
    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.

  • 34.
    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. 

  • 35.
    Ahlstedt, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Registered nurses' work motivation and intention to stay at the workplace2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There is currently a shortage of registered nurses (RNs) and high turnover of RNs, both nationally and internationally. Work motivation is an important part of a healthy work environment and something we need to know more about from an RN perspective.

    The overarching aim of this thesis was to enhance our understanding of the organisational and social workplace factors that contribute to an attractive environment for RNs, by exploring factors associated with work motivation. Four research questions were posed. (i) What factors create the conditions for motivation in RNs’ daily work? (ii) What role does social support in the workplace play in RNs’ work motivation? (iii) What role does the opportunity to work with relevant tasks play in RNs’ work motivation? (iv) Are there differences between healthcare settings regarding RNs’ social support, illegitimate tasks, and associations with work motivation? Four empirical studies were performed to answer these questions. Two were qualitative studies based on an ethnographic approach and two were quantitative cross-sectional studies based on a stratified national sample of RNs. The results of the qualitative studies indicate that crucial factors for RNs' work motivation include a friendly and permissive atmosphere in daily work. Visible progress and receiving feedback from the work itself also positively contributed to motivation. Additionally, RNs' opportunities to learn and support each other through ongoing communication during daily work tended to have a positive impact on work motivation. Effective collaboration between physicians and RNs with mutual respect, understanding of each other's competencies, and creating an environment where RNs could seek clarification were also central to work motivation. The quantitative studies revealed that the opportunity for social support from the immediate manager or co-workers was significant for dimensions related to RNs’ work motivation and the willingness to stay in the workplace. The associations differed in strength between healthcare settings. Furthermore, the results indicated that a factor in RNs' work motivation was the ability to work with tasks perceived as relevant, not illegitimate. However, the results highlighted that a significant portion of RNs performed illegitimate tasks, and that illegitimate tasks were more prevalent for RNs in home healthcare than those in primary care and hospitals. This is something to consider as more complex care is being conducted outside of hospitals. The thesis adds new knowledge that can be useful to the development of attractive workplaces, which could contribute to more RNs choosing to remain in their position for a longer period.

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  • 36.
    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, 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.

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  • 37. 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.

  • 38.
    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.

  • 39.
    Ahmadi, Zainab
    et al.
    Lund Univ, Dept Clin Sci Lund, Resp Med Allergol & Palliat Med, Lund, Sweden..
    Björk, Joar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Karolinska Inst, Stockholm Ctr Healthcare Eth CHE, LIME, Stockholm, Sweden.
    Gilljam, Hans
    Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden..
    Gogineni, Madhuri
    Stockholms Sjukhem, Palliat Home Care & Hosp Wards, Stockholm, Sweden..
    Gustafsson, Torbjörn
    Runold, Michael
    Karolinska Univ Hosp, Dept Resp Med & Allergy, Stockholm, Sweden.;Karolinska Inst, Dept Med Solna, Resp Med Unit, Stockholm, Sweden..
    Ringbæk, Thomas
    Univ Hosp Umeå, Dept Resp Med & Allergy, Umeå, Sweden.;Allergy & Lung Clin, Elsinore, Denmark..
    Wahlberg, Josefin
    Blekinge Hosp, Dept Med, Karlskrona, Sweden..
    Wendel, Lotta
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden..
    Ekström, Magnus
    Lund Univ, Dept Clin Sci Lund, Resp Med Allergol & Palliat Med, Lund, Sweden..
    Smoking and home oxygen therapy: a review and consensus statement from a multidisciplinary Swedish taskforce2024In: European Respiratory Review, ISSN 0905-9180, E-ISSN 1600-0617, Vol. 33, no 171, article id 230194Article, review/survey (Refereed)
    Abstract [en]

    Background: Home oxygen therapy (HOT) improves survival in patients with hypoxaemic chronic respiratory disease. Most patients evaluated for HOT are former or active smokers. Oxygen accelerates combustion and smoking may increase the risk of burn injuries and fire hazards; therefore, it is considered a contraindication for HOT in many countries. However, there is variability in the practices and policies regarding this matter. This multidisciplinary Swedish taskforce aimed to review the potential benefits and risks of smoking in relation to HOT, including medical, practical, legal and ethical considerations.

    Methods: The taskforce of the Swedish Respiratory Society comprises 15 members across respiratory medicine, nursing, medical law and ethics. HOT effectiveness and adverse risks related to smoking, as well as practical, legal and ethical considerations, were reviewed, resulting in five general questions and four PICO (population–intervention–comparator–outcome) questions. The strength of each recommendation was rated according to the GRADE (grading of recommendation assessment, development and evaluation) methodology.

    Results: General questions about the practical, legal and ethical aspects of HOT were discussed and summarised in the document. The PICO questions resulted in recommendations about assessment, management and follow-up of smoking when considering HOT, if HOT should be offered to people that meet the eligibility criteria but who continue to smoke, if a specific length of time of smoking cessation should be considered before assessing eligibility for HOT, and identification of areas for further research.

    Conclusions: Multiple factors need to be considered in the benefit/risk evaluation of HOT in active smokers. A systematic approach is suggested to guide healthcare professionals in evaluating HOT in relation to smoking.

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  • 40.
    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.

  • 41.
    Ahmed, Anisuddin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition. Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Sayeed, Abu
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Tanwi, Tania Sultana
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Saha, Nondo
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Hanson, Molly
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition.
    Protyai, Dipanjan Adhikary
    Univ Dhaka, Inst Stat Res & Training, Dhaka, Bangladesh..
    Hossain, Aniqa Tasnim
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Ahmed, Ali
    Western Sydney Univ, Penrith Campus, Sydney, Australia..
    Rahman, Fariya
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Akter, Ema
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Nusrat, Nowrin
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Badsha, Md Shawon
    Univ Dhaka, Inst Stat Res & Training, Dhaka, Bangladesh..
    Rahman, Afruna
    Int Ctr Diarrhoeal Dis Res Icddr B, Infect Dis Div IDD, Dhaka, Bangladesh..
    Islam, Md Khairul
    WaterAid, Dhaka, Bangladesh..
    Alam, Md. Shah
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Nahar, Quamrun
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Arifeen, Shams El
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Rahman, Ahmed Ehsanur
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Tahsina, Tazeen
    Int Ctr Diarrhoeal Dis Res Icddr B, Maternal & Child Hlth Div MCHD, Dhaka, Bangladesh..
    Trends and inequity in improved sanitation facility utilisation in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys2023In: BMC Research Notes, E-ISSN 1756-0500, Vol. 16, article id 303Article in journal (Refereed)
    Abstract [en]

    Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage.

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  • 42. 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, 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.

  • 43.
    Ahonen, Hanna
    et al.
    Jönköping University.
    Broström, Anders
    Jönköping University; University Hospital Linköping.
    Fransson, Eleonor I.
    Jönköping University.
    Neher, Margit
    Jönköping University.
    Lindmark, Ulrika
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Jönköping University.
    "The terrible dryness woke me up, I had some trouble breathing"-Critical situations related to oral health as described by CPAP-treated persons with obstructive sleep apnea2022In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 31, no 6, article id e13670Article in journal (Refereed)
    Abstract [en]

    Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.

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  • 44.
    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, 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.

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  • 45.
    Aidemark, Jan
    et al.
    Linnaeus University.
    Askenäs, Linda
    Linnaeus University.
    Nygårdh, Annette
    Jönköping University, HHJ, Avdelningen för omvårdnad.
    Strömberg, Anna
    Linköping University.
    User involvement in the co-design of self-care support systems for heart failure patients2015In: Procedia Computer Science, 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.

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  • 46.
    Airaksinen, Lina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Jensen, Cassandra
    Mälardalen University, School of Health, Care and Social Welfare.
    Att vårda en närstående med demenssjukdom: En litteraturöversikt av anhörigas erfarenheter2023Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
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  • 47.
    Ajiko, Mary Margaret
    et al.
    Soroti Reg Referral Hosp, Uganda; Karolinska Inst, Sweden.
    Kressner, Julia
    Karolinska Inst, Sweden.
    Matovu, Alphonsus
    Karolinska Inst, Sweden; Mubende Reg Referral Hosp, Uganda.
    Nordin, P.
    Umea Univ, Sweden; Ostersunds Sjukhus, Sweden.
    Wladis, Andreas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Löfgren, Jenny
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Surgical procedures for children in the public healthcare sector: a nationwide, facility-based study in Uganda2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 7, article id e048540Article in journal (Refereed)
    Abstract [en]

    Objective This study investigated the surgical services for children at the highest levels of the public healthcare sector in Uganda. The aim was to determine volumes and types of procedure performed and the patients and the human resource involved. Design The study was a facility-based, record review. Setting The study was carried out at the National Referral Hospital, all 14 regional referral hospitals and 14 general hospitals in Uganda, representing the highest levels of hospital in the public healthcare sector. Participants The subjects were children Results The study hospitals contribute with an average annual rate of paediatric surgery at 22.0 per 100 000 paediatric population. This is a fraction of the estimated need. Most of the procedures were performed for congenital anomalies (n=3111, 39.4%), inflammation and infection (n=2264, 28.7%) and trauma (n=1210, 15.3%). Specialist surgeons performed 60.3% (n=4758) of the procedures, and anaesthesia was administered by specialist physician anaesthetists in 11.6% (n=917) of the cases. Conclusions A variety of paediatric surgical procedures are performed in a relatively decentralised system throughout Uganda. Task shifting and task sharing of surgery and anaesthesia are widespread: a large proportion of surgical procedures was carried out by non-specialist physicians, with anaesthesia mostly delivered by non-physician anaesthetists. Reinforcing the capacity and promoting the expansion of the health facilities studied, in particular the general hospitals and regional referral hospitals, could help reduce the immense unmet need for surgical services for children in Uganda.

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  • 48.
    Ajiko, Mary Margaret
    et al.
    Surgery, Soroti Regional Referral Hospital, Kampala, Uganda; Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Kressner, Julia
    Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Matovu, Alphonsus
    Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Surgery, Mubende Regional Referral Hospital, Kampala, Uganda.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Östersunds Sjukhus, Östersund, Sweden.
    Wladis, Andreas
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Löfgren, Jenny
    Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Surgical procedures for children in the public healthcare sector: A nationwide, facility-based study in Uganda2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 7, article id e048540Article in journal (Refereed)
    Abstract [en]

    Objective: This study investigated the surgical services for children at the highest levels of the public healthcare sector in Uganda. The aim was to determine volumes and types of procedure performed and the patients and the human resource involved.

    Design: The study was a facility-based, record review.

    Setting: The study was carried out at the National Referral Hospital, all 14 regional referral hospitals and 14 general hospitals in Uganda, representing the highest levels of hospital in the public healthcare sector.

    Participants: The subjects were children <18 years who underwent major surgery in the study hospitals during 2013 and 2014.

    Results: The study hospitals contribute with an average annual rate of paediatric surgery at 22.0 per 100 000 paediatric population. This is a fraction of the estimated need. Most of the procedures were performed for congenital anomalies (n=3111, 39.4%), inflammation and infection (n=2264, 28.7%) and trauma (n=1210, 15.3%). Specialist surgeons performed 60.3% (n=4758) of the procedures, and anaesthesia was administered by specialist physician anaesthetists in 11.6% (n=917) of the cases.

    Conclusions: A variety of paediatric surgical procedures are performed in a relatively decentralised system throughout Uganda. Task shifting and task sharing of surgery and anaesthesia are widespread: a large proportion of surgical procedures was carried out by non-specialist physicians, with anaesthesia mostly delivered by non-physician anaesthetists. Reinforcing the capacity and promoting the expansion of the health facilities studied, in particular the general hospitals and regional referral hospitals, could help reduce the immense unmet need for surgical services for children in Uganda.

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  • 49.
    Ajiko, Mary Margaret
    et al.
    Karolinska Inst, Sweden; Soroti Reg Referral Hosp, Uganda.
    Weidman, Viking
    Uppsala Univ, Sweden.
    Nordin, Pär
    Department of Surgery and Perioperative Sciences, University of Umeå, Umeå, Sweden.
    Wladis, Andreas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Löfgren, Jenny
    Karolinska Inst, Sweden.
    Prevalence of Paediatric Surgical Conditions in Eastern Uganda: A Cross-Sectional Study2022In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, no 3, p. 701-708Article in journal (Refereed)
    Abstract [en]

    Background The role of surgery in global health has gained greater attention in recent years. Approximately 1.8 billion children below 15 years live in low- and middle-income countries (LMIC). Many surgical conditions affect children. Therefore, paediatric surgery requires specific emphasis. Left unattended, the consequences can be dire. Despite this, there is a paucity of data regarding prevalence of surgical conditions in children in LMIC. The present objective was to investigate the prevalence of paediatric surgical conditions in children in a defined geographical area in Eastern Uganda. Method A cross-sectional study was carried out in the Iganga-Mayuge Health and Demographic Surveillance Site located in Eastern Uganda. Through a two-stage, cluster-based sampling process, 490 households from 49 villages were randomly selected, generating a study population of 1581 children. The childrens caregivers were interviewed, and the children were physically examined by two medical doctors to identify any surgical conditions. Results The interview was performed with 1581 children, and 1054 were physically examined. Among these, the overall prevalence of any surgical condition was 16.0 per cent (n = 169). Of these, 39 per cent had an unmet surgical need (66 of 169). This is equivalent to a 6.3 per cent prevalence of current unmet surgical need. The most common groups of surgical condition were congenital anomalies and trauma-related conditions. Conclusion Surgical conditions in children are common in eastern Uganda. The unmet need for surgery is high. With a growing population, the need for paediatric surgical capacity will increase even further. The health care system must be reinforced to provide services for children with surgical conditions if United Nations Sustainability Development Goal 3 is to be achieved by 2030.

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  • 50. 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)
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