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  • 1.
    Abbott, Allan
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Schröder, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Enthoven, Paul
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 4, artikel-id e019906Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP.

    Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context.

    Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated.

    Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and implementation in Sweden and associated national quality register data collection are potential future developments of the project.

  • 2.
    Abidi, L.
    et al.
    Maastricht University, Netherlands.
    Oenema, A.
    Maastricht University, Netherlands.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Anderson, P.
    Maastricht University, Netherlands; Newcastle University, England.
    van de Mheen, D.
    Maastricht University, Netherlands; IVO Addict Research Institute, Netherlands; Erasmus MC, Netherlands.
    Strategies to Overcome Barriers to Implementation of Alcohol Screening and Brief Intervention in General Practice: a Delphi Study Among Healthcare Professionals and Addiction Prevention Experts2016Ingår i: Prevention Science, ISSN 1389-4986, E-ISSN 1573-6695, Vol. 17, nr 6, s. 689-699Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Despite the evidence base, alcohol screening and brief intervention (ASBI) have rarely been integrated into routine clinical practice. The aim of this study is to identify strategies that could tackle barriers to ASBI implementation in general practice by involving primary healthcare professionals and addiction prevention experts. A three-round online Delphi study was carried out in the Netherlands. The first-round questionnaire consisted of open-ended questions to generate ideas about strategies to overcome barriers. In the second round, participants were asked to indicate how applicable they found each strategy. Items without consensus were systematically fed back with group median ratings and interquartile range (IQR) scores in the third-round questionnaire. In total, 39 out of 69 (57 %) invited participants enrolled in the first round, 214 participants completed the second round, and 144 of these (67 %) completed the third-round questionnaire. Results show that participants reached consensus on 59 of 81 strategies, such as the following: (1) use of E-learning technology, (2) symptom-specific screening by general practitioners (GPs) and/or universal screening by practice nurses, (3) reimbursement incentives, (4) supportive materials, (5) clear guidelines, (6) service provision of addiction care centers, and (7) more publicity in the media. This exploratory study identified a broad set of strategies that could potentially be used for overcoming barriers to ASBI implementation in general practice and paves the way for future research to experimentally test the identified implementation strategies using multifaceted approaches.

  • 3.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    I takt med framtiden: Utveckling av ett nytt interprofessionellt curriculum vid Hälsouniversitetet i Linköping2015Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Hälso- och sjukvårdsutbildningarnas ansvar att utbilda professionella som kan samarbetaoch förstå varandras kompetens, för att utföra och utveckla patientsäker vård, betonas alltmer i den globala debatten om framtidens hälso- och sjukvård. Modern professionsutbildning inom hälso- och sjukvården måste idag därför innehålla moment av god kvalitet där studenter lär med, av och om varandra för att utveckla interprofessionell kompetens. Hälsouniversitetet i Linköping är pionjär, både nationellt och internationellt, när det gäller interprofessionellt lärande tack vare satsningen på integrerade utbildningsmoment som funnits med sedan från starten 1986. Den här rapporten är en sammanställning av den interna process som har genomförts för att initiera ett pedagogiskt utvecklingsprojekt med avsikt att revidera och utveckla dessa gemensamma utbildningsmoment inriktade mot interprofessionellt lärande. Texten är upplagd kronologiskt och inleds med det direktiv som fakultetsledningen gav för att en utvald grupp lärare skulle kunna utarbeta ett förslag på hur de interprofessionella lärandemomenten vid Hälsouniversitetet skulle kunna förbättras. Härefter följer den rapport som utredningsgruppen lämnade, och som sedan skickades på remiss till olika intressenter. Rapporten följs av en sammanställning och bearbetning av de inkomna remissvaren och till sist följer fakultetsstyrelsens beslut om hur curriculum för interprofessionell utbildning inom Hälsouniversitetet ska utvecklas eller förändras. Det är vår förhoppning att dokumentationen av processen för att förnya fakultetens interprofessionella utbildning ska ge inspiration för fortsatt förändrings- och utvecklingsarbete både inom och utom Linköpings universitet.

  • 4.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Dyrdal Solbrekke, Tone
    Oslo universitet, Norway.
    Karseth, Berit
    Oslo Universitet, Norway.
    Nyström, Sofia
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    From university to professional practice: Students as journeymen between cultures of education and work2014Ingår i: International handbook of research in professional and practice-based learning, Volume 1 / [ed] Stephen Billett, Christian Harteis, Hans Gruber, Dordrecht: Springer Netherlands, 2014, 1, s. 461-484Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    The overarching research problem addressed in this chapter is the relationship between professional/higher education and professional work. The chapter will discuss the relevance of university education for professional practice with a particular focus on professional identity formation and formation of professional responsibility. We deiscuss how different professional programs and their traditions and culturs shape different curricula structures that have an impact on students professional identity formation and transition to work. We will also discuss ecperiences with and learning of professional responsibility in the web of commitments within educational settings and how new multiple expectations emerge and lead to new learning experiencies when entering work life. The argument of the chapter is based on the rationale and findings from an extensive international research program, conducted between 2001-2008.

  • 5.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Fenwick, Tara
    University of Stirling, Scotland.
    Hopwood, Nick
    University of Technology Sydney, Australia.
    Theorising simulation in higher education: difficulty for learners as an emergent phenomenon2016Ingår i: Teaching in Higher Education, ISSN 1356-2517, E-ISSN 1470-1294, Vol. 21, nr 6, s. 613-627Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Despite the widespread interest in using and researching simulation in higher education, little discussion has yet to address a key pedagogical concern: difficulty. A sociomaterial view of learning, explained in this paper, goes beyond cognitive considerations to highlight dimensions of material, situational, representational and relational difficulty confronted by students in experiential learning activities such as simulation. In this paper we explore these dimensions of difficulty through three contrasting scenarios of simulation education. The scenarios are drawn from studies conducted in three international contexts: Australia, Sweden and the UK, which illustrate diverse approaches to simulation and associated differences in the forms of difficulty being produced. For educators using simulation, the key implications are the importance of noting and understanding (1) the effects on students of interaction among multiple forms of difficulty; (2) the emergent and unpredictable nature of difficulty; and (3) the need to teach students strategies for managing emergent difficulty.

  • 6.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Gustavsson, MariaLinköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, HELIX Competence Centre.Fejes, AndreasLinköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Book of Abstracts: 3rd International ProPEL Conference 2017, 14-16 June 2017, Hosted by Linköping University, Sweden2017Proceedings (redaktörskap) (Övrigt vetenskapligt)
  • 7.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Gustavsson, Maria
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, HELIX Competence Centre.
    Fejes, Andreas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Professional practice, education and learning: A sociomaterial perspective2018Ingår i: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 40, nr 3, s. 239-241Artikel i tidskrift (Övrigt vetenskapligt)
  • 8.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nordenström, Elin
    University of Gothenburg, Gothenburg, Sweden.
    Rooney, Donna
    University of TechnologySydneyAustralia.
    Rystedt, Hans
    University of Gothenburg, Gothenburg, Sweden.
    Video as a Tool for Researching Simulation Practices2019Ingår i: Video as a Tool for Researching Simulation Practices: Materiality, Embodiment, Interaction / [ed] Madeleine Abrandt Dahlgren, Hans Rystedt, Li Felländer-Tsai and Sofia Nyström, Cham: Springer Publishing Company, 2019, s. 31-55Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    This chapter provides examples of how arrangements for collection and analyses of video data were organized across different sites. The common approach to data collection builds on established methods for recording of audiovisual materials in the social sciences with a focus on interaction and learning. The chapter describes how arrangements for data collection across different sites were organised, and how video analysis can be used as a method for collaborative analysis of practices. One approach is entitled purposeful approach to collaborative data analysis. A second approach draws on video-based studies of situated action, and a third approach of analysis is the use of qualitatively different readings of the same data. One does not replace the other, but rather draws out different features.

  • 9.
    Abrandt Dahlgren, Madeleine
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Rystedt, HansDepartment of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden.Felländer-Tsai, LiDepartment of Clinical Science, Intervention and Technology (CLINTEC) Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden.Nyström, SofiaLinköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap. Region Östergötland, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Simulation in Health Care: Materiality, Embodiment, Interaction2019Samlingsverk (redaktörskap) (Refereegranskat)
    Abstract [en]

    Series editors abstract:

    A key goal of this book series is to contribute to discussions about and processes for improving the enactment of occupational capacities through professional practice- based experiences. A related goal is associated with understanding and enhancing the contributions that different kinds of experiences can make to the formation and continuity of those occupational practices. The volumes in this series have contrib- uted a range of perspectives, approaches and outcomes to these discussions. This volume continues that tradition through considerations of how simulation-based activities can contribute to enhancing occupational practices in which working and learning progresses inter- and intra-professionally within healthcare settings. The procedural concern here is to enhance patient safety through improving the quality of collaborative working and learning by healthcare workers. The conceptual concern here is to understand how such working and learning can be understood more fully as a process of interdependence amongst practitioners, and how such co- working and learning progresses, in what ways and for what outcomes. Added here are the ways in which technology comes to mediate and support that process. Perhaps only through such considerations, focused empirical work and detailed analysis will our understanding of human capacities, their enactment and evaluation transcend from either wholly individualised or wholly socialised accounts.

    The sections comprising this book are drawn from a large collaborative study hosted by three institutions that have longer and solid traditions of making contribu- tions to understanding the development of professional capacities through interpro- fessional practices (i.e. Linkoping), dedicated focuses on improving healthcare practices (Karolinska) and the use of technology in working and learning (Gothenburg). These collaborations have been informed and enriched by contribu- tors from other institutions who bring explanatory concepts. The attempt to utilise, accommodate and optimise these different contributions is exercised within the organisation of the sections of the book and chapters within it, highlighted by a process of dual considerations and separate commentaries. Each of these sections provides an overview, statements about procedural matters (e.g. how to conduct inquiries or how to analyse data), proposing and advancing particular explanatory accounts, and also offering perspectives on how educational or work practice might be enhanced. This structuring is particularly helpful as it provides focused consid- erations of particular phenomena (e.g. team-based approaches to simulation, use of video recordings, doing simulations) through description, analysis and commentary.

    In these ways, this volume offers contributions to discussions about the goals for, processes of and outcomes of professional and practice-based learning in a manner that is highly consistent with the ambitions of this book series.

  • 10.
    Aerts, Marc
    et al.
    Interuniversity Institute for Biostatistics and Statistical Bioinformatics.
    Minalu, Girma
    Interuniversity Institute for Biostatistics and Statistical Bioinformatics.
    Bösner, Stefan
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Buntinx, Frank
    Department of Public Health and Primary Care, KU Leuven, Belgium; Department of General Practice, Maastricht University, The Netherlands..
    Burnand, Bernard
    Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland..
    Haasenritter, Jörg
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Herzig, Lilli
    Institute of Family Medicine, University of Lausanne, Switzerland..
    Knottnerus, J André
    Department of General Practice, Maastricht University, The Netherlands..
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Vikbolandet.
    Renier, Walter
    Department of Public Health and Primary Care, KU Leuven, Belgium.
    Sox, Carol
    Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, USA..
    Sox, Harold
    Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH , USA; Patient-Centered Outcomes Research Institute, Washington, USA..
    Donner-Banzhoff, Norbert
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Pooled individual patient data from five countries were used to derive a clinical prediction rule for coronary artery disease in primary care.2017Ingår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 81, s. 120-128Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To construct a clinical prediction rule for coronary artery disease (CAD) presenting with chest pain in primary care.

    STUDY DESIGN AND SETTING: Meta-Analysis using 3,099 patients from five studies. To identify candidate predictors, we used random forest trees, multiple imputation of missing values, and logistic regression within individual studies. To generate a prediction rule on the pooled data, we applied a regression model that took account of the differing standard data sets collected by the five studies.

    RESULTS: The most parsimonious rule included six equally weighted predictors: age ≥55 (males) or ≥65 (females) (+1); attending physician suspected a serious diagnosis (+1); history of CAD (+1); pain brought on by exertion (+1); pain feels like "pressure" (+1); pain reproducible by palpation (-1). CAD was considered absent if the prediction score is <2. The area under the ROC curve was 0.84. We applied this rule to a study setting with a CAD prevalence of 13.2% using a prediction score cutoff of <2 (i.e., -1, 0, or +1). When the score was <2, the probability of CAD was 2.1% (95% CI: 1.1-3.9%); when the score was ≥ 2, it was 43.0% (95% CI: 35.8-50.4%).

    CONCLUSIONS: Clinical prediction rules are a key strategy for individualizing care. Large data sets based on electronic health records from diverse sites create opportunities for improving their internal and external validity. Our patient-level meta-analysis from five primary care sites should improve external validity. Our strategy for addressing site-to-site systematic variation in missing data should improve internal validity. Using principles derived from decision theory, we also discuss the problem of setting the cutoff prediction score for taking action.

  • 11.
    Af Sandeberg, Margareta
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Children's and Women's Health, Karolinska University Hospital.
    Wenemark, Marika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för verksamhetsstöd och utveckling, Verksamhetsutveckling vård och hälsa.
    Bartholdson, Cecilia
    Department of Women's and Children's Health, Karolinska Institutet, Children's and Women's Health, Karolinska University Hospital.
    Lützén, Kim
    Department of Women's and Children's Health, Karolinska Institutet.
    Pergert, Pernilla
    Department of Women's and Children's Health, Karolinska Institutet, Children's and Women's Health, Karolinska University Hospital.
    To change or not to change - translating and culturally adapting the paediatric version of the Moral Distress Scale-Revised (MDS-R)2017Ingår i: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 18, nr 14, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Paediatric cancer care poses ethically difficult situations that can lead to value conflicts about what is best for the child, possibly resulting in moral distress. Research on moral distress is lacking in paediatric cancer care in Sweden and most questionnaires are developed in English. The Moral Distress Scale-Revised (MDS-R) is a questionnaire that measures moral distress in specific situations; respondents are asked to indicate both the frequency and the level of disturbance when the situation arises. The aims of this study were to translate and culturally adapt the questionnaire to the context of Swedish paediatric cancer care. In doing so we endeavoured to keep the content in the Swedish version as equivalent to the original as possible but to introduce modifications that improve the functional level and increase respondent satisfaction.

    METHODS: The procedure included linguistic translation and cultural adaptation of MDS-R's paediatric versions for Physicians, Nurses and Other Healthcare Providers to the context of Swedish paediatric cancer care. The process of adjustment included: preparation, translation procedure and respondent validation. The latter included focus group and cognitive interviews with healthcare professionals in paediatric cancer care.

    RESULTS: To achieve a Swedish version with a good functional level and high trustworthiness, some adjustments were made concerning design, language, cultural matters and content. Cognitive interviews revealed problems with stating the level of disturbance hypothetically and items with negations caused even more problems, after having stated that the situation never happens.

    CONCLUSIONS: Translation and cultural adaptation require the involvement of various types of specialist. It is difficult to combine the intention to keep the content as equivalent to the original as possible with the need for modifications that improve the functional level and increase respondent satisfaction. The translated and culturally adapted Swedish MDS-R seems to have equivalent content as well as improved functional level and respondent satisfaction. The adjustments were made to fit paediatric cancer care but it could be argued that the changes are relevant for most areas of paediatric care of seriously ill patients.

  • 12.
    Afrell, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Att leva med en kropp som värker: samtal med fysioterapeuten2014Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Bakgrund och syfte: Fysioterapeuter i primärvården möter, bedömer och behandlar patienter med långvarig benign muskuloskeletal smärta. Tillståndet är vanligt och men likafullt komplext. Syftet med detta avhandlingsarbete har varit att i ett kroppsligt existentiellt perspektiv utforska och begreppsliggöra upplevelsen av att leva med långvarig benign muskuloskeletal smärta samt att utifrån detta utveckla en metod för samtal och bedömning inom icke specialiserad fysioterapi.

    Metoder: Arbete I var en intervjustudie med fenomenologisk ansats där vi undersökte hur individer med långvarig smärta upplevde sin kropp och sina besvär. Fyra aspekter av kroppsupplevelsen beskrevs och ur dessa urskildes fyra klart åtskilda typologier av förhållningssätt. I arbete II gjorde vi två gruppintervjuer med sex fysioterapeuter om deras erfarenheter av att i kliniskt arbete använda frågor – nyckelfrågor - ur frågeguiden i arbete I som givit särskilt rika svar. Utskrifterna av gruppintervjuerna analyserades med fenomenografisk ansats. I arbete III undersöktes patienters svar på nyckelfrågorna, ställda av fysioterapeuter under kliniskt arbete, och de fyra aspekterna av kroppsupplevelse från arbete I utgjorde begrepp för en deduktiv analys. I arbete IV slutligen prövades nyckelfrågorna och  typologierna av en större grupp (31) fysioterapeuter i primärvården och deras erfarenheter och den möjliga användbarheten av metoden studerades. En kvalitativ innehållsanalys med beräkning av koder användes.

    Resultat: Vi skapade fyra typologier av förhållningssätt till långvarig smärta: Acceptera sitt öde, acceptera genom aktiv förändring, befinna sig mellan acceptans och avståndstagande eller ta avstånd från sin värkande kropp. Dessa typologier byggdes upp av fyra aspekter av kroppsupplevelse: Kroppen som en aspekt av identiteten, kroppstillit, kroppsmedvetenhet samt förståelse av sin smärta. I arbete II visade det sig möjligt att tillsamman patient och fysioterapeut, med hjälp av nyckelfrågorna, föra ett kroppsligt existentiellt samtal. I samtalen lärde fysioterapeuten känna patienten som person, det föreföll som att en process inom patienten satte igång, samt att deras relation förändrades. Patienten var villig att samtala om sin värkande kropp och hade ord för detta. I studie III banade nyckelfrågorna väg för reflektioner om kropp, existens och biografi. De fyra aspekterna av kroppsupplevelse hade en central plats i patienternas beskrivningar. I arbete IV beskrev de deltagande sjukgymnasterna överlag positiva erfarenheter av att använda nyckelfrågor och typologier. Patienterna reflekterade, känslor väcktes och relationen och kommunikationen förbättrades ofta. Typologierna hjälpte till att få ett helhetsperspektiv på patientens problematik och att förstå var patienten befann sig i rehabiliteringsprocessen, vilket kunde vara värdefull vid bedömning och val av behandling.

    Konklusion: Metoden, sju nyckelfrågor tillsammans med den erbjudna möjliga referensramen för tolkning av svaren (de fyra typologierna), förefaller lätt att ta till sig för intresserade fysioterapeuter i icke specialiserad verksamhet.Användandet av metoden belyser vikten av en utvidgning av fysioterapeutrollen. Utmaningen är att möta hela människan, som är sin levda kropp såväl som sin identitetskris buren av känslor som sorg och ilska. Detta kan sporra till att fullt ut utnyttja de möjligheter i mötet med patienten som den fysioterapeutiska yrkesrollen omfattar.

    Delarbeten
    1. Living with a body in pain – between acceptance and denial
    Öppna denna publikation i ny flik eller fönster >>Living with a body in pain – between acceptance and denial
    2007 (Engelska)Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, nr 3, s. 291-296Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The aetiology of nonspecific musculoskeletal pain is considered to be multi-factorial. Long-standing pain not only has a negative impact on the individual's general health but also changes the individual's experience of him/her self and his/her world. The aim of this study was to describe how individuals with long-standing musculoskeletal pain, in a bodily existential perspective, relate to their aching body. Semi-structured interviews with 20 patients were analysed using mainly a phenomenological-hermeneutic method. From the analysis, four main categories reflect the meaning contents of the interviews: the body as an aspect of identity; body reliance; body awareness; ways of understanding pain. From these categories, four distinct typologies were inferred: surrendering to ones fate; accepting by an active process of change; balancing between hope and resignation; rejecting the body. The result indicates that patients with long-standing pain are to be found along a spectrum from accepting to rejecting the aching body. Body awareness and body reliance seem to have importance in the process of acceptance of the body as well as life situation as a whole, which we regard as interesting hypotheses for further inquiry.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2007
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-106745 (URN)10.1111/j.1471-6712.2007.00475.x (DOI)17727540 (PubMedID)
    Tillgänglig från: 2014-05-21 Skapad: 2014-05-21 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    2. We got the whole story all at once: physiotherapists use of key questions when meeting patients with long-standing pain
    Öppna denna publikation i ny flik eller fönster >>We got the whole story all at once: physiotherapists use of key questions when meeting patients with long-standing pain
    2010 (Engelska)Ingår i: SCANDINAVIAN JOURNAL OF CARING SCIENCES, ISSN 0283-9318, Vol. 24, nr 2, s. 281-289Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Long-standing musculoskeletal pain has many dimensions. Physiotherapy lacks a tested method of dialogue with which physiotherapists and patients can together explore pain in all its complexity. The present aim was to find out how physiotherapists experienced the influence of systematically prepared key questioning on their relation to, and understanding of, patients with long-standing pain. A group of six physiotherapists with long experience of pain rehabilitation used such questions in their encounters with their patients. Two periods of work with the questions were followed by discussions in which the physiotherapists shared their experience in a joint focus group. Verbatim transcripts of the discussions constitute the data of the study. A phenomenographic method was used for the analysis. The responses to the key questions gave the physiotherapists an insight into the patient as a person. The questions started a process of change in the patient, and changed the physiotherapists relation to her or him. The patient expressed feelings and experience, and this also seemed to encourage a change in chosen coping strategies. This new content of the interaction challenged the physiotherapists role, thus raising questions about her professional mandate.

    Ort, förlag, år, upplaga, sidor
    Blackwell Publishing Ltd, 2010
    Nyckelord
    qualitative method, phenomenography, dialogue method, key questions, biopsychosocial, pain management, physiotherapy, professional mandate
    Nationell ämneskategori
    Teknik och teknologier
    Identifikatorer
    urn:nbn:se:liu:diva-56678 (URN)10.1111/j.1471-6712.2009.00718.x (DOI)000277713500011 ()
    Tillgänglig från: 2010-05-31 Skapad: 2010-05-31 Senast uppdaterad: 2014-05-21
    3. Telling about long-lasting pain – the role of key questions in physiotherapy encounters
    Öppna denna publikation i ny flik eller fönster >>Telling about long-lasting pain – the role of key questions in physiotherapy encounters
    2014 (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Aim: For a physiotherapist in primary care wishing to meet her/his patient in the entirety of possible causes of long-lasting pain, the ability to perceive its nuances and context is indispensable.

    The aim was to investigate the verbal responses of patients with long-lasting pain to key questions addressing their biography, identity and lived body.

    Methodology: Three Swedish physiotherapists asked eight patients with long-lasting pain seven questions regarding body experience at the introductory and concluding, tape-recorded, treatment sessions. A deductive, qualitative analysis was made through four concepts naming aspects of body experience: body reliance, body awareness, models for explaining pain and the body’s integration in the identity.

    Major findings: The key questions opened ways to bodily-existential reflections. The aspects of body experience were central to the patients’ descriptions. Appreciable differences emerged between the patients in how they described the experience of living with pain, and in some cases differences were seen between the conversations of the first and the last treatment session with the same patient.

    Conclusions: The questions addressed crucial issues of living with pain and seem to have a potential to capture changes in body experience. Physiotherapists may recognize their patients’ biographical disruptions, reconstruction and adapt their treatment accordingly.

    Nyckelord
    Pain management, Clinical dialogue, Physiotherapy, Bodily existential perspective, Body awareness, Body reliance, Key questions, Deductive qualitative analysis
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-106746 (URN)
    Tillgänglig från: 2014-05-21 Skapad: 2014-05-21 Senast uppdaterad: 2014-05-21Bibliografiskt granskad
    4. Improving the interaction between the physiotherapist and the patient with long-lasting pain
    Öppna denna publikation i ny flik eller fönster >>Improving the interaction between the physiotherapist and the patient with long-lasting pain
    2014 (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Purpose: To investigate whether it would be possible to improve the understanding and communication between physiotherapists and patients with long-lasting pain by, in a systematic way, approaching their condition from a bodily existential perspective.

    Method: 31 physiotherapists answered written open questions about what happened when they in 90 encounters used key questions about living with pain together with a tentative frame for interpreting the answers - typologies of approaches to living with long-lasting pain. In the analysis, we combined qualitative content analysis with the counting of the numbers of codes.

    Results: According to the physiotherapists, patients were positive to answering the key questions, which also evoked emotional responses and reflection. The relation between the physiotherapists and their patients improved. The typologies helped the physiotherapists understand their patients better, as well as in assessing the patients’ problems and choosing treatment. In all, positive experience clearly dominated. Conclusion: When used by physiotherapists with an interest in patients with longlasting pain, the key questions and typologies seem to enrich the clinical interaction in many cases. To try the generalisability of our findings, we regard it an interesting possibility to conduct a larger, quantitative questionnaire study based on the experiences and results of the present one.

    Nyckelord
    Qualitative method, pain management, pain assessment, clinical dialogue, communication, bodily existential, physiotherapy
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-106747 (URN)
    Tillgänglig från: 2014-05-21 Skapad: 2014-05-21 Senast uppdaterad: 2014-05-21Bibliografiskt granskad
  • 13.
    Ageberg, Eva
    et al.
    Lund Univ, Sweden.
    Bunke, Sofia
    Lund Univ, Sweden.
    Lucander, Karolina
    Lund Univ, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Donaldson, Alex
    La Trobe Univ, Australia; Federat Univ Australia, Australia.
    Facilitators to support the implementation of injury prevention training in youth handball: A concept mapping approach2019Ingår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 29, nr 2, s. 275-285Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a need for research to identify effective implementation strategies for injury prevention training within real-world community sports. The aim of this ecological participatory study was to identify facilitators, among stakeholders at multiple levels, that could help injury prevention training become part of regular training routines in youth team handball. Concept mapping, a mixed-method approach for qualitative data collection and quantitative data analysis, was used. Stakeholders (n = 196) of two community team handball clubs (29% players, 13% coaches, 38% caregivers, 11% club, district and national handball administrators, 9% unknown) participated in a brainstorming process. After the research team synthesized the 235 generated statements, 50 stakeholders (34% players, 22% coaches, 24% caregivers, 20% administrators) sorted 89 unique facilitator statements into clusters and rated them for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis yielded five clusters (stress value 0.231): "Understanding and applying knowledge," "Education, knowledge, and consistency," "Set-up and exercises," "Inspiration, motivation, and routines," and "Club policy and expert collaboration." The cluster "Understanding and applying knowledge" had the highest mean importance (3.17 out of 4) and feasibility (2.93) ratings. The 32 statements rated as both highly important and feasible (Go-zone) indicate action is required at the individual (end-users) and organizational (policymakers) levels to implement injury prevention training. Results suggest that developing evidence-based context-specific injury prevention training, incorporating physiological, biomechanical and psychological components, and an associated context-specific implementation plan in partnership with all stakeholders should be a high priority to facilitate the implementation of injury prevention training in youth team handball.

  • 14.
    Agvall, Björn
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvården i centrala länsdelen.
    Paulsson, Thomas
    Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Belgium.
    Foldevi, Mats
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvården i centrala länsdelen.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Alehagen, Urban
    Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Resource use and cost implications of implementing a heart failure program for patients with systolic heart failure in Swedish primary health care2014Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, s. 731-738Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: Heart failure (HF) is a common but serious condition which involves a significant economic burden on the health care economy. The purpose of this study was to evaluate cost and quality of life (QoL) implications of implementing a HF management program (HFMP) in primary health care (PHC).

    Methods and results: This was a prospective randomized open-label study including 160 patientswith a diagnosis of HF from five PHC centers in south-eastern Sweden. Patients randomized to the intervention group received information about HF from HF nurses and from a validated computer-based awareness program. HF nurses and physicians followed the patients intensely in order to optimize HF treatment according to current guidelines. The patients in the control group were followed by their regular general practitioner (GP) and received standard treatment according to local management routines. No significant changes were observed in NYHA class and quality-adjusted life years (QALY), implying that functional class and QoL were preserved. However, costs for hospital care (HC) and PHC were reduced by EUR 2167, or 33%. The total cost was EUR 4471 in the intervention group and EUR 6638 in the control group.

    Conclusions: Introducing HFMP in Swedish PHC in patients with HF entails a significant reduction in resource utilization and costs, and maintains QoL. Based on these results, a broader implementation of HFMP in PHC may be recommended. However, results should be confirmed with extended follow-up to verify  long-term effects.

  • 15.
    Ahlberg, Eva-Lena
    et al.
    Region Östergötland, Centrum för verksamhetsstöd och utveckling.
    Elfström, Johan
    Region Östergötland, Centrum för verksamhetsstöd och utveckling.
    Borgstedt Risberg, Madeleine
    Region Östergötland, Centrum för verksamhetsstöd och utveckling.
    Öhrn, Annica
    Region Östergötland, Regionstyrelsen.
    Andersson, Christer
    Region Östergötland, Regionstyrelsen.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Learning From Incident Reporting?: Analysis of Incidents Resulting in Patient Injuries in a Web-Based System in Swedish Health Care2017Ingår i: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives Incident reporting (IR) systems have the potential to improve patient safety if they enable learningfrom the reported risks and incidents. The aim of this study was to investigate incidents registered in an IR system in a Swedish county council.

    Methods The study was conducted in the County Council of Östergötland, Sweden. Data were retrieved from the IR system, which included 4755 incidents occurring in somatic care that resulted in patient injuries from 2004 to 2012. One hundred correctly classified patient injuries were randomly sampled from 3 injury severity levels: injuries leading to deaths, permanent harm, and temporary harm. Three aspects were analyzed: handling of the incident, causes of the incident, and actions taken to prevent its recurrence.

    Results Of the 300 injuries, 79% were handled in the departments where they occurred. The department head decided what actions should be taken to prevent recurrence in response to 95% of the injuries. A total of 448 causes were identified for the injuries; problems associated with procedures, routines, and guidelines were most common. Decisions taken for 80% of the injuries could be classified using the IR system documentation and root cause analysis. The most commonly pursued type of action was change of work routine or guideline.

    Conclusions The handling, causes, and actions taken to prevent recurrence were similar for injuries of different severity levels. Various forms of feedback (information, education, and dialogue) were an integral aspect of the IR system. However, this feedback was primarily intradepartmental and did not yield much organizational learning.

  • 16.
    Ahlstrand, I.
    et al.
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Thyberg, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. School of Health Sciences, Jönköping University, Jönköping, Sweden; School of Occupational Therapy and Social Work, CHIRI, Curtin University, Perth, WA, Australia.
    Dahlström, Örjan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Björk, Mathilda
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Rehabenheten. School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project2015Ingår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, nr 4, s. 259-264Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier. Method: This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years. Results: Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2. Conclusions: Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.

  • 17.
    Ahlstrand, Inger
    et al.
    Jonköping University, Sweden.
    Björk, Mathilda
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Rehabenheten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Jonköping University, Sweden.
    Thyberg, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. Jonköping University, Sweden; Curtin University, Australia.
    Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis2015Ingår i: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, nr 8, s. 1353-1362Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study aimed to examine the difficulties with performing valued life activities in relation to pain intensity in women and men with rheumatoid arthritis (RA). In total, 737 persons with RA (73 % women) from three rheumatology units in Sweden responded to a questionnaire measuring performance of 33 valued life activities and self-rated pain. The relationships between performance of valued life activities (VLAs) and pain (measured by visual analogue scale (VAS)) were analysed based on gender. Multiple linear regression analyses were conducted with the total VLA score as dependent variable. Women reported more pain and difficulties in performing valued life activities than men. Across genders, 85 % reported at least one valued life activity affected by RA. Significantly more women than men encountered difficulties in performing some activities such as cooking, gardening and meeting new people. Women reported higher pain intensity (35 mm) than men (31 mm). Almost all 33 difficulty ratings for valued life activities were higher among persons with high pain (greater than 40 mm) than persons with lower pain. Difficulty ratings for valued life activities correlated positively with pain in persons with lower pain, but not among those with high pain. The results highlight the importance of addressing pain, especially among women with RA, as they reported pain to impact on their valued life activities. Interestingly, this was evident also in women with lower levels of pain.

  • 18.
    Ahlstrand, Inger
    et al.
    School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Vaz, Sharmila
    School of Occupational Therapy & Social Work, CHIRI, Curtin University, Perth, WA, Australia.
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Thyberg, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Björk, Mathilda
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis2017Ingår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, nr 6, s. 824-834Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study whether personal factors (self-efficacy and pain acceptance) mediate the relationship between pain and performance of valued life activities in persons with rheumatoid arthritis.

    METHODS: Persons with rheumatoid arthritis for at least four years (n = 737; 73% women) answered a questionnaire measuring self-efficacy, pain acceptance, performance of valued life activities, and self-rated pain. Relationships among these constructs were explored using univariate and multivariate analyses. Structural equation modelling was then used to examine the mediational role of personal factors on the relationship between pain and performance of valued life activities.

    RESULTS: A direct negative association between pain and performance of valued life activities was identified (Beta = .34, P < .001). This suggests that people with rheumatoid arthritis who had higher levels of pain has increased difficulties in performing valued life activities. Self-efficacy and activity engagement component of pain acceptance mediated the relationship between pain and performance of valued life activities, however the pain willingness component of pain acceptance did not influence participation in valued life activities.

    CONCLUSION: These findings highlight the importance of considering personal factors, such as pain acceptance and self-efficacy, in facilitating participation in valued life activities.

  • 19.
    Ahlstrom, Gerd
    et al.
    Lund Univ, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Benzein, Eva
    Linnaeus Univ, Sweden.
    Behm, Lina
    Lund Univ, Sweden.
    Wallerstedt, Birgitta
    Linnaeus Univ, Sweden.
    Persson, Magnus
    Lund Univ, Sweden.
    Sandgren, Anna
    Linnaeus Univ, Sweden.
    Implementation of knowledge-based palliative care in nursing homes and pre-post post evaluation by cross-over design: a study protocol2018Ingår i: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 17, artikel-id 52Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The demography of the world is changing as the population is ageing. Because of this change to a higher proportion of older people, the WHO has called for improved palliative care for older persons. A large number of all deaths in the industrialised world occur while older people are living in nursing homes and therefore a key question becomes how the principles of palliative care can be implemented in that context. The aims of this study are: a) to describe a model of an educational intervention with the goal of implementing knowledge-based palliative care in nursing homes, and b) to describe the design of the evaluation of the effectiveness regarding the implementation of knowledge-based palliative care. Methods/design: A complex intervention is evaluated by means of a cross-over design. An educational intervention concerning palliative care consisting of five seminars during 6 months for staff and managers has been developed and conducted in 20 nursing homes in two counties. Before the intervention started, the feasibility was tested in a pilot study conducted in nursing homes not included in the main study. The intervention is evaluated through a non-randomized experimental design with intervention and control groups and pre- and post-assessments. The evaluation includes older persons living in nursing homes, next-of-kin, staff and managers. Data collection consists of quantitative methods such as questionnaires and register data and qualitative methods in the form of individual interviews, focus-group interviews and participant observations. Discussion: The research will contribute to new knowledge about how to implement knowledge-based palliative care in a nursing home setting. A strength of this project is that the Medical Research Council framework of complex intervention is applied. The four recommended stages, Development, Feasibility and piloting, Evaluation and Implementation, are combined for the educational intervention, which functions as a strategy to achieve knowledge-based palliative care in the nursing homes. Implementation is always a question of change and a good theoretical understanding is needed for drawing valid conclusions about the causal mechanisms of change. The topic is highly relevant considering the worlds ageing population. The data collection is completed and the analysis is ongoing.

  • 20.
    Ahlström, Christer
    et al.
    VTI, Swedish Natl Rd and Transport Res Inst, Linkoping, Sweden.
    Anund, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. VTI, Swedish Natl Rd and Transport Res Inst, Linkoping, Sweden.
    Fors, Carina
    VTI, Swedish Natl Rd and Transport Res Inst, Linkoping, Sweden.
    Åkerstedt, Torbjorn
    Stockholm Univ, Sweden; Karolinska Inst, Sweden.
    Effects of the road environment on the development of driver sleepiness in young male drivers2018Ingår i: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 112, s. 127-134Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Latent driver sleepiness may in some cases be masked by for example social interaction, stress and physical activity. This short-term modulation of sleepiness may also result from environmental factors, such as when driving in stimulating environments. The aim of this study is to compare two road environments and investigate how they affect driver sleepiness. Thirty young male drivers participated in a driving simulator experiment where they drove two scenarios: a rural environment with winding roads and low traffic density, and a suburban road with higher traffic density and a more built-up roadside environment. The driving task was essentially the same in both scenarios, i.e. to stay on the road, without much interaction with other road users. A 2 x 2 design, with the conditions rural versus suburban, and daytime (full sleep) versus night-time (sleep deprived), was used. The results show that there were only minor effects of the road environment on subjective and physiological indicators of sleepiness. In contrast, there was an increase in subjective sleepiness, longer blink durations and increased EEG alpha content, both due to time on task and to night-time driving. The two road environments differed both in terms of the demand on driver action and of visual load, and the results indicate that action demand is the more important of the two factors. The notion that driver fatigue should be countered in a more stimulating visual environment such as in the city is thus more likely due to increased task demand rather than to a richer visual scenery. This should be investigated in further studies.

  • 21.
    Ahn, Song Ee
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Rimpilainen, Sanna
    University of Stirling, UK.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Fenwick, Tara
    University of Stirling, UK.
    Interprofessional training in technology-enhanced medical simulation: Locations and knowings2013Ingår i: Conference Programme Book: 8th International Conference on Researching Work and Learning 2013, 2013, s. 15-16Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    This paper take an actor-network theory perspective on the use of medical simulators in professional education as a means of training students in medical education and nursing in handling acute emergency situations in health care.  The main aim of the study is to investigate what activities are performed in what material arrangements in a full cycle of simulation, i.e  the briefing, the simulation in the emergency room, the observations in the control room and the debriefing and what knowing is produced as an effect of these arrangements.

     The use of simulators has become a common teaching strategy in medical education. An ageing population, declining financial resources and lack of trained health care personnel are global trends that call for changing the system of health care practice as well as for professional education in the sector.  To build more effective health services, professionals are required to work more collaboratively and in partnership with health care consumers (WHO 2008; 2010). Recently, leading medical experts have also criticised the training of health personnel for not adequately preparing for cooperation and inter-professional communication (Frenk et al, 2010). In health care, this concern situations demanding effective communication for making prompt decisions that are of critical importance in emergency situations. Training of students and professionals by means of full-scale simulators is a response to accommodate for these needs.  Education in simulation-based environments is seen to offer opportunities to address the needs for training interprofessional collaboration by focusing on communication, situation awareness, decision making and coping with stress (Arafeh et al 2010; Östergaard et al,2011). Cook et al has shown in a meta analysis of more than 600 research articles, that in comparison with no intervention, technology-enhanced simulation is consistently associated with large effects for outcomes of knowledge, skills, and behaviors but moderate effects for patient-related outcomes (Cook et al 2011). A majority of the studies are effect studies with quantitative designs. The authors argue that there is a need for rigorous, theory based qualitative studies in order to clarify how and when to effectively use technology enhanced simulations in the training of health care professionals.

     The present study draws upon Actor-network theory (Latour, 2005).  This perspective which situates materiality as a part of the social practices, provides theoretical tools for observation and discussion of the relation between the material assemblages and human actors. Observations of full-scale simulations of acute trauma handling in the emergency room with ten groups of medical and nursing students make up the data for analysis. Preliminary findings indicate that the different locations and material arrangements of the simulation cycle produce different kinds of knowing and learning than the intended curriculum objectives. The findings can contribute to the theoretical knowledge of how to design simulation-based medical education.

     

     

     

     

     

  • 22.
    Ahn, Song Ee
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Rimpiläinen, Sanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Three locations of technology enhanced medical simulation training and their effect on learning and knowing2014Ingår i: Professional Matters: Materialities and virtualities of professional learning, 2014Konferensbidrag (Refereegranskat)
    Abstract [en]

    This qualitative study aims to address the identified gap in literature concerning  the lack of rigorous, theory-based, qualitative studies to clarify how and when to effectively use simulations to train health care professionals (Cook, et al, 2011). By drawing upon actor-network theory (ANT) (Latour, 2005) an approach that situates materiality as a part of the social practices, and provides theoretical tools for observation and discussion of the relation between the material assemblages and human actors, we have investigated how learning takes place during a simulation-based medical training. Knowing and learning, according to ANT, are not simply cognitive or social phenomena, but are seen as emerging as effects of the socio-material networks gathered together and being performed into being in particular locations (Law, 2004; Rimpiläinen, 2011).  In this study we have focussed on observing the socio-material arrangements that emerged in three locations involved in the simulation – the simulation room, the observation room and the reflection room - and analysing what kinds of knowing and learning they have produced through which socio-material arrangements. Data for analysis consists of observations of full-scale simulations of acute trauma handling in the emergency room with ten groups of medical and nursing students.  Preliminary findings indicate that the different locations and material arrangements of the simulation cycle produce different kinds of knowing and learning from the intended curriculum objectives. The findings can contribute to the theoretical knowledge of how to design simulation-based medical education.

  • 23.
    Ahn, Song-Ee
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Utbildningsvetenskap.
    Rimpiläinen, Sanna
    University of Gothenburg.
    Theodorsson, Annette
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurokirurgiska kliniken US.
    Fenwick, Tara
    University of Stirling.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Learning in Technology-Enhanced Medical Simulation:Locations and Knowings2015Ingår i: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 5, nr 2, s. 1-12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This qualitative study focuses on how knowings and learning take place in full-scale simulation training of medical and nursing students, by drawing upon actor-network theory (ANT). ANT situates materiality as a part of the social practic-es. Knowing and learning, according to ANT, are not simply cognitive or social phenomena, but are seen as emerging as effects of the relation between material assemblages and human actors being performed into being in particular locations. Data consists of observations of simulations performed by ten groups of students. The analysis focuses on the emerging knowings in the socio-material—arrangements of three locations involved in the simulation—the simulation room, the observation room and the reflection room. The findings indicate that medical knowing, affective knowing and communicative knowing are produced in different ways in the different locations and material arrangements of the simulation cycle.

  • 24.
    Albrecht, Matthew A.
    et al.
    Curtin University, Australia .
    Stuart, Geoffrey W.
    La Trobe University, Australia .
    Falkmer, Marita
    Curtin University, Australia, Jonköping University, Sweden .
    Ordqvist, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Leung, Denise
    Curtin University, Australia .
    Foster, Jonathan K.
    Curtin University, Australia Health Department WA, Australia .
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Brief Report: Visual Acuity in Children with Autism Spectrum Disorders2014Ingår i: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 44, nr 9, s. 2369-2374Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Recently, there has been heightened interest in suggestions of enhanced visual acuity in autism spectrum disorders (ASD) which was sparked by evidence that was later accepted to be methodologically flawed. However, a recent study that claimed children with ASD have enhanced visual acuity (Brosnan et al. in J Autism Dev Disord 42:2491-2497, 2012) repeated a critical methodological flaw by using an inappropriate viewing distance for a computerised acuity test, placing the findings in doubt. We examined visual acuity in 31 children with ASD and 33 controls using the 2 m 2000 Series Revised Early Treatment Diabetic Retinopathy Study chart placed at twice the conventional distance to better evaluate possible enhanced acuity. Children with ASD did not demonstrate superior acuity. The current findings strengthen the argument that reports of enhanced acuity in ASD are due to methodological flaws and challenges the reported association between visual acuity and systemising type behaviours.

  • 25.
    Alftberg, Åsa
    et al.
    Department of Social Work, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Ahlström, Gerd
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Behm, Lina
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Sandgren, Anna
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Benzein, Eva
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University,Växjö, Sweden.
    Wallerstedt, Birgitta
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Rasmussen, Birgit H.
    Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden. Birgit.Rasmussen@med.lu.se; The Institute for Palliative Care, Region Skane and Lund University, Lund, Sweden.
    Conversations about Death and Dying with Older People: An Ethnographic Study in Nursing Homes2018Ingår i: Healthcare, E-ISSN 2227-9032, Vol. 6, nr 2, artikel-id 63Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Nursing homes are often places where older persons amp;ldquo;come to die.amp;rdquo; Despite this, death and dying are seldom articulated or talked about. The aim of this study was to explore assistant nursesamp;rsquo; experiences of conversations about death and dying with nursing home residents. This study is part of an implementation project through a knowledge-based educational intervention based on palliative care principles. An ethnographic study design was applied in seven nursing homes, where eight assistant nurses were interviewed and followed in their daily assignments through participant observations. The assistant nurses stated that they had the knowledge and tools to conduct such conversations, even though they lacked the time and felt that emotional strain could be a hinder for conversations about death and dying. The assistant nurses used the strategies of distracting, comforting, and disregarding either when they perceived that residentsamp;rsquo; reflections on death and dying were part of their illness and disease or when there was a lack of alignment between the residentsamp;rsquo; contemplations and the concept of dying well. They indicated that ambivalence and ambiguity toward conversations about death and dying should be taken into consideration in future implementations of knowledge-based palliative care that take place in nursing homes after this project is finalized.

  • 26.
    Alföldi, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Dragioti, Elena
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Wiklund, Tobias
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    SPREADING OF PAIN AND INSOMNIA IN PATIENTS WITH CHRONIC PAIN: RESULTS FROM A NATIONAL QUALITY REGISTRY (SQRP)2017Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 1, s. 63-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore how demographics, pain, psychosocial factors and insomnia relate to the spread of chronic pain. Methods: The study included 708 patients (68% women; median age 46 years; interquartile range 3557 years) with chronic pain who were referred to a multidisciplinary pain centre. Spreading of pain was assessed using a questionnaire covering 36 anatomically predefined pain regions. Data were collected on demographics, pain symptoms, psychological distress, and insomnia (Insomnia Severity Index). Four sub-categories of chronic pain were established: chronic local pain, chronic regional pain medium, chronic regional pain heavy, and chronic widespread pain. Results: The median number of pain regions was 10 (interquartile range 6-18). Prevalence of chronic pain was as follows: chronic local pain 9%, chronic regional pain medium 21%, chronic regional pain heavy 39%, and chronic widespread pain 31%. In the regression models, being a woman and persistent pain duration had the strongest associations with spreading of pain, but anxiety, pain interference, and insomnia were also important factors. Conclusion: Spreading of chronic pain can only partly be explained by the simultaneous levels of insomnia. Female sex, pain duration, pain interference and anxiety appear to have more significant relationships with the spread of pain. Targeting these factors may lead to improvements in treatment and prevention strategies.

  • 27.
    Alföldi, Peter
    et al.
    Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin.
    Gerdle, Björn
    Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin.
    Wiklund, Tobias
    Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin.
    Comorbid insomnia in patients with chronic pain: a study based on the Swedish quality registry for pain rehabilitation (SQRP)2014Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 36, nr 20, s. 1661-1669Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: This study investigates the prevalence of insomnia and its relationship to other symptoms and health aspects in patients with chronic pain. Methods: Patients with chronic pain conditions (n = 845) referred to a multidisciplinary pain centre completed surveys provided by the Swedish quality registry for pain rehabilitation (SQRP). The SQRP collects data on socio-demographics, health status, symptoms of pain, mood and insomnia and life satisfaction. Results: The majority of patients (65.3%) had clinical insomnia according to the insomnia severity index (ISI). Insomnia correlated significantly but weakly with pain, depression, anxiety and coping; the strongest multivariate correlations were found with depression and anxiety followed by pain interference and pain severity. Pain intensity, depression and anxiety correlated stronger than ISI with respect to the two investigated aspects of health. Conclusions: The prevalence of insomnia is high in patients with chronic pain conditions, but the level of importance in relation to other symptoms for health aspects is low, and the associations with other important symptoms are relatively weak. One way to increase the effects of multimodal rehabilitation programs may be to provide interventions directed specifically at insomnia rather than focusing only on interventions that address pain, depression and anxiety. Implications for Rehabilitation The prevalence of insomnia is high in patients with complex chronic pain conditions. Relatively low correlations existed between insomnia and pain intensity, depression, anxiety and other psychological aspects. Pain intensity, anxiety and depression were more important for perceived health aspects than insomnia. One way to increase the effects of multimodal rehabilitation programs may be to also include interventions directed directly to insomnia.

  • 28.
    Al-Karkhi, Isam
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Al-Rubaiy, Raad
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Rosenqvist, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Medicinska specialistkliniken .
    Falk, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvården i centrala länsdelen. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Nyström, Fredrik H
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Endokrinmedicinska kliniken.
    Comparisons of automated blood pressures in a primary health care setting with self-measurements at the office and at home using the Omron i-C10 device2015Ingår i: Blood Pressure Monitoring, ISSN 1359-5237, E-ISSN 1473-5725, Vol. 20, nr 2, s. 98-103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: We aimed to compare blood pressure (BP) levels recorded using the semiautomatic oscillometric Omron i-C10 BP device in patients with or without hypertension in three different settings: (a) when used by a doctor or a nurse at the office (OBP); (b) when used for self-measurement by the patient at the office (SMOBP); and (c) when used for 7 consecutive days at home (HBP).

    MATERIALS AND METHODS: A total of 247 individuals were invited to participate, but 78 of these individuals declined and a further seven were excluded, leaving a final cohort of 162 participants.

    RESULTS: The mean OBP was higher than HBP (difference 8.1±14/3.1±8.8 mmHg, P<0.0001) and so was SMOBP compared with HBP (difference 7.0±13/4.2±7.3 mmHg, P<0.0001). Sixteen participants (9.9%) had at least 10 mmHg higher systolic SMOBP than OBP and 28 (17%) participants had at least 10 mmHg lower systolic SMOBP than OBP. Participants who were current smokers had a larger mean difference between systolic OBP and SMOBP than nonsmokers (OBP-SMOBP in smokers: 6.6±9.4 mmHg, OBP-SMOBP in nonsmokers: 0.5±9.2 mmHg, P=0.011 between groups).

    CONCLUSION: Self-measurement of BP in the office does not preclude an increase in BP when levels in the individual patients are compared with HBP using the same equipment. Thus, SMOBP with a semiautomatic device does not lead to a reduction in the white-coat effect in the same manner as fully automatic devices.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.

  • 29.
    Allvin, Renée
    et al.
    Clinical Skills Centre, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro.
    Berndtzon, Magnus
    Metodikum - Skill Centre of Medical Simulation Region County Jönköping, Jönköping.
    Carlzon, Liisa
    Simulation Centre West, Department of Research, Education and Development, Sahlgrenska University Hospital, Gothenburg.
    Edelbring, Samuel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm.
    Hult, Håkan
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Hultin, Magnus
    Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Medical Faculty, Umeå University, Umeå.
    Karlgren, Klas
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm; Department of Research, Education and Development and Innovation, Södersjukhuset Hospital, Stockholm.
    Masiello, Italo
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset Hospital, Stockholm.
    Södersved Källestedt, Marie-Louise
    Clinical Skills Centre, Centre for Clinical Research, Uppsala University, Västerås.
    Tamás, Éva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Confident but not theoretically grounded: experienced simulation educators perceptions of their own professional development2017Ingår i: Advances in Medical Education and Practice, ISSN 1179-7258, E-ISSN 1179-7258, Vol. 8, s. 99-108Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Medical simulation enables the design of learning activities for competency areas (eg, communication and leadership) identified as crucial for future health care professionals. Simulation educators and medical teachers follow different career paths, and their education backgrounds and teaching contexts may be very different in a simulation setting. Although they have a key role in facilitating learning, information on the continuing professional development (pedagogical development) of simulation educators is not available in the literature.

    Objectives: To explore changes in experienced simulation educators’ perceptions of their own teaching skills, practices, and understanding of teaching over time.

    Methods: A qualitative exploratory study. Fourteen experienced simulation educators participated in individual open-ended interviews focusing on their development as simulation educators. Data were analyzed using an inductive thematic analysis.

    Results: Marked educator development was discerned over time, expressed mainly in an altered way of thinking and acting. Five themes were identified: shifting focus, from following to utilizing a structure, setting goals, application of technology, and alignment with profession. Being confident in the role as an instructor seemed to constitute a foundation for the instructor’s pedagogical development.

    Conclusion: Experienced simulation educators’ pedagogical development was based on self-confidence in the educator role, and not on a deeper theoretical understanding of teaching and learning. This is the first clue to gain increased understanding regarding educational level and possible education needs among simulation educators, and it might generate several lines of research for further studies.

  • 30.
    Almberg, Maria
    et al.
    Mobil Centre Gothenburg, Sweden.
    Selander, Helena
    Mobil Centre Gothenburg, Sweden; University of Gothenburg, Sweden.
    Falkmer, Marita
    Curtin University, Australia; Jonköping University, Sweden.
    Vaz, Sharmila
    Curtin University, Australia.
    Ciccarelli, Marina
    Curtin University, Australia.
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. Curtin University, Australia.
    Experiences of facilitators or barriers in driving education from learner and novice drivers with ADHD or ASD and their driving instructors2017Ingår i: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 20, nr 2, s. 59-67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Little is known about whether individuals with autism spectrum disorder (ASD) or attention deficit hyperactive disorder (ADHD) experience any specific facilitators or barriers to driving education. Objective: To explore the facilitators or barriers to driving education experienced by individuals with ASD or ADHD who obtained a learners permit, from the perspective of the learner drivers and their driving instructors. Methods: Datawere collected from33 participants with ASD or ADHD, and nine of their driving instructors. Results: Participants with ASD required twice asmany driving lessons andmore on-road tests than those with ADHD. Participants with ADHD repeated the written tests more than those with ASD. Driving license theory was more challenging for individuals with ADHD, whilst individuals with ASD found translating theory into practice and adjusting to "unfamiliar driving situations to be the greatest challenges. Conclusion: Obtaining a driving license was associated with stressful training experience.

  • 31.
    Alonso, Juan-Manuel
    et al.
    Int Assoc Athlet Federat, Med & Antidoping Commiss, Monaco, Monaco; Qatar Orthoped & Sports Med Hosp, Sports Med Dept, Aspetar, Doha, Qatar.
    Jacobsson, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Centrum för hälso- och vårdutveckling, Folkhälsocentrum.
    Ronsen, Ola
    Int Assoc Athlet Federat, Med & Antidoping Commiss, Monaco, Monaco; Aker Solut, Lysaker, Norway.
    Kajenienne, Alma
    Int Assoc Athlet Federat, Med & Antidoping Commiss, Monaco, Monaco; Lithuanian Univ Hlth Sci, Inst Sport, Kaunas, Lithuania.
    Dahlström, Örjan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap, Institutet för handikappvetenskap, IHV.
    Spreco, Armin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Edouard, Pascal
    Univ Hosp St Etienne, Fac Med, Sports Med Unity, Dept Clin & Exercise Physiol, St Etienne, France; Univ Lyon, Exercise Physiol Lab, LPE EA 4338, St Etienne, France; French Athlet Federat, Med Commiss, Paris, France.
    Preparticipation injury complaint is a risk factor for injury: a prospective study of the Moscow 2013 IAAF Championships.2015Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 49, nr 17, s. 1118-U45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To determine the health status of athletes before the start of an international athletics championship and to determine whether preparticipation risk factors predicted in-championship injuries.

    METHODS: At the beginning of the 2013 International Association of Athletics Federations (IAAF) World Championships, all registered athletes (n=1784) were invited to complete a preparticipation health questionnaire (PHQ) on health status during the month preceding the championships. New injuries that occurred at the championships were prospectively recorded.

    RESULTS: The PHQ was completed by 698 (39%) athletes; 204 (29.2%) reported an injury complaint during the month before the championships. The most common mode of onset of preparticipation injury complaints was gradual (43.6%). Forty-nine athletes in the study reported at least one injury during the championships. Athletes who reported a preparticipation injury complaint were at twofold increased risk for an in-championship injury (OR=2.09; 95% CI 1.16 to 3.77); p=0.014). Those who reported a preparticipation gradual-onset injury complaint were at an almost fourfold increased risk for an in-championship time-loss injury (OR=3.92; 95% CI 1.69 to 9.08); p=0.001). Importantly, the preparticipation injury complaint severity score was associated with the risk of sustaining an in-championship injury (OR=1.14; 95% CI 1.06 to 1.22); p=0.001).

    SUMMARY AND CONCLUSIONS: About one-third of the athletes participating in the study reported an injury complaint during the month before the championships, which represented a risk factor for sustaining an injury during the championship. This study emphasises the importance of the PHQ as a screening tool to identify athletes at risk of injuries before international championships.

  • 32.
    Alvarsson, Michael
    et al.
    Institutionen för molekylär medicin och kirurgi, Karolinska institutet - PO Endokrinologi och njurmedicin Stockholm, Sweden Institutionen för molekylär medicin och kirurgi, Karolinska institutet - PO Endokrinologi och njurmedicin Stockholm, Sweden.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ödeshög.
    Ny era inom terapin för typ 2-diabetes – men vad är nytt?: Metformin fortfarande förstahandsval, men därefter rekommenderas att behandlingen individualiseras2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    n/a

  • 33.
    Aman, Malin
    et al.
    Swedish Sch Sport and Hlth Sci, Sweden.
    Larsen, Karin
    Swedish Sch Sport and Hlth Sci, Sweden; Umea Univ, Sweden.
    Forssblad, Magnus
    Swedish Sch Sport and Hlth Sci, Sweden; Karolinska Inst, Sweden.
    Näsmark, Annica
    Swedish Sch Sport and Hlth Sci, Sweden; Capio Artro Clin, Sweden.
    Waldén, Markus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Swedish Sch Sport and Hlth Sci, Sweden.
    Hägglund, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Swedish Sch Sport and Hlth Sci, Sweden.
    A Nationwide Follow-up Survey on the Effectiveness of an Implemented Neuromuscular Training Program to Reduce Acute Knee Injuries in Soccer Players2018Ingår i: The Orthopaedic Journal of Sports Medicine, ISSN 2325-9671, Vol. 6, nr 12, artikel-id 2325967118813841Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A cruciate ligament (CL) injury is a severe injury in soccer. Neuromuscular training programs have a well-documented preventive effect, but there are few studies on the effectiveness of such a program at a national level. The Swedish Knee Control Program (KCP) was found to be effective in preventing CL injuries in youth female soccer players. The KCP was implemented nationwide in Sweden in 2010. Purpose: To evaluate the effectiveness of the Swedish KCP in reducing acute knee injuries in soccer players at a nationwide level. Study Design: Descriptive epidemiology study. Methods: All licensed soccer players in Sweden are covered by the same insurance company. Using this insurance database, around 17,500 acute knee injuries that were reported to the insurance company between 2006 and 2015 were included in the study. By matching the number of licensed soccer players with the number of reported injuries each year, the annual incidence of knee and CL injuries was able to be calculated. To evaluate the spread of the KCP nationally, a questionnaire was sent to all 24 Swedish district football associations (FAs) with questions regarding KCP education. The number of downloads of the KCP mobile application (app) was obtained. Results: The incidence of CL injuries decreased during the study period for both male (from 2.9 to 2.4 per 1000 player-years) and female players (from 4.9 to 3.9 per 1000 player-years). The overall incidence of knee injuries decreased in both male (from 5.6 to 4.6 per 1000 player-years) and female players (from 8.7 to 6.4 per 1000 player-years). Comparing before and after the nationwide implementation of the KCP, there was a decrease in the incidence of CL injuries by 6% (rate ratio [RR], 0.94 [95% CI, 0.89-0.98]) in male players and 13% (RR, 0.87 [95% CI, 0.81-0.92]) in female players and a decrease in the incidence of knee injuries by 8% (RR, 0.92 [95% CI, 0.89-0.96]) and 21% (RR, 0.79 [95% CI, 0.75-0.83]), respectively (P amp;lt; .01 for all). This trend corresponded to a reduction of approximately 100 CL injuries each year in Sweden. A total of 21 of 24 district FAs held organized KCP educational courses during the study period. The percentage of district FAs holding KCP courses was between 46% and 79% each year. There were 101,236 downloads of the KCP app. Conclusion: The KCP can be considered partially implemented nationwide, and the incidence of knee and CL injuries has decreased in both sexes at a nationwide level.

  • 34.
    Andersen, Pia
    et al.
    Department of Research and Development, Region Kronoberg, Sweden.
    Holmberg, Sara
    Region Kronoberg, Sweden.
    Lendahls, Lena
    Department of Research and Development, Region Kronoberg, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Kristenson, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Physical Activity on Prescription with Counsellor Support: A 4-Year Registry-Based Study in Routine Health Care in Sweden2018Ingår i: Healthcare, E-ISSN 2227-9032, Vol. 6, nr 2, artikel-id E34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Public health gains from physical activity on prescription (PAP) depend on uptake in routine care. We performed an evaluation of the implementation, in a Swedish county council, of counsellors who give personalized support to PAP recipients aimed at facilitating PAP delivery. The aim was to compare characteristics between PAP recipients and the health care population as well as between PAP recipients who used and did not use counsellor support. We also investigated professional belonging and health care setting of health care professionals who prescribed PAP. 

    Methods: All patients’ ≥18 years who received PAP during 2009–2012 in primary and secondary care in the County Council of Kronoberg were included (n = 4879). Data were retrieved from electronic medical records. Main outcome measures were patient and professional characteristics. 

    Results: A third of the PAP recipients had diseases in ≥5 diagnostic groups and more than half had ≥11 office visits the year before receiving PAP. Counsellor support was used by one-third and PAP recipients who used counsellor support had more multiple diagnoses and office visits compared with non-users. Physicians issued 44% of prescriptions and primary care was the predominant setting. The amount of PAP did not change over time, but the proportion of physicians’ prescriptions decreased while the proportion of nurses’ prescriptions increased. 

    Conclusions: PAP recipients had high morbidity and were frequent health care attenders, indicating that PAP was predominantly used for secondary or tertiary prevention. PAP rates did not increase as intended after the implementation of counsellor support. View Full-Text

  • 35.
    Andersen, Pia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Tekniska fakulteten. Reg Kronoberg, Sweden.
    Lendahls, Lena
    Reg Kronoberg, Sweden; Linnaeus Univ, Sweden.
    Holmberg, Sara
    Reg Kronoberg, Sweden; Lund Univ, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Patients experiences of physical activity on prescription with access to counsellors in routine care: a qualitative study in Sweden2019Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, artikel-id 210Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundPhysical activity on prescription (PAP) has been implemented in several countries, including Sweden, to support patients who might benefit from increased physical activity. This study explores the experiences of recipients of PAP in routine health care in Sweden that offers the recipients support from physical activity counsellors. The aim was to explore influences on engagement in physical activity by PAP recipients from a long-term perspective.MethodsWe conducted individual semi-structured interviews using a topic guide with a purposively selected sample of 13 adult PAP recipients 1.5 to 2.5years after PAP. Interviews were recorded, transcribed verbatim and analysed through inductive and deductive content analysis. The questions were informed by Capability-Opportunity-Motivation-Behaviour (COM-B), which was also used as a framework to analyse the data by means of categorizing the factors (influences on the behaviour).ResultsTen factors (i.e. sub-categories) that influenced the participants engagement in physical activity were identified. PAP recipients capability to engage in physical activity was associated with adapting the PAP to the individuals physical capacity and taking into account the individuals previous experiences of physical activity. PAP recipients opportunity to engage in physical activity was related to receiving a prescription, receiving professional counselling and follow-up from a physical activity counsellor, collaboration between prescriber and counsellor, having access to appropriate activities, having a balanced life situation and having support from someone who encouraged continued physical activity. PAP recipients motivation to engage in physical activity was associated with the desire to improve his or her health condition and finding activities that encouraged continuation.ConclusionsPAP recipients engagement in physical activity was influenced by their capability, opportunity and motivation to undertake this behaviour. Numerous extraneous factors influence capability and motivation. Physical activity counsellors were found to be important for sustained activity because they use an individual approach to counselling and flexible follow-up adapted to each individuals need of support.

  • 36.
    Andersen, Åsa
    et al.
    Uppsala University, Sweden.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Anderzen, Ingrid
    Uppsala University, Sweden.
    Kristiansson, Per
    Uppsala University, Sweden.
    Larsson, Kjerstin
    Uppsala University, Sweden.
    Positive experiences of a vocational rehabilitation intervention for individuals on long-term sick leave, the Dirigo project: a qualitative study2017Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, artikel-id 790Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The process of returning to work after long-term sick leave can sometimes be complex. Many factors, (e.g. cooperation between different authorities and the individual as well as individual factors such as health, emotional well-being and self-efficacy) may have an impact on an individuals ability to work. The aim of this study was to investigate clients experiences with an individually tailored vocational rehabilitation, the Dirigo project, and encounters with professionals working on it. The Dirigo project was based on collaboration between rehabilitation authorities, individually tailored interventions and a motivational interviewing approach. Methods: A descriptive qualitative design was used with data collected through interviews. Fourteen individuals on long-term sick leave took part in individual semi-structured interviews. The interviews were analysed using content analysis. Results: The analysis showed overall positive experience of methods and encounters with professionals in a vocational rehabilitation project. The positive experiences were based on four key factors: 1. Opportunities for receiving various dimensions of support. 2. Good overall treatment by the professionals. 3. Satisfaction with the working methods of the project, and 4. Opportunities for personal development. Conclusions: The main result showed that the clients had an overall positive experience of a vocational rehabilitation project and encounters with professionals who used motivational interviewing as a communication method. The overall positive experience indicated that their interactions with the different professionals may have affected their self-efficacy in general and in relation to transition to work. The knowledge is essential for the professionals working in the area of vocational rehabilitation. However, vocational rehabilitation interventions also need a societal approach to be able to offer clients opportunities for job training and real jobs.

  • 37.
    Anderson, Peter
    et al.
    Newcastle University, England; Maastricht University, Netherlands.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Medicinska specialistkliniken.
    Spak, Fredrik
    University of Gothenburg, Sweden.
    Reynolds, Jillian
    Hospital Clin Barcelona, Spain.
    Drummond, Colin
    Kings Coll London, England; South London and Maudsley NHS Fdn Trust, England.
    Segura, Lidia
    Govt Catalonia, Spain.
    Keurhorst, Myrna N.
    Radboud University of Nijmegen, Netherlands.
    Palacio-Vieira, Jorge
    Govt Catalonia, Spain.
    Wojnar, Marcin
    Medical University of Warsaw, Poland.
    Parkinson, Kathryn
    Newcastle University, England.
    Colom, Joan
    Govt Catalonia, Spain.
    Kloda, Karolina
    Pomeranian Medical University, Poland.
    Deluca, Paolo
    Kings Coll London, England.
    Baena, Begona
    Govt Catalonia, Spain.
    Newbury-Birch, Dorothy
    Newcastle University, England.
    Wallace, Paul
    UCL, England.
    Heinen, Maud
    Radboud University of Nijmegen, Netherlands.
    Wolstenholme, Amy
    Kings Coll London, England.
    van Steenkiste, Ben
    Maastricht University, Netherlands.
    Mierzecki, Artur
    Pomeranian Medical University, Poland.
    Okulicz-Kozaryn, Katarzyna
    State Agency Prevent Alcohol Related Problems, Poland.
    Ronda, Gaby
    Maastricht University, Netherlands.
    Kaner, Eileen
    Newcastle University, England.
    Laurant, Miranda G. H.
    Radboud University of Nijmegen, Netherlands; HAN University of Appl Science, Netherlands.
    Coulton, Simon
    University of Kent, England.
    Gual, Toni
    Hospital Clin Barcelona, Spain.
    Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial2016Ingår i: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 111, nr 11, s. 1935-1945Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimTo test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers. DesignCluster randomized factorial trial with 12-week implementation and measurement period. SettingPrimary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden. ParticipantsA total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden. InterventionsPHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI. MeasurementsThe primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period. FindingsDuring a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI=1.13-1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI=1.56-2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI=1.77-3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI=1.11-2.53). ConclusionsProviding primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption.

  • 38.
    Anderson, Peter
    et al.
    Newcastle University, England; Maastricht University, Netherlands.
    Coulton, Simon
    University of Kent, England.
    Kaner, Eileen
    Newcastle University, 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.
    Kloda, Karolina
    Pomeranian Medical University, Poland.
    Reynolds, Jillian
    Hospital Clin Barcelona, Spain.
    Segura, Lidia
    Govt Catalonia, Spain.
    Wojnar, Marcin
    Medical University of Warsaw, Poland.
    Mierzecki, Artur
    Pomeranian Medical University, Poland.
    Deluca, Paolo
    Kings Coll London, England.
    Newbury-Birch, Dorothy
    University of Teesside, England.
    Parkinson, Kathryn
    Newcastle University, England.
    Okulicz-Kozaryn, Katarzyna
    State Agency Prevent Alcohol Related Problems, Poland.
    Drummond, Colin
    Kings Coll London, England; South London and Maudsley NHS Fdn Trust, England.
    Gual, Antoni
    Hospital Clin Barcelona, Spain.
    Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial2017Ingår i: Annals of family medicine (online), ISSN 1544-1709, E-ISSN 1544-1717, Vol. 15, nr 4, s. 335-340Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE We aimed to test whether 3 strategies-training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice-have a longer-term effect on primary care clinicians delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool. METHODS We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention-screening and, if screen-positive, advice-at 9 months. RESULTS Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03-1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention. CONCLUSIONS Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months.

  • 39.
    Anderson, Peter
    et al.
    Newcastle University, England; Maastricht University, Netherlands.
    Kaner, Eileen
    Newcastle University, England.
    Keurhorst, Myrna
    Radboud University of Nijmegen, Netherlands; Saxion University of Appl Science, Netherlands.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Medicinska specialistkliniken.
    van Steenkiste, Ben
    Maastricht University, Netherlands.
    Reynolds, Jillian
    IDIBAPS, Spain.
    Segura, Lidia
    Govt Catalonia, Spain.
    Wojnar, Marcin
    Medical University of Warsaw, Poland.
    Kloda, Karolina
    Pomeranian Medical University, Poland.
    Parkinson, Kathryn
    Newcastle University, England.
    Drummond, Colin
    Kings Coll London, England; Maudsley NHS Fdn Trust, England.
    Okulicz-Kozaryn, Katarzyna
    State Agency Prevent Alcohol Related Problems, Poland.
    Mierzecki, Artur
    Pomeranian Medical University, Poland.
    Laurant, Miranda
    Radboud University of Nijmegen, Netherlands; HAN University of Appl Science, Netherlands.
    Newbury-Birch, Dorothy
    University of Teesside, England.
    Gual, Antoni
    IDIBAPS, Spain.
    Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial2017Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, nr 2, artikel-id 121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training and support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCUs) in different locations throughout Catalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training and support and financial reimbursement to providers. Our design was a randomized factorial trial with baseline measurement period, 12-week implementation period, and 9-month follow-up measurement period. Our outcome measures were: attitudes of individual providers in working with drinkers as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and the proportion of consulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was then associated with more positive attitudes. Training and support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudes through its impact on higher intervention activity. We conclude that improving primary health care providers screening and brief advice activity for heavy drinking requires a combination of training and support and on-the-job experience of actually delivering screening and brief advice activity.

  • 40.
    Anderson, Peter
    et al.
    Newcastle Univ, England; Maastricht Univ, Netherlands.
    Kloda, Karolina
    Pomeranian Med Univ, Poland.
    Kaner, Eileen
    Newcastle Univ, England.
    Reynolds, Jillian
    Hosp Clin Barcelona, Spain.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Medicinska specialistkliniken.
    Pelgrum-Keurhorst, Myrna N.
    Radboud Univ Nijmegen, Netherlands; Saxion Univ Appl Sci, Netherlands.
    Segura, Lidia
    Govt Catalonia, Spain.
    Wojnar, Marcin
    Med Univ Warsaw, Poland.
    Mierzecki, Artur
    Pomeranian Med Univ, Poland.
    Deluca, Paolo
    King’s College London, London, UK.
    Newbury-Birch, Dorothy
    Teesside Univ, England.
    Parkinson, Kathryn
    Newcastle Univ, England; State Agcy Prevent Alcohol Related Problems, Poland.
    Okulicz-Kozaryn, Katarzyna
    State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland.
    Drummond, Colin
    Kings Coll London, England; South London and Maudsley NHS Fdn Trust, England.
    Laurant, Miranda G. H.
    Radboud Univ Nijmegen, Netherlands; HAN Univ Appl Sci, Netherlands.
    Gual, Antoni
    Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain.
    Impact of practice, provider and patient characteristics on delivering screening and brief advice for heavy drinking in primary healthcare: Secondary analyses of data from the ODHIN five-country cluster randomized factorial trial2017Ingår i: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 23, nr 1, s. 241-245Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The implementation of primary healthcare-based screening and advice that is effective in reducing heavy drinking can be enhanced with training. Objectives: Undertaking secondary analysis of the five-country ODHIN study, we test: the extent to which practice, provider and patient characteristics affect the likelihood of patients being screened and advised; the extent to which such characteristics moderate the impact of training in increasing screening and advice; and the extent to which training mitigates any differences due to such characteristics found at baseline. Methods: A cluster randomized factorial trial involving 120 practices, 746 providers and 46 546 screened patients from Catalonia, England, the Netherlands, Poland, and Sweden. Practices were randomized to receive training or not to receive training. The primary outcome measures were the proportion of adult patients screened, and the proportion of screen-positive patients advised. Results: Nurses tended to screen more patients than doctors (OR = 3.1; 95% CI: 1.9, 4.9). Screenpositive patients were more likely to be advised by doctors than by nurses (OR = 2.3; 95% CI: 1.4, 4.1), and more liable to be advised the higher their risk status (OR = 1.9; 95% CI: 1.3, 2.7). Training increased screening and advice giving, with its impact largely unrelated to practice, provider or patient characteristics. Training diminished the differences between doctors and nurses and between patients with low or high-risk status. Conclusions: Training primary healthcare providers diminishes the negative impacts that some practice, provider and patient characteristics have on the likelihood of patients being screened and advised.

  • 41.
    Andersson, Kristin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Närsjukvården i västra Östergötland, Medicinska specialistkliniken.
    Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative2015Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, nr 31Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care.

    Methods: A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional model of care. Outcomes were defined using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting regular practice of lifestyle promotion; implementation, fidelity to the original lifestyle team protocol. Data collection methods included a patient questionnaire (n = 888), a staff questionnaire (n = 120) and structured interviews with all practice managers and, where applicable, team managers (n = 8). The chi square test and problem-driven content analysis was used to analyse the questionnaire and interview data, respectively.

    Results:Reach: patients at control centres (48%, n = 211) received lifestyle promotion significantly more often compared with patients at intervention centres (41%, n = 169). Effectiveness: intervention staff was significantly more positive towards the effectiveness of lifestyle promotion, shared competency and how lifestyle promotion was prioritized at their centre. Adoption: 47% of staff at intervention centres and 58% at control centres reported that they asked patients about their lifestyle on a daily basis. Implementation: all intervention centres had implemented multi-professional teams and team managers and held regular meetings but struggled to implement in-house referral structures for lifestyle promotion, which was used consistently among staff.

    Conclusions:Intervention centres did not show higher rates than control centres on reach of patients or adoption among staff at this stage. All intervention centres struggled to implement working referral structures for lifestyle promotion. Intervention centres were more positive on effectiveness outcomes, attitudes and competency among staff, however. Thus, lifestyle teams may facilitate lifestyle promotion practice in terms of increased responsiveness among staff, illustrated by positive attitudes and perceptions of shared competency. More research is needed on lifestyle promotion referral structures in primary care regarding their configuration and implementation.

  • 42.
    Andersson, Per
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Karlsson, Jan-Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Department of Internal Medicine, County Council of Jönköping, Jönköping.
    Landberg, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi.
    Festin, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Norrköping, Sweden.
    Consequences of high-sensitivity troponin T testing applied in a primary care population with chest pain compared with a commercially available point-of-care troponin T analysis: an observational prospective study2015Ingår i: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 8, nr 1, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:There is a demand for a highly sensitive and specific point-of care test to detect acute myocardial infarction (AMI). It is unclear if a high-sensitivity troponin assay will have enough discriminative power to become a decision support in primary care. The aim of this study was to evaluate a high-sensitivity troponin T assay performed in three primary health care centres in southeast Sweden and to compare the outcome with a point-of-care troponin T test.METHODS:This study included 115 patients who consulted their general practitioner for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue in the last 7days. Troponin T was analysed by a point-of-care test and a high-sensitivity method together with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and creatinine. All patients were checked for AMI or unstable angina (UA) within 30days of study enrolment. Univariate and multivariate logistic regression was carried out to examine possible connections between troponin T[greater than or equal to]15ng/L, clinical variables and laboratory findings at baseline. In addition, 21 patients with troponin T[greater than or equal to]15ng/L and no signs of AMI or UA were followed up for 2-3years.RESULTS:Three patients were diagnosed with AMI and three with UA. At the [greater than or equal to]15ng/L cut-off, the troponin T method had 100% sensitivity, 75% specificity for AMI and a positive predictive value of 10%. The troponin T point-of-care test missed one case of AMI and the detection limit was 50ng/L. Troponin T[greater than or equal to]15ng/L was correlated to age [greater than or equal to]65years (odds ratio (OR), 10.9 95% CI 2.28-51.8) and NT-proBNP in accordance with heart failure (OR 8.62 95% CI 1.61-46.1). Fourteen of the 21 patients, without signs of AMI or UA at baseline, still had increased troponin T at follow-up after 2-3years.CONCLUSIONS:A high-sensitivity troponin T assay could become useful in primary care as a point-of-care test for patients <65years. For patients older than 65-70years, a higher decision limit than [greater than or equal to]15ng/L should be considered and used in conjunction with clinical parameters and possibly with NT-proBNP.

  • 43.
    Andersson, Per
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ljungsbro.
    Sederholm Lawesson, Sofia
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Karlsson, Jan-Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Dept Internal Med, Sweden.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Vikbolandet.
    Thylén, Ingela
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Characteristics of patients with acute myocardial infarction contacting primary healthcare before hospitalisation: a cross-sectional study2018Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, artikel-id 167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The characteristics of patients with on-going myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients. Methods: This was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014. Results: A total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66 +/- 11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (pamp;lt;0.01). The probability of utilising the PHC before hospitalisation was associated with fluctuating symptoms (OR 1.74), pain intensity (OR 0.90) symptoms during off-hours (OR 0.42), study hospital (OR 3.49 and 2.52, respectively, for two of the county hospitals) and a final STEMI diagnosis (OR 0.58). Conclusions: Ambulance services are still underutilized in acute MI patients. A substantial part of the patients contacts their primary healthcare centre before they are diagnosed with MI, although experiencing cardinal symptoms such as chest pain. There is need for better knowledge in the population about symptoms of MI and adequate pathways to qualified care. Knowledge and awareness amongst primary healthcare professionals on the occurrence of MI patients is imperative.

  • 44.
    Andersson, Sten-Ove
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Militär akutsjukvård i fält: när den övade verkligheten blir verklig2014Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Aims: Governing for the Armed Forces health care is respect for human dignity and the view of each individual as irreplaceable. The quality of the military care will be at a level equivalent to that of today's civil peace healthcare, which requires that the training is of high quality. Casualty care in the military environment is a complex, challenging and dangerous task. Today there is a lack of knowledge about how to learn these skills. The purpose of the research was to identify the knowledge area pre-hospital care in the military environment by examining what doctors, nurses, paramedics and officers learn about military health care during preparation and exercise.

    Method: A phenomenographic approach was used in all sub-studies, and empirical data were collected by means of semi-structured interviews. Study I‐III are cross-sectional studies and study IV is a longitudinal study. Twelve registered nurses who had served in Bosnia were interviewed for study I, and 24 conscript paramedics were interviewed for study II. Study III included 20 officers in their pre-deployment training for service in Afghanistan and Liberia, and Study IV included 7 doctors and twenty nurses who previously had served in Afghanistan, Bosnia, Kosovo and Liberia.

    Results: Learning military health care by training and gaining experience can be seen as different abilities; interaction, action and reflection. In-depth analysis at a meta--‐level revealed that the integration between the military and military medical fields of knowledge was missing. The results indicate that participants' understanding of their respective fields of knowledge is inadequate and needs to be integrated in education in a clearer way.

    Implications: To create opportunities for better education and integration in these fields of knowledge are proposed (1) that the findings of the thesis could be utilised to develop the design of the curriculum (2) the inter-professional learning is introduced as a part of creating a safer and more effective pre-hospital care, (3) the clinical competence becomes part of the development of pre-hospital emergency care in the field, and (4) that the training is built according to the principle of "train as you fight" with emphasis on the requirements in the combat zone.

    Delarbeten
    1. The criteria nurses use in assessing acute trauma in military emergency care
    Öppna denna publikation i ny flik eller fönster >>The criteria nurses use in assessing acute trauma in military emergency care
    2007 (Engelska)Ingår i: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 15, nr 3, s. 148-156Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Emergency medical care for seriously injured patients in war or warlike situations is highly important when it comes to soldiers' survival and morale. The Swedish Armed Forces sends nurses, who have limited experience of caring for injured personnel in the field, on a variety of international missions. The aim of this investigation was to identify the kind of criteria nurses rely on when assessing acute trauma and what factors are affecting the emergency care of injured soldiers. A phenomenographic research approach based on interviews was used. The database for the study consists of twelve nurses who served in Bosnia in 1994-1996. The criteria nurses rely on, when assessing acute trauma in emergency care, could be described in terms of domain-specific criteria such as a physiological, an anatomical, a causal and a holistic approach as well as contextual criteria such as being able to communicate, having a sense of belonging, the military environment, the conscript medical orderly and familiarity with health-caring activity. The present study shows that the specific contextual factors affecting emergency care in the field must also be practised before the nurse faces military emergency care situations. This calls for realistic exercises and training programs, where experience from civilian emergency care is interwoven with the knowledge specific to military medical care. © 2007 Elsevier Ltd. All rights reserved.

    Nyckelord
    International mission, Military emergency care, Military nursing, Qualitative method
    Nationell ämneskategori
    Samhällsvetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-49199 (URN)10.1016/j.aaen.2007.05.002 (DOI)
    Tillgänglig från: 2009-10-11 Skapad: 2009-10-11 Senast uppdaterad: 2017-12-12
    2. Interaction, action, and reflection: how medics learn medical care in the Swedish armed forces
    Öppna denna publikation i ny flik eller fönster >>Interaction, action, and reflection: how medics learn medical care in the Swedish armed forces
    Visa övriga...
    2013 (Engelska)Ingår i: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 178, nr 8, s. 861-866Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The objective of this study is to examine how medics within the Swedish Armed Forces perceive their learning outcome following military prehospital training. A qualitative study with a phenomenographic approach was used to investigate how leaming is perceived among military medics. At meta level, the results can be viewed as an interaction, i.e., being able to collaborate in the medical platoon, including the ability to interact within the group and being able to lead; an action, i.e., being able to assess and treat casualties, including the ability to communicate with the casualty, to prioritize, and to be able to act; and a reflection, i.e., having confidence in one's own ability in first aid, including being prepared and feeling confident. Interaction during the period of education is important for learning. Action, being able to act in the field, is based on a drill in which the subject progresses from simple to complex procedures. Reflection, leaming to help others, is important for confidence, which in turn creates preparedness, thereby making the knowledge meaningful.

    Ort, förlag, år, upplaga, sidor
    AMSUS, 2013
    Nationell ämneskategori
    Medicin och hälsovetenskap Samhällsvetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-106000 (URN)10.7205/MILMED-D-13-00048 (DOI)
    Tillgänglig från: 2014-04-16 Skapad: 2014-04-16 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    3. Fixing the Wounded or Keeping Lead in the Air: Tactical Officers’ Views of Emergency Care on the Battlefield
    Öppna denna publikation i ny flik eller fönster >>Fixing the Wounded or Keeping Lead in the Air: Tactical Officers’ Views of Emergency Care on the Battlefield
    Visa övriga...
    2015 (Engelska)Ingår i: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 180, nr 2, s. 224-229Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The aim of this study was to identify tactical officers’ views of pre-hospital emergency care in the field before an international mission. A qualitative study with a phenomenographic approach based on interviews was used. The result of this study is a set of descriptive categories on a collective level, showing the variation in how the tactical officers perceived the phenomenon of emergency care in the battlefield. The result can be viewed as (1) noncombat oriented including being able to do one’s specialist task, being able to talk with local people and being able to give first aid, (2) combat oriented including soldiers’ skills and roles in the unit, being able to act in the unit and being able to lead the care of  injured These findings are important for officers’ preparation for international missions. The interaction between military and medical knowledge on-site care should be developed between the tactical officer and the medical personnel in order to minimize suffering and to enhance the possibility for survival of the casualty.

    Ort, förlag, år, upplaga, sidor
    Association of Military Surgeons Us, 2015
    Nationell ämneskategori
    Samhällsvetenskap Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-111668 (URN)10.7205/MILMED-D-13-00558 (DOI)000349101900016 ()25643391 (PubMedID)
    Anmärkning

    Funding Agencies|Swedish Armed Forces; Centre for Defence Medicine; VastraFrolunda; Department of Medical and Health Sciences, University of Linkoping

    Tillgänglig från: 2014-10-28 Skapad: 2014-10-28 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    4. Doctors’ and Nurses’ Perceptions of Military Pre-hospital Emergency Care
    Öppna denna publikation i ny flik eller fönster >>Doctors’ and Nurses’ Perceptions of Military Pre-hospital Emergency Care
    Visa övriga...
    2014 (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    The aim of this study was to identify physicians’ and nurses’ perceptions of military prehospital emergency care before and after an international mission. A qualitative empirical study with a phenomenographic approach was used. The aim is to identify the area of knowledge, pre-hospital care in a military environment, in terms of expressions from doctors and nurses focussing on the variation in how learning of pre-hospital care is perceived. The result of the study is a set of descriptive categories on a collective level, showing the variation in how doctors and nurses perceived the phenomenon of military pre-hospital emergency care. The results after predeployment training can be categorized as (1) to learn military medicine, (2) to take care of the casualty and (3) to have safety awareness. The results after an international mission can be categorized as (1) to collaborate with others, (2) to deliver general health care, and (3) to improve competence in military medicine. Possible implications of the results from the present study are the following; (I) better conditions for doctors and nurses to provide appropriate military medical care by clarification and better understanding of professions in the mission area (doctors, nurses, officers), since they may have different goals for their actions, (II) to pay attention to all aspects of military health care during predeployment training, including general health care in the mission area, (III) to implement new knowledge in military medicine in the predeployment training, and (IV) to train for the reality all doctors and nurses are about to meet. These results indicate  that the training should be developed in order to optimize the prepare physicians and nurses for international assignments. This may result in increased safety for the provider of care, while at the same time minimizing suffering and enhancing the possibility of survival of the injured.

    Nationell ämneskategori
    Medicin och hälsovetenskap Samhällsvetenskap Omvårdnad
    Identifikatorer
    urn:nbn:se:liu:diva-111669 (URN)
    Tillgänglig från: 2014-10-28 Skapad: 2014-10-28 Senast uppdaterad: 2014-10-28Bibliografiskt granskad
  • 45.
    Andersson, Sten-Ove
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden.
    Lundberg, Lars
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden/Borås University, School of Health Sciences,Borås Sweden.
    Jonsson, Anders
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden/Borås University, School of Health Sciences,Borås Sweden.
    Tingström, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Doctors’ and Nurses’ Perceptions of Military Pre-hospital Emergency Care2014Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    The aim of this study was to identify physicians’ and nurses’ perceptions of military prehospital emergency care before and after an international mission. A qualitative empirical study with a phenomenographic approach was used. The aim is to identify the area of knowledge, pre-hospital care in a military environment, in terms of expressions from doctors and nurses focussing on the variation in how learning of pre-hospital care is perceived. The result of the study is a set of descriptive categories on a collective level, showing the variation in how doctors and nurses perceived the phenomenon of military pre-hospital emergency care. The results after predeployment training can be categorized as (1) to learn military medicine, (2) to take care of the casualty and (3) to have safety awareness. The results after an international mission can be categorized as (1) to collaborate with others, (2) to deliver general health care, and (3) to improve competence in military medicine. Possible implications of the results from the present study are the following; (I) better conditions for doctors and nurses to provide appropriate military medical care by clarification and better understanding of professions in the mission area (doctors, nurses, officers), since they may have different goals for their actions, (II) to pay attention to all aspects of military health care during predeployment training, including general health care in the mission area, (III) to implement new knowledge in military medicine in the predeployment training, and (IV) to train for the reality all doctors and nurses are about to meet. These results indicate  that the training should be developed in order to optimize the prepare physicians and nurses for international assignments. This may result in increased safety for the provider of care, while at the same time minimizing suffering and enhancing the possibility of survival of the injured.

  • 46.
    Andersson, Sten-Ove
    et al.
    Linnaeus University, Sweden, Swedish Armed Forces, V Frölunda, Sweden.
    Lundberg, Lars
    Försvarsmakten, Centrum för Försvarsmedicin, Sweden, Borås University, Sweden.
    Jonsson, Anders
    Borås University, Sweden.
    Tingström, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Doctors' and nurses' perceptions of military pre-hospital emergency care - When training becomes reality2017Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 32, s. 70-77Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The aim of this study was to identify physicians' and nurses' perceptions of military pre-hospital emergency care before and after an international mission. A qualitative empirical study with a phenomenographic approach was used. The results after pre-deployment traing can be categorised as 1) learning about military medicine and 2) taking care of the casualty. The results after an international mission can be categorised as 1) collaborating with others 2) providing general health care and 3) improving competence in military medicine. The results indicate that the training should be developed in order to optimise pre-deployment training for physicians and nurses. This may result in increased safety for the provider of care, while at the same time minimising suffering and enhancing the possibility of survival of the injured.

  • 47.
    Andersson, Sten-Ove
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden.
    Lundberg, Lars
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden/Borås University, School of Health Sciences,Borås Sweden.
    Jonsson, Anders
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden/Borås University, School of Health Sciences,Borås Sweden.
    Tingström, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Fixing the Wounded or Keeping Lead in the Air: Tactical Officers’ Views of Emergency Care on the Battlefield2015Ingår i: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 180, nr 2, s. 224-229Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to identify tactical officers’ views of pre-hospital emergency care in the field before an international mission. A qualitative study with a phenomenographic approach based on interviews was used. The result of this study is a set of descriptive categories on a collective level, showing the variation in how the tactical officers perceived the phenomenon of emergency care in the battlefield. The result can be viewed as (1) noncombat oriented including being able to do one’s specialist task, being able to talk with local people and being able to give first aid, (2) combat oriented including soldiers’ skills and roles in the unit, being able to act in the unit and being able to lead the care of  injured These findings are important for officers’ preparation for international missions. The interaction between military and medical knowledge on-site care should be developed between the tactical officer and the medical personnel in order to minimize suffering and to enhance the possibility for survival of the casualty.

  • 48.
    Andersson, Sten-Ove
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden.
    Lundberg, Lars
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden.
    Jonsson, Anders
    Centre for Defence Medicine, Swedish Armed Forces, Göteborg, Sweden.
    Tingström, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Interaction, action, and reflection: how medics learn medical care in the Swedish armed forces2013Ingår i: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 178, nr 8, s. 861-866Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of this study is to examine how medics within the Swedish Armed Forces perceive their learning outcome following military prehospital training. A qualitative study with a phenomenographic approach was used to investigate how leaming is perceived among military medics. At meta level, the results can be viewed as an interaction, i.e., being able to collaborate in the medical platoon, including the ability to interact within the group and being able to lead; an action, i.e., being able to assess and treat casualties, including the ability to communicate with the casualty, to prioritize, and to be able to act; and a reflection, i.e., having confidence in one's own ability in first aid, including being prepared and feeling confident. Interaction during the period of education is important for learning. Action, being able to act in the field, is based on a drill in which the subject progresses from simple to complex procedures. Reflection, leaming to help others, is important for confidence, which in turn creates preparedness, thereby making the knowledge meaningful.

  • 49.
    André, Malin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Billstedt, Eva
    University of Gothenburg, Sweden .
    Bengtsson, Calle
    University of Gothenburg, Sweden .
    Hallstrom, Tore
    University of Gothenburg, Sweden .
    Lissner, Lauren
    University of Gothenburg, Sweden .
    Skoog, Ingmar
    University of Gothenburg, Sweden .
    Sundh, Valter
    University of Gothenburg, Sweden University of Gothenburg, Sweden .
    Waern, Margda
    University of Gothenburg, Sweden .
    Bjorkelund, Cecilia
    University of Gothenburg, Sweden .
    Personality in women and associations with mortality: a 40-year follow-up in the Population Study of Women in Gothenburg2014Ingår i: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 14, nr 61Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The question of whether personality traits influence health has long been a focus for research and discussion. Therefore, this study was undertaken to examine possible associations between personality traits and mortality in women. Methods: A population-based sample of women aged 38, 46, 50 and 54 years at initial examination in 1968-69 was followed over the course of 40 years. At baseline, 589 women completed the Cesarec-Marke Personality Schedule (the Swedish version of the Edwards Personal Preference Schedule) and the Eysenck Personality Inventory. Associations between personality traits and mortality were tested using Cox proportional hazards models. Results: No linear associations between personality traits or factor indices and mortality were found. When comparing the lowest (Q1) and highest quartile (Q4) against the two middle quartiles (Q2 + Q3), the personality trait Succorance Q1 versus Q2 + Q3 showed hazard ratio (HR) = 1.37 (confidence interval (CI) = 1.08-1.74), and for the factor index Aggressive non-conformance, both the lowest and highest quartiles had a significantly higher risk of death compared to Q2 + Q3: for Q1 HR = 1.32 (CI = 1.03-1.68) and for Q4 HR = 1.36 (CI = 1.06-1.77). Neither Neuroticism nor Extraversion predicted total mortality. Conclusions: Personality traits did not influence long term mortality in this population sample of women followed for 40 years from mid- to late life. One explanation may be that personality in women becomes more circumscribed due to the social constraints generated by the role of women in society.

  • 50.
    André, Malin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Department Public Health and Caring Science, Sweden.
    Grondal, Hedvig
    Uppsala University, Sweden.
    Strandberg, Eva-Lena
    Lund University, Sweden; Blekinge County Council, Sweden.
    Brorsson, Annika
    Lund University, Sweden; Skåne Reg, Sweden.
    Hedin, Katarina
    Lund University, Sweden; Kronoberg County Council, Sweden.
    Uncertainty in clinical practice - an interview study with Swedish GPs on patients with sore throat2016Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, nr 56Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines. Methods: An interview study was conducted among a strategic sample of 25 general practitioners (GPs). Results: All GPs mentioned potential dangerous differential diagnoses and complications. Four strategies for coping with uncertainty were identified, one of which was compliant with guidelines, "Adherence to guidelines", and three were idiosyncratic: "Clinical picture and C-reactive protein (CRP)", "Expanded control", and "Unstructured". The residual uncertainty differed for the different strategies: in the strategy "Adherence to guidelines" and " Clinical picture and CRP" uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and near-patient CRP; in the strategy " Expanded control" uncertainty was balanced based on expanded control; and in the strategy "Unstructured" uncertainty prevailed in spite of redundant examination and anamnesis. Conclusion: The majority of the GPs avoided uncertainty and deemed they had no problems. Their strategies either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of compliance to guidelines. A few GPs did not manage to cope with uncertainty or had to put in excessive work to control uncertainty.

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