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Ledin, Torbjörn
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Sinkvist, D., Theodorsson, A., Ledin, T. & Theodorsson, E. (2017). Five Year Data and Results of Continuous Quality Improvement Using SKURT. Educational Research Applications, 2017(05), Article ID ERCA-125.
Open this publication in new window or tab >>Five Year Data and Results of Continuous Quality Improvement Using SKURT
2017 (English)In: Educational Research Applications, E-ISSN 2575-7032, Vol. 2017, no 05, article id ERCA-125Article in journal (Refereed) Published
Abstract [en]

Student rating of teaching isessentialfor attaining and maintaining higheducational quality.A quality improvement system, SKURT,based on digital online weekly combined quantitative, ten-graded scale, and qualitative, open-ended free text, group feedback from medical students was developed. Students rated all educational, non-clerkship, items throughout the entire medical program, spanning eleven terms. The results were semi-publicly available for students and faculty at a Swedish university. This study describes datafrom five-year use of the system,focusing on how the use of SKURT influenced educational items found to be in the most substantial need for improvements.

Statistically but hardly practically significant improvement in average feedback grade was found during the observation period (average 7.07 in 2009 to 7.24 in 2013 (p<0.001)).The medical program was already in 2007recognized ascenter of excellent quality in higher education. When analyzing the 18 lectures with lowest outcome in the spring 2009 compared to the fall 2013, five were discontinued. The remaining 13 lectures improved significantly (p<0.001) 116% from 2.94 (SD 0.92) to 6.34 (SD 2.58). 

A weekly group feedback system employing the principles used in SKURTis useful forimproving the quality of medical education particularlyby improvingthe items with the lowest ratings.

Place, publisher, year, edition, pages
IL, USA: Gavin Publishers, 2017
Keywords
Medical Education; Online Evaluation; Problem-based Learning; Quality Improvement; Rating of Teachers; Student Evaluation
National Category
Other Health Sciences
Identifiers
urn:nbn:se:liu:diva-145230 (URN)10.29011/2575-7032/100025 (DOI)
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-02-27Bibliographically approved
Sinkvist, D., Theodorsson, A., Ledin, T. & Theodorsson, E. (2017). SKURT: Quality Improvement System with Comprehensive Weekly Digital Student Group Feedback. Educational Research Applications, 2017(5), Article ID RCA-124.
Open this publication in new window or tab >>SKURT: Quality Improvement System with Comprehensive Weekly Digital Student Group Feedback
2017 (English)In: Educational Research Applications, E-ISSN 2575-7032, Vol. 2017, no 5, article id RCA-124Article in journal (Refereed) Published
Abstract [en]

Students’ role in evaluation and rating of teachers and education has been extensively researched for nearly a century. Applied worldwide, students’ ratings account for the majority of the available data.We created a new quality improvement system, SKURT, using digital online weekly combined quantitative, ten-graded scale, and qualitative, open-ended free text, group feedback from medical students. Students rated all educational, non-clerkship, items throughout the entire medical program, spanning eleven terms. The rating process is since 2008 an integral part of a medical program at a Swedish university. The results are, after a screening process, semi-publicly available on-demand, for students and faculty, creating a feedback loop enabling continuous improvement of quality.A thorough literature search of students rating of teaching found no other corresponding weekly group rating system spanning all educational items. Quality improvement systems based on similar principles as SKURT can uncover problem areas that are difficult to find using other rating systems and has the potential to circumvent several biases, risks and shortcomings of traditional rating systems in current use.

Place, publisher, year, edition, pages
Gavin Publishers, 2017
Keywords
Medical Education; Online Evaluation; Problem-Based Learning; Quality Improvement; Rating of Teachers; Student Evaluation
National Category
Other Health Sciences
Identifiers
urn:nbn:se:liu:diva-145282 (URN)
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-03-08Bibliographically approved
Zarenoe, R., Hällgren, M., Andersson, G. & Ledin, T. (2017). Working Memory, Sleep, and Hearing Problems in Patients with Tinnitus and Hearing Loss Fitted with Hearing Aids. Journal of the American Academy of Audiology, 28(2), 141-151
Open this publication in new window or tab >>Working Memory, Sleep, and Hearing Problems in Patients with Tinnitus and Hearing Loss Fitted with Hearing Aids
2017 (English)In: Journal of the American Academy of Audiology, ISSN 1050-0545, Vol. 28, no 2, p. 141-151Article in journal (Refereed) Published
Abstract [en]

Background: Tinnitus is a common condition and there is a need to evaluate effects of tinnitus management in relation to moderating factors such as degree of hearing loss. As it is possible that tinnitus influences concentration, and thus is likely to disturb cognitive processing, the role of cognitive functioning also needs to be investigated.

Purpose: To compare a group of patients with sensorineural hearing loss and tinnitus to a control group with only sensorineural hearing loss (and no tinnitus). To investigate working memory, sleep, and hearing problems measured before and after hearing rehabilitation.

Research Design: A prospective study.

Study Sample: The sample consisted of 100 patients, 50 with hearing loss and tinnitus, and 50 controls with hearing loss but no tinnitus. All patients were between 40 and 82 yr old and had a pure-tone average (PTA; average of 0.5, 1, 2, and 4 kHz) ,70 dB HL.

Intervention: Patients were tested before and after rehabilitation with hearing aids with regard to their working memory capacity, sleep quality, hearing problems, speech recognition, and tinnitus annoyance.

Data Collection and Analysis: Eight patients dropped out of the study. Thus, a total of 92 patients were included for analysis, with 46 in each group. As a consequence of unplanned age and PTA differences between the groups, an age-matched subsample (n 5 30 1 30) was selected for further analysis. Tests including the Reading Span, Hearing-in-Noise Test (HINT), Tinnitus Handicap Inventory (THI), Hearing Handicap Inventory for the Elderly (HHIE), and Pittsburgh Sleep Quality Index (PSQI) were administered before and after hearing aid rehabilitation.

Results: There were no between-group differences at baseline in the full sample (n 5 92), with the exception of the THI (p , 0.001) and the PSQI (p , 0.002), on which the hearing loss and tinnitus group had significantly higher scores. Pre/post changes were significant for both groups on the Reading Span, and HHIE. However, these improvements were significantly larger for the patients in the hearing loss and tinnitus group on the Reading Span test (p , 0.001) and the PSQI (p , 0.001). Patients with tinnitus and hearing loss also exhibited significantly improved THI scores at follow-up, compared to baseline ( p, 0.001). We conducted the same analyses for the age-matched subsample (n 5 30 1 30). For the baseline data, only the THI (p , 0.001) and the PSQI (p , 0.015) difference remained significant. With regard to the pre/post changes, we found the same differences in improvement in Reading Span ( p , 0.001) and the PSQI (p , 0.015) as in the full sample.

Conclusions: Patients with tinnitus benefited from hearing aid rehabilitation. The observed differences in cognitive function were unexpected, and there were larger score improvements on the Reading Span test in the hearing loss and tinnitus group than in the hearing loss group. Patients with tinnitus and hearing loss may receive extra benefit in terms of cognitive function following hearing aid rehabilitation.

Place, publisher, year, edition, pages
American Academy of Audiology, 2017
Keywords
sensorineural hearing loss; hearing aids; tinnitus; working memory capacity
National Category
Public Health, Global Health, Social Medicine and Epidemiology Neurology Otorhinolaryngology Psychology
Identifiers
urn:nbn:se:liu:diva-132160 (URN)10.3766/jaaa.16023 (DOI)000394478500005 ()28240981 (PubMedID)2-s2.0-85014508703 (Scopus ID)
Available from: 2016-10-19 Created: 2016-10-19 Last updated: 2018-05-02Bibliographically approved
Zarenoe, R. & Ledin, T. (2014). Quality of life in patients with tinnitus and sensorineural hearing loss. B-ENT, 10(1), 41-51
Open this publication in new window or tab >>Quality of life in patients with tinnitus and sensorineural hearing loss
2014 (English)In: B-ENT, ISSN 1781-782X, Vol. 10, no 1, p. 41-51Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to evaluate the quality of life in patients with tinnitus and SNHL, to investigate patients’ mental and physical health and to measure the level of satisfaction concerning the care experienced by the patients.

Methods: Three questionnaires related to patients` physical and psychological health, were mailed to 714 Swedish patients with tinnitus and sensorineural hearing loss.

Results: Female patients had significantly higher Tinnitus Handicap Inventory scores than male patients. Patients who were satisfied with the care they obtained had significantly higher PTA. It was found that the satisfied group had significantly lower THI-scores. In the dissatisfied group, 61% of patients had no hearing aids compared to 42% in the satisfied group.

Conclusion: Our cohort of patients estimated their life quality and general health at a good level almost 4.5 years after their first report of tinnitus. Another finding was that 47% of patients were not satisfied with the treatment they obtained. In the dissatisfied group, 61% of patients had no hearing aids. Further research is required to find an approach that could motivate patients with both tinnitus and hearing impairment to use hearing aids.

Place, publisher, year, edition, pages
ROYAL BELGIAN SOC EAR, NOSE, THROAT, HEAD & NECK SURGERY, 2014
Keywords
Tinnitus, Sensorineural hearing loss, Questionnaire, Quality of life
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-81412 (URN)000334566200007 ()24765828 (PubMedID)
Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2017-02-20Bibliographically approved
Zarenoe, R. & Ledin, T. (2013). A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population. Auris, nasus, larynx, 40(1), 41-45
Open this publication in new window or tab >>A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population
2013 (English)In: Auris, nasus, larynx, ISSN 0385-8146, E-ISSN 1879-1476, Vol. 40, no 1, p. 41-45Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: We aimed to describe a large cohort of patients with tinnitus and sensorineural hearing loss (SNHL) in Sweden, and also to explore the possibility of finding potential possible differences between various diagnoses within SNHL. It is also of great interest to see how a multidisciplinary team was used in the different subgroups and the frequency of hearing aids use in patients with tinnitus.

METHODS: Medical records of all patients who had received the diagnosis SNHL in Östergötland County, Sweden between 2004 and 2007 were reviewed. Patients between 20 and 80 years with tinnitus and a pure tone average (PTA) lower than 70dB HL were included in the study. Patients were excluded from the analyses if they had a cochlear implantation, middle ear disorders or had a hearing loss since birth or childhood. The investigators completed a form for each included patient, covering background facts, and audiograms taken at the yearly check up.

RESULTS: Of a total 1672 patients' medical record review, 714 patients were included. The majority of patients (79%) were in the age group over 50 years. In male patients with bilateral tinnitus, the PTA for the left ear was significantly higher than for the right ear. The results regarding the configuration of hearing loss revealed that 555 patients (78%) had symmetric and 159 (22%) asymmetric hearing loss. Retrocochlear examinations were done in 372 patients and MRI was the most common examination. In all patients, 400 had no hearing aids and out of those 220 had unilateral tinnitus and 180 patients had bilateral tinnitus. 219 patients had a PTA>20dB HL and did not have any hearing aid. Results demonstrated that the Stepped Care model was not used widely in the daily practice. In our study, patients with bilateral-, unilateral hearing loss or Mb Ménière were the most common patients included in the Stepped Care model.

CONCLUSION: In a large cohort of patients with SNHL and tinnitus, despite their hearing loss only 39% had hearing aids. It was observed that the medical record review often showed a lack of information about many background factors, such as; patients' general health condition, which could be a quality factor that needs improvement. Our results show that the Stepped Care model could be an effective option for providing a better access for tinnitus-focused treatment, although the number of patients in this study who were included in the Stepped Care model was low.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81411 (URN)10.1016/j.anl.2012.05.005 (DOI)22652486 (PubMedID)
Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2017-12-07Bibliographically approved
Wahlberg, J., Sydsjö, G., Ledin, T., Bågesund, M. & Ekman, B. (2013). Impaired Postural Balance in Turner Syndrom. Hormone and Metabolic Research, 45(7), 537-540
Open this publication in new window or tab >>Impaired Postural Balance in Turner Syndrom
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2013 (English)In: Hormone and Metabolic Research, ISSN 0018-5043, E-ISSN 1439-4286, Vol. 45, no 7, p. 537-540Article in journal (Refereed) Published
Abstract [en]

An impaired body balance has been found in Turner syndrome (TS) in clinical tests like Rombergs’s test and walking on a balance beam. The aim of the study was to assess postural balance in TS subjects with specific balance testing using dynamic posturography and relate to body composition. Nineteen TS subjects (20–57 years) were included. Balance was measured with dynamic posturography (Equitest) and compared with 19 sex and age-matched controls (22–59 years). Equitest, visual, vestibular, and somatosensory systems were provoked with increasing difficulty (6 tests, SO1–SO6) and body sway was measured with a dual forceplate. Body composition was measured with DXA. No difference was found between the TS subjects and the controls on fixed platform with open eyes (SO1), with closed eyes (SO2), with stable platform and visual disorientation (SO3), or on unstable platform with open eyes (SO4). In the difficult tests on unstable platform the TS subjects did worse compared with controls both in the test with eyes closed (SO5), p<0.01, and in the test with visual disorientation (SO6), p<0.05. Composite (a merge of all six recordings) was significantly lower in the TS-group, p<0.05. In the TS group high total body weight was related to worse outcome on tests SO5, SO6, and composite, while total bone mass, age, height, or waist showed no significant association with balance scores. Our findings indicate that TS could have an increased risk for falling due to impaired ability to manage complex coordination tasks.

Place, publisher, year, edition, pages
Georg Thieme Verlag KG, 2013
Keywords
oestrogen deficiency - Turner syndrome - balance - posturography - body weight
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-104004 (URN)10.1055/s-0033-1333718 (DOI)000321576900011 ()23389991 (PubMedID)2-s2.0-84879499237 (Scopus ID)
Available from: 2014-02-06 Created: 2014-02-06 Last updated: 2017-12-06Bibliographically approved
Wilhelmsson, N., Dahlgren, L. O., Hult, H., Wirell, S., Ledin, T. & Josephson, A. (2013). Phenomenographic study of basic science understanding-senior medical students' conceptions of fatigue. Education for Health, 26(3), 156-163
Open this publication in new window or tab >>Phenomenographic study of basic science understanding-senior medical students' conceptions of fatigue
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2013 (English)In: Education for Health, ISSN 1357-6283, E-ISSN 1469-5804, Vol. 26, no 3, p. 156-163Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Helping students learn to apply their newly learned basic science knowledge to clinical situations is a long-standing challenge for medical educators. This study aims to describe how medical students' knowledge of the basic sciences is construed toward the end of their medical curriculum, focusing on how senior medical students explain the physiology of a given scenario. Methods A group of final-year medical students from two universities was investigated. Interviews were performed and phenomenographic analysis was used to interpret students' understanding of the physiology underlying the onset of fatigue in an individual on an exercise bicycle.

RESULTS: Three categories of description depict the qualitatively different ways the students conceptualized fatigue. A first category depicts well integrated physiological and bio-chemical knowledge characterized by equilibrium and causality. The second category contains conceptions of finite amount of substrate and juxtaposition of physiological concepts that are not fully integrated. The third category exhibits a fragmented understanding of disparate sections of knowledge without integration of basic science and clinical knowledge.

DISCUSSION: Distinctive conceptions of fatigue based with varying completeness of students' understanding characterized the three identified categories. The students' conceptions of fatigue were based on varying understanding of how organ systems relate and of the thresholds that determine physiological processes. Medical instruction should focus on making governing steps in biological processes clear and providing opportunity for causal explanations of clinical scenarios containing bio-chemical as well as clinical knowledge. This augments earlier findings by adding descriptions in terms of the subject matter studied about how basic science is applied by students in clinical settings.

Place, publisher, year, edition, pages
The Network:Towards Unity for Health, 2013
Keywords
Phenomenography, problem-based learning, qualitative methodology, student learning, undergraduate medical education
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-110130 (URN)10.4103/1357-6283.125990 (DOI)25001348 (PubMedID)
Available from: 2014-09-03 Created: 2014-09-03 Last updated: 2017-12-05Bibliographically approved
Lundin, F., Ledin, T., Wikkelsø, C. & Leijon, G. (2013). Postural function in idiopathic normal pressure hydrocephalus before and after shunt surgery: a controlled study using computerized dynamic posturography (EquiTest). Clinical neurology and neurosurgery (Dutch-Flemish ed. Print), 115(9), 1626-1631
Open this publication in new window or tab >>Postural function in idiopathic normal pressure hydrocephalus before and after shunt surgery: a controlled study using computerized dynamic posturography (EquiTest)
2013 (English)In: Clinical neurology and neurosurgery (Dutch-Flemish ed. Print), ISSN 0303-8467, E-ISSN 1872-6968, Vol. 115, no 9, p. 1626-1631Article in journal (Refereed) Published
Abstract [en]

Introduction

Postural dysfunction is one of the major features of idiopathic normal pressure hydrocephalus (iNPH). With computerized dynamic posturography (CDP) balance can be assessed objectively. The primary aim of this study was to describe the postural function in iNPH patients pre- and post-operatively in comparison with healthy individuals (HI) using CDP.

Subjects and methods

Thirty-five patients (16 M, 19 F) with a mean age of 73 (range 49–81) with iNPH, and sixteen HI (7 M, 9 F) aged 73 (62–89) were included. iNPH patients were operated on with a ventriculo-peritoneal shunt. Patients and HI were tested regarding motor function, balance and cognition. CDP, EquiTest (NeuroCom International, Clackamas, OR), was performed before and three months after shunt surgery and twice in HI, with a three-month interval.

Results

Pre-operatively, the 35 patients had poorer balance measured with the Sensory Organizing Test (SOT) score in every condition (p = 0.01 in SOT 1 and p < 0.001 in SOT 2–6) compared to the HI. The greatest difference was in test conditions measuring mainly vestibular function, where loss of balance (LOB) was frequent. Twenty patients were evaluated three months after shunt surgery and 18/20 (90%) of them were considered shunt responders, with a mean improvement of motor score of 26% (range 5–67%). There was an improvement post-operatively in the weighted composite SOT score (p < 0.05) but no significant change in any of the SOT conditions. LOB was not significantly reduced in any of the test conditions.

Conclusion

CDP showed that the patients had a poorer balance than the HI. The greatest difference was in SOT 5–6, indicating that the postural disturbance is of primarily central vestibular origin. There was a slight improvement of balance post-operatively.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Idiopathic normal pressbre hydrocephalus, Postural function, Computerized dynamic posturography, Shunt surgery
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-100038 (URN)10.1016/j.clineuro.2013.02.015 (DOI)000324787900011 ()
Available from: 2013-10-25 Created: 2013-10-25 Last updated: 2017-12-06
Lindgren, S., Brannstrom, T., Hanse, E., Ledin, T., Nilsson, G., Sandler, S., . . . Donner, J. (2011). Medical education in Sweden. Medical teacher, 33(10), 798-803
Open this publication in new window or tab >>Medical education in Sweden
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2011 (English)In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 33, no 10, p. 798-803Article in journal (Refereed) Published
Abstract [en]

Undergraduate medical education in Sweden has moved from nationally regulated, subject-based courses to programmes integrated either around organ systems or physiological and patho-physiological processes, or organised around basic medical science in conjunction with clinical specialities, with individual profiles at the seven medical schools. The national regulations are restricted to overall academic and professional outcomes. The 51/2 year long university undergraduate curriculum is followed by a mandatory 18 months internship, delivered by the County Councils. While quality control and accreditation for the university curriculum is provided by the Swedish National Agency for Higher Education, no such formal control exists for the internship; undergraduate medical education is therefore in conflict with EU directives from 2005. The Government is expected to move towards 6 years long university undergraduate programmes, leading to licence, which will facilitate international mobility of both Swedish and foreign medical students and doctors. Ongoing academic development of undergraduate education is strengthened by the Bologna process. It includes outcome (competence)-based curricula, university Masters level complying with international standards, progression of competence throughout the curriculum, student directed learning, active participation and roles in practical clinical education and a national assessment model to assure professional competence. In the near future, the dimensioning of Swedish undergraduate education is likely to be decided more by international demands and aspects of quality than by national demands for doctors.

Place, publisher, year, edition, pages
Informa Healthcare, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-71563 (URN)10.3109/0142159X.2011.570816 (DOI)000295218300010 ()
Available from: 2011-10-21 Created: 2011-10-21 Last updated: 2017-12-08
Kammerlind, A.-S. C., Ledin, T., Ödkvist, L. & Skargren, E. (2011). Recovery after acute unilateral vestibular loss and predictors for remaining symptoms. American Journal of Otolaryngology, 32(5), 366-375
Open this publication in new window or tab >>Recovery after acute unilateral vestibular loss and predictors for remaining symptoms
2011 (English)In: American Journal of Otolaryngology, ISSN 0196-0709, E-ISSN 1532-818X, Vol. 32, no 5, p. 366-375Article in journal (Refereed) Published
Abstract [en]

Purpose: The aims of this study were to follow recovery during the first 6 months after acute unilateral vestibular loss (AUVL) and to determine predictors for self-rated remaining symptoms. Materials and methods: Forty-two subjects were included less than 10 days after AUVL. Static and dynamic clinical balance tests, visual analogue scales, University of California Los Angeles Dizziness Questionnaire, Dizziness Beliefs Scale, European Quality of Life questionnaire, Dizziness Handicap Inventory, and Hospital Anxiety and Depression Scale were performed at inclusion and at 7 follow-ups over 6 months. Subjects rated their symptoms on visual analogue scales daily at home. Videonystagmography was performed in the acute stage and after 10 weeks. Results: Decrease of symptoms and improvement of balance function were larger during the first compared with the latter part of the follow-up period. Visual analogue scale ratings for balance problems were higher than those for dizziness. A prediction model was created based on the results of 4 tests in the acute stage: standing on foam with eyes closed, standing on 1 leg with eyes open, visual analogue scale rating of vertigo at rest, and European Quality of Life questionnaire rating of health-related quality of life. The prediction model identified subjects at risk of having remaining symptoms after 6 months with a sensitivity of 86% and a specificity of 79%. Conclusions: Recovery mainly takes place during the first weeks after AUVL. Subjects rate more balance problems than dizziness. Self-rated remaining symptoms after 6 months may be predicted by clinical balance tests and subjective ratings in the acute stage.

Place, publisher, year, edition, pages
WB Saunders, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-71109 (URN)10.1016/j.amjoto.2010.07.008 (DOI)000294704200002 ()
Available from: 2011-09-30 Created: 2011-09-30 Last updated: 2017-12-08
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