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  • 1.
    Berg, Katarina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Idvall, Ewa
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Nilsson, Ulrica
    Örebro University Hospital.
    Franzén Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Psychometric evaluation of the post-discharge surgical recovery scale2010Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, nr 4, s. 794-801Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aim and objectives Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patients recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness. Methods Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbachs alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearsons correlation coefficient. Patients ability to work and their self-rated health on postoperative day 14 were used as external indicators of change. Results Six items showed floor or ceiling effects. Cronbachs coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63). Conclusions The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

  • 2.
    Bernhardsson, Susanne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Närhälsan Rehabilitation, Region Västra Götaland, Hönö, Sweden.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Larsson, Maria E. H.
    Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden; The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden2015Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, nr 6, s. 1169-1177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aims and objectives

    Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables.

    Methods

    419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire.

    Results

    The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1–16). The most common treatment interventions across the three conditions were advice on posture (reported by 82–94%), advice to stay active (86–92%), and different types of exercise (65–92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29–96%. Modalities such as laser therapy and ultrasound were sparingly used (<5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience.

    Conclusions

    Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent.

  • 3.
    Broström, Anders
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Sunnergren, Ola
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet.
    Svanborg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk neurofysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Neurofysiologiska kliniken US.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea2013Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, nr 1, s. 173-184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aims and objectives  Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long-term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group-based programme using problem-based learning (PBL) for CPAP initiation. Educational programme  The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months. Methods  A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi-structured interviews using a phenomenographic approach. Results  72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle. Conclusion and practice implications  A group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.

  • 4.
    Carlfjord, Siw
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvården i centrala länsdelen.
    Lindberg, Malou
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Andersson, Agneta
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Sustained use of a tool for lifestyle intervention implemented in primary health care: a 2-year follow-up2013Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, nr 2, s. 327-334Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rational, aims and objectives: Sustainability of new methods implemented in health care is one of the most central issues in addressing the gap between research and practice, but is seldom assessed in implementation studies. The aim of this study was to evaluate the implementation of a new tool for lifestyle intervention in primary health care (PHC) 2 years after the introduction, and assess if the implementation strategy used influenced sustainability.

    Method: A computer-based lifestyle intervention tool (CLT) was introduced at six PHC units in Sweden in 2008, using two implementation strategies: explicit and implicit. The main difference between the strategies was a 4-week test period followed by a decision session, included in the explicit strategy. Evaluations were performed after 6, 9 and 24 months. After 24 months, the RE-AIM framework was applied to assess and compare outcome according to strategy.

    Results: A more positive outcome regarding Reach, Effectiveness, Adoption and Implementation in the explicit group could be almost completely attributed to one of the units. Maintenance was low and after 24 months, differences according to strategy were negligible.

    Conclusion: After 24 months the most positive outcomes regarding all RE-AIM dimensions were found in one of the units where the explicit strategy was used. The explicit strategy per se had some effect on the dimension Effectiveness, but was not associated with sustainability overall. Staff at the most successful unit earlier had positive expectations regarding the CLT and found it compatible with existing routines.

  • 5.
    Carlfjord, Siw
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nilsing-Strid, Emma
    University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Holmgren, Theresa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study2019Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, nr 4, s. 622-629Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, Aims, and Objectives

    To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence‐based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence‐based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation.

    Methods

    A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis.

    Results

    The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient‐ and provider‐related challenges to the implementation were mentioned.

    Conclusions

    The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.

  • 6.
    Edvardsson, Maria
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i Finspång, Primärvården i Finspång.
    Sund-Levander, Märtha
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Ernerudh, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Region Östergötland, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin. Linköpings universitet, Hälsouniversitetet.
    Theodorsson, Elvar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Region Östergötland, Diagnostikcentrum, Klinisk kemi. Linköpings universitet, Hälsouniversitetet.
    Grodzinsky, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Rättsmedicinalverket, Linköping, Sweden.
    Clinical use of conventional reference intervals in the frail elderly2015Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, nr 2, s. 229-235Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aims and objectives

    Reference intervals provided by the laboratory are commonly established by measuring samples from apparently healthy subjects in the ages 18–65 years, excluding elderly individuals with chronic diseases and medication. The aim of our study was to establish whether current reference intervals for immune parameters and chemical biomarkers are valid for older individuals including those with chronic diseases, so-called frail elderly.

    Methods

    Data from our cohort of 138 non-infected nursing home residents (NHR), mean age 86.8 years, range 80–98, were compared with raw data, as basis for the development of reference intervals, obtained from reference populations, like blood donors (IgA, IgG, IgM, C3 and C4) and from the Nordic Reference Interval Project (NORIP) (alanine aminotransferase, albumin, aspartate aminotransferase, creatinine, gamma-glutamyl transferase, lactate dehydrogenase, phosphate, sodium and urea). Immune parameters were measured by nephelometry and in NORIP the measurements were performed by means of different routine methods, in more than 100 laboratories.

    Results

    Only nine individuals (7%) of NHR were found to be free from chronic disease. C3, C4 (P < 0.001) and IgG levels (P < 0.05) were higher, while IgM levels (P < 0.001) were lower in NHR compared with reference blood donors. Levels of alanine aminotransferase, phosphate (P < 0.001), albumin (P < 0.05) and sodium (P < 0.01) were lower while creatinine and urea levels were higher (P < 0.001) in NHR compared with NORIP subjects.

    Conclusion

    Comparing laboratory results from elderly people with conventional reference intervals can be misleading or even dangerous, as normal conditions may appear pathological, or vice versa and thus lead to unnecessary or even harmful treatment.

  • 7.
    Eldh, Ann Catrine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Uppsala universitet, Sweden.
    Facilitating patient participation by embracing patients’ preferences: a discussion2019Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, nr 6, s. 1070-1073Artikel i tidskrift (Övrigt vetenskapligt)
    Publikationen är tillgänglig i fulltext från 2020-03-27 08:33
  • 8.
    Gelhaus, Petra
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Psykiatri- och habiliteringsenheten.
    Robot decisions: on the importance of virtuous judgment in clinical decision making2011Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, nr 5, s. 883-887Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aims and objectives The aim of this article is to argue for the necessity of emotional professional virtues in the understanding of good clinical practice. This understanding is required for a proper balance of capacities in medical education and further education of physicians. For this reason an ideal physician, incarnating the required virtues, skills and knowledge is compared with a non-emotional robot that is bound to moral rules. This fictive confrontation is meant to clarify why certain demands on the personality of the physician are justified, in addition to a rule-and principle-based moral orientation and biomedical knowledge and skills. less thanbrgreater than less thanbrgreater thanMethods Philosophical analysis of thought experiments inspired by science fiction literature by Isaac Asimov. less thanbrgreater than less thanbrgreater thanResults Although prima facie a rule-oriented robot seems more reliable and trustworthy, the complexity of clinical judgment is not met by an encompassing and never contradictory set of rules from which one could logically derive decisions. There are different ways how the robot could still work, but at the cost of the predictability of its behaviour and its moral orientation. In comparison, a virtuous human doctor who is also bound to these rules, although less strictly, will more reliably keep at moral objectives, be understandable, be more flexible in case the rules come to their limits, and will be more predictable in these critical situations. Apart from these advantages of the virtuous human doctor referring to her own person, the most problematic deficit of the robot is its lacking deeper understanding of the inner mental events of patients which makes good contact, good communication and good influence impossible. Conclusion Although an infallibly rule-oriented robot seems more reliable at first view, in situations that require complex decisions like clinical practice the agency of a moral human person is more trustworthy. Furthermore, the understanding of the patients emotions must remain insufficient for a non-emotional, non-human being. Because these are crucial preconditions for good clinical practice, enough attention should be given to develop these virtues and emotional skills, in addition to the usual attention on knowledge, technical skills and the obedience to moral rules and principles.

  • 9.
    Hofmann, Bjorn
    et al.
    Norwegian Univ Sci and Technol NTNU, Norway; Univ Oslo, Norway.
    Bond, Ken
    CADTH, Canada.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Evaluating facts and facting evaluations: On the fact-value relationship in HTA2018Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 24, nr 5, s. 957-965Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Health technology assessment (HTA) is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of fake facts and truth production. Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of evaluating facts and the social-constructivist account of facting values. Our analysis reveals diverse relationships between facts and a spectrum of values, ranging from basic human values, to the values of health professionals, and values of and in HTA, as well as for decision making. We argue for sensitivity to the relationship between facts and values on all levels of HTA, for being open and transparent about the values guiding the production of facts, and for a primacy for the values close to the principal goals of health care, ie, relieving suffering. We maintain that philosophy (in particular ethics) may have an important role in addressing the relationship between facts and values in HTA. Philosophy may help us to avoid fallacies of inferring values from facts; to disentangle the normative assumptions in the production or presentation of facts and to tease out implicit value judgements in HTA; to analyse evaluative argumentation relating to facts about technologies; to address conceptual issues of normative importance; and to promote reflection on HTAs own value system. In this we argue for a(n Aristotelian) middle way between the traditional positivist account of evaluating facts and the social-constructivist account of facting values, which we call factuation. We conclude that HTA is unique in bringing together facts and values and that being conscious and explicit about this factuation is key to making HTA valuable to both individual decision makers and society as a whole.

  • 10.
    Hälleberg-Nyman, Maria
    et al.
    School of Health Sciences, Örebro University, Örebro, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Forsman, Henrietta
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Wallin, Lars
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ostaszkiewicz, Joan
    Centre for Quality and Patient Safety Research, Barwon Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, Australia.
    Hommel, Ami
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden; Department of Orthopaedics, Skaane University Hospital, Lund, Sweden.
    Eldh, Ann Catrine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Dalarna University, Sweden; Uppsala University, Sweden.
    Promoting evidence‐based urinary incontinence management in acute nursing and rehabilitation care: A process evaluation of an implementation intervention in the orthopaedic context2019Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, nr 2, s. 282-289Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aims, and objectives

    The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence‐based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence‐based practice for UI in patients aged 65 or older undergoing hip surgery.

    Methods

    A 3‐month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed.

    Results

    Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence‐based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit.

    Conclusion

    To promote evidence‐based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence‐based management of UI.

  • 11.
    Idvall, Ewa
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad.
    Berg, Katarina
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad.
    Unosson, Mitra
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad.
    Brudin, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi.
    Differences between nurse and patient assessments on postoperative pain management in two hospitals2005Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 11, nr 5, s. 444-451Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale: Differences between patient and professional assessments on pain and pain management have been reported, but no further analysis has described the statistical problems of pseudocorrelation concerning the nature of these differences. Aim: The aim of the present study was: (1) to investigate the differences between nurse and patient assessments of post-operative pain management in two hospitals, and (2) to discuss the nature and scope of these differences. Method: The subjects were 209 inpatients and 63 nurses from a central county hospital and 77 inpatients and 34 nurses from a university hospital. The 'Strategic and Clinical Quality Indicators in Postoperative Pain Management' questionnaire was used, comprising 14 items in four sub-scales (communication, action, trust and environment) and two questions concerning the worst pain experienced during the past 24 hours and general satisfaction. Result: Except for the trust sub-scale in one hospital, the correlations between patient and nurse ratings concerning all assessments were significant in both hospitals (r = 0.22 - 0.59). Both groups of patients had significantly higher (better) scores than judged by the nurses on the environment sub-scale and general satisfaction. In contrast, nurses from both hospitals tended to significantly underestimate patients' worst pain during the past 24 hours. Other differences between patient and nurse assessments were either non-significant or inconsistent between hospitals. Using so-called Oldham plots nurses tended to under-estimate severe pain more often than mild pain, as judged by the patients, but this association was weak and statistically significant in one hospital only. Conclusion: Although the effects of pseudocorrelation are minimized by using Oldham plots, they are not cancelled. This issue is discussed, and we conclude that this study does not support the notion that the nurses tend to underestimate severe pain more often than mild pain. © 2005 Blackwell Publishing Ltd.

  • 12.
    Idvall, Ewa
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad.
    Brudin, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi.
    Do health care professionals underestimate severe pain more often than mild pain? Statistical pitfalls using a data simulation model2005Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 11, nr 5, s. 438-443Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale: When comparing patients' pain ratings with the health care professional's conception of pain assessed by Visual Analogue Scales (VAS) ratings, statistical problems arise. Method and Result: In this data simulation study we have shown that the tendency for health care professionals to underestimate severe pain compared with mild pain is probably not attributed to difficulties in judging severe pain more often than mild but the result of professionals having a different and often narrower distribution of their ratings compared with patients. © 2005 Blackwell Publishing Ltd.

  • 13.
    Kall, Ingela
    et al.
    Närhälsan Stenungsund Rehabil, Sweden; Umeå University, Sweden.
    Larsson, Maria E. H.
    University of Gothenburg, Sweden; Primary Health Care Narhalsan Primary Care Research and De, Sweden.
    Bernhardsson, Susanne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Närhälsan Rehabil Hönö Öckerö, Sweden.
    Use of outcome measures improved after a tailored implementation in primary care physiotherapy: a prospective, controlled study2016Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, nr 5, s. 668-676Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aims and objectivesIt is important that physiotherapists routinely use outcome measures to evaluate treatment results. There is limited knowledge about effective ways to increase use of outcome measures. The objectives were to investigate the effect of a tailored implementation of guidelines for evaluation of physiotherapy treatment and to explore differences in outcome subgrouped by demographic variables. MethodsA prospective, controlled study was conducted in primary care physiotherapy in western Sweden. 448 publicly employed physiotherapists participated. The intervention comprised a tailored, multi-component implementation of guidelines for treatment and evaluation of musculoskeletal disorders. The core component was a 3-hour implementation seminar. The control group received no intervention. Self-reported attitudes towards, access to and use of outcome measures were assessed with a web-based questionnaire before and after the implementation. ResultsAfter the implementation, a significantly higher proportion of physiotherapists in the intervention group than in the control group reported using outcome measures frequently, 54.8% vs. 35.6%, a 19.2% difference. The proportion of physiotherapists who reported that they considered outcome measures important to use and that they had easy access to outcome measures at their workplace, were similar in both groups at follow-up, 92.8% vs. 93.1%, and 95.2% vs. 90.8%, respectively. At follow-up, no differences related to demographic variables were found in the subgroup analyses. ConclusionsThe findings suggest that a tailored, multi-component implementation can be effective in increasing use of outcome measures. Although most physiotherapists considered outcome measures important and reported having easy access to them at their workplace, only a little more than half reported using outcome measures after the intervention.

  • 14.
    Lymer, Ulla-Britt
    et al.
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet.
    Richt, Bengt
    Linköpings universitet, Institutionen för hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Patients’ conceptions of quality care and barrier care2006Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 12, nr 6, s. 682-691Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim  To describe patients’ conceptions of quality care and barrier care.

    Methods  As this study concerned conceptions of care, a phenomenographic approach was chosen. Fourteen adult orthopaedic patients participated. Data-collection was performed by means of semi-structured interviews. The qualitative data were analysed with two foci, conceptions of quality care and conceptions of barrier care. Different categories of understanding, that is, conceptions, constitute the the essential outcome of phenomenographic analysis. The research was conducted in one county hospital and in one regional hospital situated in different cities in the south of Sweden.

    Results and Conclusions  Patients’ conceptions of quality care resulted in six categories. When comparing the findings with previous research in this field, the findings of the present study confirmed to a large extent the findings from other studies of quality care. Patients’ conceptions of barrier care resulted in five categoris. The conceptions of barrier care must be considered as elements in patients’ conceptions of quality care, and this must be called atention to in efforts to measure patient satisfaction and in analyses of good care. It also can influence health care workers’ compliance to guidelines in infection control procedures.

  • 15.
    Magidy, Mahnaz
    et al.
    Akademiska sjukhus, Uppsala, Sweden.
    Warren-Stomberg, Margareta
    University of Gothenburg, Sweden.
    Bjerså, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Assessment of post-operative pain management among acutely and electively admitted patients - a Swedish ward perspective2016Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, nr 2, s. 283-289Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aims and objectivesSwedish health care is regulated to involve the patient in every intervention process. In the area of post-operative pain, it is therefore important to evaluate patient experience of the quality of pain management. Previous research has focused on mapping this area but not on comparing experiences between acutely and electively admitted patients. Hence, the aim of this study was to investigate the experiences of post-operative pain management quality among acutely and electively admitted patients at a Swedish surgical department performing soft-tissue surgery. MethodsA survey study design was used as a method based on a multidimensional instrument to assess post-operative pain management: Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Consecutive patients at all wards of a university hospitals surgical department were included. Data collection was performed at hospital discharge. ResultsIn total, 160 patients participated, of whom 40 patients were acutely admitted. A significant difference between acutely and electively admitted patients was observed in the SCQIPP area of environment, whereas acute patients rated the post-operative pain management quality lower compared with those who were electively admitted. ConclusionsThere may be a need for improvement in the areas of post-operative pain management in Sweden, both specifically and generally. There may also be a difference in the experience of post-operative pain quality between acutely and electively admitted patients in this study, specifically in the area of environment. In addition, low levels of the perceived quality of post-operative pain management among the patients were consistent, but satisfaction with analgesic treatment was rated as good.

  • 16.
    Palacio-Vieira, J.
    et al.
    Govt Catalonia, Spain.
    Segura, L.
    Govt Catalonia, Spain.
    Anderson, P.
    Newcastle Univ, England; Maastricht Univ, Netherlands.
    Wolstenholme, A.
    Kings Coll London, England.
    Drummond, C.
    Kings Coll London, England; South London and Maudsley NHS Fdn Trust, England.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Medicinska specialistkliniken.
    Wojnar, M.
    Med Univ Warsaw, Poland.
    Kaner, E.
    Newcastle Univ, England.
    Keurhorst, M. N.
    Radboud Univ Nijmegen, Netherlands.
    van Steenkiste, B.
    Maastricht Univ, Netherlands.
    Kloda, K.
    Pomeranian Med Univ, Poland.
    Mierzecki, A.
    Pomeranian Med Univ, Poland.
    Parkinson, K.
    Newcastle Univ, England.
    Newbury-Birch, D.
    Teesside Univ, England.
    Okulicz-Kozaryn, K.
    State Agcy Prevent Alcohol Related Problems, Poland.
    Deluca, P.
    Kings Coll London, England.
    Colom, J.
    Govt Catalonia, Spain.
    Gual, A.
    Hosp Clin Barcelona, Spain; IDIBAPS, Spain; Inst Carlos III, Spain.
    Improving screening and brief intervention activities in primary health care: Secondary analysis of professional accuracy based on the AUDIT-C2018Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 24, nr 2, s. 369-374Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction and objectiveThe ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. MethodFrom 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12-week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT-C; the proportion of screen-negative patients given advice, and the proportion of screen-positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet-based counselling. ResultsThirty-two of 36711 questionnaires were incorrectly completed, and 65 of 29641 screen-negative patients were falsely classified. At baseline, 27% of screen-negative patients were given advice, and 22.5% screen-positive patients were not given advice. These proportions halved during the 12-week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen-positive patients not given advice (OR=0.56; 95% CI, 0.31-0.99; Pamp;lt;.05). ConclusionAlthough the use of AUDIT-C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives.

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