| 61. |
- Arvidsson, Susann, 1965-, et al.
(författare)
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Callers' perceptions of their contact with a rheumatology telephone helpline
- 2019
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Ingår i: Musculoskeletal Care. - Oxford : Wiley. - 1478-2189 .- 1557-0681. ; 17:1, s. 105-112
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Tidskriftsartikel (refereegranskat)abstract
- Background Telephone helplines are useful for improving patients' access to healthcare services and reducing the need for frequent face-to-face contact with healthcare professionals. Little is known about how people who phone a helpline perceive the encounter. Objectives The aims of the present study were to describe the variation in how callers perceive their encounter with a rheumatology telephone helpline. Methods The study had a descriptive, qualitative design and used a phenomenographic approach, comprising 27 semi-structured telephone interviews with callers to Rheuma Direct, a rheumatology telephone helpline with specially trained nurses. The callers comprised 22 women and five men, aged 22-89 years (mean 54 years). Results The callers phoned Rheuma Direct when they had problems obtaining answers to questions on the internet or from healthcare professionals. Three descriptive categories emerged: constructive dialogue, specialized competence and applicability. The callers perceived that it was a constructive dialogue when they were able to discuss their concerns with someone, received emotional support, felt reassured and were satisfied with the information provided. They perceived specialized competence when the nurses were experienced and skilful, the advice provided complemented previously received information and when they had more knowledge after the call. The callers perceived that Rheuma Direct had applicability because it was easy to access and they could make different choices before, during and after the telephone call. Conclusions Callers to a rheumatology telephone helpline perceived it as a valuable complement to other sources of information, and felt that it could provide them with the tools to manage their disease better, as well as future contacts with healthcare professionals.
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| 62. |
- Ashfaq, Awais, 1990-, et al.
(författare)
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DEED : DEep Evidential Doctor
- 2023
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Ingår i: Artificial Intelligence. - Amsterdam : Elsevier. - 0004-3702 .- 1872-7921. ; 325
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Tidskriftsartikel (refereegranskat)abstract
- As Deep Neural Networks (DNN) make their way into safety-critical decision processes, it becomes imperative to have robust and reliable uncertainty estimates for their predictions for both in-distribution and out-of-distribution (OOD) examples. This is particularly important in real-life high-risk settings such as healthcare, where OOD examples (e.g., patients with previously unseen or rare labels, i.e., diagnoses) are frequent, and an incorrect clinical decision might put human life in danger, in addition to having severe ethical and financial costs. While evidential uncertainty estimates for deep learning have been studied for multi-class problems, research in multi-label settings remains untapped. In this paper, we propose a DEep Evidential Doctor (DEED), which is a novel deterministic approach to estimate multi-label targets along with uncertainty. We achieve this by placing evidential priors over the original likelihood functions and directly estimating the parameters of the evidential distribution using a novel loss function. Additionally, we build a redundancy layer (particularly for high uncertainty and OOD examples) to minimize the risk associated with erroneous decisions based on dubious predictions. We achieve this by learning the mapping between the evidential space and a continuous semantic label embedding space via a recurrent decoder. Thereby inferring, even in the case of OOD examples, reasonably close predictions to avoid catastrophic consequences. We demonstrate the effectiveness of DEED on a digit classification task based on a modified multi-label MNIST dataset, and further evaluate it on a diagnosis prediction task from a real-life electronic health record dataset. We highlight that in terms of prediction scores, our approach is on par with the existing state-of-the-art having a clear advantage of generating reliable, memory and time-efficient uncertainty estimates with minimal changes to any multi-label DNN classifier. © 2023 The Author(s)
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| 63. |
- Ashfaq, Awais, 1990-, et al.
(författare)
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Readmission prediction using deep learning on electronic health records
- 2019
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Ingår i: Journal of Biomedical Informatics. - Maryland Heights, MO : Elsevier BV. - 1532-0464 .- 1532-0480. ; 97
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Tidskriftsartikel (refereegranskat)abstract
- Unscheduled 30-day readmissions are a hallmark of Congestive Heart Failure (CHF) patients that pose significant health risks and escalate care cost. In order to reduce readmissions and curb the cost of care, it is important to initiate targeted intervention programs for patients at risk of readmission. This requires identifying high-risk patients at the time of discharge from hospital. Here, using real data from over 7500 CHF patients hospitalized between 2012 and 2016 in Sweden, we built and tested a deep learning framework to predict 30-day unscheduled readmission. We present a cost-sensitive formulation of Long Short-Term Memory (LSTM) neural network using expert features and contextual embedding of clinical concepts. This study targets key elements of an Electronic Health Record (EHR) driven prediction model in a single framework: using both expert and machine derived features, incorporating sequential patterns and addressing the class imbalance problem. We evaluate the contribution of each element towards prediction performance (ROC-AUC, F1-measure) and cost-savings. We show that the model with all key elements achieves higher discrimination ability (AUC: 0.77; F1: 0.51; Cost: 22% of maximum possible savings) outperforming the reduced models in at least two evaluation metrics. Additionally, we present a simple financial analysis to estimate annual savings if targeted interventions are offered to high risk patients. © 2019 The Authors
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| 64. |
- Axelsson, Åsa B., et al.
(författare)
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Good and bad experiences of family presence during acute care and resuscitation. What makes the difference?
- 2005
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Ingår i: European Journal of Cardiovascular Nursing. - Amsterdam : Elsevier. - 1474-5151 .- 1873-1953. ; 4:2, s. 161-169
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Tidskriftsartikel (refereegranskat)abstract
- Background: Family presence (FP) in the resuscitation room is still controversial, and its appropriateness for patient and family has been discussed. We examined both positive and negative experiences in order to establish the reasons for the difference.Aim: The aim of the present literature review was to describe patients', relatives' and staff's opinions and experiences of FP during invasive procedures and resuscitation.Method: 12 original papers, published between January 1995 and February 2003, were reviewed. Most patients and relatives agreed that they had positive experiences of FP. They described how FP enhanced the feeling of support and connectedness within the family. Family members believed that FP helped them in their grieving process. Most staff members without FP experience felt that FP would increase the risk of psychological distress for the family. Those who had participated in an FP programme believed that FP was not only beneficial for the family but also for staff.Conclusion: Family presence during resuscitation and acute care has the potential to enhance the care of the patient and to benefit everyone involved. However, implementation of FP during resuscitation must take account of potential problems.
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| 65. |
- Axelsson, Åsa B., 1955, et al.
(författare)
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How bystanders perceive their cardiopulmonary resuscitation intervention : a qualitative study
- 2000
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Ingår i: Resuscitation. - Amsterdam : Elsevier. - 0300-9572 .- 1873-1570. ; 47:1, s. 71-81
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Tidskriftsartikel (refereegranskat)abstract
- The importance of bystander cardiopulmonary resuscitation (CPR) prior to arrival of the emergency medical service is well documented. In Sweden, CPR is initiated prior to emergency medical services (EMS) arrival in about 30% of cardiac arrests out-of-hospital, a figure which should be improved urgently. To do so, it is of interest to know more about the bystanders' perceptions of their intervention. A qualitative method inspired by the phenomenographic approach was applied to 19 bystanders who had performed CPR. In the analysis, five main categories and 14 subcategories emerged. The main categories were: to have a sense of humanity, to have competence, to feel an obligation, to have courage and to feel exposed. Interviews described how humanity and concern for another human being were the foundation of their intervention. CPR training offers the possibility to give appropriate help in this emergency. If the aim of CPR training was extended beyond teaching the skill of CPR to include preparation of the rescuer for the intervention and his/her reactions, this might increase the number of people able to take action in the cardiac arrest situation.
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| 66. |
- Backman, Ellen, MSc, 1981-, et al.
(författare)
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Gastrostomy tube insertion in children with developmental or acquired disorders : a register-based study
- 2020
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Ingår i: Developmental Medicine & Child Neurology. - Chichester : Wiley-Blackwell. - 0012-1622 .- 1469-8749. ; 62:10, s. 1191-1197
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe trends in gastrostomy tube insertion in children with developmental or acquired disorders in Sweden and assess their demographic characteristics. Method: Children aged 0 to 18 years with gastrostomy tube insertions recorded between 1998 and 2014 were identified in the Swedish National Patient Register. Associations between disorder type and year of surgery, as well as age at surgery, were analysed using linear regression analyses. The association between disorder type and mortality 2 years from gastrostomy tube insertion was also analysed using logistic regression analysis. Results: The data for 4112 children (2182 males, 1930 females), with a median age of 2 years (interquartile range=1–8y), were analysed. Children who presented with developmental disorders were the largest group (n=3501, 85%). The most common diagnosis in children with developmental disorders was cerebral palsy (n=165, 4%). In children with acquired disorders, acute lymphoblastic leukaemia (n=117, 3%) was the most common diagnosis. Gastrostomy tube insertions increased from 1998 to 2014, with the greatest increase in children with developmental disorders, who were younger than children with acquired disorders when the gastrostomy tube was first inserted. Age at tube insertion decreased in both groups during the study period. Mortality was higher in children with acquired disorders, suggesting that gastrostomy tube insertion should be part of a palliative care approach. Interpretation: Child characteristics differed depending on whether the underlying disorder was developmental or acquired, suggesting a need for clinical health care guidelines related to the specific goals of gastrostomy tube insertion. What this paper adds: Gastrostomy tube insertions increased by 140% from 1998 to 2014 in Sweden. The age of children with developmental disorders decreased by 1 month per year during the study period. Children presenting with developmental disorders were younger than children with acquired disorders when the gastrostomy tube was first inserted. Mortality was higher in children with acquired disorders. © 2020 The Authors. DevelopmentalMedicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press
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| 67. |
- Baigi, Amir, 1953, et al.
(författare)
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Non-attendees' attitudes to the design of a cardiac rehabilitation programme focused on information of risk factors and professional involvement
- 2009
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Ingår i: European Journal of Cardiovascular Nursing. - Amsterdam : Elsevier. - 1474-5151 .- 1873-1953. ; 8:1, s. 62-66
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Tidskriftsartikel (refereegranskat)abstract
- Background: Enhancing the accuracy of the content of cardiac rehabilitation programmes (CRPs) and providing the mediators preferred by patients can increase attendance rates in line with secondary prevention goals. The aim of this study was therefore to explore non-attendees' attitudes to the design of a CRP focused on information of risk factors and professional involvement. Method: Consecutive patients with coronary heart disease (n = 100) who declined to participate in a CRP answered a questionnaire focusing on patients' attitudes to risk factors and cardiac rehabilitation. Results: Non-attendees considered that information of hypertension and information of sedentary lifestyle constituted the most important content of a CRP. Physicians, nurses and social workers were considered the most suitable professional categories. Females preferred nurses when discussing smoking issues while males preferred physicians. More males compared to females preferred occupational therapists for dealing with stress, physicians for depression and social workers for social isolation. Conclusions: Non-attendees' attitudes are similar to those of attendees and quite traditional in that they favour physician or nurse-led activities. There is a difference in attitude between male and female.
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| 68. |
- Baigi, Amir, 1953, et al.
(författare)
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Sense of coherence as well as social support and network as perceived by patients with a suspected or manifest myocardial infarction: a short-term follow-up study
- 2008
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Ingår i: Clinical Rehabilitation. - London : SAGE Publications. - 0269-2155 .- 1477-0873. ; 22:7, s. 646-652
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare sense of coherence as well as social support and network as perceived by ischaemic heart disease patients at baseline and two weeks post-discharge in terms of age, sex, educational and marital status. Design: Multicentre study with a prospective short-term follow-up design. Setting: A university hospital, a central hospital and a district hospital in southern Sweden. Subjects: Consecutive sample of 246 patients with a suspect or manifest myocardial infarction. Main measures: The Lubben Social Network Scale (LSNS-R), the Medical Outcome Study (MOS) Social Support Survey and the Sense of Coherence Scale were included in a self-administered questionnaire and answered twice, together with sociodemographic variables. Results: Bivariate analyses indicated changes in social support (practical support increased in men and decreased in women; both P= 0.003) and social network (family network increased among >65 year olds; P= 0.001, men; P= 0.013, and women; P= 0.033, those with a low; P=0.017, and intermediate; P= 0.033, educational level, as well as those cohabiting; P= 0.0001), but did not reveal any difference in sense of coherence. Conclusions: Sociodemographic variables have no influence on sense of coherence but do affect social support (i.e. practical support and social network, family). Ischaemic heart disease patients' short stay in hospital implies that the network outside the hospital has to assume responsibility, but at the same time it is important for health care professionals to have sufficient knowledge to be able to support the specific needs of patients and their family members.
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| 69. |
- Barow, Thomas, 1969, et al.
(författare)
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Junge Menschen mit geistiger Behinderung in Schweden und deren Übergang in die Arbeitswelt: Forschungsstand und Perspektiven
- 2016
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Ingår i: Hedderich, I. & Zahnd, R. (red.). Teilhabe und Vielfalt: Herausforderungen einer Weltgesellschaft. - Bad Heilbrunn : Verlag Julius Klinkhardt. - 9783781520592 ; , s. 337-343
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Bokkapitel (refereegranskat)abstract
- Der Übergang von der Schule in die Arbeitswelt bedeutet eine Weichenstellung im Lebenslauf, nicht zuletzt mit Blick auf die Situation von Menschen mit geistiger Behinderung. Gerade für diese Personengruppe und im Kontext hoher Jugendarbeitslosigkeit bestätigen jüngste Forschungen in Schweden die Schwierigkeiten, im Erwerbsleben Fuß zu fassen. Der Beitrag präsentiert den schwedischen Forschungsstand und die sich daraus ergebenden Perspektiven.
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| 70. |
- Behrns, Ingrid, 1961, et al.
(författare)
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A comparison between written and spoken narratives in aphasia
- 2009
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Ingår i: Clinical Linguistics & Phonetics. - London : Taylor & Francis. - 0269-9206 .- 1464-5076. ; 23:7, s. 507-528
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to explore how a personal narrative told by a group of eight persons with aphasia differed between written and spoken language, and to compare this with findings from 10 participants in a reference group. The stories were analysed through holistic assessments made by 60 participants without experience of aphasia and through measurement of lexical and syntactic variables. The findings showed that the participants with aphasia generally received lower ratings than the reference group, but also that stories written by participants with aphasia were rated as easier to understand, more interesting, and more coherent than the group’s spoken stories. Regression analysis showed that syntax could predict several of the rated variables for the stories told by the participants with aphasia. Results point to the need to include writing training in language rehabilitation in order to increase the ability for persons with aphasia to participate in communicative situations in everyday life.
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