| 241. |
- Gadolin, Christian, et al.
(författare)
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Organising Healthcare with Multi-Professional Teams : Activity Coordination as a Logistical Flow
- 2016
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Ingår i: Offentlig Förvaltning. Scandinavian Journal of Public Administration. - : Göteborgs universitet. - 2000-8058 .- 2001-3310. ; 20:4, s. 53-72
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Tidskriftsartikel (refereegranskat)abstract
- Multi-professional teams are now common when organising healthcare. Such teams areconsidered to resolve fragmentation issues amongst units and their functions, facilitateefficient and high quality care and are also deemed to enable different professions to meetand exchange experience and knowledge. The expected consequence is superior decisionsand improved care. However, research suggests that the deployment of multi-professionalteams within healthcare organisations is problematic with regard to knowledge sharingand integration between different professional groups. While often recognised, the reasonfor this shortcoming has rarely been explored in depth. This study consequently elaborateson the factors hindering knowledge sharing through illustrating and discussing thelogics of different professional groups and the ensuing consequences when multiprofessionalteams interact. The finding is that the teams are being utilised by the medicalprofessions in accordance with their professional logic. This results in the coordination ofactivities, incorporating the patient flow logistics amongst the different professions; makingthe impact of multi-professional teams concrete in practice and illustrating their potentialpositive outcomes for professionals and patients, even though they are not operatingas forums for overt knowledge integration for the different professions.
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| 242. |
- Gadolin, Christian
(författare)
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The Logics of Healthcare - In Quality Improvement Work
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Quality improvement (QI) has become a cornerstone in contemporary healthcare organizations with the aim of enabling management that facilitates efficiency and effectiveness, while providing a consistent correlation between health spending and indicators of access to and quality of care. However, despite years of reform which have attempted to change healthcare professionals’ practice, traditional professional modes of working remain relatively stable and entrenched. Previous research has highlighted the fact that healthcare professionals’ active involvement in quality improvement work (QIW) is often lacking. Such a lack is often explained by professionals’ scepticism towards management, managers, and organizationally related improvement initiatives. Yet, there is a shortage of studies which focus on analysis at the level of the actor when studying healthcare professionals’ involvement in QIW.This dissertation presents a qualitative case study of the QIW undertaken by a multi-professional diabetes care team. It enables a description and analysis of healthcare professionals’ involvement in QIW at the actor level of analysis. A theoretical framework, consisting of the combination of institutional logics and institutional work, is applied in order to focus on varied and complementary aspects of institutional dynamics while simultaneously emphasizing the embeddedness of actors’ actions and interactions.The study shows that healthcare professionals’ identification with and adherence to the professional logic in general impairs their involvement in QIW. Adherence entails perceiving professional judgments and discretion as legitimate in guiding practice and work. However, the study emphasizes that adherence to the professional logic varies amongst professionals representing different professions. This means that healthcare professionals’ acceptance of the bureaucratic control of work as legitimate differs - enabling diverse approaches and practices in QIW. Furthermore, the study illustrates that the physicians’ relative dominance hinders the utilization of multiple perspectives in the multi-professional team. This finding elucidates how dominance and hierarchization of logics enable healthcare professionals’ practice to remain relatively stable, despite managerial attempts to change and alter it. Finally, the study delineates the interactions needed in order to bridge institutional logics at the actor level of analysis. Such interactions are characterized by reciprocal acts of claiming and granting influence that constitute creative/disruptive institutional work, enabling actors to find new approaches to each other and further facilitate healthcare professionals’ involvement in QIW.
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| 243. |
- Garcia, Danilo, 1973, et al.
(författare)
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IRT analyses of the Swedish Dark Triad Dirty Dozen
- 2018
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Ingår i: Heliyon. - : Elsevier BV. - 2405-8440. ; 4:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Dark Triad (i.e., Machiavellianism, narcissism, and psychopathy) can be captured quickly with 12 items using the Dark Triad Dirty Dozen (Jonason and Webster, 2010). Previous Item Response Theory (IRT) analyses of the original English Dark Triad Dirty Dozen have shown that all three subscales adequately tap into the dark domains of personality. The aim of the present study was to analyze the Swedish version of the Dark Triad Dirty Dozen using IRT.Method: 570 individuals (n(males) = 326, n(females) = 242, and 2 unreported), including university students and white-collar workers with an age range between 19 and 65 years, responded to the Swedish version of the Dark Triad Dirty Dozen (Garcia et al., 2017a, b).Results: Contrary to previous research, we found that the narcissism scale provided most information, followed by psychopathy, and finally Machiavellianism. Moreover, the psychopathy scale required a higher level of the latent trait for endorsement of its items than the narcissism and Machiavellianism scales. Overall, all items provided reasonable amounts of information and are thus effective for discriminating between individuals. The mean itemdiscriminations (alphas) were 1.92 for Machiavellianism, 2.31 for narcissism, and 1.99 for psychopathy.Conclusion: This is the first study to provide IRT analyses of the Swedish version of the Dark Triad Dirty Dozen. Our findings add to a growing literature on the Dark Triad Dirty Dozen scale in different cultures and highlight psychometric characteristics, which can be used for comparative studies. Items tapping into psychopathy showed higher thresholds for endorsement than the other two scales. Importantly, the narcissism scale seems to provide more information about a lack of narcissism, perhaps mirroring cultural conditions.
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| 244. |
- Gellerstedt, Martin, 1966-, et al.
(författare)
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Are patients willing to take a more active role? : Questionnaires to measure patients’ willingness to be empowered
- 2022
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 105:3, s. 741-749
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveOne crucial prerequisite for increased patient empowerment is the willingness among patients to take a more active role. The aim of this study was to develop questionnaires for measuring a patient’s willingness to be empowered in general and by using e-health.MethodsThe study was based on a random sample from an online panel. The 800 responders were Swedish citizens and reflected the internet-using population in Sweden regarding age, gender, income, and education. The measurement properties were evaluated according to the Rasch Measurement Theory.ResultsThe analyses showed two questionnaires with adequate fit to the basic measurement model and with high reliability (PSI 0.84 and 0.89, respectively).ConclusionWe conclude that this study generated two questionnaires with an intuitive order of items illustrating an understandable progression of willingness to be empowered in general as well as for e-health.Practice implicationsThe suggested questionnaires are valuable tools supporting the effort to tailor empowerment strategies to meet the patient’s willingness. Questionnaires will also be valuable for evaluating strategies for supporting willingness, studying factors related to willingness and potential inequalities due to e.g. varying digital literacy, and for enabling identification of patient stereotypes using cluster analyses.
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| 245. |
- Gellerstedt, Martin, 1966-, et al.
(författare)
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Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?
- 2006
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Ingår i: Eur J Emerg Med. - London, UK : Lippincott Williams & Wilkins, Ltd.. - 0969-9546 .- 1473-5695. ; 13:5, s. 290-4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate whether a computer-based decision support system could be useful for the emergency medical system when identifying patients with acute myocardial infarction (AMI) or life-threatening conditions and thereby improve the allocation of life support level. METHODS: Patients in the Municipality of Goteborg who dialled the dispatch centre due to chest pain during a period of 3 months. To analyse the relationship between patient characteristics (according to a case record form used during an interview) and the response variables (AMI or life-threatening condition), multivariate logistic regression was used. For each patient, the probability of AMI/life-threatening condition was estimated by the model. We used these probabilities retrospectively to allocate advanced life support or basic life support. This model allocation was then compared with the true allocation made by the dispatchers. RESULTS: The sensitivity, that is, the percentage of AMI patients allocated to advanced life support, was 85.7% in relation to the true allocation made by the dispatchers. The corresponding sensitivity regarding allocation made by the model was 92.4% (P=0.17). The specificity was also slightly higher for the model allocation than the dispatcher allocation. Among the 15 patients with AMI who were allocated to basic life support by the dispatchers, nine died (eight during and one after hospitalization). Among the eight patients with AMI allocated to basic life support by the model, only one patient died (in hospital) (P=0.02). CONCLUSION: A computer-based decision support system including a prevalence function could be a valuable tool for allocating the level of life support. The case record form, however, used for the interview can be refined and a model based on a larger sample and confirmed in a prospective study is recommended.
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| 246. |
- Gellerstedt, Martin, 1966-, et al.
(författare)
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Could prioritisation by emergency medicine dispatchers be improved by using computer-based decision support? : A cohort of patients with chest pain
- 2016
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 220, s. 734-738
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Tidskriftsartikel (refereegranskat)abstract
- Background: To evaluate whether a computer-based decision support system could improve the allocation of patients with acute coronary syndrome (ACS) or a life-threatening condition (LTC). We hypothesised that a system of this kind would improve sensitivity without compromising specificity. Methods: A total of 2285 consecutive patients who dialed 112 due to chest pain were asked 10 specific questions and a prediction model was constructed based on the answers. We compared the sensitivity of the dispatchers' decisions with that of the model-based decision support model. Results: A total of 2048 patients answered all 10 questions. Among the 235 patients with ACS, 194 were allocated the highest prioritisation by dispatchers (sensitivity 82.6%) and 41 patients were given a lower prioritisation (17.4% false negatives). The allocation suggested by the model used the highest prioritisation in 212 of the patients with ACS (sensitivity of 90.2%), while 23 patients were underprioritised (9.8% false negatives). The results were similar when the two systems were compared with regard to LTC and 30-day mortality. This indicates that computer-based decision support could be used either for increasing sensitivity or for saving resources. Three questions proved to be most important in terms of predicting ACS/LTC, [1] the intensity of pain, [2] the localisation of pain and [3] a history of ACS. Conclusion: Among patients with acute chest pain, computer-based decision support with a model based on a few fundamental questions could improve sensitivity and reduce the number of cases with the highest prioritisation without endangering the patients.
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| 247. |
- Gellerstedt, Martin, 1966-, et al.
(författare)
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Does sex influence the allocation of life support level by dispatchers in acute chest pain?
- 2010
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Ingår i: The American journal of emergency medicine. - Philadelphia, PA : Elsevier BV. - 1532-8171 .- 0735-6757. ; 28:8, s. 922-7
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate (a) the differences between men and women in symptom profile, allocated life support level (LSL), and presence of acute myocardial infarction (AMI), life-threatening condition (LTC), or death and (b) whether a computer-based decision support system could improve the allocation of LSL.
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| 248. |
- Gellerstedt, Martin, 1966-
(författare)
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Interpretation of diagnostic information given patient characteristics
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim with this thesis was to describe, exemplify and develop theory for reference values and diagnostic tests, especially focusing on the variability between individuals. To facilitate interpretation of medical information it is common to establish some kind of limit. There are several different rationales for the choice of such a limit. Reference values are intended to be solely descriptive, while medical decision limits are used for identification of a present or future disorder. The frequently used bimodal model can be used not only for discrimination between healthy vs diseased but for separation of other conditions as well. Reference values for amplitude of accommodation among school children were suggested based on a bimodal model discriminating between children with vs without symptoms occurring at near work. If the variability between individuals is high compared to the variability found within an individual or if the diagnostic information is subjective, it may be favorable to use the individual as its own reference. The diagnosis of food-hypersensitivity for patients with subjective symptoms was used as an illustration. A pre-defined approach for interpretation of case records gave high inter-observer reliability, and gave different diagnoses than a previously used approach. To harmonize the sensitivity and specificity of reference values across subpopulations, partitioning of reference values is one possibility. Existing criteria are limited to the consideration of only two subpopulations. A computer assisted procedure for considering partitioning of several subpopulations was developed. The potential relationship between diagnostic accuracy of a test and other factors are highlighted in diagnostic theory. However, there is no advice regarding how to adjust for this relationship. Two possibilities have been presented; to use a multivariate model including interactions or to use different thresholds for different subpopulations. Diagnostic information could be individually adjusted by using a prevalence function which estimate probability of target disorder, given patient characteristics. A computer based decision support system including such a prevalence function was shown to have potential benefits for assisting medical decisions.
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| 249. |
- Gellerstedt, Martin, 1966-, et al.
(författare)
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Interpretation of subjective symptoms in double-blind placebo-controlled food challenges - interobserver reliability
- 2004
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Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : Wiley. - 0105-4538 .- 1398-9995. ; 59, s. 354-356
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Subjective symptoms after food challenges are difficult to interpret and no standard is available. We discuss a strategy for how to interpret a diary. Furthermore, the interobserver reliability is evaluated. METHODS: Diaries for 32 patients with subjective symptoms were used. The diaries were re-evaluated with a predefined strategy by three independent observers. RESULTS: The proportion of positives was 21.9% among the old diagnoses, according to the new approach 34.4% (observers I and II) and 37.5% (observer III) were positive. The new approach had high interobserver reliability (97 and 100%). CONCLUSIONS: The proportion of positives depends on how subjective symptoms are interpreted. Interpretations of subjective symptoms in diaries could be made with high interobserver reliability.
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| 250. |
- Gerafi, Joel, et al.
(författare)
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Neglect and aphasia in the acute phase as predictors of functional outcome 7 years after ischemic stroke
- 2017
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 24:11, s. 1407-1415
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 EAN Background and purpose: Visuospatial inattention (VSI) and language impairment (LI) are often present early after stroke and associations with an unfavorable short-term functional outcome have been reported. The purpose of this study was to investigate whether a screening of VSI and LI as indicators of cortical symptoms early after stroke could predict long-term functional outcomes. Methods: A consecutive cohort of 375 patients with ischemic stroke was assessed for the occurrence of VSI at a median of 7 days after admission (interquartile range, 1–5 days) using the Star Cancellation Test and for LI (within the first 7 days) with the language item in the Scandinavian Stroke Scale. Seven years later, functional outcomes were assessed by the modified Rankin scale and Frenchay Activities Index in 235 survivors without recurrent stroke. Relationships between baseline predictors and functional outcome at 7 years were analyzed with bivariate correlations and multiple categorical regressions with optimal scaling. Results: The regression model significantly explained variance in the modified Rankin scale (R 2 = 0.435, P < 0.001) and identified VSI (P = 0.001) and neurological deficits (P < 0.001; Scandinavian Stroke Scale score without the language item) as the significant independent predictors. The model for Frenchay Activities Index was also significant (R 2 = 0.269, P < 0.001) with VSI (P = 0.035) and neurological deficits (P < 0.001) as significant independent predictors. Conclusions: Visuospatial inattention at acute stroke has an independent impact on long-term functional outcomes. Early recognition may enable targeted rehabilitative interventions.
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