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  • 151.
    Entenza Gutierrez, Nedicto
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sjöström, Anneli
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ögonsjuksköterskors erfarenheter av tolkanvändning i patientmötet: En fenomenografisk studie2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
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  • 152.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Sjukskrivningskoordinatorns roll: Patientens perspektiv2014Report (Other academic)
    Abstract [sv]

    Inom landstinget har funktionen sjukskrivningskoordinator införts med uppgift att bland annat samordna arbetet inom rehabiliteringsgarantin.

    I den här studien utvärderades funktionen sjukskrivningskoordinator inom primärvården i Landstinget i Kalmar län utifrån patientens perspektiv. Målet var att ta reda på patienters egen uppfattning om betydelsen av en sjukskrivningskoordinator inom deras sjukskrivningsprocess. Denna studie är en fortsättning av en tidigare studie kring effekterna av införandet av en sjukskrivningskoordinator inom Landstinget i Kalmar län då koordinatorsfunktionen utvärderades utifrån hälso- och sjukvårdspersonalens perspektiv.

    Samtliga patienter var positiva till att ha en koordinator involverad i sin sjukskrivningsprocess och de upplevde koordinatorsfunktionen som ett stöd. Koordinatorn sågs som ”spindeln i nätet” som samordnade kontakter både internt och externt. Patienterna upplevde att de hade fått ett bra bemötande och koordinatorns personlighet var en viktig faktor för hur väl de tyckte att funktionen fungerade.

    Sammanfattningsvis såg patienten koordinatorn som ett värdefullt stöd i sin sjukskrivningsprocess och för sitt välmående.

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  • 153.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Utvärdering – Sjukskrivningskoordinators roll inom Landstinget i Kalmar län2013Report (Other academic)
    Abstract [sv]

    Rehabiliteringsgarantin syftar till att stärka den enskildes ställning i sjukskrivningsprocessen och säkerställa att patienten får tillgång till medicinsk behandling och rehabilitering i form av kognitiv beteendeterapi och multimodal rehabilitering. Sjukskrivningskoordinatorns huvuduppgifter är dels att samordna detta nya arbetssätt och dels att förebygga eller minska behovet av sjukskrivning. Därutöver ska koordinatorn fungera som kontaktperson med berörda interna och externa enheter i sjukskrivnings/rehabiliteringsprocessen.

    Målet med denna utvärdering var att ta reda på hur enheterna och de berörda yrkeskategorierna, indirekt patienterna, har påverkats av införandet av funktionen sjukskrivningskoordinator inom Landstinget i Kalmar län. Utvärderingen avses vara ett underlag för beslut om koordinatorns framtida roll i landstinget om statsbidraget upphör.

    Datainsamlingen skedde både kvalitativt och kvantitativt genom semistrukturerade djupintervjuer respektive webbenkät.

    Införandet av sjukskrivningskoordinator uppfattades som mestadels positivt bland tillfrågade koordinatorer, verksamhetschefer och läkare, det fanns dock genomgående en del som var mer negativa. De tre yrkeskategorierna har olika perspektiv vilket delvis återspeglades i svaren. Koordinatorerna själva var ofta lite mer positivt inställda, och läkarna hamnade delvis i ”två läger”. Rollen/funktionen som sjukskrivningskoordinator ansågs dock vara viktig för såväl verksamheten och sjukskrivningsprocessen, som för patienten och läkaren. Koordinatorn ansågs fungera som samordnande ”spindel i nätet” med kontakter både internt och externt, och uppfattades ha lett till en effektivare sjukskrivningsprocess. Detta skiljde sig dock utifrån olika enheters behov. Ur patientens perspektiv bedömde majoriteten av de tillfrågade att det inneburit ökad trygghet och säkerhet samt snabbare vårdkedja och färre sjukvårdskontakter.

    Sammanfattningsvis verkar rollen som sjukskrivningskoordinator i stort vara en uppskattad resurs av både verksamhetschefer och läkare samt av koordinatorerna själva. Det finns dock mer att önska kring dess utformning, och kanske att funktionen borde anpassas utifrån respektive enhets enskilda behov.

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  • 154.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hammar, Tora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Schönström, Nils
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Stakeholder consensus on the purpose of clinical evaluation of electronic health records is required2017In: Health Policy and Technology, ISSN 2211-8837, E-ISSN 2211-8845, Vol. 6, no 2, p. 152-160Article in journal (Refereed)
    Abstract [en]

    Objective

    To explore the purpose and performance of clinical evaluation of electronic health records (EHRs) among stakeholders in order to identify any need for regulatory actions or guidelines.

    Methods

    This was a qualitative study of information collected in semi-structured interviews (n=28) of representatives of the five largest EHR vendors in Sweden, healthcare provider IT managers, users, and representatives of national authorities.

    Results

    We found a difference between the stated purpose of clinical evaluation of EHRs by the authorities and the perception of the purpose by the vendors, IT managers, and the users. The respondents gave divergent answers about the medical purpose of the application: e.g. availability of data, overview and documentation, patient safety, process efficiency, decision support, a working tool, and an aid to communication and follow-up. Several vendors found it difficult to put the term clinical evaluation in its specific context, instead referring to literature reviews, risk analyses, risk-management processes, acceptance tests, test facilities, pilot tests, and proven experience.

    Conclusions

    Stakeholders need to agree on a mutually acceptable, consistent method to guide regulatory decisions. The lack of consensus regarding the purpose and performance of clinical evaluation of EHRs could impact negatively on a safe and efficient documentation in healthcare. Thus, there is a need for more consistent use of terms and concepts in, and a more systematic approach to, clinical evaluation of EHRs. To ensure that the implementation of IT in healthcare meets expectations, delivers the desired outcome, and does not create new problems, it should be evaluated.

  • 155.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Carlsson, Martin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Hospital.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Wanby, Pär
    Kalmar County Hospital.
    A cost analysis of systematic vitamin D supplementation in the elderly versus supplementation based on assessed requirements2017In: Journal of Aging Research and Healthcare, ISSN 2474-7785, Vol. 2, no 2, p. 13-22Article in journal (Refereed)
    Abstract [en]

    Hypovitaminosis D is common among older people and treatment with vitamin D is associated with reduced risk of falls and fractures. This paper provides a cost analysis of assessing the vitamin D status of and providing the pharmaceuticals for elderly citizens in Kalmar County, Sweden (population approximately 230,000). Four hypothetical interventions were analyzed: (a) systematic vitamin D/calcium supplementation to all elderly (≥75 years), (b) assessment of vitamin D status in elderly and supplementation to those with insufficient levels, (c) systematic vitamin D/calcium supplementation to all nursing-home residents, and (d) assessment of vitamin D status in nursing-home residents and supplementation to those with insufficient levels. The calculations were based on an estimated reduction in overall costs due to the assessed number of hip fractures after vitamin D/calcium supplementation. The annual net economic benefit of vitamin D/calcium supplementation was estimated at (a) €304,000, (b) €860,000, (c) €755,000, and (d) €740,000. The provision of systematic vitamin D supplementation to nursing-home residents would provide a substantial net economic benefit to society and assessment of the vitamin D status before starting supplementation does not seem to be necessary. Although assessment of all elderly citizens would be more comprehensive, the true proportion with insufficient vitamin D levels in the general population is uncertain and to reaching consensus on the most advantageous daily vitamin D intake, vitamin D blood levels are necessary. Also, systematic supplementation to all elderly would result in other outcomes that could be worth the cost, but that remains to be evaluated.

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  • 156.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Magnusson, Lennart
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Swedish Family Care Competence Centre (NKA).
    Hälsoekonomisk studie av barn och vuxna med fetalt alkoholsyndrom2015Report (Other academic)
    Abstract [sv]

    Att barn och unga lever i hem med missbruk och/eller allvarlig sjukdom medför direkta och indirekta kostnader för samhället på kort och lång sikt. Denna hälsoekonomiska studie är en beräkning av samhällets årliga kostnad för den andel av befolkningen som vuxit upp som barn som anhörig till förälder med psykisk sjukdom eller missbruk av alkohol eller narkotika.

  • 157.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Magnusson, Lennart
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. The Swedish Family Care Competence Centre.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Societal costs of fetal alcohol syndrome in Sweden2017In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 18, no 5, p. 575-585Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the annual societal cost of fetal alcohol syndrome (FAS) in Sweden, focusing on the secondary disabilities thought feasible to limit via early interventions.

    METHODS: Prevalence-based cost-of-illness analysis of FAS in Sweden for 2014. Direct costs (societal support, special education, psychiatric disorders and alcohol/drug abuse) and indirect costs (reduced working capacity and informal caring), were included. The calculations were based on published Swedish studies, including a register-based follow-up study of adults with FAS, reports and databases, and experts.

    RESULTS: The annual total societal cost of FAS was estimated at €76,000 per child (0-17 years) and €110,000 per adult (18-74 years), corresponding to €1.6 billion per year in the Swedish population using a prevalence of FAS of 0.2 %. The annual additional cost of FAS (difference between the FAS group and a comparison group) was estimated at €1.4 billion using a prevalence of 0.2 %. The major cost driver was the cost of societal support.

    CONCLUSIONS: The cost burden of FAS on the society is extensive, but likely to be underestimated. A reduction in the societal costs of FAS, both preventive and targeted interventions to children with FAS, should be prioritized. That is, the cost of early interventions such as placement in family homes or other forms of housing, and special education, represent unavoidable costs. However, these types of interventions are highly relevant to improve the individual's quality of life and future prospects, and also, within a long-term perspective, to limit the societal costs and personal suffering.

  • 158.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Schönström, Nils
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Klinisk utvärdering av medicinska informationssystem: Fokus på elektroniska patientjournalsystem2014Report (Other academic)
    Abstract [sv]

    Vården blir allt mer beroende av effektiva och ändamålsenliga informationssystem. Många system har införts utan närmare prövning och kontroll av den kliniska nyttan till skillnad mot införande av nya läkemedel. Medicinska informationssystem är en medicinteknisk produkt och ska följa dess regelverk, till exempel ha en uttalad avsedd användning som inbegriper patientnyttan. Att regelverket för medicintekniska produkter även gäller för medicinska informationssystem har dock i vissa delar haft svårt att slå igenom hos tillverkarna som, bland annat, har skyldighet att genomföra kliniska utvärderingar. För att förbättra genomslagskraften av regelverket uppdrog Läkemedelsverket åt eHälsoinstitutet att kartlägga kunskapen om och följsamheten till regelverket avseende klinisk utvärdering.

    Syftet med föreliggande studie var primärt att ta fram ett beslutsunderlag för hur klinisk utvärdering av medicinska informationssystem bör gå till, med fokus på elektroniska patientjournalsystem, och sekundärt att konkretisera de krav som ska vara uppfyllda för systemen och att undersöka vilken information som är lämplig i en framtida vägledning. För att lösa detta preciserades flera målfrågeställningar vilka berörde vad klinisk utvärdering av patientjournalsystem innebär och syftar till, varför det är nödvändigt, hur de genomförs, om de överensstämmer med regelverket och hur de bör genomföras.

    Totalt 28 semistrukturerade intervjuer genomfördes med tillverkare, IT-förvaltare, användare och nationella företrädare, med kommentarer från en referensgrupp.

    Respondenterna var positiva till att diskutera klinisk utvärdering och till att frågan belystes, men tyckte att frågeställningarna var komplexa och svåra att besvara samt att termer och begrepp uppfattades svåra att förstå. Det kunde upplevas abstrakt och svårt att kliniskt utvärdera ett medicinskt informationssystem jämfört med mer hårdvarubaserad medicinteknisk apparatur.

    Det medicinska syftet och den avsedda användningen med journalsystemet ska definieras av tillverkaren, vilka också var tydliga med att beskriva detta, medan IT-förvaltarna och användarna inte visste vad tillverkarna angivit för medicinskt syfte. Trots att IT-förvaltarna och användarna var osäkra på tillverkarnas beskrivning av det medicinska syftet hade de ändå en ganska tydlig uppfattning om vad det medicinska syftet med systemen är eller kanske snararare vilket/vilka behov de borde uppfylla enligt användaren. Syfte och behov upplevdes gå i vartannat och beskrevs bland annat med orden tillgänglighet, överblick, dokumentation, patientsäkerhet, effektivitet, beslutsstöd, arbetsverktyg, kommunikation och uppföljning.

    Flera av tillverkarna hade svårt att koppla begreppet klinisk utvärdering till patientjournalsystem och hade svårt att sätta begreppet i ett sammanhang. Tillverkarna förknippade istället sina svar till vad man faktiskt använder sig av såsom litteraturstudier, riskanalys, riskhanteringsprocess, acceptanstest, testmiljö, pilottest och beprövad erfarenhet.

    Till skillnad från vad som gäller för läkemedel har införandet av medicinska informationssystem inga tydligt definierade faser. Ett sätt att förtydliga och förenkla klinisk utvärdering av medicinska informationssystem skulle vara att göra en tydlig fasindelning, som blir lätt att kontrollera. Utifrån våra intervjuer skulle faserna kunna innehålla följande steg:

    • Teoretisk del – litteraturstudier, intervjuform
    • Utvecklingsfasen – riskanalys, riskhanteringsprocess, acceptanstest
    • Testmiljö – standardiserade användningsfall/testfall
    • Pilottest – skarp miljö i liten skala under översikt
    • Breddinförande
    • Uppföljning
    • Beprövad erfarenhet

    Sammanfattningsvis har vi funnit stora variationer i tolkningen av klinisk utvärdering av medicinska informationssystem och ett stort behov av förslag till att stärka den kliniska utvärderingen. Våra rekommendationer i det framtida arbetet med klinisk utvärdering av medicinska informationssystem är att ta fram:

    • Enhetliga definitioner av termer och begrepp
    • Gemensamt regelverk med tydliga riktlinjer
    • Förenklad vägledning anpassad till svenska förhållanden
    • Specifik utbildning kring avsedd användning och regelverkens tillämpning
    • Branschöverenskommelser
    • Tydliga krav vid tillsyn

    Föreliggande rapport avser att bidra till att både förtydliga tolkningen av regelverket och underlätta följsamheten och förhoppningen är att rapporten ska kunna användas i en framtida vägledning avseende klinisk utvärdering av medicinska informationssystem.

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  • 159.
    Eriksson, Michaela
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Stalbohm, Hannah
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Prevalensstudie av torra ögonsymptom genom OSDIenkäten2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 160.
    Eriksson, Moa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Färgperception i det perifera synfältet2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this study was to see whether it is possible to detect and distinguish different colours in the peripheral field of vision and also if the colour perception differs between different eccentricities.

    10 people participated in the study; the study was conducted on the right eye for each participant. The average age was 23 years with a range from 19 to 29 years. The colour perception was tested by presenting four different coloured LED-diodes (red, green, blue and white) at different eccentricities in the periphery. The eccentricities tested were 0-60° temporally in 10° intervals.

    All participants were able to distinguish the four colours out to 40°. At 50° the number of correct answers dropped significantly and at 60° the participants could no longer distinguish the colours. A highly significant correlation (p<0,0001) was found between colour perception and eccentricity. A highly significant difference (p<0,0001) was found between colour perception in the fovea and at 50° and 60°. However there was no significant difference (p>0,05) between the fovea and 10-40°.

    It is possible to distinguish colours in the periphery out to at least 40°. There is also a certain difference between the colour perception at different eccentricities. This difference could however depend on other factors besides eccentricity.

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  • 161.
    Eriksson, Pär
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hammar, Tora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Lagrosen, Stefan
    Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Linnaeus University, School of Business and Economics, Department of Marketing.
    Nilsson, Evalill
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Digital consultation in primary healthcare: the effects on access, efficiency and patient safety based on provider experience; a qualitative study2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 4, p. 498-506Article in journal (Refereed)
    Abstract [en]

    Objective The objective of the study was to explore the experiences of healthcare staff working with and being part of the implementation of a digital platform for patient-provider consultation across quality dimensions of access, efficiency, and patient safety. Design The study uses qualitative design to investigate experiences and the views of healthcare professionals. Data collection combined semi-structured individual and focus-group interviews. Content analysis was used to identify categories within the content areas 'access', 'efficiency', and 'patient safety'. Setting The basis for the study was an e-consultation platform introduced in three primary healthcare centres in the County of Kalmar in southeast Sweden in 2019. Results Healthcare staff experienced that the platform offered an open channel for communication with patients in need of frequent contact. This reduced anxiety and therefore the frequency of follow-up appointments. Healthcare staff also noted that the platform offered flexibility in contact benefitting patients with mental health problems. These patients were found to make contact through the platform after closing hours when problems were more acute or intense. However, the risk of digitally illiterate groups being excluded was also noted. Efficiency gains were identified among patients with simple cases which were handled more quickly through the platform. However, low uptake and the experience that the platform did not replace, rather was added on top of other already existing functions and procedures, negatively affected the overall efficiency. Standardized questions in automated medical history-taking contributed to patient safety. Conclusion The findings suggest that text-based e-consultation platforms may bring important quality improvements to primary healthcare service in terms of access, efficiency, and patient safety. Yet, areas where e-consultation does not contribute to quality improvements puts important quality gains at risk.

  • 162.
    Etemadian, Gelareh
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Esber, Shadi
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Sambandet mellan myopi och utbildning hos svenska skolbarn2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 163.
    Fagerberg, Emilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Prevalens av ackommodativaproblem hos universitetsstudentervid Linnéuniversitetet i Kalmar2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this study was to evaluate the prevalence of accommodative dysfunction inuniversity student at Linneaus university in Kalmar.In this study 30 subjects were recruited (24 women and 6 men) and they were all studentsat Linneaus university. The average age was 22.5±2.2 years. The oldest participant were28 years old and the youngest was 19 years old. First they had to answer a symptomsquestionnaire called CISS, then they underwent a refraction followed by a fullaccommodative examination including amplitude of accommodation, fused crosscylinder, relative accommodation and accommodative facility. The results of theaccommodative tests were compared to normal values for each test to diagnose theparticipants with accommodative dysfunction.Of the 30 participants, 11 had symptoms related to much nearwork from the CISSquestionnaire. However, only 3 participants had both symptoms and at least two abnormaltest results which gave a result of 10% with accommodative dysfunction where all 3 hadaccommodative insufficiens.The result of 10% with accommodative dysfunction is lower than what previous studieshave shown in both university students and the general population. This study does notshow that university students has more accommodative problems than the generalpopulation. All examinations in this study were done with the participants currentrefractions while the participants answered the symptoms questionnaire based on theircurrent spectacles. This could be a factor why there were more symptomatic participantsthan the number of participants with an accommodative dysfunction.

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  • 164.
    Fatula, Zuhal
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Abedali, Shehed
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Skiljer sig arbetsförhållandena inom optikerbranschen beroende på arbetsplats?: En enkätstudie2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: The aim of this study was to identify if there are any differences in time given for vision examination and administrative task between optometrists working in privately owned practices and corporate chains. The secondary aim was to see if there are difference in work related stress between them.

    Method: The digital survey consisted of 16 questions and was distributed to the 3300 members of the Facebook group ”Optikforum” which partly consists of certified Optometrists but also those who are active in the industry in any way. The survey was distributed to the 1550 members of ”Optikerförbundet” as well.

    Result: A total of 295 Optometrists answered the digital survey, of which 47% feel that their work is stressful. It turned out that there is a difference between different workplaces when it comes to how much time the Optometrists get for administrative work and eye examinations. The majority of the Optometrists in the privately owned stores turned out to have more time and less stress than those in the chain-owned and franchise/purchasing chain-bound stores.

    Conclusion: It is important that employers give the Optometrists enough time for the eye examination. Optometrists should be given extra time to be able to handle administrative work such as referral writing, in this way they can take their breaks to recover their energy and not to do what they do not have time for during working hours. This is important both for the patient's safety and the Optometrists well-being.

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  • 165.
    Ferdinando, Petrazzuoli
    et al.
    Lund University, Sweden.
    Vestberg, Susanna
    Lund University, Sweden.
    Midlov, Patrik
    Lund University, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Lund University, Sweden.
    Stomrud, Erik
    Lund University, Sweden.
    Palmqvist, Sebastian
    Lund University, Sweden.
    Brief Cognitive Tests Used in Primary Care Cannot Accurately Differentiate Mild Cognitive Impairment from Subjective Cognitive Decline2020In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 75, no 4, p. 1191-1201Article in journal (Refereed)
    Abstract [en]

    Background: Differentiating mild cognitive impairment (MCI) from subjective cognitive decline (SCD) is important because of the higher progression rate to dementia for MCI and when considering future disease-modifying drugs that will have treatment indications at the MCI stage. Objective: We examined if the two most widely-used cognitive tests, the Mini-Mental State Examination (MMSE) and clock-drawing test (CDT), and a test of attention/executive function (AQT) accurately can differentiate MCI from SCD. Methods: We included 466 consecutively recruited non-demented patients with cognitive complaints from the BioFINDER study who had been referred to memory clinics, predominantly from primary care. They were classified as MCI (n = 258) or SCD (n = 208) after thorough neuropsychological assessments. The accuracy of MMSE, CDT, and AQT for identifying MCI was examined both in training and validation samples and in the whole population. Results: As a single test, MMSE had the highest accuracy (sensitivity 73%, specificity 60%). The best combination of two tests was MMSE < 27 points or AQT > 91 seconds (sensitivity 56%, specificity 78%), but in logistic regression models, their AUC (0.76) was not significantly better than MMSE alone (AUC 0.75). CDT and AQT performed significantly worse (AUC 0.71; p < 0.001-0.05); otherwise no differences were seen between any combination of two or three tests. Conclusion: Neither single nor combinations of tests could differentiate MCI from SCD with adequately high accuracy. There is a great need to further develop, validate, and implement accurate screening-tests for primary care to improve accurate identification of MCI among individuals that seek medical care due to cognitive symptoms.

  • 166.
    Fernando, Caroline
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Dynamics of accommodation after high accommodation demand2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: To investigate accommodative response (AR), speed and response time of accommodation after prolonged reading under accommodative stress.

    Methods: Thirteen participants had their binocular vision assessed along with refraction during an initial visit. These participants came for a second visit in which refraction was measured continuously using the COAS HD VR aberrometer. During measurement participants shifted their gaze between targets at 33 cm and 3 meters in 2 conditions: near-far and far-near. Measurements of refraction were taken 3 times: immediately before and after the reading task as well as 10 minutes after reading. During reading, accommodative stress was induced by a negative lens tailored to ensure the use of 70% of the individual amplitude of accommodation.

    Results: Results were extracted successfully from twelve participants. Immediately after the reading task the mean AR from both conditions tested (near-far and far-near) reduced by 0.11 D (SE = 0.18) when compared with immediately before reading. Compared with after reading, AR increased by 0.12 D (SE =0.18) after resting. There was a statistically significant difference between subjective fatigue before and after the reading task.

    Conclusion: AR decreased significantly after 20 minutes of reading under visual stress. When exposed persistently to this type of tasks the fast and temporary adaptation of the accommodative system may become permanent. Adaptations can lead to asthenopia and may be involved in refractive error changes

  • 167.
    Ferreira, Marisa Borges
    et al.
    University of Minho, Portugal;Association “Todos com a Esclerose Multipla (TEM)”, Portugal.
    Pereira, Paulo Alexandre
    Association “Todos com a Esclerose Multipla (TEM)”, Portugal;University of Minho, Portugal.
    Parreira, Marta
    Association “Todos com a Esclerose Multipla (TEM)”, Portugal.
    Sousa, Ines
    University of Minho, Portugal.
    Figueiredo, José
    Association “Todos com a Esclerose Multipla (TEM)”, Portugal.
    Cerqueira, João José
    University of Minho, Portugal;Hospital de Braga, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Relationships between neuropsychological and antisaccade measures in multiple sclerosis patients2018In: PeerJ, E-ISSN 2167-8359, Vol. 6, p. 1-18, article id e5737Article in journal (Refereed)
    Abstract [en]

    Background

    The Stroop test is frequently used to assess deficits in inhibitory control in people with multiple sclerosis (MS). This test has limitations and antisaccade eye movements, that also measure inhibitory control, may be an alternative to Stroop.

    Objectives

    The aim of this study was twofold: (i) to investigate if the performance in the antisaccade task is altered in patients with MS and (ii) to investigate the correlation between performances in neuropsychological tests, the Stroop test and the antisaccade task.

    Methods

    We measured antisaccades (AS) parameters with an infrared eye tracker (SMIRED 250 Hz) using a standard AS paradigm. A total of 38 subjects diagnosed with MS and 38 age and gender matched controls participated in this study. Neuropsychological measures were obtained from the MS group.

    Results

    Patients with MS have higher error rates and prolonged latency than controls in the antisaccade task. There was a consistent association between the Stroop performance and AS latency. Stroop performance but not AS latency was associated with other neuropsychological measures in which the MS group showed deficits.

    Conclusions

    Our findings suggest that AS may be a selective and independent measure to investigate inhibitory control in patients with MS. More studies are necessary to confirm our results and to describe brain correlates associated with impaired performance in the antisaccade task in people diagnosed with MS.

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  • 168.
    Filipsson, Emelie
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    EvoTears® effekt på tårfilmens lipidskikt över tid2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 169.
    Finnman, Louise
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Förekomsten av refraktionsfel hos befolkningen mellan 10-35 år i Guatemala2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: The aim of this study was to examine the prevalence of hyperopia and myopia among people aged 10-35 years in Guatemala. Also to investigate the prevalence of refractive errors in various occupational groups.

    Methods: The study was conducted from March 28 to April 9 during a journey with Vision For All. The measurements were performed in the area around Antigua and Alta Verapaz with binocular subjective refraction. Spherical equivalent refractive errors were used to quantify ametropia. The ametropia was defined as hyperopia SE > +0,75 D and myopia SE < -0,75 D. The equipment used consisted of flippers (+1,00 to +2,50 D), Snellen Eye Chart with tumbling E, trial lenses, trial frame and protocol.

    Results: 503 people participated (311 women and 192 men) aged 10-35 years. The prevalence of hyperopia was highest at 30 %, 19 % had myopia and 51 % had emmetropia. The incidence of myopia was highest in the age group between 16-20 years at 27 %. The most common refractive error associated with occupation was hyperopia.

    Conclusions: The results showed a higher prevalence of hyperopia than myopia among the population aged 10-35 years in Guatemala. The most common refractive error in the various occupational groups was hyperopia. Similar results with a higher prevalence of hyperopia can be seen in earlier studies from Central- and South America.

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  • 170.
    Finnström, Caroline
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Fixationsdisparitet: En jämförelse av tre olika tester2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this study was to compare three clinical tests used for measuring fixation disparity. The correlation between fixation disparity and phoria was evaluated and the repeatability for each method.This study included 19 subjects (aged from 20 to 31 years); all had functional binocular vision. The order of the tests in the examination was chosen to prevent fatigue from effecting the results. Following case history, binocular refraction, and phoria measurements at distance and near, the examination proceeded in measurement of fixation disparity with each of the three tests; three measurements were performed for each, and averaged. The examination concluded with measurements of NPC, amplitude of accommodation and vergences.Eleven of 19 subjects had FD to some degree according to Mallett, Saladin or Wesson. Since the Mallett unit only measures the associated phoria, the results could not be used in this study.This study shows a significant difference in measured FD between Wesson and Saladin (p=0.027). A Bland-Altman analysis showed a significant difference between the results; it showed that the higher the fixation disparity the greater the difference between the two measurements (p <0.0001). The repeatability was good for Wesson (ICC = 0.95) and Mallett (ICC = 0.87), however lower for Saladin (ICC = 0.71). A One Way- RM ANOVA showed no significant difference between the three measurements for each method. FD deviated in the same direction as the measured phoria for 47 % of the subjects; 10 % had FD that deviated in the opposite direction from the measured phoria. Wesson and Saladin showed no significant correlation to the phoria: Wesson (Pearsson r = 0.15; p = 0.11), and Saladin (Pearsson r = 0.17; p= 0.08).The study shows that there is a significant difference in the results of fixation disparity between the Saladin card and the Wesson card indicating that these methods can’t be used interchangeably. Repeatability was better for Mallett and Wesson but not so good for Saladin. There was a significant correlation between phoria and fixation disparity in means of the direction of deviation i.e. an exophoria is often followed by an exo fixation disparity.In a clinical setting, it might be advisable to adopt one single method and not compare results with those obtained by other instruments.

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  • 171.
    Forsberg, Gustaf
    et al.
    Linköping University Hospital, Sweden;Linköping University, Sweden.
    Taxbro, Knut
    Ryhov County Hospital, Sweden;Linköping University, Sweden.
    Elander, Louise
    Linköping University, Sweden;Vrinnevi Hospital, Sweden;Nyköping Hospital, Sweden;Linköping University Hospital, Sweden.
    Hanberger, Håkan
    Linköping University, Sweden;Linköping University Hospital, Sweden.
    Berg, Sören
    Linköping University Hospital, Sweden;Linköping University, Sweden.
    Idh, Jonna
    Linköping University, Sweden;Västervik Hospital, Sweden.
    Berkius, Johan
    Västervik Hospital, Sweden.
    Ekman, Andreas
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar Hospital, Sweden.
    Hammarskjöld, Fredrik
    Ryhov County Hospital, Sweden;Linköping University, Sweden.
    Niward, Katarina
    Linköping University, Sweden;Linköping University Hospital, Sweden.
    Östholm Balkhed, Åse
    Linköping University, Sweden;Linköping University Hospital, Sweden.
    Risk factors for ventilator-associated lower respiratory tract infection in COVID-19, a retrospective multicenter cohort study in Sweden2024In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 68, no 2, p. 226-235Article in journal (Refereed)
    Abstract [en]

    Background: Ventilator-associated lower respiratory tract infections (VA-LRTI) increase morbidity and mortality in intensive care unit (ICU) patients. Higher incidences of VA-LRTI have been reported among COVID-19 patients requiring invasive mechanical ventilation (IMV). The primary objectives of this study were to describe clinical characteristics, incidence, and risk factors comparing patients who developed VA-LRTI to patients who did not, in a cohort of Swedish ICU patients with acute hypoxemic respiratory failure due to COVID-19. Secondary objectives were to decipher changes over the three initial pandemic waves, common microbiology and the effect of VA-LTRI on morbidity and mortality.Methods: We conducted a multicenter, retrospective cohort study of all patients admitted to 10 ICUs in southeast Sweden between March 1, 2020 and May 31, 2021 because of acute hypoxemic respiratory failure due to COVID-19 and were mechanically ventilated for at least 48 h. The primary outcome was culture verified VA-LRTI. Patient characteristics, ICU management, clinical course, treatments, microbiological findings, and mortality were registered. Logistic regression analysis was conducted to determine risk factors for first VA-LRTI.Results: Of a total of 536 included patients, 153 (28.5%) developed VA-LRTI. Incidence rate of first VA-LRTI was 20.8 per 1000 days of IMV. Comparing patients with VA-LRTI to those without, no differences in mortality, age, sex, or number of comorbidities were found. Patients with VA-LRTI had fewer ventilator-free days, longer ICU stay, were more frequently ventilated in prone position, received corticosteroids more often and were more frequently on antibiotics at intubation. Regression analysis revealed increased adjusted odds-ratio (aOR) for first VA-LRTI in patients treated with corticosteroids (aOR 2.64 [95% confidence interval [CI]] [1.31-5.74]), antibiotics at intubation (aOR 2.01 95% CI [1.14-3.66]), and days of IMV (aOR 1.05 per day of IMV, 95% CI [1.03-1.07]). Few multidrug-resistant pathogens were identified. Incidence of VA-LRTI increased from 14.5 per 1000 days of IMV during the first wave to 24.8 per 1000 days of IMV during the subsequent waves.Conclusion: We report a high incidence of culture-verified VA-LRTI in a cohort of critically ill COVID-19 patients from the first three pandemic waves. VA-LRTI was associated with increased morbidity but not 30-, 60-, or 90-day mortality. Corticosteroid treatment, antibiotics at intubation and time on IMV were associated with increased aOR of first VA-LRTI.

  • 172.
    Forsberg, Matilda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Skillnad i konjunktivala papiller hos kontaktlinsbärare vs. icke-kontaktlinsbärare2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Vid förändringar i konjunktivas struktur vid infektioner, inflammationer och allergi kan det uppstå ojämnheter i det övre ögonlocket, dessa kallas papiller. En papill är ett område som innehåller eosinofiler och neutrofiler och beror på konjunktival hypertrofi. Papiller kan uppkomma av olika anledningar. Det kan till exempel bero på mekanisk påverkan på grund av linsbärande. För att bli av med eventuella papiller kan patienten ordineras linsvila.

    Syfte: Syftet med studien var att genom evertering undersöka den palpebrala konjunktivan och ta reda på om kontaktlinsbärare har mer konjunktivala papiller än icke-kontaktlinsbärare.

    Metod: I studien deltog 38 försökspersoner i åldrarna 19-26 år. Försökspersonerna delades in i två olika grupper, kontaktlinsbärare och icke-kontaktlinsbärare. För att räknas som kontaktlinsbärare skulle de bära kontaktlinser minst 1 dag per vecka. För att räknas som icke-kontaktlinsbärare skulle de bära kontaktlinser mindre än en dag per vecka. Samtliga patienters ögonlock everterades och fotograferades. Sedan graderades bilderna med hjälp av Efrons graderingsskala i 0,1-steg. Den palpebrala konjunktivan delades in i fem zoner för att lättare kunna beskriva var på ögonlocket eventuella papiller fanns.

    Resultat: Studien visade att förekomsten av konjunktivala papiller inte är större hos kontaktlinsbärare än hos icke-kontaktlinsbärare. Mängden papiller skiljde sig inte inom zonerna, dock skiljde det sig mellan zonerna. På det högra ögat var det mest papiller i zon 4, alltså nasalt. På det vänstra ögat var det mest papiller i zon 1, alltså där den palpebrala konjunktivan viks.

    Slutsats: Studien påvisar vikten av att göra en grundlig undersökning vid varje kontaktlinstillpassning. Om detta inte görs och papiller upptäcks vid återbesök, kan optikern omöjligt veta om papillerna beror på kontaktlinsen eller om de fanns där redan innan. 

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    Matilda Forsberg.pdf
  • 173.
    Forsman, L. Davies
    et al.
    Karolinska Inst ; Karolinska Univ Hosp Solna.
    Schön, Thomas
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linköping University.
    Simonsson, U. S. H.
    Uppsala University.
    Bruchfeld, J.
    Karolinska Inst ; Karolinska Univ Hosp Solna.
    Larsson, M.
    Linköping University.
    Jureen, P.
    Publ Hlth Agcy Sweden.
    Sturegard, E.
    Regional and University Laboratories, Region Skåne.
    Giske, C. G.
    Karolinska Univ Hosp.
    Angeby, K.
    Karolinska Univ Hosp;Univ W Indies.
    Intra- and Extracellular Activities of Trimethoprim-Sulfamethoxazole against Susceptible and Multidrug-Resistant Mycobacterium tuberculosis2014In: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 58, no 12, p. 7557-7559Article in journal (Refereed)
    Abstract [en]

    We investigated the activity of trimethoprim-sulfamethoxazole (SXT) against Mycobacterium tuberculosis, the pathogen that causes tuberculosis (TB). The MIC distribution of SXT was 0.125/2.4 to 2/38 mg/liter for the 100 isolates tested, including multi- and extensively drug-resistant isolates (MDR/XDR-TB), whereas the intracellular MIC90 of sulfamethoxazole (SMX) for the pansusceptible strain H37Rv was 76 mg/liter. In an exploratory analysis using a ratio of the unbound area under the concentration-time curve from 0 to 24 h over MIC (fAUC(0-24)/MIC) using >= 25 as a potential target, the cumulative fraction response was >= 90% at doses of >= 2,400 mg of SMX. SXT is a potential treatment option for MDR/XDR-TB.

  • 174.
    Fournstedt, Daniel
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Jämförelse mellan Scheimpflug imaging och anterior segment OCT i mätning av Corneal tjocklek.2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: The purpose of this study was to compare corneal thickness measured both centrally and midperipherally, between two instruments using different measuring principles. The study also looked at correlation between corneal thickness and intraocular pressure (IOP).

    Methods: Central and midperipheral corneal thickness was measured on the right eyes of 31 subjects with two different instruments. Instruments were Scheimpflug-camera from Bon Sirius and an AS/OCT from Optos. Measurements were taken on central cornea (CCT) and midperipheral (nasal (NCT), temporal (TCT), superior (SCT) and inferior (ICT)) at a distance of 1.75 mm from the apex. Mean age of the subjects was 23.6 ± 4.5 years. (19-44 years). A CT-80A non-contact tonometer (NonCT) from Topcon was used to measure the intraocular pressure (IOP).

    Results: A mean-value for central corneal thickness was calculated to 542.4 µm and 540.4 µm for Bon Sirius and AS/OCT repectively. Remaining measured points had mean-values for corneal thickness of, NCT: 577.7 µm & 558.5 µm. TCT: 555.0 µm & 545.2 µm. SCT: 585.7 µm & 554.5 µm. ICT: 563.0 µm & 548.9 µm, respectively. Mean-difference for CCT was 2.4 µm and it showed a significant difference between the two instruments with a p-value of 0.007. Remaining measured points all showed a significant difference of p<0.05. NCT: 19.2 µm. TCT: 9.8 µm. SCT: 31 µm. ICT: 14 µm. A correlation between IOP and CCT measured in both Sirius and AS/OCT was positive with r = 0.7 and p<0.05.

    Conclusion: The results showed that Sirius gives higher values for corneal thickness then ASOCT in all five measurement points. The results show that these instruments can be used interchangeably when measuring central corneal thickness. However, caution should be used when measuring midperipheral corneal thickness as the there is a significant differences between these two instruments.

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    Daniel F. Exjobb.
  • 175.
    Fredin, Patrik
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Correlation between Corneal Radius of Curvature and Corneal Eccentricity2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The primary aim of this study was to find if there is any correlation between the corneal radius of curvature and its eccentricity.

    Method: 45 subjects participated in this study, 24 emmetropes, 18 myopes and three hyperopes. All subjects were free of ocular abnormalities and had no media opacities. All the subjects had normal ocular health and good visual acuity of 1.0 or better for both distance and near. The values for eccentricity and corneal radius of curvature were obtained by using a Topcon CA-100F Corneal Analyzer.

    Results: For the 4.5 mm zone the only significant correlation between corneal radius of curvature and eccentricity was obtained for the mean of the meridian (p = 0.007). On the other hand, we found no significant correlation for the average of two meridians or for meridian 1 and meridian 2 separately in the 8.0 mm zone.

    Conclusions: We found no correlation between the corneal radius of curvature and the eccentricity for both zones. In addition, no correlation could be found between the spherical equivalent of the refractive errors and the corneal eccentricity. The reason for not finding any significant correlation between the two entities could be due to factors such as smaller sample size and poor distribution of refractive errors in the sample. Moreover, there may be other factors that could influence the overall corneal shape like eye shape, axial length and corneal diameter, which was not evaluated in this study.

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    Patrik Fredin
  • 176.
    Fridlund, Jimmy
    et al.
    Kalmar County Hospital.
    Woksepp, Hanna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Hospital.
    Schön, Thomas
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Hospital ; Linköping University.
    A microbiological method for determining serum levels of broad spectrum β-lactam antibiotics in critically ill patients2016In: Journal of Microbiological Methods, ISSN 0167-7012, E-ISSN 1872-8359, Vol. 129, p. 23-27Article in journal (Refereed)
    Abstract [en]

    Background Recent studies show that suboptimal blood levels of β-lactam antibiotics are present in intensive care unit (ICU) patients. A common reference method for assessing drug concentrations is liquid chromatography coupled with mass-spectrometry (LC-MS) which is highly accurate but rarely available outside reference centres. Thus, our aim was to develop a microbiological method for monitoring β-lactam antibiotic serum levels which could be used at any hospital with a microbiological laboratory. Methods The method was developed as a 96-well broth microdilution format to assess the concentrations of cefotaxime (CTX), meropenem (MER), and piperacillin (PIP). Patient serum containing antibiotics were diluted in suspensions of bacteria with known minimal inhibitory concentrations (MICs). Serum antibiotic concentrations were calculated by dividing the MIC with the dilution factor at which the serum inhibited growth of the bacterial suspension. Serum (n = 88) from ICU patients at four hospitals in south-east Sweden were analysed and compared to LC-MS analysis. Results The overall accuracy and precision for spiked samples and patient samples was within the pre-set target of ± 20.0% for all drugs. There was a significant correlation between the microbiological assay and LC-MS for the patient samples (CTX: r = 0.86, n = 31; MER: r = 0.96, n = 11; PIP: r = 0.88, n = 39) and the agreement around the clinical cut-off for CTX (4.0 mg/l), MER (2.0 mg/l) and PIP (16.0 mg/l) was 90%, 100% and 87%, respectively. Conclusion The microbiological method has a performance for determination of serum levels of meropenem, piperacillin and cefotaxime suitable for clinical use. It is an inexpensive method applicable in any microbiology laboratory.

  • 177.
    Friedrichsen, Maria
    et al.
    Vrinnevi Hospital, Sweden;Linköping University, Sweden.
    Jaarsma, Tiny
    Linköping University, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kronoberg, Sweden.
    Waldreus, Nana
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Hedman, Christel
    Karolinska Institutet, Sweden;Stockholms Sjukhem Foundation, Sweden.
    Jaarsma, Pier
    Linköping University, Sweden.
    Lythell, Caroline
    Linköping University, Sweden.
    Milovanovic, Micha
    Linköping University, Sweden;Vrinnevi Hospital, Sweden.
    Karlsson, Marit
    Linköping University, Sweden.
    Milberg, Anna
    Linköping University, Sweden.
    Söderlund Schaller, Anne
    Linköping University, Sweden;Pain & Rehabilitation Center Linköping, Sweden.
    Assistant nurses' experiences of thirst and ethical dilemmas in dying patients in specialized palliative care — A qualitative study2023In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 79, no 11, p. 4292-4303Article in journal (Refereed)
    Abstract [en]

    AimsTo describe assistant nurses' experiences of thirst and ethical challenges in relation to thirst in terminally ill patients in specialized palliative care (PC) units.DesignA qualitative, reflexive thematic design with an inductive analysis was used.MethodsData were collected during November 2021-January 2023. Twelve qualitative interviews with assistant nurses working in five different specialized PC units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. The study was guided by the Standards for Reporting Qualitative Research (SRQR).ResultsTwo main themes were found in this study. (1) 'A world of practice for thirst relief' where assistant nurses present a task-oriented world where the knowledge of thirst is an experience-based unspoken knowledge where mainly routines rule. (2) Ethical challenges presents different ethical problems that they meet in their practice, such as when patients express thirst towards the end of their life but are too severely ill to drink or when they watch lack of knowledge in the area among other health professionals.ConclusionThirst in dying patients is a neglected area that assistant nurses work with, without communicating it. Their knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patient's record. There is a need for nurses to take the lead in changing nursing practice regarding thirst.Patient or Public ContributionNo patient or public contribution.ImpactIn palliative care, previous studies have shown that dying patients might be thirsty. Assistant nurses recognize thirst in dying patients, but thirst is not discussed in the team. Nurses must consider the patient's fundamental care needs and address thirst, for example in the nursing process to ensure patients quality of life in the last days of life.Reporting MethodThe study was guided by the SRQR.What does this Article Contribute to the Wider Global Clinical Community?Thirst is a distressing symptom for all humans. However, when a patient is dying, he or she loses several functions and can no longer drink independently. The knowledge from this article contributes to our understanding of current practice and shows an area that requires immediate attention for the improvement of fundamental palliative care delivery.

  • 178.
    Friedrichsen, Maria
    et al.
    Vrinnevi Hospital, Sweden;Linköping University, Sweden.
    Lythell, Caroline
    Vrinnevi Hospital, Sweden;Linköping University, Sweden.
    Jaarsma, Tiny
    Linköping University, Sweden.
    Jaarsma, Pier
    Linköping University, Sweden.
    Angstrom, Helene
    Vrinnevi Hospital, Sweden.
    Milovanovic, Micha
    Linköping University, Sweden;Vrinnevi Hospital, Sweden.
    Karlsson, Marit
    Linköping University, Sweden.
    Milberg, Anna
    Vrinnevi Hospital, Sweden;Linköping University, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kronoberg, Sweden.
    Hedman, Christel
    Karolinska Institutet, Sweden;Stockholms Sjukhem Foundation, Sweden.
    Waldreus, Nana
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Schaller, Anne Soderlund
    Linköping University, Sweden;Linköping Pain & Rehabilitation Center, Sweden.
    Thirst or dry mouth in dying patients? -A qualitative study of palliative care physicians' experiences2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 8, article id e0290075Article in journal (Refereed)
    Abstract [en]

    IntroductionThirst and dry mouth are common symptoms among patients at the end of life. In palliative care today, there is a focus on mouth care to alleviate thirst. There are no qualitative studies on thirst from a physician's experience, which is why this study is needed. PurposeThis study aimed to explore palliative care physicians' experiences and views of thirst in patients at the end of life. MethodsA qualitative interview study with an inductive approach was carried out. Sixteen physicians working in specialised palliative care units in Sweden were included. The interviews were analysed with a reflexive thematic analysis. ResultsThe analysis resulted in three basic assumptions regarding thirst: It is dry mouth, not thirst; patients are dry in their mouth and thirsty; and, I do not know if they are thirsty. Further, four different themes regarding how to relieve thirst appeared: drips will not help thirst but cause harm; the body takes care of thirst itself; drips might help thirst; and, mouth care to relieve thirst or dry mouth. ConclusionsThe palliative care physicians had different experiences regarding thirst, from thirst never arising, to a lack of awareness. They thought good mouth care worked well to alleviate the feeling of thirst and dry mouth. Most physicians did not want to give patients drips, while some did. This study indicates that there are many unanswered questions when it comes to thirst at end-of-life and that further research is needed.

  • 179.
    Friedrichsen, Maria
    et al.
    Vrinnevi Hospital, Sweden;Linköping University, Sweden.
    Lythell, Caroline
    Vrinnevi Hospital, Sweden.
    Waldreus, Nana
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Jaarsma, Tiny
    Linköping University, Sweden.
    Ångström, Helene
    Vrinnevi Hospital, Sweden.
    Milovanovic, Micha
    Linköping University, Sweden;Vrinnevi Hospital, Sweden.
    Karlsson, Marit
    Linköping University, Sweden.
    Milberg, Anna
    Linköping University, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kronoberg, Sweden.
    Hedman, Christel
    Karolinska Institutet, Sweden;Stockholms Sjukhem Foundation, Sweden.
    Schaller, Anne Söderlund
    Linköping University, Sweden.
    Jaarsma, Pier
    Linköping University, Sweden.
    Ethical challenges around thirst in end-of-life care -experiences of palliative care physicians2023In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 24, no 1, article id 61Article in journal (Refereed)
    Abstract [en]

    BackgroundThirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area.AimThe aim of this study was to explore palliative care physicians' experiences of ethical challenges in relation to thirst in terminally ill patients.MethodsA qualitative interview study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis.ResultsWhen presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient's autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering.ConclusionsAll physicians in this study reported that "Starting, continuing or discontinuing drips" was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular.

  • 180.
    Frölander, Michaela
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Friedenthal, Linnéa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hur påverkas patientrekommendationer av svenska optikers egna kostvanor och livsstil?2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 181.
    Fung, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Sklerala linsers påverkan på ögats aberrationer hos patienter med keratokonus eller astigmatism2017Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna studie var att undersöka hur sklerala linser påverkar ögats aberrationer hos patienter med keratokonus eller astigmatism.

    Metod: 18 ögon därav tre med keratokonus och resterande med astigmatism ≥ 1,50 D undersöktes i denna studie. Aberrationsmätningar utfördes med en COAS-HD VR aberrometer, innan och 30 minuter efter isättning av skleral lins. Resultatet analyserades med parat t-tester.

    Resultat: Deltagarna delades in i två grupper, patienter med astigmatism och patienter med keratokonus. Gruppen med astigmatism bestod av 15 ögon med astigmatism mellan -1,63 D och -4,92 D. Det var en statistiskt signifikant minskning vid bärandet av sklerala linser då medelvärdet sjönk från -2,85 ± 1,11 D till -1,00 ± 0,62 D (p <0,01). En minskning av högre ordningens aberrationer visades då medelvärde av HOA RMS (3:e t.o.m. 6:e ordningen) sjönk från 0,151 ± 0,046 µm till 0,134 ± 0,037 µm, dock var denna minskning ej statistisk signifikant (p=0,28). Gruppen med keratokonus bestod av tre ögon med astigmatism mellan -2,62 D och -4,82 D. Även för denna grupp var det en statistiskt signifikant minskning där medelvärdet av cylinderstyrkan sjönk från -3,60 ± 1,12 D till -0,75 ± 0,68 D (p <0,01). HOA RMS sjönk från 0,660 ± 0,332 µm till 0,317 ± 0,034 µm, dock var denna minskning ej statistisk signifikant (p=0,19).

    Slutsats: Sklerala linser minskar både lägre och högre ordningens aberrationer hos personer med astigmatism och keratokonus. Förändringen av högre ordningens aberrationer var dock inte statiskt signifikant (p> 0,05).

  • 182.
    Gerhardsson, Ida
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Visus hos äldre bilförare2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 183.
    Gierow, Peter
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Kacz, Lucyna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Effect of Age and Gender on Dry Eye according to Tests and Symptoms2018In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 59, no 9Article in journal (Other academic)
  • 184.
    Gierow, Peter
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Larsson, Nathalie
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Boström, Johanna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Comparison oF Different Tests for Evaluation of the Meibomian Glands2015In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 56, no 7Article in journal (Other academic)
  • 185.
    Gottliebsen, Kristian
    et al.
    Herøy Helsesenter, Norway.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Limited evidence of benefits of patient operated intelligent primary care triage tools: findings of a literature review2020In: BMJ Health & Care Informatics, E-ISSN 2632-1009, Vol. 27, no 1, p. 1-7, article id e100114Article, review/survey (Refereed)
    Abstract [en]

    Introduction There is consistent evidence that the workload in general practices is substantially increasing. The digitalisation of healthcare including the use of artificial intelligence has been suggested as a solution to this problem. We wanted to explore the features of intelligent online triage tools in primary care by conducting a literature review.

    Method A systematic literature search strategy was formulated and conducted in the PubMed database and the Cochrane Library. Articles were selected according to inclusion/exclusion criteria. Results and data were systematically extracted and thematically analysed. 17 articles of that reported large multimethod studies or smaller diagnostic accuracy tests on clinical vignettes were included. Reviews and expert opinions were also considered.

    Results There was limited evidence on the actual effects and performance of triage tools in primary care. Several aspects can guide further development: concepts of system design, system implementation and diagnostic performance. The most important findings were: a need to formulate evaluation guidelines and regulations; their assumed potential has not yet been met; a risk of increased or redistribution of workloads and the available symptom checker systems seem overly risk averse and should be tested in real-life settings.

    Conclusion This review identified several features associated with the design and implementation of intelligent online triage tools in a primary care context, although most of the investigated systems seemed underdeveloped and offered limited benefits. Current online triage systems should not be used by individuals who have reasonable access to traditional healthcare. Systems used should be strictly evaluated and regulated like other medical products.

  • 186.
    Grandin, Lydia
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Pettersson, Stina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Finns det någon relation mellan upplevt socialt stöd och synfunktion hos patienter under behandling för neovaskulär AMD?2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 187.
    Gunnarsson, A. Birgitta
    et al.
    University of Gothenburg, Sweden;Region Kronoberg, Sweden.
    Aurin, Ingrid Edvardsson
    Region Kronoberg, Sweden.
    Holmberg, Sara
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kronoberg, Sweden;Lund University, Sweden.
    Being in a meaningful context. Nature and animal-assisted activities as perceived by adults with autism2024In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630Article in journal (Refereed)
    Abstract [en]

    IntroductionAnimal-assisted and nature-based interventions in psychosocial treatment for various groups of clients have been studied internationally. However, there is little knowledge about how young adults with autism experience participation in such types of interventions. This clinical study aimed to describe the feasibility of animal-assisted and nature-based activities on a farm as a complementary intervention for young adults with autism and social withdrawal.MethodsThe participants were aged 18-30 years, diagnosed with autism and social withdrawal, with no organised occupation during the previous year. Eleven of 13 participants completed a 12-week intervention in small groups. They took part in interviews before and after, which focused on their current life situation and expectations about, and experiences of the intervention. The feasibility was described in terms of participants' characteristics, attendance, and their experiences of participating in the activity. Data were analysed with descriptive statistics and qualitative content analysis.Consumer and community involvementThe intervention was formed in collaboration with participating supervisors, ordinary clinical staff, and a young woman with a user perspective.FindingsThe level of feasibility was found to be high. The mean participation rate during the activity days was 75% and varied from 50 to 100%. The analysis of the participants' experiences from the activity generated three categories, "Being in a meaningful context", "Creating a comfort zone" and "Developing structure in everyday life", and each of these included sub-categories.ConclusionThe main categories revealed a dynamic process based in meaningfulness, comfort and structure in everyday life. The positive experiences of undemanding activities, emotional relationships and non-verbal communication with the horses were prominent and might facilitate the development of social interaction. However, the intervention's timeframe of 12 weeks was experienced as too short for long-lasting change.

  • 188.
    Gunnarsson, Birgitta
    et al.
    University of Gothenburg, Sweden;Region Kronoberg, Sweden.
    Hörberg, Ulrica
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Wagman, Petra
    Jönköping University, Sweden.
    Holmberg, Sara
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Holmgren, Kristina
    University of Gothenburg, Sweden.
    Sternudd, Hans T.
    Linnaeus University, Faculty of Arts and Humanities, Department of Music and Art.
    Be WellTM – an intervention using photo-supported conversations to promote well-being in people living with stress-related illness2022In: Caring in a changing world, 2022Conference paper (Refereed)
    Abstract [en]

    Background: Stress-related mental health illnesses are increasing in all ages. Be-WellTM is a health-promoting intervention intended for primary healthcare. Be-WellTM involves 12 sessions based on photo-supported conversations. Patients use their mobiles to photograph situations about well-being, and the photos are used as a starting point for dialogues with their therapist. Aim: The aims of this study are to evaluate the feasibility of Be-WellTM, and to compare the outcomes concerning health and well-being in the intervention group with those of a control group. Method: This ongoing study is conducted in Swedish primary healthcare. A total of 70 patients in working age, living with stress-related disorders will be recruited. The intervention group receive the intervention Be-WellTM in addition to care as usual, and the controls only receive care as usual. Prior to and directly after the intervention, and after 6 months, the participants complete questionnaires and take part in qualitative interviews about stress and well-being in their present life-situation and experiences from participating in Be-WellTM. Non-parametric and qualitative analysis will be used. Results: Twenty-nine of 35 participants have been recruited to the intervention and 28 of 35 participants to the control group. We will present the research design and preliminary outcomes from the baseline and follow-up data.Conclusion: If the intervention Be-WellTM is found to be feasible with positive outcomes, the health-promoting intervention Be-WellTM can be useful as a complementary intervention in primary healthcare for patients with stress-related illness. Implications for Caring in a changing world: Probably, photo-supported conversations may promote well-being to other patients in different life situations, but future research is warranted.

  • 189.
    Gunnarsson, Birgitta
    et al.
    University of Gothenburg, Sweden;Region Kronoberg, Sweden.
    Wagman, Petra
    Jönköping University, Sweden.
    Sternudd, Hans T.
    Linnaeus University, Faculty of Arts and Humanities, Department of Music and Art.
    Holmberg, Sara
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kronoberg, Sweden;Lund University, Sweden.
    Holmgren, Kristina
    University of Gothenburg, Sweden.
    Hörberg, Ulrica
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    A study protocol of the photo-supported conversations about the well-being intervention (Be Well™) for people with stress related disorders2021In: BMC Psychology, E-ISSN 2050-7283, Vol. 9, no 1, article id 123Article in journal (Refereed)
    Abstract [en]

    Background: Stress-related illnesses constitute a huge problem in society. The primary care services in Sweden form the first line of care whose role is to coordinate interventions for reducing symptoms, as well as health-promoting interventions. There is lack of knowledge concerning health-promoting interventions for these illnesses. The aim of this study is to evaluate whether photo-supported conversations about well-being (Be Well™) as an intervention, in addition to care as usual within the primary care services, improves health and well-being for patients with stressrelated illnesses. The intervention will be compared to a control group, who receive care as usual. A further aim is to conduct a process evaluation.

    Methods/Design: This ongoing project has a quasi-experimental design, using quantitative and qualitative methods, and includes patients from primary care centres in two Swedish counties. Seventy patients, 20–67 years, with stress-related illnesses will be recruited. They constitute an intervention group, which receive the intervention together with care as usual, and a control group, which receive care as usual. The intervention, photo-supported conversations about well-being, involves 12 sessions. Care as usual entails medication, occupational therapy, physiotherapy and/or psychotherapy. Data collection is carried out at baseline, and outcomes are assessed directly after the intervention, as well as six months after completion of the intervention. The outcomes are evaluated based on factors related to health, well-being and everyday occupations. Furthermore, data concerning experiences of wellbeing and perceptions of the intervention will be collected in interviews. The therapists will also be interviewed about their experiences of performing the intervention. Data will be analysed with non-parametric statistics, and qualitative methodology.

    Discussion: The project is based on the concept that focusing on well-being despite living with stress-related illness may positively impact health and well-being as well as activity-related aspects, and that photo-supported conversations about well-being can contribute a complement to other treatment and rehabilitation. A strength is the use of a wide range of methods: such as quantitative measures, photographs, and qualitative interviews with participants and therapists. The results will thus provide knowledge about potential effects of this health-promoting intervention.

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  • 190.
    Gustafsson, Karolina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Påverkas pupilldiametern av ögats refraktiva status?2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: Understanding how pupil size changes under different light conditions is important for refractive surgery, in contact lens fitting, as well as in the development of multifocal contact lenses. It is therefore of great value to have good measurement results and trustworthy methods. The accuracy and repeatability of the instruments used for these measurements are also critical.The purpose of this study was to investigate whether there was a potential relationship between the pupil diameter and the eye's refractive error with the use of the pupilometer incorporated within Sirius. A secondary purpose arose during the study, to evaluate the repeatability of the instrument Sirius. The null hypothesis of this study was; that pupil diameter is greater in myopes than hyperopes and emmetropes - that one would see a decrease in pupil diameter from myopes to emmetropes and also a decrease in pupil diameter from emmetropes to hyperopes.

    Method: There were 64 participants who took part in this study, aged between 20 to 36 years. Of these, three were excluded because they did not fit the inclusion criteria. The participants were divided into three different groups according to their spherical equivalent refractive errors: there were 26 myopes (range -7.75 D to -0.75 D), 17 emmetropes (range -0.50 D to +0.50 D), and 18 hyperopes (range + 0.75 D to + 5.75 D). Both eyes was measured. Pupil diameter was first measured in Sirius in a darkened room, where the computer was the only light source and the screen's brightness was dimmed. An objective refraction was done with the use of an autorefractor to get an estimated refractive value. Thereafter, retinoscopy was performed in a trial frame with a retinoscopy rack or loose trial lenses. The participants with higher astigmatism were also controlled with the use of the Jackson cross-cylinder. The pupil response was checked in all participants following pupil diameter measurements, to ensure that both eyes did not exhibit pupil defects. The result was analyzed with Excel and GraphPad Prism.

    Results: Since this study did not find any difference between the right and left eye, the data analysis was performed for right eye only. The mean and standard deviation (SD) of spherical equivalent power for myopes was -2.75 ±1.95 D, emmetropes -0.06 ±0.37 D and hyperopes +1.51 ±1.37 D. This study showed a weak trend between refractive error and pupil diameter, but no significant correlation between pupil diameter and the refractive state of the eye was evident, irrespective of lighting conditions; scotopic (p = 0.38), mesopic (p = 0.17) or photopic (p = 0.16). As expected, a clear decrease in pupil diameter with increased illumination intensity was found. A variance analysis (one-way, repeated measures ANOVA) was performed on the three different measurement in each illumination level, to confirm the repeatability of Sirius. The ICC values were 0.94 for scotopic, 0.87 for mesopic and 0.95 for photopic lighting conditions.

    Conclusuion: The study shows no significant correlation between pupil diameter and the refractive state of the eye over the range of -7.75 D to + 5.75 D. In this study, we also investigated the repeatability of the measurements values obtained with Sirius using the ICC; this showed that Sirius has a good repeatability in measuring pupil diameter in all three light levels.

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  • 191.
    Gustafsson, Maria
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Läshastighet på datorskärm med färgade overlays2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: To investigate reading speed on a computer screen and if it can be improved by using coloured overlays, and also if there is any difference in reading speed on printed paper and computer screen.

    Methods: The participants (n=30) read a Wilkins rate of reading test translated into Swedish, where the number of words read out loud in one minute was compared when reading on a paper without overlay and on a computer screen with and without an overlay. This study was performed on students aged 18-31 years.

    Results: This study shows that there is no significant difference in reading speed between reading on a printed paper and on a computer screen (p=0.508). The participants read 1.6 ± 13.3 words/min more on the computer screen than on the paper. A significant difference however was found in reading on a computer screen with and without coloured overlay (p=0.008). The reading speed increased with 4.7 ± 9.1 words/min with a coloured overlay.

    Conclusions: The reading speed on paper is similar to the reading speed on computer screen. The reading speed on the computer screen can be increased by placing a coloured overlay in front of the text.

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  • 192.
    Gustafsson, Sandra
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Landström Hansson, Sanna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Jämförelsen av central corneal tjocklek uppmätt med olika kliniska instrument: En kvantitativ studie2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: The purpose of this study was to examine the repeatability and comparability of three clinical instruments used to measure the corneal thickness in healthy eyes. The different instruments all have various fields of usage but the focus in this study is pachymetry: measurement of the corneal thickness.

    Method: In total, 64 people participated in this study. Everyone that participated were above the age of 18 and were located at Linneaus university in Kalmar, Sweden at the time the measurements took place. The three optical pachymetry instruments used were Topcon TRK-2P, Bon Sirius and Essilor Wavefront Analyzer Medica 700+. Three measurements were taken on each instrument on the participants’ both eyes. All collected data was collated in Google Sheets and analyzed in Graphpad Prism (version 9). 

    Results: The repeatability was tested with ICC that was above 0,98 on all the instruments. CR was between 5,28-8,80 μm and CV was between 6,29-6,74%. The comparability showed that there was a significant difference between the three instruments (One-way RM- ANOVA,  p<0,0001).

    Conclusion: All three instruments that were used during this study showed an excellent repeatability when measuring healthy eyes. However, there were significant differences between the instruments themselves. This means that you should stick to the same instrument while following up patients.

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  • 193.
    Gustavsson, Ida
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hur smink påverkar ögat och kontaktlinsen - en pilotstudie2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med den här studien var att undersöka smink påverkar kontaktlinsen och ögast främre segment vid bärande av mjuka korttidsslinser.

    Metod: De medverkande fick använda smink en vecka och vara utan smink en vecka. Efter varje testperiod noterades eventuella beläggningar och skador på linserna och vanliga ögonkomplikationer graderades. Inför varje testperiod fick deltagarna vara utan linser från och med kvällen innan och de fick ett nytt par linser och ett nytt linsetui.

    Resultat: Det fanns ingen statistisk signifikant skillnad mellan testperioderna gällande ögonkomplikationerna, förutom vid palpebral konjunktival ojämnhet som visade sig ha ett högre medelvärde efter sminkperioden jämfört med  den sminkfria perioden.  En lins hade skador efter den osminkade perioden och en lins hade skador efter sminkperioden. Beläggningar återfanns i större utsträckning efter smink-veckan, men skillnaden var inte statistisk signifikant.  

    Slutsats:Studien visar på att smink inte påverkar kontaktlinsen eller ögat, förutom palpebrala konjunktiva, negativt efter en vecka sminkanvändning.

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  • 194.
    Gustavsson, Linn
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Bedömning av ögats ackommodativa respons- en jämförelse mellan aberrometri och dynamisk retinoskopi2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna studie var att undersöka om det finns några skillnader i den ackommodativa responsen när den fastställs med tre olika mätmetoder. De utvalda metoderna för denna studie var dynamisk retinoskopi i form av Nott och Monocular Estimation Method (MEM) samt en COAS-HD VR aberrometer.

    Metod: 29 personer (7 män och 22 kvinnor) deltog i studien, vars medelålder var 23,6 ± 3,1 år. På varje enskild patient gjordes en subjektiv refraktion med en efterföljande mätning av dess ackommodativa respons med tre olika mätmetoder på ett 40 centimeters arbetsavstånd. Resultaten av studien analyserades med hjälp av Repeated Measures-ANOVA och ett post-hoc test i form av Sidak´s. Överensstämmelsen mellan metoderna redovisades därefter visuellt i form av ett Bland-Altman plot.

    Resultat: Det visade sig att alla tre metoder gav liknande värden på den ackommodativa responsen, vilket resulterade i att det inte fanns en statistiskt signifikant skillnad mellan metoderna (p = 0,1103) enligt Repeated Measures-ANOVA. Bland-Altman plot visade på att metoderna ej kan användas ombytligt i syftet att mäta ackommodativ respons, då det var för brett mellan övre och undre gränsen för överensstämmelse metoderna emellan.

    Slutsats: Resultatet av denna studie visar att det inte finns någon statistiskt signifikant skillnad i den ackommodativa respons som uppmätts med Nott, MEM och COAS-HD VR. Det visade sig att metoderna inte kan användas ombytligt i syftet att mäta den ackommodativa responsen, då en dålig överenstämmelse fanns mellan metoderna. 

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  • 195.
    Guthrie, Philip
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Är det någon skillnad mellan Sirius & Wave Analyzer Medica 700 vid pakymetri och topografiska mätningar?2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med studien var att jämföra korneala mätningar tagna med två olika topografiska mätinstrument (Sirius & Wave Analyzer Medica 700) och att utvärdera om dessa två instrument kan användas utbytbart.

    Metod: Det var 23 stycken deltagare i denna studie som var indelade i två grupper. Det var 17 stycken deltagare i grupp A som hade en normal kornea och i grupp B var det 6 stycken deltagare som hade en onormal kornea. Tre upprepade mätningar utfördes på det högra ögat för alla deltagare med båda instrumenten. Förutom på en deltagare som hade keratokonus i hens vänstra öga. De simulerade K (Sim-K) parametrarna som innehåller ”Flattest” (Kf), ”Steepest” (Ks) och ”Average” K (Km) analyserades. Dessutom togs den centrala korneas tjocklek också med båda mätinstrumenten och utvärderades.

    Resultat: En skillnad mellan de uppmätta värdena för de två mätinstrumenten hittades. Mellan dessa två mätinstrument var medelvärdet av skillnaden i grupp A för parametrarna Kf, Ks och Km ungefär 0,1mm. I grupp B var medelvärdet av skillnaden för parametrarna Kf, Ks och Km ungefär 0,15mm. För pachymetri var medelvärdet av skillnaden för de två mätinstrumenten 23µm för grupp A och 31µm för grupp B.

    Slutsats: De två topografiska mätinstrumenten visade en statistiskt signifikant skillnad i mätning utav korneala parametrarna. Trots att det var en statistiskt signifikant skillnad när man jämförde Sim-K för båda mätinstrumenten var skillnaden kliniskt obetydlig för de deltagare som hade en frisk kornea. Därför kan båda utav dessa mätinstrument användas utbytbart för att mäta keratometri i friska ögon.

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  • 196.
    Gyllensten, Hanna
    et al.
    University of Gothenburg, Sweden.
    Fuller, Joanne M.
    University of Gothenburg, Sweden.
    Johansson Östbring, Malin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Kalmar County, Sweden.
    Commentary: how person-centred is pharmaceutical care?2022In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 44, no 1, p. 270-275Article in journal (Refereed)
    Abstract [en]

    Health systems in many countries are currently undergoing an evolution towards more person-centred care. However, an overview of the literature shows that there is little or no guidance available on how to apply person-centred care to pharmaceutical care and clinical pharmacy practices. In this paper we apply a model for person-centred care created by a national multidisciplinary research centre in Gothenburg, Sweden, to the clinical work tasks of outpatient and inpatient pharmacists and describe how pharmaceutical care can become more person-centred.

  • 197.
    Göransson, Julia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    En jämförande studie av ackommodation mellan glasögon och kontaktlinser hos myoper2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: Contact lenses increase the accommodative demand in myopes. The purpose of this study is to investigate if the increase of accommodative demand becomes greater after 30 minutes of reading when shifting between spectacles and contact lenses.

    Method: 15 myopes participated in the study, 14 women and 1 man. The participants' average refractive error was -2.49 ± 1.71D and all read at least 1.0 at 6 m and 6p at 40 cm with spectacles and contact lenses. Each subject participated on two separate occasions, first with spectacles and then with contact lenses. The accommodative response, amplitude and facility were measured before and after 30 minutes of reading at the distance of 33 cm, on both occasions. The results were compiled in Microsoft Office Excel, where the mean, standard deviation, standard error and paired t-test were used to analyze the results.

    Result: The accommodative response increases significantly with contact lenses and the increase was greater after 30 minutes of reading. The accommodative amplitude shows a significant decrease in contact lenses and more after reading. The accommodative facility shows no significance. High standard deviations show varied results among participants and several of the participants were below normal values ​​for the accommodative facility.

    Conclusion: Myopes accommodative requirements increases with contact lenses use as compared to spectacles. The accommodative effort after 30 minutes of short distance reading is greater in contact lenses than spectacles.

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  • 198.
    Hammar, Tora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    eMedication – improving medication management using information technology2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Medication is an essential part of health care and enables the prevention andtreatment of many conditions. However, medication errors and drug-relatedproblems (DRP) are frequent and cause suffering for patients and substantial costsfor society. eMedication, defined as information technology (IT) in themedication management process, has the potential to increase quality, efficiencyand safety but can also cause new problems and risks.In this thesis, we have studied the employment of IT in different steps of themedication management process with a focus on the user's perspective. Sweden isone of the leading countries when it comes to ePrescribing, i.e. prescriptionstransferred and stored electronically. We found that ePrescribing is well acceptedand appreciated by pharmacists (Study I) and patients (Study II), but that therewas a need for improvement in several aspects. When the pharmacy market inSweden was re-regulated, four new dispensing systems were developed andimplemented. Soon after the implementation, we found weaknesses related toreliability, functionality, and usability, which could affect patient safety (StudyIII). In the last decade, several county councils in Sweden have implementedshared medication lists within the respective region. We found that physiciansperceived that a regionally shared medication list generally was more complete butoften not accurate (Study IV). Electronic expert support (EES) is a decisionsupport system which analyses patients´ electronically-stored prescriptions in orderto detect potential DRP, i.e. drug-drug interactions, therapy duplication, highdose, and inappropriate drugs for geriatric or pediatric patients. We found thatEES detected potential DRP in most patients with multi-dose drug dispensing inSweden (Study V), and that the majority of alerts were regarded as clinicallyrelevant (Study VI).For an improved eMedication, we need a holistic approach that combinestechnology, users, and organization in implementation and evaluation. The thesissuggests a need for improved sharing of information and support for decisionmaking, coordination, and education, as well as clarification of responsibilitiesamong involved actors in order to employ appropriate IT. We suggestcollaborative strategic work and that the relevant authorities establish guidelinesand requirements for IT in the medication management process.

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  • 199.
    Hammar, Tora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Förändringar i informationsrisker vid övergång från lokal till gemensam läkemedelslista2013Report (Other academic)
    Abstract [sv]

    En viktig utgångspunkt för en säker läkemedelsanvändning är att informationen om en patients ordinationer är tillgänglig, korrekt, fullständig och aktuell. Läkemedelslistor som är gemensamma för olika vårdinstanser och aktörer anges ofta som en väg för att ge en säkrare läkemedelsanvändning, en väg som många landsting valt att gå, och en väg som planeras för Sverige nationellt. Det är oklart vilka de egentliga konsekvenserna blir av att övergå från lokal till gemensam läkemedelslista. Hur förändras informationen kring läkemedelsordinationer? Vilka informationsrisker minskar, vilka ökar och vilka risker kvarstår? Syftet med denna studie var att beskriva förändringar i informationsrisker utifrån aspekterna riktighet, tillgänglighet och konfidentialitet (1) upplevda vid övergång från lokal läkemedelslista till en landstingsgemensam läkemedelslista och (2) väntade vid framtida införande av en nationell gemensam läkemedelslista. Studien gjordes som en beskrivande kvalitativ intervjustudie utifrån läkarnas perspektiv. Semistrukturerade intervjuer genomfördes med sju läkare från fyra olika landsting som varit med om en övergång från lokal till gemensam läkemedelslista.

    Studien visade att övergången från lokal till gemensam läkemedelslista upplevdes förbättra patientsäkerheten genom ökad tillgänglighet och potential att ge en ökad riktighet. Överlag var listorna mer fullständiga men med en ökad mängd inaktuella läkemedel, ofta orsakad av att läkare arbetar på olika sätt med läkemedelslistan. En gemensam läkemedelslista upplevdes innebära en ökad risk att kränka patienters integritet och ökade krav på IT-säkerhet för att skydda informationens konfidentialitet. Dock upplevde läkarna att få patienter fann det besvärande utan snarare var förvånade över att läkare inte alltid haft tillgång till all information. Risker för händelser som kan skapa problem med tillgängligheten fanns både före och efter införandet av gemensam läkemedelslista. Avbrotten är enligt läkarna sällsynta, men ofta saknas reservrutiner när avbrotten inträffar. Dospatienternas läkemedelsinformation var överlag något som alla läkare tog upp som särskilt problematiskt eller riskfyllt då läkemedelslistorna i journalsystemet ofta var helt felaktiga för dospatienter och att det samtidigt inte var helt tydligt i journalsystemet om en patient var dospatient. Trots att stora delar av sjukvården inom ett landsting eller en region har en gemensam lista kvarstår problemet att listan oftast inte är gemensam med kommunen, inte är gemensam med apoteken och i de flesta fall inte utgör patientens egen källa om läkemedelsordinationer.

    Vid övergången till en nationell läkemedelslista kunde liknande förändringar väntas som vid övergången till gemensam läkemedelslista regionalt. En stor skillnad är att det inte är hela journalen som blir gemensam. Läkarnas behov av en nationell lista varierade, liksom deras uppfattningar om hur den bäst skulle användas och implementeras. En nationell läkemedelslista har potentialen att öka patientsäkerheten men det är viktigt att vara medveten om att en gemensam läkemedelslista inte löser alla problem, behov av läkemedelsgenomgångar och kommunikation med patient och mellan vårdgivare kvarstår. För att implementeringen av en nationell läkemedelslista ska lyckas måste man utgå från professionens behov av den nationella listan i det kliniska arbetet och utifrån dem fastställa tydliga rutiner för hur listan ska föras in och användas.

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  • 200.
    Hammar, Tora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health.
    Patienternas och personalens upplevelser av läkemedelsprocessen och förväntningar på Nationella läkemedelslistan: Rapport till E-hälsomyndigheten2021Report (Other academic)
    Abstract [sv]

    Sverige är på gång att införa ett nytt register, Nationella läkemedelslistan (NLL), baserat på en lag som trädde i kraft 1 maj 2021. Målet är att NLL ska ge hälso- och sjukvård, apotek och patienter tillgång till samma information om förskrivna och uthämtade läkemedel. Förväntningarna är att NLL ska bidra till förbättrad patientsäkerhet, men en sådan stor förändring innebär också en risk för okända negativa effekter.

    Syftet med projektet var att undersöka upplevelser av läkemedelsprocessen och förväntningar på NLL från de tre perspektiven vård, apotek och individ innan den nya lagen trädde i kraft. Ett av projektets delmål var att ta fram en modell för detta som möjliggör att studera förändringar över tid. Våren 2020 genomfördes 33 intervjuer med läkare, sjuksköterskor, farmaceuter på apotek och kliniska farmaceuter, patienter och anhöriga runt om i Sverige. April 2021 genomfördes enkäter som besvarades av 809 informanter från samma kategorier som intervjuerna.

    Det är tydligt att det finns betydande problem med informationshanteringen i läkemedelsprocessen som ger utmaningar för personal i vården, på apotek och patienter och skapar osäkerhet och merarbete för att veta vilka läkemedel som är aktuella. Detta innebär patientsäkerhetsrisker och är negativt ur ett samhällsperspektiv. Undersökningen visar också ett tydligt behov av en gemensam nationell läkemedelslista. Förväntningarna på NLL är höga och många hoppas att den nya lagen ska innebära ökad patientsäkerhet och att många av de upplevda problemen ska bli bättre. Resultaten visar samtidigt på en stor oro, farhågor och upplevda hinder samt delvis orealistiska förväntningar i förhållande till det som är på väg att implementeras. Dessutom upplevde många att de saknat information, har en otydlig bild om vad som ska förändras och när, eller inte känner till NLL sedan tidigare.

    De flesta förhoppningarna som beskrivs från alla parter bygger till största del på att vårdens arbetssätt anpassas, att förskrivarna kan hålla listan aktuell, ta ansvar för helheten och ta hänsyn till andra ordinationer, samt hantera ändringar i behandling så att informationen följer med till listan. Detta i sin tur kräver att vårdpersonalen kan arbeta i system som ger dem bra stöd för detta arbete, att det är tydligt hur det ska arbeta och inte krävs manuell informationsöverföring. Arbetet med NLL är en förutsättning för att lösa många av de problem som upplevs i läkemedelsprocessen och har således potentialen att förbättra patientsäkerhet. Olösta frågor som skapar oro i vården är till exempel hur informationen från NLL som bygger på recept ska kunna återföras i journalsystemen på ett bra sätt då informatiken där bygger på ordinationer som innehåller andra informationsmängder och en annorlunda logik. Det är viktigt att fastställa en konkret och gemensam bild av önskat arbetssätt kring NLL med patientsäkerheten i fokus, och hur integration ska ske så att det på ett tydligt och enkelt sätt stödjer detta arbetssätt och ser till att viktig information inte går förlorad. Här behövs bland annat en konstruktiv dialog mellan E‑hälsomyndigheten och vården kring möjligheter med NLL utifrån nuvarande lagstiftning och förutsättningar. 

    Sist men inte minst vill vi lyfta vikten av forskning och uppföljning kopplat till informationshanteringen i läkemedelsprocessen och arbetet med NLL. Effekter blir ofta andra och fler än väntat. Komplexitet, stora utmaningar och läkemedelslistans betydelse för patientsäkerheten gör att det är extra viktigt att kunna följa införandet av NLL och identifiera både positiva och negativa effekter samt hinder för implementering. I rapporten presenteras en modell för uppföljning av effekter mätt som användarnas upplevelser samt ett förslag till en bredare modell som även innefattar en kombination med andra kvantitativa mått som är relevanta i sammanhanget. 

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    Slutrapport NLL
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    Bilaga 1 Intervjuguider rapport NLL
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    Bilaga 2 Enkäter rapport NLL
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    Bilaga 3 Nya frågor Nationell patientenkät rapport NLL
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