Background: Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective: This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods: This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals-one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the Cardio Set Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results: The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions: Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.

BACKGROUND:

A rapid emergency care intervention can prevent the cardiac arrest from resulting in death. In order for Cardio Pulmonary Resuscitation (CPR) to have any real significance for the survival of the patient, it requires an educational effort educating the large masses of people of whom the youth is an important part. The aim of this study was to investigate the effect of a two-hour education intervention for youth regarding their self-confidence in performing Adult Basic Life Support (BLS).

METHODS:

A quantitative approach where data consist of a pre- and post-rating of seven statements by 50 participants during an intervention by means of BLS theoretical and practical education.

RESULTS:

The two-hour training resulted in a significant improvement in the participants' self-confidence in identifying a cardiac arrest (pre 51, post 90), to perform compressions (pre 65, post 91) and ventilations (pre 64, post 86) and use a defibrillator (pre 61, post 81). In addition, to have the self-confidence to be able to perform, and to actually perform, first aid to a person suffering from a traumatic event was significantly improved (pre 54, post 89).

CONCLUSION:

By providing youth with short education sessions in CPR, their self-confidence can be improved. This can lead to an increased will and ability to identify a cardiac arrest and to begin compressions and ventilations. This also includes having the confidence using a defibrillator. Short education sessions in first aid can also lead to increased self-confidence, resulting in young people considering themselves able to perform first aid to a person suffering from a traumatic event. This, in turn, results in young people perceiveing themselves as willing to commence an intervention during a traumatic event. In summary, when the youth believe in their own knowledge, they will dare to intervene.

BACKGROUND:

A rapid emergency care intervention can prevent the cardiac arrest from resulting in death. In order for Cardio Pulmonary Resuscitation (CPR) to have any real significance for the survival of the patient, it requires an educational effort educating the large masses of people of whom the youth is an important part. The aim of this study was to investigate the effect of a two-hour education intervention for youth regarding their self-confidence in performing Adult Basic Life Support (BLS).

METHODS:

A quantitative approach where data consist of a pre- and post-rating of seven statements by 50 participants during an intervention by means of BLS theoretical and practical education.

RESULTS:

The two-hour training resulted in a significant improvement in the participants' self-confidence in identifying a cardiac arrest (pre 51, post 90), to perform compressions (pre 65, post 91) and ventilations (pre 64, post 86) and use a defibrillator (pre 61, post 81). In addition, to have the self-confidence to be able to perform, and to actually perform, first aid to a person suffering from a traumatic event was significantly improved (pre 54, post 89).

CONCLUSION:

By providing youth with short education sessions in CPR, their self-confidence can be improved. This can lead to an increased will and ability to identify a cardiac arrest and to begin compressions and ventilations. This also includes having the confidence using a defibrillator. Short education sessions in first aid can also lead to increased self-confidence, resulting in young people considering themselves able to perform first aid to a person suffering from a traumatic event. This, in turn, results in young people perceiveing themselves as willing to commence an intervention during a traumatic event. In summary, when the youth believe in their own knowledge, they will dare to intervene.

Insomnia is a common occurrence and can have a negative impact on physiological, psychological and social well-being. There is a need for simple, effective solutions to increase sleep quality. It has been suggested that weighted blankets and vests can provide a beneficial calming effect, especially in clinical disorders. Hence, we aimed to investigate the effects of a chain weighted blanket on insomnia, using objective and subjective measures. Objectively, we found that sleep bout time increased, as well as a decrease in movements of the participants, during weighted blanket use. Subjectively, the participants liked sleeping with the blanket, found it easier to settle down to sleep and had an improved sleep, where they felt more refreshed in the morning. Overall, we found that when the participants used the weighted blanket, they had a calmer night’s sleep. A weighted blanket may aid in reducing insomnia through altered tactile inputs, thus may provide an innovative, non-pharmacological approach and complementary tool to improve sleep quality.

Syftet med fördjupningsarbetet har varit att via en pilotstudie öka kunskapen om ungdomar med funktionsnedsättning i Umeå, med avseende på psykisk hälsa, och på hur de upplever sin vardag i skolan, med kamrater och i familjen. Psykisk hälsa undersöktes genom att ungdomar med funktionsnedsättning som går i specialklasser (grundsärskolans högstadium, högstadium för ungdomar med Asperger, högstadium för ungdomar med rörelsenedsättningar), fick besvara en enkät under skoltid. För att kunna relatera till den undersökning som Statens Folkhälsoinstitut genomförde hos ungdomar i Sverige 2009 har samma enkät använts.

Resultatet visar att de flesta ungdomar har angett att de mår bra, trivs i skolan, har bra kontakt med sina lärare och med sina föräldrar. Majoriteten mår lika bra som de flesta ungdomar i landet och t.om bättre än de ungdomar i Folkhälsoinstitutets undersökning, som angett att de hade någon funktionsnedsättning.

Inom några områden visades dock lägre resultat. Ungdomarna i vår undersökning uppgav att deras svårigheter påverkade deras vardag i familjen och vid fritidsaktiviteter. De umgås mer sällan med kamrater, motionerar mindre och har färre fritidsaktiviteter. Ungdomar med Asperger skiljer ut sig mest i vår undersökning, de är mindre nöjda med livet och med sig själva, känner sig mer ensamma,  umgås mer sällan med kamrater och har mindre kul, jämfört med ungdomar i grundsärskolan.

Det finns områden där stödet ifrån Barn- och ungdomshabiliteringen kan förbättras, som att utveckla metoder för socialt samspel och stärka ungdomarnas identitet och i samarbete med andra aktörer öka delaktigheten till en mer aktiv fritid.

Background: Children with cerebral palsy (CP) face particular challenges, e.g. daily pain that threaten their participation in school activities. This study focuses on how teachers, personal assistants, and clinicians in two countries with different cultural prerequisites, Sweden and South Africa, manage the pain of children in school settings.

Method: Participants’ statements collected in focus groups were analysed using a directed qualitative content analysis framed by a Frequency of attendance-Intensity of involvement model, which was modified into a Knowing-Doing model.

Results: Findings indicated that pain management focused more on children’s attendance in the classroom than on their involvement, and a difference between countries in terms of action-versus-reaction approaches. Swedish participants reported action strategies to prevent pain whereas South African participants primarily discussed interventions when observing a child in pain.

Conclusion: Differences might be due to school- and healthcare systems. To provide effective support when children with CP are in pain in school settings, an action-and-reaction approach would be optimal and the use of alternative and augmentative communication strategies would help to communicate children’s pain. As prevention of pain is desired, structured surveillance and treatment programs are recommended along with trustful collaboration with parents and access to “hands-on” pain management when needed.

Dysregulation of the complement system is evident in many CNS diseases but mechanisms regulating complement activation in the CNS remain unclear. In a recent large rat genomewide expression profiling and linkage analysis we found co-regulation of complement C3 immediately downstream of butyrylcholinesterase (BuChE), an enzyme hydrolyzing acetylcholine (ACh), a classical neurotransmitter with immunoregulatory effects. We here determined levels of neurofilament-light (NFL), a marker for ongoing nerve injury, C3 and activity of the two main ACh hydrolyzing enzymes, acetylcholinesterase (AChE) and BuChE, in cerebrospinal fluid (CSF) from patients with MS (n = 48) and non-inflammatory controls (n = 18). C3 levels were elevated in MS patients compared to controls and correlated both to disability and NFL. C3 levels were not induced by relapses, but were increased in patients with >= 9 cerebral lesions on magnetic resonance imaging and in patients with progressive disease. BuChE activity did not differ at the group level, but was correlated to both C3 and NFL levels in individual samples. In conclusion, we show that CSF C3 correlates both to a marker for ongoing nerve injury and degree of disease disability. Moreover, our results also suggest a potential link between intrathecal cholinergic activity and complement activation. These results motivate further efforts directed at elucidating the regulation and effector functions of the complement system in MS, and its relation to cholinergic tone.

Background: Patients who receive palliative care experience that they lose their independence through the disease and are frustrated that their body is not functioning as before. They also experience that their situation make them change their attitudes towards life. Several patients appreciate when healthcare professionals show genuine interest and the same patients have confidence in the healthcare system. Some patients experience that the healthcare professionals have no time and that their knowledge regarding their psychosocial problems is inadequate. Aim: The purpose is to describe nurses experience of nursing in palliative care. Method: Qualitative literature study with descriptive synthesis. Ten qualitative articles have been analyzed and is presented in the result. Results: After analysis, two themes were disclosed; Becoming enriched and Being challenged who described nurse’s experiences presented under five subthemes. Conclusion: Nurses perceived, among other things, that they were strengthened as a person and that they learned to re-prioritize and appreciate life. They also experienced grief over the fate of patients and it was common to take work home. Several of the nurses perceived that doctors did not give them support, others felt that their lack of experience contributed to the care worsening.

Aim. To develop and validate a new instrument measuring patient anxiety during Magnetic Resonance Imaging examinations, Magnetic Resonance Imaging-Anxiety Questionnaire. Background. Questionnaires measuring patients anxiety during Magnetic Resonance Imaging examinations have been the same as used in a wide range of conditions. To learn about patients experience during examination and to evaluate interventions, a specific questionnaire measuring patient anxiety during Magnetic Resonance Imaging is needed. Design. Psychometric cross-sectional study with test-retest design. Methods. A new questionnaire, Magnetic Resonance Imaging-Anxiety Questionnaire, was designed from patient expressions of anxiety in Magnetic Resonance Imaging-scanners. The sample was recruited between October 2012-October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbachs alpha. Criterion-related validity, known-group validity and test-retest was calculated. Results. Patients referred for Magnetic Resonance Imaging of either the spine or the heart, were invited to participate. The development and validation of Magnetic Resonance Imaging-Anxiety Questionnaire resulted in 15 items consisting of two factors. Cronbachs alpha was found to be high. Magnetic Resonance Imaging-Anxiety Questionnaire correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing Magnetic Resonance Imaging scan of the heart than for those examining the spine. Test-retest reliability demonstrated acceptable level for the scale. Conclusion. Magnetic Resonance Imaging-Anxiety Questionnaire bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during Magnetic Resonance Imaging examinations.

Obesity is a major health problem in the Western world. Mean birth weight has increased during the last 25 years. One explanation is that the proportion of large for gestational age (LGA) infants has increased. Such infants risk developing obesity, cardiovascular disease and diabetes later in life. Despite the risk of neonatal hypoglycemia, their postnatal metabolic adaptation has not been investigated. Our data, obtained with stable isotope labeled compounds, demonstrate that newborn LGA infants have increased lipolysis and decreased insulin sensitivity. After administration of glucagon, the plasma levels of glucose and the rate of glucose production increased. The simultaneous increase in insulin correlated with the decrease in lipolysis, indicating an antilipolytic effect of insulin in these infants.

We also demonstrated an intergenerational effect of being born LGA, since women born LGA, were at higher risk of giving birth to LGA infants than women not born LGA. Further, the LGA infants formed three subgroups: born long only, born heavy only, and born both long and heavy. Infants born LGA of women with high birth weight or adult obesity were at higher risk of being LGA concerning weight alone, predisposing to overweight and obesity at childbearing age. In addition we found that pregnant women with gestational diabetes were at increased risk of giving birth to infants that were heavy alone. This could explain the risk of both perinatal complications and later metabolic disease in infants of this group of women.

To identify determinants of fetal growth, 20 pregnant women with a wide range of fetal weights were investigated at 36 weeks of gestation. Maternal fat mass was strongly associated with insulin resistance. Insulin resistance was related to glucose production, which correlated positively with fetal size. The variation in resting energy expenditure, which was closely related to fetal weight, was largely explained by BMI, insulin resistance, and glucose production. Lipolysis was not rate limiting for fetal growth in this group of women. Consequently, high maternal glucose production due to a high fat mass may result in excessive fetal growth.

A personal assistant has to promote equality in living conditions for persons with severe disabilities. The aim of this study was to explore how personal assistants experience their work and what strategies they employ to alleviate work-related stress. Thirty personal assistants were interviewed and latent content analysis was performed. The findings regarding the experiences of work-related stress could be brought together under the theme of “difficulties of being in a subordinate position,” and those regarding management strategies could be brought together under the theme of “coming to terms with the work situation.” There is a need to empower personal assistants through training programs including tailored education, working communities, and coaching.

Scientific medicine has been successful by ways of an ever more detailed understanding and mastering of bodily functions and dysfunctions. Biomedical research promises new triumphs, but discontent with medical practice is all around. Since several decades this has been acknowledged and discussed. The philosophical traditions of phenomenology and hermeneutics have been proposed as promising ways to approach medical practice, by ways of a richer understanding of the meaning structures of health and illness. In 2000, Swedish philosopher Fredrik Svenaeus published a book where he proposes that the phenomenological hermeneutics of Martin Heidegger and also the reflections on health and illness of Hans-Georg Gadamer offer important ways to approach the nature of medicine. In particular, Svenaeus argues that the goal of medicine is to promote and restore health, and that health ought to be seen as "homelike being-in-the-world". Unhealth, illness, consequently should be understood as a situation where a person's "being-in-the-world" in characterized by that lack of the rhythm, balance and "tune" of everyday living that characterizes not "being at home". In this article, Svenaeus' position is briefly outlined. Questions are raised whether "unhomelikeness" is to be seen as a metaphor, and, if so, if it is a fruitful such. Furthermore, I discuss whether or not a discourse on health and illness in these terms may be misleading in a situation where the ontological presuppositions of Heidegger are lost out of sight and the popular understanding of health psychology predominates. I also approach the question whether Svenaeus' assumptions may inadvertently lead us to an unjustifiably broad understanding of the tasks of medicine. It is finally concluded that Svenaeus phenomenological and hermeneutical approach is both interesting and promising. There are, however, several questions that ought to be pursued further, and the step from philosophical analysis to everyday clinical discourse may be unexpectedly long and risky.

Is literary experience of any practical relevance to the clinician? This is the overall question addressed by this investigation, which starts by tracing the historical roots of scientific medicine. These are found to be intimately linked to a form of rationality associated with the scientific revolution of the 17th century and with “modernity”. Medical practice, however, is dependent also on another form of rationality associated with what Stephen Toulmin calls “the epistemology of the biographical”. The very core of clinical medicine is shown to be the clinical encounter, an interpretive meeting where the illness experience is at the centre of attention. The physician can reach the goals of medicine only by developing clinical judgement. Clinical judgement is subjected to close analysis and is assumed to be intimately connected to the form of knowledge Aristotle called phronesis.

In order to explore how literature – drama, novels, poetry – may be related to clinical judgement, a view of literature is presented that emphasizes literature as an invitation to the reader, to be met responsibly and responsively. Literature carries a potential for a widened experience, for a more nuanced perception of reality – and this potential is suggested to be ethically relevant to the practice of medicine. The “narrative rationality” of a literary text constitutes a complement to the rationality pervading scientific medicine.

The final step in my analysis is a closer exploration of the potential of the literary text to contribute to the growth of clinical judgement, in relation to the challenges of everyday clinical work. Some of the conditions that may facilitate such growth are outlined, but it is also shown that full empirical evidence for the beneficial effects of reading on the clinician reader is beyond reach.

Background The Swedish national quality register for electroconvulsive therapy (Q-ECT) contains data on patients receiving treatment with electroconvulsive therapy (ECT) in Sweden. Aim This study determined the validity of diagnoses, treatment dates, and rating scales in the Q-ECT by investigating the degree of accordance between data from the Q-ECT and patient records. Materials and methods From January 2016 to December 2017, 200 treatment series were randomly selected from the Q-ECT. The corresponding patient records were requested from the treating hospitals. Data on the indicative diagnosis, dates for the first and the last ECT session, and rating scales were compared between the Q-ECT and patient records using (i) a strict and (ii) a liberal method of assessment. Using the liberal method, each variable was assessed as accordant if it belonged to the same diagnosis group, or if the dates differed by less than 1 week, or ratings differed by only 1 point on the Clinical Global Impression Scale (CGI- S), or no more than 3 points on the Montgomery angstrom sberg Depression Rating Scale between the Q-ECT and the patient record. Results A total of 179 patient records were received. The strict method of assessment showed an accordance of 89% or higher for all studied variables. The liberal method showed an accordance of 95% or higher. Conclusions We conclude that data on the studied variables in the Q-ECT have high validity. However, limited use of some rating scales makes the results uncertain. Measures can be taken to further improve the data quality.

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

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

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

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

Background: Effective clinical teaching is crucially important for the future of patient care. Robust clinical training therefore is essential to produce physicians capable of delivering high quality health care. Tools used to evaluate medical faculty teaching qualities should be reliable and valid. This study investigates the psychometric properties of modification of the System for Evaluation of Teaching Qualities (SETQ) instrument in the clinical years of undergraduate medical education.

Methods: This cross-sectional multicenter study was conducted in four teaching hospitals in the Kingdom of Bahrain. Two-hundred ninety-eight medical students were invited to evaluate 105 clinical teachers using the SETQ instrument between January 2015 and March 2015. Questionnaire feasibility was analyzed using average time required to complete the form and the number of raters required to produce reliable results. Instrument reliability (stability) was assessed by calculating the Cronbach’s alpha coefficient for the total scale and for each sub-scale (factor). To provide evidence of construct validity, an exploratory factor analysis was conducted to identify which items on the survey belonged together, which were then grouped as factors.

Results: One-hundred twenty-five medical students completed 1161 evaluations of 105 clinical teachers. The response rates were 42% for student evaluations and 57% for clinical teacher self-evaluations. The factor analysis showed that the questionnaire was composed of six factors, explaining 76.7% of the total variance. Cronbach’s alpha was 0.94 or higher for the six factors in the student survey; for the clinical teacher survey, Cronbach’s alpha was 0.88. In both instruments, the item-total correlation was above 0.40 for all items within their respective scales.

Conclusion: Our modified SETQ questionnaire was found to be both reliable and valid, and was implemented successfully across various departments and specialties in different hospitals in the Kingdom of Bahrain.

The 1945 census was the last to record ethnicity in Sweden, and in 1973, registering ethnicity became virtually illegal. Swedish population statistics and official health and social registers therefore do not contain information on the ethnic background of the people registered. Exploring socio-medical and epidemiological research in Sweden from the 1940s to the 1980s, the chapter discusses the tension between ethical and legal constraints on the one hand, and the scientific, administrative, and political need for accurate information on minority and ethnic groups on the other. Three alternative research strategies to substitute for the lack of data on ethnicity are identified: using alternative but related categories such as nationality, country of birth, or immigrant status; “reading ethnicity” from pre-existing data collections; and conducting time-consuming and costly special studies designed to enable researchers to bypass the proscription of ethnic registration. These strategies have produced new epidemiological and socio-medical understandings concerning ethnicity and health/disease. However, as certain groups and categories have been statistically more available or visible in society than others, an uneven body of knowledge has evolved. In effect, some minorities have been spotlighted while others have remained hidden in plain sight.

Background: Ultrasound diagnostics in muscuskeletal injuries has been more popular in recent years. Clinical examination after anamnesis is the basics for a correct diagnosis although in combination with muscuskeletal ultrasound diagnostics (MSKUL) diagnose can be more precise. This study will show how MSKUL can be a complement to physical testing with a brief history overwiew, pros and cons and areas of use. Objective: The aim of this study was to summerize scientific litterature with focus on how ultrasound diagnostics can amplify and increase accuracy of an physioterapeutic examination on muscuskeletal injuries and how it can be a complement to the physical examination. Method: Design: Descriptive litterature study. Review on what ultrasound disgnostics is and how it can be a help in determing correct diagnosis in different muscuskeletal injuries to respond to the objective of this study. Results: A total of six articles was included in the result compilation which aims to respond to the objective of this study. All articles were retrieved from PubMed and most articles were reviews with the focus on how diagnostics with ultra sound can amplify and increase the accuracy af the physioterapheutic examination in muscuskeletal injuries, and how ultra sound can complement the clinical examination and what the benefits are in relation to other assesments. Conclusion: Muscuskeletal ultra sound diagnosis is a valuble tool in physiotherapy on muscuskeltal injuries. It can increase the accuracy in diagnosis and complement the clinical examination by finding pathology that can`t be found thru a clinical examination. Keywords: Muscuskeletal ultra sound, ultra sound diagnostics, sports injuries, power doppler ultra sound, radiation, physical therapy.

Inom vården är kommunikation mellan vårdgivare och patient en stor del. Kommunikationsprocessen kan försvåras då man tillhör olika kulturer genom t.ex. nationalitet, kön eller socioekonomisk bakgrund. Fenomenet har studerats inom vården tidigare, men studier med hörselvårdsperspektiv har inte påträffats. Denna studie vill därför undersöka hur audionomer ser på kommunikation och de svårigheter som kan uppstå i ett patientmöte.

Syftet med intervjustudien är att undersöka vilka kommunikationssvårigheter som kan uppståpå grund av kulturella skillnaderi audionomens möte med en patient. Studien inriktas även på hur detta påverkar audionomens arbete och vilka strategier som används för att hantera de svårigheter som uppstår.

Intervjustudien är av kvalitativ karaktär och har transkriberats, tolkats och analyserats med hermeneutisk ansats. Analysmetod har varit meningskategorisering där viktiga och relevanta delar ur det transkriberade materialet plockats fram och sammanställts till diagram.

Audionomerna tar upp flera målgrupper där kommunikationen är svår och även vilka strategier de använder för att underlätta patientmötet. Flera audionomer verkar se hörselproblematik som den främsta anledningen till bristande kommunikation. Fortsatt forskning krävs dock för att ta reda på om detta beror på att de inte har några problem att handskas med olika kulturer eller om det beror på avsaknad av kunskap inom detta område.

Quaternary ammonium compounds (QACs) are common antimicrobials that are used in a variety of consumer products, such as lotions, sunscreen, hair conditioners and hand sanitizers, to inhibit bacterial growth. However, it has been noted that bacteria exposed to QACs can develop resistance, and additionally, resistance to QACs has been observed to provide cross-resistance to antibiotics. In order to identify genetic adaptations for this resistance pattern, we exposed E. coli to three different QACs at sub-MIC and above-MIC concentrations, and identified genetic changes by whole genome sequencing. We found that initial adaptation, at sub-MIC levels, happened through efflux mechanisms, and that subsequent genetic changes, during above-MIC exposure, involved genes associated with the cell membranes and with transcription/translation. We also found that these genetic changes provided cross-resistance to other QACs as well as to several antibiotics.

Complex mixtures of antibiotics and metals are present in many environments ranging from municipal sewage to irrigation water and manure used as agricultural fertilizer. Such mixtures of drugs and metals exert unique selection pressures on local bacterial communities and could function as hotspots for enrichment of antibiotic resistance genes. The presence of metals in the environment has previously been linked to increases in tolerance to antibiotics. In this study, we investigated metal-potentiated selection of antibiotic resistant Salmonella enterica strains. Six environmentally relevant metals were examined in combinations with three different antibiotics. By performing competitions between an antibiotic resistant mutant and the isogenic wild type in each metal-antibiotic combination, we assessed the minimal selective concentration (MSC) of the antibiotic for the resistant strain. The metals silver, cadmium and mercury all exhibited potentiating effects, reducing the MSC of the antibiotic up to 5-fold as compared to in the absence of the metal. We further show that the potentiating metals increased permeability of the cellular outer membrane. These results demonstrate that the presence of a metal can decrease the concentration of an antibiotic required to select for an antibiotic resistant strain, and they indicate that this process involves metal-facilitated uptake of the antibiotic following damage to the outer membrane.

Human activities are responsible for an accumulation of metals in health care and agricultural environments, and plasmid-encoded metal tolerance operons enable bacteria to rapidly adapt to metal exposure under such conditions. While the mechanisms of action of many metal resistance systems have been described, there is still limited understanding of their role in co-selection of antibiotic resistance in metal-containing environments. Whether plasmid-encoded metal resistance genes confer significant selective advantages is of interest as it has implications for plasmid enrichment and the spread of plasmid-borne antibiotic resistance genes. To increase our understanding of plasmid-mediated metal resistance, we studied the sil operon and its phenotypes in E. coli during growth in the absence and presence of silver and copper. We found that the sil operon provides resistance to both silver and copper. However, it is induced by copper only, and constitutive expression due to point mutations in the two-component silS gene provides high-level silver resistance. Furthermore, we showed that a high-level silver resistant mutant could be enriched in the presence of silver. This enrichment entailed co-selection of the multidrug resistance plasmid pUUH239.2. Our results show that a copper resistance operon can provide high-level silver resistance following a single point mutation, and that the silver resistance phenotype subsequently can co-select for antibiotic resistance in the presence of silver. 

I denna rapport presenteras resultat från två enkäter som skickades till läkare verksamma inom psykiatrin i Stockholms län år 2018 respektive år 2020. Enkäterna innehöll frågor om läkares arbete med sjukskrivningar. Syftet var att få kunskap om läkares erfarenheter av arbete med sjukskrivning av patienter inom psykiatrin och om detta förändrades när den nya funktionen rehabiliteringskoordination(1-3) infördes vid psykiatriska enheter. Enkäterna baserades på enkäter använda i tidigare studier(4, 5).

Background and objectives: There is no consensus in the literature regarding which rapid maxillary expansion (RME) design or activation rate benefits the patients the most. Therefore, the primary aim of this systematic review was to see whether there is a difference in the skeletal and dentoalveolar effects of different RME appliances in children and growing adolescents. The secondary aim was to see whether these effects are different when using different activation protocols for these appliances. Data collection and analysis: The search was done in three databases (PubMed, Cochrane Library, and Web of Science). The following inclusion criteria were used: randomized controlled trial, prospective controlled studies, 15 or more patients in each study, human subjects up to 18 years of age, and RME effects had to be assessed by computed tomography/cone beam computed tomography. Study appraisal and synthesis methods: Quality of the methodology was classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines as high, moderate, or low. Results: The search resulted in 145 titles and abstracts; 109 of them were excluded based on pre-established criteria. Thirty-six full-text articles were assessed for eligibility and 18 of which satisfied the inclusion criteria. Finally, seven articles were deemed eligible for full inclusion and revealed that all appliances and protocols showed significant expansion in the mid-palatal suture. No evidence was found for the cause of dental tipping. Limitations: In this systematic review, having different age groups in each study and using different anatomical landmarks and outcome measures for assessing the skeletal and dental effects made it difficult to conduct a meta-analysis. Conclusions: There is moderate evidence that all designs produce significant expansion at the mid-palatal suture. However, lack of studies comparing appliances and protocols has been found. Finally, no evidence-based conclusions could be drawn about the appliance effect on teeth tipping.

Bakgrund

Morfologisk kunskap har visats gynna läsutvecklingen vilket lett till ökat forskningsintresse för hur morfologisk träning och medvetandegörande kan främja läsförmågan, framförallt bland elever med läs- och skrivsvårigheter. Hur morfologisk kunskap ter sig i typisk språkproduktion och huruvida morfologiska skillnader finns beroende på om produktionen utgörs av tal eller skrift är däremot mindre beforskat. En svårighet när det kommer till forskning om morfologisk produktion är att morfologiskt processande sannolikt sker under den språkliga förberedelsefasen vilken är svår att undersöka experimentellt. Ett sätt att fånga morfologiskt processande under produktion är att undersöka när personer möter svårigheter och hur de bearbetar dessa svårigheter. 

Syfte

Studiens syfte var att undersöka eventuella samband mellan morfologisk osäkerhet (dvs. pauser, revideringar och fel) i talat och skrivet språk samt undersöka om dessa osäkerheter avspeglas i ett morfologiskt kunskapstest.

Metod

Nitton högstadieelever fick genomföra en skrivuppgift, en muntlig uppgift samt ett nykonstruerat morfologiskt kunskapstest. Elevernas skrivprocess registrerades med hjälp av keystroke-logging för att analysera morfologisk osäkerhet under skrivande samt andel morfologiska fel och särskrivningar i den slutgiltiga elevtexten. Den muntliga uppgiften spelades in och analyserades med avseende på morfologisk osäkerhet under muntlig framställning. Morfologitestet, vilket bestod av sex deltester, genomfördes skriftligt och det sammanlagda resultatet för varje elev beräknades. 

Resultat

Ingen elev uppvisade morfologisk osäkerhet under muntlig produktion. Under skrivande noterades följande processer i morfemgränser på gruppnivå: pauser (10,21%), revideringar (1,31%), fel (0,49%) och särskrivningar (0,52%). Andel morfologiska osäkerheter under skriftlig produktion hade inget signifikant samband med resultatet på det morfologiska kunskapstestet. Post hoc-analys visade dock ett positivt samband mellan morfologiska pauser i skrivprocessen och antal poäng på ett deltest som undersöker morfologisk-syntaktisk kunskap. 

Slutsatser

Denna explorativa studie indikerar att morfologisk osäkerhet är ovanlig i talproduktion men att det kan förekomma i skrivprocessen, främst genom pauser i morfemgränser.  Resultatet antyder vidare att samband finns mellan pauser i morfemgränser under egen produktion och resultatet på ett test avsett att mäta morfologisk-syntaktisk kunskap. Resultatet bör dock tolkas aktsamt med hänsyn till det låga deltagarantalet och studiens explorativa angreppssätt.

Background: We require high-quality information on the current burden, the types of therapy and resources available, methods of delivery, care pathways and long-term outcomes for people with aphasia.

Aim: To document and inform international delivery of post-stroke aphasia treatment, to optimise recovery and reintegration of people with aphasia.

Methods & Procedures: Multi-centre, prospective, non-randomised, open study, employing blinded outcome assessment, where appropriate, including people with post-stroke aphasia, able to attend for 30 minutes during the initial language assessment, at first contact with a speech and language therapist for assessment of aphasia at participating sites. There is no study-mandated intervention. Assessments will occur at baseline (first contact with a speech and language therapist for aphasia assessment), discharge from Speech and Language Therapy (SLT), 6 and 12-months post-stroke. Our primary outcome is changed from baseline in the Amsterdam Nijmegen Everyday Language Test (ANELT/Scenario Test for participants with severe verbal impairments) at 12-months post-stroke. Secondary outcomes at 6 and 12 months include the Therapy Outcome Measure (TOMS), Subjective Index of Physical and Social Outcome (SIPSO), Aphasia Severity Rating Scale (ASRS), Western Aphasia Battery Aphasia Quotient (WAB-AQ), stroke and aphasia quality of life scale (SAQoL-39), European Quality of Life Scale (EQ-5D), lesion description, General Health Questionnaire (GHQ-12), resource use, and satisfaction with therapy provision and success. We will collect demography, clinical data, and therapy content. Routine neuroimaging and medication administration records will be accessed where possible; imaging will be pseudonymised and transferred to a central reading centre. Data will be collected in a central registry. We will describe demography, stroke and aphasia profiles and therapies available. International individual participant data (IPD) meta-analyses will examine treatment responder rates based on minimal detectable change & clinically important changes from baseline for primary and secondary outcomes at 6 and 12 months. Multivariable meta-analyses will examine associations between demography, therapy, medication use and outcomes, considering service characteristics. Where feasible, costs associated with treatment will be reported. Where available, we will detail brain lesion size and site, and examine correlations with SLT and language outcome at 12 months.

Conclusion: International differences in care, resource utilisation and outcomes will highlight avenues for further aphasia research, promote knowledge sharing and optimise aphasia rehabilitation delivery. IPD meta-analyses will enhance and expand understanding, identifying cost-effective and promising approaches to optimise rehabilitation to benefit people with aphasia.

Bakgrund: Äldre personer upplever ofta ett ökat behov av medicinisk behandling på grund av åldersrelaterade hälsoproblem, vilket kan leda till polyfarmaci (användning av flera läkemedel samtidigt). Denna situation medför risker såsom ökad förekomst av biverkningar och interaktioner mellan läkemedel. Syfte: Syfte med denna studie var att undersöka förekomsten av polyfarmaci och uppmärksamma läkemedelshanteringen hos personer över 66 år baserad på den svenska nationella studien om åldrande och vård, Swedish National Study On Aging And Care in Blekinge (SNAC-Blekinge, SNAC-B). Metod: Data samlades in från 427 deltagare i åldrarna 66 år och äldre genom SNAC-B studien. Studien genomfördes som en deskriptiv tvärsnittsstudie med kvantitativ ansats för att undersöka förekomsten av polyfarmaci bland äldre. Resultat: Resultaten av studien visade att den största delen av deltagarna som bestod av äldre vuxna i åldrarna 66 år och äldre, hade en ökad frekvens av läkemedelsanvändning. Det var en jämn fördelning mellan könen när det gäller antalet läkemedel som tas. Medelvärdet för antalet läkemedel per person var 4,8 medan medianen var 4. Personer som har polyfarmaci är 21,3% män och 25,3% kvinnor av det totala antalet deltagare. Trots att de flesta följer ordinationen var det en betydande andel som glömmer eller avstår från att ta sina mediciner. Slutsats: Resultatet indikerar behovet av ökad medvetenhet och utbildning kring läkemedelsanvändning bland äldre individer. Genom att förstå riskerna med polyfarmaci och hur man hanterar flera läkemedel kan patienter vara mer delaktiga i sin egen vård och bidra till att minska för läkemedelsrelaterade problem.

The National Tonsil Surgery Register in Sweden collects perioperative data from health care professionals and patient reported outcome measures 30 days and 6 months after surgery. Since 2009, patient-reported outcome measures, include questions related to pain.

Objective: To illustrate the process of improvements, efforts, and the use of a quality register in pain, and pain management after tonsil surgery in Sweden.

Method: Quantitative and qualitative research.

Results: Registry data indicated unrelieved postoperative pain with a high proportion of health care contacts. This resulted in the implementation of the Swedish National Guidelines (2013), and patient information published on the website www.tonsilloperation.se. The guidelines recommend multimodal pain treatment with paracetamol combined with COX-inhibitors, and if necessary, oral clonidine rather than opioids as rescue analgesics. A national survey (2015) showed that Swedish ENT-professionals’ opinions of, and the ENT-departments adherence to the guidelines were good. According to the national registry data (2017), the implementation has resulted in longer use of post-operative analgesic and fewer contacts with healthcare. Simultaneously, registry data showed that operating methods and techniques, age, and indication for surgery affect the pain outcome. Results from age-oriented pain diaries and qualitative interviews (2017-2018) capture the children’s and caregivers’ perspectives on pain, and pain treatment. Preliminary results show that type of pain treatment affects the quality of the postoperative care and recovery.

Conclusion: Pain management after tonsil surgery has been, and still is, a challenge for ENT-professionals and constant improvements are necessary.

The objective of this register study was to explore factors affecting pain after pediatric tonsil surgery, using patient-reported outcomes from questionnaires in the National Tonsil Surgery Registry in Sweden, 30 days after surgery.

Material and method: A total of 32,225 tonsil surgeries on children (aged 1-18 years) during 2009-2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE±A) and 18,321 tonsillotomies with or without adenoidectomy (TT±A). Pain was evaluated by using patient-reported outcomes from questionnaires in the National Tonsil Surgery Registry in Sweden, 30 days after surgery. Results: In surgery cases of indication obstruction, the TT±A stopped taking painkillers and returned to normal eating habits sooner, and had less contact with health care services due to pain, compared to TE±A. After TE±A, the indication infection group had more days on analgesics and more contacts with health care services due to pain, compared to the indication obstruction group. TE±A with cold-dissection technique resulted in fewer days on painkillers compared to warm-technique, and reduced the number of contacts with health care services due to pain. Older children were affected by more days of morbidity than the younger ones, but there was no gender difference after adjustment for age, dissection technique and hemostasis technique. Implementation of national guidelines for pain treatment (2013) and patient information on the website tonsilloperation.se seems to have increased the days on analgesics after surgery.

Conclusion: Pain after tonsil surgery depends on the surgical procedure and technique, as well as factors such as the patient’s age and surgical indication.

Stuttering is one of the most well-known speech disorders, but the underlying neurological mechanisms are debated. In addition to genetic factors, there are also major non-genetic contributions. It is here proposed that infection with group A beta-hemolytic streptococcus (GAS) was a major underlying cause of stuttering until the mid-1900s when penicillin was introduced in 1943. The main mechanism proposed is an autoimmune reaction from tonsillitis, targeting specific molecules, for example within the basal ganglia. It is here also proposed that GAS infections may have continued to cause stuttering to some extent, to the present date, though more rarely. If so, early diagnosis of such cases would be of importance. Childhood cases with sudden onset of stuttering after throat infection may be particularly important to assess for possible GAS infection. The support for this hypothesis primarily comes from three lines of argument. First, medical record data from the 1930s strongly indicates that there was one type of medical event in particular that preceded the onset of childhood stuttering with unexpected frequency: diseases related to GAS throat infections. In particular, this included tonsillitis and scarlet fever, but also rheumatic fever. Rheumatic fever is a childhood autoimmune sequela of GAS infection, which was a relatively widespread medical problem until the early 1960s. Second, available reports of changes of the childhood prevalence of stuttering indicate striking parallels between stuttering and the incidence of rheumatic fever, with: (1) decline from the early 1900s; (2) marked decline from the introduction of penicillin in the mid 1940s; and (3) reaching a more stable level in the 1960s. The correlations between the data for stuttering and rheumatic fever after the introduction of penicillin are very high, at about 0.95. Third, there are established biological mechanisms linking GAS tonsillitis to immunological effects on the brain. Also, a small number of more recent case reports have provided further support for the hypothesis linking stuttering to GAS infection. Overall, it is proposed that the available data provides strong evidence for the hypothesis that GAS infection was a major cause of stuttering until the mid-1900s, interacting with genetic predisposition.

Fem psykoterapeuter, med blandad grundutbildning, på en barnspsykiatrisk klinik i Blekinge, har intervjuats. Syftet har varit att undersöka vilka erfarenheter och upplevelser psykoterapeuterna har av att möta barn, ungdomar och familjer, tillhörande Jehovas Vittnen, i barnpsykiatrin. Jehovas Vittnen är ett trossamfund som finns över hela världen. Det är en tro som dikterar tydliga och stränga levnadsvillkor för sina medlemmar och som inte deltar i övriga samhällets förekommande traditioner.

I intervjuerna har samtliga terapeuter upplevelser av att det är svårare att utmana och skapa förändring i dessa fall. Utmanandet av ett system där man lever reglerad utifrån en tro som Jehovas Vittnen, upplevs bekymmersamt. Terapeuterna saknar tillräcklig kunskap om samfundet och om barns levnadsvillkor där. Samtliga terapeuter uppger också att det inte är en självklar och naturlig sak att fråga patienter om deras trostillhörighet.

I intervjuerna framkommer en negativt färgad bild av samfundet och svårigheter kring att jobba terapeutiskt i en kultur som är främmande den terapeuterna själv lever och är skolade i.

Det faktum att terapeuterna inte har någon egen trostillhörighet verkar vara försvårande, då frågor om tro inte finns som en naturlig del i terapeuternas repertoar. Rädsla för att kränka den lagstadgade religionsfriheten och den privata sfären, är något som leder till försiktighet vid dessa möten. I uppsatsens avslutande del sker ett resonemang kring och ges förslag på frågor som skulle kunna ingå som en del i terapeuters anamnesupptagning, vid möten med nya familjer

Mål: Syftet med studien är att beskriva patienternas inställningar till användningen av en QPL, huruvida det är ett möjligt redskap att använda under farmaceutmötet på svenska öppenvårdsapotek. Dessutom att undersöka den rapporterade skillnaden i kunskapsnivå efter användningen av QPL mellan patienterna som valde att använda QPL:en under farmaceutmötet och patienterna som valde att inte göra det. Samt att undersöka om olika bakgrundsfaktorer påverkar användningen av QPL.

Metod: En kvantitativ analys av redan besvarade enkäter genomfördes för att besvara syftet och frågeställningen. Enkäterna analyserades deskriptivt med hjälp av beskrivande mått och genom inferentiell statistik i Microsoft Excel. Delstudien bestod av 179 enkäter. 

Resultat: Totalt kodades 179 enkäter utifrån inklusionskriterierna. Patienterna rapporterade att QPL introducerades i 96% (n=172) och användes i 46% (n=83) av farmaceutmöten. Majoriteten av patienterna (n=101) upplevde att QPL inte tog mycket tid att läsa och (n=121) tyckte att frågorna var enkla att förstå. Å andra sidan rapporterade patienterna som hämtade minst ett nytt läkemedel och patienterna som hade svenska som modersmål att de använde QPL mer än andra. Samtidigt upplevde patienterna som använde QPL:en under farmaceutmötet en ökad kunskapsnivå om läkemedel jämfört med patienterna som inte använde QPL:en under mötet.

Slutsats: Patienterna upplevde att QPL:en var ett funktionellt verktyg som fick de att ställa fler frågor och förstå sitt sjukdomstillstånd bättre. QPL:en kan effektiviseras ytterligare genom att förkortas ned och finnas i fler språk. Samtidigt bör farmaceut-patientkommunikation på öppenvårdsapotek effektiviseras ytterligare.

Affibody molecules constitute a class of small (7 kDa) scaffold proteins that can be engineered to have excellent tumor targeting properties. High reabsorption in kidneys complicates development of affibody molecules for radionuclide therapy. In this study, we evaluated the influence of the composition of cysteine-containing C-terminal peptide-based chelators on the biodistribution and renal retention of (188)Re-labeled anti-HER2 affibody molecules. Biodistribution of affibody molecules containing GGXC or GXGC peptide chelators (where X is G, S, E or K) was compared with biodistribution of a parental affibody molecule ZHER2:2395 having a KVDC peptide chelator. All constructs retained low picomolar affinity to HER2-expressing cells after labeling. The biodistribution of all (188)Re-labeled affibody molecules was in general comparable, with the main observed difference found in the uptake and retention of radioactivity in excretory organs. The (188)Re-ZHER2:V2 affibody molecule with a GGGC chelator provided the lowest uptake in all organs and tissues. The renal retention of (188)Re-ZHER2:V2 (3.1 ± 0.5 %ID/g at 4 h after injection) was 55-fold lower than retention of the parental (188)Re-ZHER2:2395 (172 ± 32 %ID/g). We show that engineering of cysteine-containing peptide-based chelators can be used for significant improvement of biodistribution of (188)Re-labeled scaffold proteins, particularly reduction of their uptake in excretory organs.

Introduktion: Kronisk hjärtsvikt (CHF) utvecklas ofta gradvis under en längre tid. Det drabbar vanligen äldre, som ofta har andra sjukdomar som hypertoni och ischemisk hjärtsjukdom. Enligt läkemedelsrekommendationer och riktlinjer ska patienter med CHF behandlas med kombinationer av angiotensinkonverterande enzymblockare (ACEI) eller angiotensinreceptorblockerare (ARB) och betablockerande läkemedel (BB) och vid NYHA funktionsklass III och IV ska patienter behandlas ytterligare med mineralkortikoidantagonister (MRA). Syfte: Syftet med studien är att analysera läkemedelsbehandlingen vid CHF, som ett underlag för att förbättra vården och till nytta för patienter med CHF och vårdgivare. Material och metoder: Denna studie var en deskriptiv tvärsnittsstudie ur den individbaserade, administrativa Vårdanalysdatabasen (VAL) vid Stockholms läns landsting (SLL). Studien inkluderade alla patienter som var ≥40 år och levde i SLL någon gång mellan juli-augusti 2012. Resultat: VAL-databasen innehöll totalt 32754 patienter med CHF. Andel patienter med CHF som behandlades med ACEI/ARB var 64 % och BB var 69 % samt MRA var 18 %. Andel patienter med CHF som behandlades med kombinationer av ACEI/ARB och BB var 40 % och med kombinationer av ACEI/ARB och BB samt MRA var 11 %. Andel män som behandlades med dessa läkemedel var högre än andel kvinnor, förutom behandling med MRA som var lika hos män och kvinnor. Behandling med dessa läkemedel minskade med stigande ålder. Konklusion: Tydliga ålders- och könsskillnader i behandling vid CHF observerades. Endast 40 % av patienter med CHF behandlades med rekommenderade kombinationer av ACEI/ARB och BB. Den rekommenderade läkemedelsbehandlingen hos patienter med CHF kan förbättras. 

Unprotected pedestrians are an exposed group in the rural traffic and the most vulnerable human body region is the head which is the source of many fatal injuries. This study was performed to gain a better understanding of the influence that the neck muscle tonus has on head kinematics during pedestrian accidents. This was done using a detailed whole body FE model and a detailed FE vehicle model. To determine the influence of the muscle tonus a series of simulations were performed where the vehicle speed, pedestrian posture and muscle tonus were varied. Since the human reaction time for muscle activation is in the order of the collision time, the pedestrian was assumed to be prepared for the oncoming vehicle in order to augment the possible influence of muscle tonus. From the simulations performed, kinematic data such as head rotations, trajectory and velocities were extracted for the whole collision event, as well as velocity and accelerations at head impact. These results show that muscle tonus can influence the head rotation during a vehicle collision and therefore alter the head impact orientation. The level of influence on head rotation was in general lower than when altering the struck leg forward and backward, but in the same order of magnitude for some cases. The influence on head accelerations was higher due to muscle tonus than posture in all cases.

Background: Patient safety is a critical issue in healthcare services particularly in surgical units and operation rooms because of the high prevalence and risk of medical errors in such settings. This study was conducted to determine whether a 1-day educational intervention can change the attitude and behavior of surgical residents regarding patient safety.

Methods: A total of 90 surgical residents were recruited from 6 university hospitals located in Tehran and Qazvin, Iran, and were randomized to either the intervention or a control group. Those in the intervention group participated in a 1-day workshop on patient safety, whereas the control group received no intervention. Both groups were followed for 3 months after the intervention was completed. The Safety Attitude Questionnaire and Oxford Non-Technical Skills scale were administered at 3 points in time (baseline, 1 month after the intervention, and 3 month later). The data were analyzed using repeated measures analysis of variance.

Results: Total score on the Safety Attitude Questionnaire improved from 54.5 (SD = 14.4) at baseline to 58.3 (SD = 13.8) 3 months after the intervention in the intervention group; all dimensions, with the exception of working condition, showed significant changes. In addition, the Oxford Non-Technical Skills scale – as assessed by attending surgeons – improved significantly in all domains (p < 0.05). More than 60% of participants in the intervention group scored in the positive range for items assessing safety and teamwork climate.

Conclusions: A 1-day interactive educational workshop may be effective in changing the attitude and practice of surgical residents regarding patient safety. Further assessment of this intervention in other healthcare settings involving health professionals from various specialties and use of an objective measure such as number of reported medical errors are needed to corroborate these findings. 

This paper gives a brief introduction to the starting points of an experimental project to study dolphin communicative behaviour using distributional semantics, with methods implemented for the large scale study of human language.

Purpose To explore multi-professional teamwork in relation to the physical environment in three newly built or renovated stroke units. Materials and methods An observational study was undertaken. The participants were all staff members of a multi-professional team working in the reviewed stroke units. The data were collected using behavioural mapping and semi-structured observations, and they were analysed by content analysis and descriptive statistics. Results Out of all the observations in the behavioural mapping, very few were of two or more members from the team together with a patient. None of the included stroke units had a co-location for all the members of the multi-professional team. Three main categories emerged from the analysis of the interviews: (i) the hub of the unit; (ii) the division of places; and (iii) power imbalance. All the categories reflected the teamwork in relation to parts of the physical environment. Conclusion The design of the physical environment is important for multi-professional teamwork. Emphasis must be placed on better understanding the impact of the physical environment and on incorporating the evidence related to multi-professional teamwork during the design of stroke units.

Majoriteten av idrottare drabbas aldrig av ätstörningar trots hård träning, prestationsinriktning och en mer eller mindre noggrann kosthållning och viktreglering . Det finns dock idrottare som under lång tid kämpar med en ätstörningsproblemtik där ett komplicerat förhållande till mat och träning uppstått. Vissa studier talar vidare för att idrotten skulle kunna skydda individen för ätstörningar medan flera studier visar en högre förekomst av ätstör-ningar och stört ätbeteende inom än utanför idrottsvärlden, i synnerhet inom estetiska och viktrelaterade idrotter . Maten och träningen är båda komplexa fenomen och en djupare insikt och öppenhet kring hur man hanterar denna form av ”idrottsskada” är värdefullt såväl inom idrottsvärlden som inom hälso- och sjukvården. Dietisten med fördjupad kunskap inom idrott och ätstörningar förefaller vara en värdefull person i detta arbete.

Syftet med denna kunskapsöversikt är att belysa hur förbättringskunskapen utvecklats i den svenska hälsovård- och välfärdssektorn, och vilka implikationer förbättringskunskap kan ha för projektet ”Barnens Bästa Gäller! i Kronoberg” (BBGiK). Rapporten avslutas med en diskussion om de möjligheter och utmaningar som påverkar projektet. Förbättringskunskap är nära besläktat med kvalitetsutveckling, och är numer vanligt förekommande i hälso- vård- och välfärdsorganisationer. De lagar och regelverk som styr innefattar skyldigheter att bedriva kvalitetsutveckling, och Ledningssystem för systematiskt kvalitetsarbete (SOSFS 2011:9) gäller för både vård- och omsorgsorganisationer.

Rapporten lyfter fram förbättringskunskapens ursprung, dess forskningsanknytning och evidens och utveckling och övergång till vård- och välfärdsorganisationer. När förbättringskunskap fått fäste i den kunskapsintensiva evidensbaserade vårdsektorn och förbättringsarbeten började bli mera vanligt, uppstod frågor om hur förbättringsmetoder fungerar. Flera av de tidiga aktörerna inom förbättringskunskap var läkare och sjuksköterskor, och därför blev det angeläget att även arbetet med förbättringar kunde betraktas utifrån evidenskrav. Runt sekelskiftet 2000 började de första forskningspublikationerna dyka upp. En av förbättringsforskningens stora utmaningar är att utveckla vetenskaplig robust kunskap, och en vanlig kritik har varit att en svag vetenskaplig och teoretisk grund.

I rapporten har befintlig litteratur producerad i Sverige, i form av böcker och bokkapitel, avhandlingar och artiklar, sammanställts och analyserats avseende publikationsfrekvens över tid och innehåll (tema). Sammanställningen lyfter fram studier som har extra relevans för projektet, såsom samverkansprojekt och olika ansatser att överföra och anpassa förbättringskunskap till den sociala sektorn. Mellan åren 2007–2020 utkom 30 böcker, bokkapitel och enklare skrifter. De flesta är läroböcker i form av antologier skrivna för vårdens professioner och handlar ofta om grundläggande förbättringskunskap. 32 avhandlingar från nio svenska lärosäten identifierades, den första från 2003. Flera avhandlingar intar organisationsperspektiv, men även ledarskap, patientsäkerhet och patientinvolvering/delaktighet förekommer. Totalt 210 artiklar identifierades publicerade mellan 1992 och 2020, med flest antal (n=166) efter 2011. Tematiseringen resulterade i sex olika teman: 1) Systematiskt och värdeskapande förbättringsarbete; 2) Samverkan mellan organisationer och vårdgivare; 3) Användning av förbättringsmetoder och (teoretiska) modeller; 4) Ledarskap och lärande; 5) Mätningar, kvalitetsregister och uppföljning; samt 6) Personinvolvering och patientsäkerhet.

Delaktighet och samskapade är en tydligt ökande trend inom vården. Samtidigt har det inom sociala verksamheter länge ansetts viktigt att beakta personers rättigheter och möjligheter till inflytande. Sammanställningen pekar mot en utveckling där samverkan mellan organisationer och samskapande med dem vård och omsorg är till för blir en allt viktigare faktor. Detta är en viktig aspekt för projektet BBGiK, som spänner över flera olika verksamheter och organisationer. Det är alltid en utmaning när olika verksamheter tillsammans ska hitta fungerande lösningar. Denna utmaning blir inte mindre av att de kommer ifrån olika kunskapstraditioner, men i projektet finns förutsättningar för gemensamt lärande runt en gemensam modell. En förutsättning för att lyckas med förbättringsarbete är ett aktivt ledarskap, och strävan mot samma gemensamma mål: ”att skapa en trygg och säker uppväxt för VARJE barn genom främjande, tidiga och samordnade insatser”.