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  • 1.
    Abbott, Allan
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Schröder, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Enthoven, Paul
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    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 trial2018Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 4Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 2.
    Abdelrahman, Islam
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Elmasry, Moustafa
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Validation of the burn intervention score in a National Burn Centre2018Inngår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 3. Abdon, Nils Johan
    et al.
    Bergfeldt, Lennart
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjärtstopp utlöst av läkemedel kanske vanligare än vi tror2010Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 8, s. 521-525Artikkel i tidsskrift (Fagfellevurdert)
  • 4. Abrahamsson, Birgitta
    et al.
    Berg, Marie-Louise U.
    Jutengren, Göran
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    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?2015Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, Vol. 27, nr 3, s. 196-200Artikkel i tidsskrift (Annet vitenskapelig)
    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)

  • 5.
    Acheampong, Faustina
    et al.
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik.
    Vimarlund, Vivian
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik. Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Centre for Information Technology and Information Systems (CenITIS). Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Innovating healthcare through remote monitoring: Effects and business model2017Inngår i: Health Care Delivery and Clinical Science: Concepts, Methodologies, Tools, and Applications, IGI Global, 2017, s. 247-268Kapittel i bok, del av antologi (Annet vitenskapelig)
    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. 

  • 6.
    Achit, Hamza
    et al.
    Université Paris-Est, IFSTTAR.
    Carnis, Laurent
    Université Paris-Est, IFSTTAR.
    Physical Impairment and Medical Care Spending by Road Accident Victims2013Inngår i: Proceedings of the 16th International Conference Road Safety on Four Continents: Beijing, China. 15-17 May 2013, Linköping: Statens väg- och transportforskningsinstitut, 2013Konferansepaper (Annet vitenskapelig)
    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.

  • 7.
    Adamiak, Grazyna Teresa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Påverkan av organisatoriska och miljömässiga faktorer på tillgänglighet till akutsjukvården2004Doktoravhandling, med artikler (Annet vitenskapelig)
    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.

  • 8.
    Adams, Mary
    et al.
    King’s College London, UK.
    Maben, Jill
    King’s College London, UK.
    Robert, Glenn
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, 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 care2017Inngår i: Health, ISSN 1363-4593, E-ISSN 1461-7196Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 9. Adriansson, C
    et al.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bergbom, I
    The use of topical anaesthesia at children's minor lacerations: an experimental study2004Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 12, nr 2, s. 74-84Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 10.
    Agevall, Lena
    et al.
    Växjö universitet, Fakulteten för humaniora och samhällsvetenskap, Institutionen för samhällsvetenskap. Statsvetenskap.
    Jonnergård, Karin
    Växjö universitet, Fakulteten för humaniora och samhällsvetenskap, Ekonomihögskolan, EHV. Ekonomistyrning.
    Management by documents - a risk of de-professionalizing?2007Inngår i: In tension between Organization and Profession: Professionals in Nordic Public Service, Nordic Academic Presss, Lund , 2007, s. 33-56Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
    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.

  • 11.
    Ahl, Caroline
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjälte, L
    Johansson, C
    Wireklint-Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Culture and care in the Swedish ambulance services2005Inngår i: Emergency Nurse, ISSN 1354-5752, E-ISSN 2047-8984, Vol. 13, nr 8, s. 30-36Artikkel i tidsskrift (Fagfellevurdert)
  • 12.
    Ahl, Caroline
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Nyström, Maria
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jansson, L
    Making up one’s mind: Patients Experiences of Calling an Ambulance2006Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 14, nr 1, s. 11-19Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 13.
    Ahl, Johannes
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Karlsmo, Martin
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    SJUKSKÖTERSKANS STRESS RELATERAD TILL ARBETSBELASTNING: En enkätsstudie2017Independent thesis Basic level (degree of Bachelor), 15 poäng / 22,5 hpOppgave
    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.

  • 14.
    Ahlgren, Asa
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. 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 county2005Inngår i: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 28, nr 1, s. 33-42Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 15.
    Ahlstrom, Gerd
    et al.
    Lund Univ, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    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 protocol2018Inngår i: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 17, artikkel-id 52Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 16. Ahlstrom, Linda
    et al.
    Hagberg, Mats
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Workplace Rehabilitation and Supportive Conditions at Work: A Prospective Study2013Inngår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, nr 2, s. 248-260Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 17.
    Ahlström, Gerd
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan.
    Integrating improvement learning into health professional educational curricula2008Inngår i: International Forum on Quality Improvement in Healthcare, France, April 24 2008: International Forum on QI , 2008, s. 1-Konferansepaper (Fagfellevurdert)
    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.

  • 18.
    Aidemark, Jan
    et al.
    Linnaeus University.
    Askenäs, Linda
    Linnaeus University.
    Nygårdh, Annette
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, 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 patients2015Inngår i: Procedia Computer Science, ISSN 1877-0509, E-ISSN 1877-0509, Vol. 64, s. 118-124Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 19.
    Akay, Altug
    et al.
    KTH, Skolan för teknik och hälsa (STH), Hälso- och systemvetenskap, Systemsäkerhet och organisation.
    Dragomir, Andrei
    Erlandsson, Björn-Erik
    KTH, Skolan för teknik och hälsa (STH), Hälso- och systemvetenskap, Systemsäkerhet och organisation.
    A Novel-Data Mining Platform to Monitor the Outcomes of Erlontinib (Tarceva) using Social Media2014Inngår i: XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013, Springer, 2014, s. 1394-1397Konferansepaper (Fagfellevurdert)
    Abstract [en]

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

  • 20.
    Akhavan, Sharareh
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Aytar, Osman
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Bogg, Lennart
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Tillgren, Per
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Blev det ett genombrott?: Utvärdering av det nationella lärandeprojektet – Vård på lika villkor2014Rapport (Annet vitenskapelig)
    Abstract [sv]

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

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

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

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

  • 21.
    Akhavan, Sharareh
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Aytar, Osman
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Bogg, Lennart
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Tillgren, Per
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Temaledare: Vård på lika villkor – Vad kan vi lära av Lärandeprojektet?2015Inngår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, nr 2, s. 103-106Artikkel i tidsskrift (Annet vitenskapelig)
  • 22.
    Akner, Gunnar
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Kunskapsstyrning genom checklistor kan bli farlig sjukvård.2017Annet (Annet (populærvitenskap, debatt, mm))
  • 23.
    Akner, Gunnar
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Socialstyrelsens kritik beror på bristande uppföljning av äldre personer2017Annet (Annet (populærvitenskap, debatt, mm))
  • 24.
    Akner, Gunnar
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Sverige ledande på värdebaserad vård2017Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, artikkel-id ELSPArtikkel i tidsskrift (Annet vitenskapelig)
    Abstract [sv]

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

  • 25.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Andersson, Christer
    Umeå University.
    Ekerstad, Niklas
    NU-sjukvården.
    Eliasson, Mats
    Umeå University.
    Gustafson, Yngve
    Umeå University.
    Järhult, Bengt
    Region Östergötland.
    Petersson, Christer
    Region Kronoberg.
    Tjärnström, Johan
    NU-sjukvården.
    von Zur-Mühlen, Bengt
    Uppsala University Hospital.
    Wingstrand, Hans
    Lund University.
    Styrningen har blivit ett hot2016Inngår i: Svenska Dagbladet, ISSN 1101-2412, Vol. 25 jul, s. 1Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 26.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Andersson, Christer
    Umeå universitet.
    Hallén, Ola
    Karlstads lasarett.
    Järhult, Bengt
    Vårdcentralen Ryd.
    Järhult, Johannes
    Professor em. Jönköping.
    Lind, Helena
    Spec onkologi och palliativ medicin, Stockholm.
    Löfmark, Rurik
    Med dr Gävle.
    Petersson, Christer
    Allmänmedicinare, Växjö.
    Rutegård, Jörgen
    Docent kirurgi, Umeå.
    Sandberg, CG
    Spec psykiatri och företagshälsovård, Stockholm.
    Schmitt, Christian
    Spec allmänmedicin, Sätila.
    Sjögren, Jonas
    Spec allmänmedicin, Västerås.
    Cizinsky, Stella
    Specialist i kardiologi, Örebro.
    Styrud, Johan
    Specialist i kirurgi, Stockholm.
    Svenberg, Torgny
    Specialist i kirurgi, Stockholm.
    Tjärnström, Johan
    Specialist i kirurgi, Trollhättan.
    Westergren, Hans
    Öl, med dr, Smärtrehab, Lund.
    Wingstrand, Hans
    Professor i ortopedi, Lund.
    Zur-Mühlen B, Bengt
    Med dr, öl neurologi, Uppsala.
    Ekerstad, Niklas
    Med dr, spec kardiologi Trollhättan.
    Elisasson, Mats
    Professor, spec internmedicin, Umeå.
    Engström, Sven
    Spec allmänmedicin, Örnsköldsvik.
    Ervander, Cecilia
    Spec allmänmedicin Lund.
    Flordal, Per Anders
    Spec kirurgi, Stockholm.
    Hagström, Bertil
    Spec allmänmedicin, Horred.
    Halldin, Jan
    Specialist i psykiatri och socialmedicin, Stockholm.
    Värdebaserad vård strider sannolikt mot lagen2017Inngår i: Dagens Samhälle, ISSN 1652-6511, artikkel-id 170315Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 27.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Andersson, Christer
    Umeå universitet.
    Hallén, Ola
    Karlstads lasarett.
    Järhult, Bengt
    Vårdcentralen Ryd.
    Järhult, Johannes
    Professor em. Jönköping.
    Löfmark, Rurik
    Med dr Gävle.
    Petetrsson, Christer
    Allmänmedicinare, Växjö.
    Sandberg, CG
    Spec psykiatri och företagshälsovård, Stockholm.
    Schmitt, Christian
    Spec allmänmedicin, Sätila.
    Sjögren, Jonas
    Spec allmänmedicin, Västerås.
    Styrud, Johan
    Specialist i kirurgi, Stockholm.
    Svenberg, Torgny
    Specialist i kirurgi, Stockholm.
    Cizinsky, Stella
    Specialist i kardiologi, Örebro.
    Tjärnström, Johan
    Specialist i kirurgi, Trollhättan.
    Wingstrand, Hans
    Professor i ortopedi, Lund.
    Ekerstad, Niklas
    Med dr, spec kardiologi Trollhättan.
    Elisasson, Mats
    Professor, spec internmedicin, Umeå.
    Engström, Sven
    Spec allmänmedicin, Örnsköldsvik.
    Ervander, Cecilia
    Spec allmänmedicin Lund.
    Flordal, Per Anders
    Spec kirurgi, Stockholm.
    Hagström, Bertil
    Spec allmänmedicin, Horred.
    Halldin, Jan
    Specialist i psykiatri och socialmedicin, Stockholm.
    Vårdkrisen är egentligen en onödig artefakt.2017Inngår i: Dagens Medicin, E-ISSN 1402-1943, nr 17, 26 April, s. 23-, artikkel-id 170428Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 28.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Ekerstad, Niklas
    Med dr, spec kardiologi Trollhättan.
    Elisasson, Mats
    Professor, spec internmedicin, Umeå.
    Engström, Sven
    Spec allmänmedicin, Örnsköldsvik.
    Ervander, Cecilia
    Spec allmänmedicin Lund.
    Flordal, Per Anders
    Spec kirurgi, Stockholm.
    Hagström, Bertil
    Spec allmänmedicin, Horred.
    Halldin, Jan
    Specialist i psykiatri och socialmedicin, Stockholm.
    Hallén, Ola
    Medicinkliniken, Karlstads lasarett.
    Järhult, Bengt
    Vårdcentralen Ryd.
    Järhult, Johannes
    Professor em. Jönköping.
    Lind, Helena
    Spec onkologi och palliativ medicin, Stockholm.
    Löfmark, Rurik
    Med dr Gävle.
    Petersson, Christer
    Allmänmedicinare, Växjö.
    Rutegård, Jörgen
    Docent kirurgi, Umeå.
    Sandberg, CG
    Spec psykiatri och företagshälsovård, Stockholm.
    Schmitt, Christian
    Spec allmänmedicin, Sätila.
    Sjögren, Jonas
    Spec allmänmedicin, Västerås.
    Styrud, Johan
    Specialist i kirurgi, Stockholm.
    Svenberg, Torgny
    Specialist i kirurgi, Stockholm.
    Tjärnström, Johan
    Specialist i kirurgi, Trollhättan.
    Westergren, Hans
    Öl, med dr, Smärtrehab, Lund.
    Wingstrand, Hans
    Professor i ortopedi, Lund.
    von Zur-Mühlen, Bengt
    Med dr, öl nefrologi, Uppsala.
    Vi står gärna bakom en utfallsbaserad vård2017Inngår i: Dagens Samhälle, ISSN 1652-6511, artikkel-id 170328Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

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

  • 29.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Kalmar, Sweden.
    Järhult, Bengt
    Ekonomiska incitament ska inte kopplas till den enskilde patienten2016Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, artikkel-id D4TPArtikkel i tidsskrift (Fagfellevurdert)
  • 30.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Järhult, Bengt
    Region Östergötland.
    Ekonomiska incitament ska inte kopplas till den enskilde patienten: Replik till Magnus Lind om värdebaserad vård2016Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, artikkel-id D4TPArtikkel i tidsskrift (Annet vitenskapelig)
  • 31.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Järhult, Bengt
    Region Östergötland.
    Värdebaserad vård införs snabbt: värdig efterträdare till NPM?2016Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, nr 20, s. 1-3, artikkel-id DXUTArtikkel i tidsskrift (Fagfellevurdert)
  • 32.
    Akner, Gunnar
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Järhult, Bengt
    Vårdcentralen Ryd.
    Värdebaserad vård utan underlag: Apropå!2016Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, nr 21, artikkel-id DZFHArtikkel i tidsskrift (Annet vitenskapelig)
  • 33.
    Albinsson, Gunilla
    et al.
    Blekinge Institute of Technology.
    Arnesson, Kerstin
    Blekinge Institute of Technology.
    Sustainable gender equality within the Swedish healthcare2013Inngår i: FALF-konferens - Arbetslivets föränderlighet, 2013, s. 3-Konferansepaper (Fagfellevurdert)
    Abstract [en]

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

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

    Aim

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

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

    Method

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

    Result

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

  • 34.
    Alexanderson, Kristina
    et al.
    Karolinska Institutet, Försäkringsmedicin.
    von Knorring, Mia
    Karolinska Institutet, Försäkringsmedicin.
    Keller, Christina
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik.
    Impact of a nationwide government program in Sweden on how healthcare managers, in their organisations, manage the work with sickness certification of patients2014Inngår i: The European journal of public health, Vol. 24, Supplement 2, 2014, s. 90-Konferansepaper (Fagfellevurdert)
  • 35.
    Algurén, Beatrix
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. University of Gothenburg, Faculty of Education, Department of Food and Nutrition, and Sport Science, Sweden.
    Andersson Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Region Jönköping County, Futurum, Sweden.
    Thor, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson, Ann-Christine
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Quality indicators and their regular use in clinical practice – results from a survey among users of two cardiovascular National Registries in Sweden2018Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

    Design: Cross-sectional online survey study.

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

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

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

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

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

    Fulltekst tilgjengelig fra 2019-05-01 00:00
  • 36.
    Ali, DK
    et al.
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Yousefzade-Chabok, S
    Trauma Research Center, Guilan University of Medical Science, Rasht, Iran.
    Jansson, B
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Mohammadi, R
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Costs related to drowning and near drowning in northern Iran (Guilan province)2011Inngår i: Ocean and Coastal Management, ISSN 0964-5691, E-ISSN 1873-524X, Vol. 54, nr 3, s. 250-255Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 37. Al-Janabi, Hareth
    et al.
    Coast, Joanna
    Flynn, Terry N
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik.
    What do people value when they provide unpaid care for an older person? A meta-ethnography with interview follow-up.2008Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, nr 1, s. 111-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 38. Allander, E
    et al.
    Bjurulf, P
    Isacsson, SO
    Smedby, B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Svanström, L
    Westrin, CG
    Skilj mellan besluts- och forskningsregister!1985Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 82, s. 4383-84Artikkel i tidsskrift (Fagfellevurdert)
  • 39. Almerud, S
    et al.
    Alapack, R.J.
    Fridlund, Bengt
    Växjö University.
    Ekebergh, Margaretha
    Växjö University.
    Beleuguered by technology: Care in technologically intense environments2008Inngår i: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 9, nr 1, s. 55-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Modern technology has enabled the use of new forms of information in the care of critically ill patients. In intensive care units (ICUs), technology can simultaneously reduce the lived experience of illness and magnify the objective dimensions of patient care. The aim of this study, based upon two empirical studies, is to find from a philosophical point of view a more comprehensive understanding for the dominance of technology within intensive care. Along with caring for critically ill patients, technology is part of the ICU staff's everyday life. Both technology and caring relationships are of indispensable value. Tools are useful, but technology can never replace the closeness and empathy of the human touch. It is a question of harmonizing the demands of subjectivity with objective signs. The challenge for caregivers in ICU is to know when to heighten the importance of the objective and measurable dimensions provided by technology and when to magnify the patients’ lived experiences, and to live and deal with the ambiguity of the technical dimension of care and the human side of nursing.

  • 40. Almerud, S
    et al.
    Alapack, R.J.
    Fridlund, Bengt
    Växjö University.
    Ekebergh, Margaretha
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Caught in an Artificial Split: A Phenomenological Study of Being a Caregiver in the Technologically Intense Environment2007Inngår i: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 24, nr 2, s. 130-136Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A symbiotic relationship exists between technology and caring, however, technologically advanced environments challenge caregivers. The aim of this study is to uncover the meaning of being a caregiver in the technologically intense environment. Ten open-ended interviews with intensive care personnel comprise the data. A phenomenological analysis shows that ambiguity abounds in the setting. The act of responsibly reading and regulating instruments easily melds the patient and the machinery into one clinical picture. The fusion skews the balance between objective distance and interpersonal closeness. The exciting captivating lure of technological gadgets seduces the caregivers and lulls them into a fictive sense of security and safety. It is mind-boggling and heart-rending to juggle ‘moments’ of slavish mastery and security menaced by insecurity in the act of monitoring a machine while caring for a patient. Whenever the beleaguered caregiver splits technique from human touch, ambiguity decays into ambivalence. Caring and technology become polarized. Everyone loses. Caregiver competence wanes; patients suffer. The intensive care unit should be technologically sophisticated, but also build-in a disclosive space where solace, trust, and reassurance naturally happen. Caring professionals need to balance state-of-the-art technology with integrated and comprehensive care and harmonize the demands of subjectivity with objective signs.

  • 41. Almerud, S
    et al.
    Alapack, R.J.
    Fridlund, Bengt
    Växjö University.
    Ekebergh, Margaretha
    Växjö University.
    Of vigilance and invisibility: being a patient in technologically intense environments2007Inngår i: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 12, nr 3, s. 151-158Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Equipment and procedures developed during the past several decades have made the modern intensive care unit (ICU) the hospital’s most technologically advanced environment. In terms of patient care, are these advances unmitigated gains? This study aimed to develop a knowledge base of what it means to be critically ill or injured and cared for in technologically intense environments. A lifeworld perspective guided the investigation. Nine unstructured interviews with intensive care patients comprise its data. The qualitative picture uncovered by a phenomenological analysis shows that contradiction and ambivalence characterized the entire care episode. The threat of death overshadows everything and perforates the patient’s existence. Four inter-related constituents further elucidated the patients’ experiences: the confrontation with death, the encounter with forced dependency, an incomprehensible environment and the ambiguity of being an object of clinical vigilance but invisible at the personal level. Neglect of these issues lead to alienating ‘moments’ that compromised care. Fixed at the end of a one-eyed clinical gaze, patients described feeling marginalized, subjected to rituals of power, a stranger cared for by a stranger. The roar of technology silences the shifting needs of ill people, muffles the whispers of death and compromises the competence of the caregivers. This study challenges today’s caregiving system to develop double vision that would balance clinical competence with a holistic, integrated and comprehensive approach to care. Under such vision, subjectivity and objectivity would be equally honoured, and the broken bonds re-forged between techne, ‘the act of nursing’, and poesis, ‘the art of nursing’.

  • 42. Almkvist, Henrik
    et al.
    Bergman, Ulf
    Karolinska Universitetssjukhuset Huddinge.
    Edlert, Maria
    Juhasz-Haverinen, Maria
    Pehrsson, Åke
    Thörnwall Bergendahl, Gunilla
    Vég, Anikó
    Läkemedelscentrum, Centrum för vårdutveckling, Stockholms läns landsting.
    Wettermark, Björn
    Kvalitetsbokslut minskade läkemedelskostnaderna i primärvården: Stockholms läns landstings modell för decentraliserat kostnadsansvar2008Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 42, s. 2930-2934Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Increasing drug expenditures have resulted in various models to increase cost consciousness among prescribing doctors. In the County of Stockholm, Sweden, a model for quality assessment of prescribing was introduced in 2006. In all, 139 of 154 primary healthcare centres (PHCs) signed a contract linking extra payment to the adherence to the Drug and Therapeutics Committee guidelines if they analysed their prescribing behaviour in an annual quality report. During the first year, the adherence to guidelines increased from 80 to 83%, substantially higher than the 0-2% annual increase that had been observed previous years. The increase was similar for those PHCs not participating in the program. Qualitative analyses of all written quality reports indicate that the incentive scheme has resulted in an increased interest in quality assessment of drug prescribing. In total, 20 million SEK was spent on incentives, with estimated savings of 100 million SEK on drug expenditures.

  • 43.
    Almqvist, Louise
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Andersson, Maria
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Sjuksköterskans möte med en patient från ett annat land.: Systematisk litteraturstudie2018Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Människor korsar geografiska gränser av olika anledningar. Sjukvården möter patienter från hela världen. Kulturella uttryck annorlunda än de sjuksköterskan har som norm har tendensen att skapa problem i det omvårdande mötet. Den personcentrerade omvårdnaden riskerar att påverkas negativt när kulturella svårigheter dem emellan måste hanteras.

    Syfte: Att belysa sjuksköterskors erfarenheter vid omvårdnad av patienter födda i ett annat land.

    Metod: En systematisk litteraturstudie enligt Forsberg och Wengström (2008) genomfördes med sökning av artiklar i Cinahl, PubMed och PsycINFO.

    Resultatet: Fyra kategorier. Kulturella skillnader, Brist på kunskap, Känslor och reaktioner och  Språksvårigheter. Annorlunda matvanor, religionsutövande, närvaro av släkt och relationen till döden exemplifierar hur de kulturella skillnaderna påverkade sjuksköterskorna. En känsla av osäkerhet handlade om situationer som sjuksköterskorna beskrev i mötet med patienten från ett annat land när kulturella skillnader fick dem att känna sig obekväma, eller frustrerade. Sjuksköterskorna uttryckte en brist på kunskap inom området och uttryckte önskemål om kulturspecifik utbildning för att höja sin kulturella kompetens. Språksvårigheter var problematiska, främst när anhöriga tolkade för patienten. Ovissheten om översättningens korrekthet och relationen mellan den som översätter och patienten ses som en risk för patientsäkerheten.

    Slutsats: Sjuksköterskan behöver utbildning i kulturell kompetens och att arbetsgivaren behöver bereda utrymme för utbildning.

  • 44. Alsved, Malin
    et al.
    Wang, Cong
    KTH, Skolan för arkitektur och samhällsbyggnad (ABE), Byggvetenskap, Strömnings- och klimatteknik.
    Civilis, Anette
    Sadrizadeh, Sasan
    KTH, Skolan för arkitektur och samhällsbyggnad (ABE), Byggvetenskap, Strömnings- och klimatteknik.
    Ekolind, Peter
    Skredsvik, Henrik
    Höjerback, Peter
    Jakobsson, Jonas
    Löndahl, Jakob
    Experimental and computational evaluation of airborne bacteria in hospital operating rooms with high airflows2018Inngår i: Proceedings of The 5th Working & Indoor Aerosols Conference 18-20 April 2018; Cassino, Italy, 2018Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Post-operative infections after surgery can be decreased by the use of efficient ventilation with clean air. In this study, we investigated three types of operating room ventilation: turbulent mixed airflow(TMA), laminar airflow (LAF) and a new type of ventilation named temperature controlled airflow(TcAF). Measurements of airborne bacteria were made during surgery and compared with values calculated by computational fluid dynamics (CFD). The results show that LAF and TcAF are most efficient in removing bacteria around the patient. With LAF, there are large differences in bacterial loads, depending on location in the room.

  • 45.
    Alverbratt, Catrin
    et al.
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur.
    Carlström, Eric
    Sahlgrenska Akademin, Göteborgs universitet.
    Åström, Sture
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur. Umeå universitet.
    Kauffeldt, Anders
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur.
    Berlin, Johan
    Högskolan Väst, Institutionen för individ och samhälle.
    The process of implementing a new working method - a project towards change in a Swedish psychiatric clinic2014Inngår i: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, ISSN 1927-6990, Vol. 3, nr 6, s. 174-189Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The implementation of evidence-based methods in hospital settings is difficult and complex. The aim of the present study was to highlight the implementation process concerning a new working method, i.e. a new assessment tool, based on the International Classification of Functioning Disability and Health (ICF), among psychiatric nursing staff on five participating wards at a Swedish county hospital. Descriptive, qualitative data were collected through focus group interviews pre- and post-implementation. Data were analysed using directed content analysis, guided by Normalization Process Theory (NPT). The results revealed that just one of the five participating wards met the criteria for a successful implementation process. The results confirm previous studies showing the difficulty of implementation. Although participants agreed with the intention of the model, they were reluctant to apply it in practice. The implementation process seemed to be influenced by factors such as: time pressure; heavy workload; stress; lack of routines in using the tool; lack of nursing staff; as well as cultural characteristics and resistance to change.

  • 46.
    Alwin, Jenny
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Lundqvist, Martina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Lundqvist, Martina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Utvärdering av försöksverksamhet med service- och signalhundar2014Rapport (Annet vitenskapelig)
    Abstract [sv]

    Denna rapport redovisar utvärderingen av en försöksverksamhet med ser-vice- och signalhundar som bedrevs mellan år 2009 och 2014. Utvärderingen inkluderar servicehundar, signalhundar samt alarmerande servicehundar (epilepsihundar och diabeteshundar). Totalt 56 ekipage (förare samt hund) ingick i utvärderingsstudien. Data i studien samlades in före samt efter genomgången service- och signalhundsutbildning. Syftet med utvärderingen är att studera hur certifierade service- och signalhundar påverkar förarnas behov av offentliga stödinsatser och de totala samhällskostnaderna. Dessutom studerades hur service- och signalhundar påverkar förarna med avseende på hälsorelaterad livskvalitet, välbefinnande, självförtroende och fysisk aktivitet samt om användningen av service- och signalhundar är kostnadseffektiv ur ett samhällsperspektiv.

      Resultat och slutsatser

    • Service- och signalhundar minskar i genomsnitt förarnas behov av offentliga stödinsatser med 197 000 kronor (6 procent) under en tioårsperiod.
    • Livskvaliteten för personer med behov av service- och signalhundar är låg jämfört med den allmänna populationen i Sverige. Studien visar på en förbättring i livskvaliteten och välbefinnandet för förare med en certifierad hund.
    • Förarnas grad av fysisk aktivitet ökade med en certifierad hund och majoriteten av dem angav att de ökat sin tid utanför hemmet samt att de även ökat sin tid för att delta i sociala aktiviteter tack vare hunden.
    • Förarnas negativa emotionella upplevelser minskar med en certifierad hund.
    • Förarna beskriver själva den certifierade hunden som ett viktigt verktyg för ökad självständighet och trygghet.
    • Den hälsoekonomiska modellen som analyserar kostnadseffektiviteten visar att ett innehav av en certifierad hund är ett dominant alternativ jämfört med att inte ha en certifierad hund. Detta innebär att kostnaderna ur ett samhällsperspektiv under en tioårsperiod är lägre (-103 000 kronor) samtidigt som effekterna i form av vunna QALY (kvalitetsjusterade levnadsår) är högre (+0,15).
    • Finansieringsanalysen visar att förare som har certifierade hundar sparar resurser åt alla aktörer (stat, kommun och landsting) men får själva ökade utgifter på grund av hunden.
    • Studien baseras på ett lågt antal observationer (56 ekipage). Det i kombination med att det är en stor spridning i resursförbrukningen mellan ekipagen medför att det finns en statistisk osäkerhet i resultaten. Slutsatserna bedöms dock som rimliga eftersom de är samstämmiga.
  • 47.
    Alwén, Erzsébet
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wessman, Carin
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Kommunernas rekryteringsprocess: HR i praktiken2015Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Rekryteringsprocessens utformning och utövande är helt avgörande för att verksamheten ska kunna fortsätta att utvecklas samt nå uppsatta mål och visioner. Hur arbetsgivare rekryterar på ett professionellt och tillförlitligt sätt kräver kompetens. Organisationer idag har i regel en egen personalavdelning som inriktar sig på att rekrytera nya medarbetare. Många organisationer som anställer personer i betydande positioner använder sig av externa rekryteringsföretag. Rekrytering är en omfattande och kostnadskrävande process, men att göra rekryteringsprocessen rätt från början kan bli förhållandevis billigare än en felrekrytering. Rätt person på rätt plats kräver planering och framförhållning för att den tilltänkta ska kunna matcha in perfekt förtjänsten.

    Syftet är att beskriva rekryteringsprocessen inom kommunalt verksamhetsområde och i vilken utsträckning befintliga HRM processer upplevs som ett stöd i arbetet för enhetschefer inom rekrytering. Åtta intervjuer med informanter i ledande befattning inom den kommunala organisationens sociala sektor har genomförts. Studiens resultat visar på svårigheter i många delar under hela rekryteringsprocessen. Detta orsakas delvis av lagföreskrifter och delvis utav huruvida den rekryterande chefen anser sig behöva följa den utav strategisk Human Resource personal utarbetade rekryteringsprocessen.

    I vilken utsträckning cheferna tog hjälp av Human Resource avdelningen eller bemanningsenheten vid rekrytering varierade i omfattning bland deltagarna. Gemensamt för kommunerna var att det i samband med en chefsrekrytering lades ner mer resurser i form av tid och pengar på att det skulle bli rätt. Författarna fick en känsla av att rekryterande enhetschefer i större utsträckning kontaktade ansvarig Human Resource personal i samband med arbetsrättsliga processer och inte i lika stor utsträckning i samband med själva rekryteringsprocessen.

  • 48. Ameh, Soter
    et al.
    Klipstein-Grobusch, Kerstin
    D'ambruoso, Lucia
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana.
    Tollman, Stephen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana.
    Gomez-Olive, Francesc Xavier
    Quality of integrated chronic disease care in rural South Africa: user and provider perspectives2017Inngår i: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 32, nr 2, s. 257-266Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The integrated chronic disease management (ICDM) model was introduced as a response to the dual burden of HIV/AIDS and non-communicable diseases (NCDs) in South Africa, one of the first of such efforts by an African Ministry of Health. The aim of the ICDM model is to leverage HIV programme innovations to improve the quality of chronic disease care. There is a dearth of literature on the perspectives of healthcare providers and users on the quality of care in the novel ICDM model. This paper describes the viewpoints of operational managers and patients regarding quality of care in the ICDM model. In 2013, we conducted a case study of the seven PHC facilities in the rural Agincourt sub-district in northeast South Africa. Focus group discussions (n = 8) were used to obtain data from 56 purposively selected patients >= 18 years. In-depth interviews were conducted with operational managers of each facility and the sub-district health manager. Donabedian's structure, process and outcome theory for service quality evaluation underpinned the conceptual framework in this study. Qualitative data were analysed, with MAXQDA 2 software, to identify 17 a priori dimensions of care and unanticipated themes that emerged during the analysis. The manager and patient narratives showed the inadequacies in structure (malfunctioning blood pressure machines and staff shortage); process (irregular prepacking of drugs); and outcome (long waiting times). There was discordance between managers and patients regarding reasons for long patient waiting time which managers attributed to staff shortage and missed appointments, while patients ascribed it to late arrival of managers to the clinics. Patients reported anti-hypertension drug stock-outs (structure); sub-optimal defaulter-tracing (process); rigid clinic appointment system (process). Emerging themes showed that patients reported HIV stigmatisation in the community due to defaulter-tracing activities of home-based carers, while managers reported treatment of chronic diseases by traditional healers and reduced facility-related HIV stigma because HIV and NCD patients attended the same clinic. Leveraging elements of HIV programmes for NCDs, specifically hypertension management, is yet to be achieved in the study setting in part because of malfunctioning blood pressure machines and anti-hypertension drug stock-outs. This has implications for the nationwide scale up of the ICDM model in South Africa and planning of an integrated chronic disease care in other low-and middle-income countries.

  • 49.
    Amin, Mahgol
    et al.
    Mälardalens högskola, Akademin för ekonomi, samhälle och teknik.
    Kubo, Tomomi
    Mälardalens högskola, Akademin för ekonomi, samhälle och teknik.
    KANBAN Implementation from a Change Management Perspective: A Case Study of Volvo IT2014Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    The purpose of this thesis is to investigate and analyze the implementation process of KANBAN, a lean technique, into a section of Volvo IT (i.e. BEAT). The KANBAN implementation into BEAT when ‘resistance for change’ and ‘forces for change’ arise is also analyzed. This implementation of KANBAN is equivalent to change taking place in the Volvo IT’s operational process. The thesis follows theories and literature on change management and lean principles in order to support the research investigation.

    How has KANBAN, with respect to change management, been implemented into an IT organization for its service production? How has KANBAN changed the operational process of the organization?

     The research conducted in the thesis is based on qualitative case study. Focused and in-depth interviews, combined with observations, are carried out to obtain the primary data for the case study. The collected primary and secondary data stems from the literature reviewed, which covers the lean principles, KANBAN, and change management. Moreover, the thesis adopts an abductive approach that goes back-and-forth between the theory and the empirical findings in order to develop a model.

    Due to various factors already existing in the BEAT, minimal resistance to change implementation was found to be present in Volvo IT. This finding indicates that change initiatives found a way to implementation because the predominance of the ‘forces for change’, as compared to, the ‘resistance to change’ is higher in BEAT. The KANBAN implementation into the IT service production is identified to be aligned with Volvo IT’s change implementation objectives. The visualization of the ‘intangible service’ workflow on the Kanban board contributes to identify the source of bottlenecks, which has been removed through effective communication in the BEAT team and better linkages between tasks. The KANBAN effectively deals with change implementation by modifying the way team members work.

  • 50.
    Amundstuen Reppe, Linda
    et al.
    Nordic University, Norway; Norwegian University of Science and Technology, Norway; St Olays Hospital, Norway.
    Lydersen, Stian
    Norwegian University of Science and Technology, Norway.
    Schjott, Jan
    Haukeland Hospital, Norway; University of Bergen, Norway; Haukeland Hospital, Norway.
    Damkier, Per
    Odense University Hospital, Denmark.
    Rolighed Christensen, Hanne
    Bispebjerg and Frederiksberg University Hospital, Denmark.
    Peter Kampmann, Jens
    Bispebjerg and Frederiksberg University Hospital, Denmark.
    Böttiger, Ylva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk farmakologi.
    Spigset, Olav
    Norwegian University of Science and Technology, Norway; St Olays Hospital, Norway.
    Relationship Between Time Consumption and Quality of Responses to Drug-related Queries: A Study From Seven Drug Information Centers in Scandinavia2016Inngår i: Clinical Therapeutics, ISSN 0149-2918, E-ISSN 1879-114X, Vol. 38, nr 7, s. 1738-1749Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The aims of this study were to assess the quality of responses produced by drug information centers (DICs) in Scandinavia, and to study the association between time consumption processing queries and the quality of the responses. Methods: We posed six identical drug-related queries to seven DICs in Scandinavia, and the time consumption required for processing them was estimated. Clinical pharmacologists (internal experts) and general practitioners (external experts) reviewed responses individually. We used mixed model linear regression analyses to study the associations between time consumption on one hand and the summarized quality scores and the overall impression of the responses on the other hand. Findings: Both expert groups generally assessed the quality of the responses as "satisfactory" to "good." A few responses were criticized for being poorly synthesized and less relevant, of which none were quality-assured using co-signatures. For external experts, an increase in time consumption was statistically significantly associated with a decrease in common quality score (change in score, -0.20 per hour of work; 95% CI, -0.33 to -0.06; P = 0.004), and overall impression (change in score, -0.05 per hour of work; 95% CI, -0.08 to -0.01; P = 0.005). No such associations were found for the internal experts assessment. Implications: To our knowledge, this is the first study of the association between time consumption and quality of responses to drug-related queries in DICs. The quality of responses were in general good, but time consumption and quality were only weakly associated in this setting. (C) 2016 The Authors. Published by Elsevier HS Journals, Inc.

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