| 981. |
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| 982. |
- Thorn, Jörgen, et al.
(författare)
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Pre-screening av rökare med mini-spirometer leder till förbättrad prediktion av KOL
- 2010
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Ingår i: Svenska läkaresällskapets handlingar: Hygiea. - 0349-1722. ; 119:1, s. 78-78
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- BakgrundTidig diagnos av kroniskt obstruktiv lungsjukdom (KOL), i kombination med rökstopp är viktigt för att förhindra vidare sjukdomsprogress. I primärvården är det önskvärt med lättillgänglig diagnostik för att om möjligt selektera patienter för spirometri. I denna studie undersöks värdet av pre-screening av lungfunktion av patienter i riskzonen för KOL (NCT01013922).MetodPatienter 45 år och äldre, med rökhistorik ≥ 15 paketår inkluderades. Uppgifter kring bl. a. rökvanor och medicinsk historik samlades in. Hälsorelaterad livskvalitet och grad av dyspné undersöktes med frågeformulär (CCQ och MRC-skalan). Lungfunktion (FEV1 och FEV6) mättes initialt med en mini-spirometer, (copd-6, Vitalograph), följt av fullständig standardspirometri inklusive reversibilitetstest (KOL diagnos = FEV1/FVC post-bronkdilatation < 70). Tidsåtgång för spirometri noterades; kostnader beräknas baserat på genomsnittlig sjuksköterskelön. Univariat logistisk regression och ROC (receiver operating characteristic curves) användes.ResultatTotal inkluderades 305 patienter från 21 primärvårdsenheter; 57 % kvinnor, medelålder (standardavvikelse, SD) 61,2 (8,4) år, FEV1/FVC 75,3 (10,2), paketår 30,2 (11,5). KOL diagnostiserades hos 83 patienter (27,2 %). Patienter med KOL hade en genomsnittlig FEV1/FEV6 kvot på 69,0 (9,1), rökare utan KOL 77,7 (9,6). Copd-6 (FEV1/FEV6) kunde med statistisk signifikans prediktera KOL. Sensitivitet och specificitet vid en FEV1/FEV6 cut off på 73,0 var 73,5 % respektive 79,7 %; arean under ROC kurvan var 0,80. Kostnaderna för en copd-6 mätning (tidsåtgång 4,2 minuter) var SEK 19,41, respektive SEK 147 (32,3 minuter) för en standardspirometri. Kostnaden för att detektera en KOL patient, med urval för spirometri baserat endast på ålder och antal paketår, var SEK 542. Genom att pre-selektera individer för spirometri med hjälp av copd-6 kunde kostnaden reduceras till SEK 283. Detta sker dock till priset av att 8,4 % lägre total detektion av KOL patienter till följd av begränsningar vad gäller sensitiviteten hos copd-6. Kön, CCQ eller MRC hade inget prediktivt värde.SammanfattningPre-screening med copd-6 för att selektera patienter med risk för KOL (≥ 45 år; ≥ 15 paketår) före utförande av standardspirometri kunde signifikant prediktera KOL. Användning av copd-6 kan minska kostnaden för att identifiera KOL patienter inom primärvården, men sensitiviteten och specificiteten är i denna studie begränsad.
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| 983. |
- Thurfjell, Åsa, et al.
(författare)
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SK-kurser i levnadsvanor rustar läkare att motivera hälsosamt val. Svenska läkaresällskapets uppdaterade förslag och kursarrangörers erfarenheter : [SK courses in lifestyle habits. Updated proposals and course organizers' experiences]
- 2024
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 121
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Tidskriftsartikel (refereegranskat)abstract
- The physician has an important role in identifying unhealthy lifestyles, offering counselling and, if necessary, referring the patient to another profession or care unit. Therefore, knowledge and skills related to lifestyle habits are included in the goal description for residents in all clinical specialities. SK courses in lifestyle habits should be based on National Guidelines for Prevention and Treatment - Support for Governance and Management (2018), issued by the Swedish National Board of Health and Welfare. Preferably, the course should include training sessions where the participants can practice the counselling techniques. The ethical principles provide the foundation for work related to lifestyle habits. The course should include evidence-based knowledge on how lifestyle habits affect symptoms, risk factors, and diseases, as well as the effect of changing lifestyle habits. Also, discussions about local routines and the physician's role in addressing lifestyle habits are valuable components of the course.
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| 984. |
- Ueda, Peter, et al.
(författare)
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Alcohol related disorders among elite male football players in Sweden : nationwide cohort study
- 2022
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Ingår i: BMJ. British Medical Journal. - : BMJ Publishing Group Ltd. - 0959-8146 .- 0959-535X. ; 379
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To assess whether male elite football players are at increased risk of alcohol related disorders compared with men from the general population, and whether such an increased risk would vary on the basis of calendar year of the first playing season in the top tier of competition, age, career length, and goal scoring abilities.DESIGN: Nationwide cohort study.SETTING: Sweden, 1924-2020.PARTICIPANTS: 6007 male football players who had played in the Swedish top division, Allsvenskan, from 1924 to 2019 and 56 168 men from the general population matched to players based on age and region of residence.MAIN OUTCOME MEASURES: Primary outcome was alcohol related disorders (diagnoses recorded in death certificates, during hospital admissions and outpatient visits, or use of prescription drugs for alcohol addiction); secondary outcome was disorders related to misuse of other drugs.RESULTS: During follow-up up to 31 December 2020, 257 (4.3%) football players and 3528 (6.3%) men from the general population received diagnoses of alcohol related disorders. In analyses accounting for age, region of residence, and calendar time, risk of alcohol related disorders was lower among football players than among men from the general population (hazard ratio 0.71, 95% confidence interval 0.62 to 0.81). A reduced risk of alcohol related disorders was observed for football players who played their first season in the top tier in the early 1960s and later, while no significant difference versus men from the general population was seen in the risk for football players from earlier eras. The hazard ratio was lowest at around age 35 years, and then increased with age; at around age 75 years, football players had a higher risk of alcohol related disorders than men from the general population. No significant association was seen between goal scoring, number of games, and seasons played in the top tier and the risk of alcohol related disorders. Risk of disorders related to other drug misuse was significantly lower among football players than the general population (hazard ratio 0.22, 95% confidence interval 0.15 to 0.34).CONCLUSIONS: In this nationwide cohort study, male football players who had played in the Swedish top tier of competition had a significantly lower risk of alcohol related disorders than men from the general population.
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| 985. |
- Verberkt, C. A., et al.
(författare)
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Healthcare and Societal Costs in Patients with COPD and Breathlessness after Completion of a Comprehensive Rehabilitation Program
- 2021
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Ingår i: COPD: Journal of Chronic Obstructive Pulmonary Disease. - : Informa UK Limited. - 1541-2555 .- 1541-2563. ; 18:2, s. 170-180
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Tidskriftsartikel (refereegranskat)abstract
- Breathlessness is one of the most frequent symptoms in chronic obstructive pulmonary disease (COPD). COPD may result in disability, decreased productivity and increased healthcare costs. The presence of comorbidities increases healthcare utilization. However, the impact of breathlessness burden on healthcare utilization and daily activities is unclear. This study’s goal was to analyze the impact of breathlessness burden on healthcare and societal costs. In this observational single-center study, patients with COPD were followed-up for 24 months after completion of a comprehensive pulmonary rehabilitation program. Every three months participants completed a cost questionnaire, covering healthcare utilization and impact on daily activities. The results were compared between participants with low (modified Medical Research Council (mMRC) grade <2; LBB) and high baseline breathlessness burden (mMRC grade ≥2; HBB). Healthcare costs in year 1 were €7302 (95% confidence interval €6476–€8258) for participants with LBB and €10,738 (€9141–€12,708) for participants with HBB. In year 2, costs were €8830 (€7372-€10,562) and €14,933 (€12,041–€18,520), respectively. Main cost drivers were hospitalizations, contact with other healthcare professionals and rehabilitation. Costs outside the healthcare sector in year 1 were €682 (€520–€900) for participants with LBB and €1520 (€1210–€1947) for participants with HBB. In year 2, costs were €829 (€662–€1046) and €1457 (€1126–€1821) respectively. HBB in patients with COPD is associated with higher healthcare and societal costs, which increases over time. This study highlights the relevance of reducing costs with adequate breathlessness relief. When conventional approaches fail to improve breathlessness, a personalized holistic approach is warranted. © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.
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| 986. |
- von Below, Bernhard, 1952, et al.
(författare)
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What factors motivate junior doctors to engage as clinical tutors? A qualitative study.
- 2018
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Ingår i: International journal of medical education. - : International Journal of Medical Education. - 2042-6372. ; 9, s. 151-157
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Tidskriftsartikel (refereegranskat)abstract
- The study aimed to explore and identify factors motivating junior doctors to engage as long-term clinical tutors in undergraduate medical education.In this qualitative study, twenty-seven participants were recruited among junior doctors attending preparatory tutor courses at the Sahlgrenska Academy, University of Gothenburg, and the Primary Healthcare system, West Sweden. They were asked to respond to open-ended questions and write a short account of their needs as clinical tutors for medical students. A qualitative content analysis was performed.A main theme emerged: "Let me develop my skills in a supportive workplace, provide feedback and merits, and I will continue tutoring". Participants described suitable personality as fundamental, and the need to develop professional skills, both as clinical tutors and physicians. Tutor education was an important source of knowledge and stimulation. A workplace environment, supporting learning and the tutor's role, was considered important, including having an adequate time frame. A clear and well-prepared assignment was regarded essential. Junior doctors requested feedback and merits in their work as long-term tutors. Clinical tutorship was considered an optional task.In this exploratory study, motivating factors of junior doctors' engagement as future long-term tutors were identified. It is important to form a process where junior doctors can build up professional competence as clinical tutors and physicians. To ensure a sustainable tutorship in the future, we suggest that universities and healthcare authorities acknowledge and further study these motivating factors.
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| 987. |
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| 988. |
- Waller, Göran, et al.
(författare)
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A cross-sectional and semantic investigation of self-rated health in the northern Sweden MONICA-study
- 2012
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Ingår i: BMC Medical Research Methodology. - London : BioMed Central. - 1471-2288. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Self-Rated Health (SRH) correlates with risk of illness and death. But how are different questions of SRH to be interpreted? Does it matter whether one asks: “How would you assess your general state of health?”(General SRH) or “How would you assess your general state of health compared to persons of your own age?”(Comparative SRH)? Does the context in a questionnaire affect the answers? The aim of this paper is to examine the meaning of two questions on self-rated health, the statistical distribution of the answers, and whether the context of the question in a questionnaire affects the answers.Methods: Statistical and semantic methodologies were used to analyse the answers of two different SRH questions in a cross-sectional survey, the MONICA-project of northern Sweden.Results: The answers from 3504 persons were analysed. The statistical distributions of answers differed. The most common answer to the General SRH was “good”, while the most common answer to the Comparative SRH was “similar”. The semantic analysis showed that what is assessed in SRH is not health in a medical and lexical sense but fields of association connected to health, for example health behaviour, functional ability, youth, looks, way of life. The meaning and function of the two questions differ – mainly due to the comparing reference in Comparative SRH. The context in the questionnaire may have affected the statistics.Conclusions: Health is primarily assessed in terms of its sense-relations (associations) and Comparative SRH and General SRH contain different information on SRH. Comparative SRH is semantically more distinct. The context of the questions in a questionnaire may affect the way self-rated health questions are answered. Comparative SRH should not be eliminated from use in questionnaires. Its usefulness in clinical encounters should be investigated.
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| 989. |
- Wallin, Jeanette M., et al.
(författare)
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The Surprise Question and Health-Related Quality of Life in Patients on Hemodialysis : A Cross-Sectional Multicenter Study
- 2024
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Ingår i: PALLIATIVE MEDICINE REPORTS. - : Mary Ann Liebert. - 2689-2820. ; 5:1, s. 306-315
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Surprise Question (SQ) is a common method aimed at identifying frail patients who need serious illness conversations to integrate a palliative approach. However, little is known about whether the SQ identifies patients on hemodialysis who perceive that they are declining or have low health-related quality of life (HRQoL)-important aspects when considering the need for serious illness conversations.Objective: To explore how nurses and physicians' responses to the SQ are associated with patients' self-reported HRQoL.Design: Cross-sectional study.Subjects: In total, 282 patients on hemodialysis were included.Measurements: One nurse and one physician responded to the SQ for each patient. The patient-reported HRQoL was measured with the RAND 36-Item Health Survey 1.0 (RAND-36) and the EuroQual vertical visual analogue scale (EQ-VAS) from the EuroQual-5 Dimension Questionnaire (EQ-5D).Results: Nurses' responses "no, not surprised" to the SQ were associated with patient-reported worsened health compared to one year ago (RAND-36), and lower perceived overall health (EQ-VAS). Physicians' responses "no, not surprised" were associated with lower overall health and lower physical functioning. Patient-reported pain, general health, fatigue, and emotional and social aspects were not associated with responses to the SQ.Conclusions: The findings indicate that the SQ identifies patients on hemodialysis who report low overall health and low physical functioning. However, the SQ did not identify patients who reported pain, emotional problems, or fatigue, which are also important aspects to consider in identifying needs for serious illness conversations, symptom management, and to be able to integrate a palliative approach.
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| 990. |
- Wanat, M., et al.
(författare)
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Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries
- 2021
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Ingår i: British Journal of General Practice. - : Royal College of General Practitioners. - 0960-1643 .- 1478-5242. ; 71:709
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Tidskriftsartikel (refereegranskat)abstract
- Background I'm Tian/care has a crucial role in responding to the COVID-19 pandemic as the first point of patient care and gatekeeper to secondary care. Qualitative studies exploring the experiences of healthcare professionals during the COVID-19 pandemic have mainly focused on secondary care. Aim To gain an understanding of the experiences of European primary care professionals (PCPs) working during the first peak of the COVID-19 pandemic. Design and setting An exploratory qualitative study, using semi structured interviews in primary care in England, Belgium, the Netherlands. Ireland. Germany, Poland, Greece, and Sweden, between April and July 7020. Method Interviews were audiorecorded, transcribed, and analysed using a combination of inductive and deductive thematic analysis techniques. Results Fighty interviews were conducted with PCPs. PCPs had to make their own decisions on how to rapidly transform services in relation to COVID-19 and non-COVID-19 care. Despite being overwhelmed with guidance. they often lacked access to practical training. Consequently. PCPs turned to their colleagues for moral support and information to try to quickly adjust to new ways of working, including remote care. arid to deal with uncertainty. Conclusion PCPs rapidly transformed primary care delivery despite a number of challenges. Representation of primary care at policy level and engagement with local primary care champions are needed to facilitate easy and coordinated access to practical information on how to adapt services, ongoing training, and access to appropriate mental health support services for PCPs. Preservation of autonomy and responsiveness of primary care are critical to preserve the ability for rapid transformation in any future crisis of care delivery.
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