| 1. |
- Entezarjou, Artin
(author)
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eVisits in the digital era of Swedish primary care
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Objective: To evaluate asynchronous digital visits (eVisits) with regard to digital communication, clinical decisionmaking,and subsequent care utilization in the digital era of primary care in Sweden.Methods: A mixed-methods approach was adopted across the various papers in the thesis, with all studiesevaluating the eVisit platform Flow in various clinical contexts.- Paper I was a comparative study of digital triage decisions when presented with automated patienthistory reports generated by the platform. Inter-rater reliability of triage decisions by majority vote in apanel of five physicians was compared to triage decisions by a machine learning model trained usingdata labelled by an expert primary care physician.- Paper II was a qualitative focus group study of nurse and physician experiences of digitalcommunication at three primary health care centers using the platform. Themes were generated usingqualitative content analysis as described by Graneheim and Lundman.- Papers III and IV were observational studies comparing office visits in the Skåne Region from Capio,a large private health care provider, to eVisit patients from Capio Go, a national eVisit service. Adultpatients with a chief complaint of sore throat, dysuria, or cough/common cold/influenza were recruited.eVisit patients were recruited prospectively digitally prior to their eVisit, while the office visit controlgroup was recruited retrospectively using letters. Paper III primarily compared antibiotic prescriptionrates per sore throat visit, while paper IV primarily compared subsequent physical health careutilization within two weeks for patients in the Skåne Region.Results: Interrater reliability was low (Cohen κ 0.17) between the panel majority vote and the machine learningmodel. Physicians and nurses experienced digitally filtered primary care, adjusting to a novel medium ofcommunication highlighting challenges in interpreting symptoms through text as well as alterations in practiceworkflow using asynchronous communication. Antibiotics prescription rate within three days was not higher aftereVisits compared to office visits (169/798 (21.2%) vs. 124/312 (39.7%) for sore throat, respectively; P<.001). Nosignificant differences in subsequent physical visits within two weeks (excluding the first 48 h of expected “digi-physical”care) were noted following eVisits compared to office visits (179 (18.0%) vs. 102 (17.6%); P = .854).Conclusions: eVisits do not seem to be associated with over-prescription of antibiotics, or over-utilization ofphysical health care when assessing common infectious symptoms. Given staff experiencing uncertainties ininterpretation of symptoms and triage decisions being inconsistent, eVisits may be best used as one of manymodalities to access primary care, with focus placed on facilitating patient-centered professional judgement bystaff, rather than automation of complex decisions.
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| 2. |
- Lang, Victoria Ashley, 1994, et al.
(author)
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Mathematical and Computational Models for Pain: A Systematic Review
- 2021
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In: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 22:12, s. 2806-2817
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Journal article (peer-reviewed)abstract
- Objective. There is no single prevailing theory of pain that explains its origin, qualities, and alleviation. Although many studies have investigated various molecular targets for pain management, few have attempted to examine the etiology or working mechanisms of pain through mathematical or computational model development. In this systematic review, we identified and classified mathematical and computational models for characterizing pain. Methods. The databases queried were Science Direct and PubMed, yielding 560 articles published prior to January 1st, 2020. After screening for inclusion of mathematical or computational models of pain, 31 articles were deemed relevant. Results. Most of the reviewed articles utilized classification algorithms to categorize pain and no-pain conditions. We found the literature heavily focused on the application of existing models or machine learning algorithms to identify the presence or absence of pain, rather than to explore features of pain that may be used for diagnostics and treatment. Conclusions. Although understudied, the development of mathematical models may augment the current understanding of pain by providing directions for testable hypotheses of its underlying mechanisms. Additional focus is needed on developing models that seek to understand the underlying mechanisms of pain, as this could potentially lead to major breakthroughs in its treatment.
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| 3. |
- Scandurra, Isabella, 1973-, et al.
(author)
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Is 'patient's online access to health records' a good reform? : Opinions from Swedish healthcare professionals differ
- 2015
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In: Conference On Enterprise Information Systems/International Conference On Project Management/Conference On Health And Social Care Information Systems And Technologies, Centeris/Projman / Hcist 2015. - Amsterdam, Netherlands : Elsevier BV. ; 64, s. 964-968
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Conference paper (peer-reviewed)abstract
- Patients' access to their own electronic health record is a controversial issue. Many care professionals are concerned about negative effects deriving from patients reading their record information without support from clinicians. Patients on the other hand often think their concerns are outweighed by the benefits. In Sweden a pilot county has provided the health record online to its 350 000 patients for 2.5 years. This study highlights one of the most important questions to handle before and during implementation of such public eHealth services; the opinions of the care professionals regarding online records as a good reform. Results from three questionnaires to various care professions show that opinions from healthcare professionals differ not only between the professions but more importantly also between those who have experience from their patients reading their health record online and those who to date have no real experience. The experienced staff was more positive. This study concludes that in order to provide for successful national implementation, it is important to quickly elicit and disseminate opinions of care professionals with real experience to their unexperienced peers. Healthcare professionals should also be more involved in the implementation of Public eHealth services that regard electronic health records and their work processes.
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| 4. |
- Gonzalez, Manuel, et al.
(author)
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Effect of a lifestyle-focused electronic patient support application for improving risk factor management, self-rated health, and prognosis in post-myocardial infarction patients : study protocol for a multi-center randomized controlled trial
- 2019
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In: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 20:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Cardiac rehabilitation (CR) programs addressing risk factor management, educational interventions, and exercise contribute to reduce mortality after myocardial infarction (MI). However, the fulfillment of guideline-recommended CR targets is currently unsatisfactory. eHealth, i.e., the use of electronic communication for healthcare, including the use of mobile smartphone applications combined with different sensors and interactive computerized programs, offers a new array of possibilities to provide clinical care. The present study aims to assess the efficacy of a web-based application (app) designed to support persons in adhering to lifestyle advice and medication as a complement to traditional CR programs for improvement of risk factors and clinical outcomes in patients with MI compared with usual care. METHODS/DESIGN: An open-label multi-center randomized controlled trial is being conducted at different CR centers from three Swedish University Hospitals. The aim is to include 150 patients with MI < 75 years of age who are confident smartphone and/or Internet users. In addition to participation in CR programs according to the usual routine at each center, patients randomized to the intervention arm will receive access to the web-based app. A CR nurse reviews the patients' self-reported data twice weekly through a medical interface at the clinic. The primary outcome of the study will be change in submaximal exercise capacity (in watts) between 2 and 4 weeks after discharge and when the patient has completed his/her exercise program at the CR center, usually around 3-6 months post-discharge. Secondary outcomes include changes in self-reported physical activity, objectively assessed physical activity by accelerometry, self-rated health, dietary, and smoking habits, body mass index, blood pressure, blood lipids, and glucose/HbA1c levels between inclusion and follow-up visits during the first year post-MI. Additionally, we will assess uptake and adherence to the application, the number of CR staff contacts, and the incidence of cardiovascular events at 1 and 3 years after the MI. Patient recruitment started in 2016, and the first study results are expected in the beginning of 2019. DISCUSSION: The present study will add evidence to whether electronic communication can be used to improve traditional CR programs for patients after MI. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03260582 . Retrospectively registered on 24 August 2017.
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| 5. |
- Wendt, Eva, 1958, et al.
(author)
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Young women's perceptions of being asked questions about sexuality and sexual abuse : a content analysis
- 2011
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In: Midwifery. - Amsterdam : Elsevier. - 0266-6138 .- 1532-3099. ; 27:2, s. 250-256
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Journal article (peer-reviewed)abstract
- OBJECTIVE: to describe young women's perceptions of being asked questions by midwives or doctors pertaining to sexuality and sexual abuse in connection with visits for gynaecological examination. DESIGN: a qualitative study. Data comprised responses to open-ended questions in a questionnaire and were analysed by qualitative content analysis. SETTING: a county in the south-west of Sweden. PARTICIPANTS: all of the 23-, 26- and 29-year-old women who attended eight midwife and youth centres for cervical screening during the period between March and July 2006 were invited to participate. The open-ended question about sexuality was answered by 413 women, and 409 women answered the question about sexual abuse, representing approximately 84% of the women who answered the questionnaire as a whole. FINDINGS: the data resulted in a total of eight categories and 31 codes, which showed the women's perceptions of being asked questions about sexuality and sexual abuse. Six of the categories dealt with why it was considered natural to be questioned. Health professionals can be trusted and questions can open up a dialogue as well as clarify the woman's situation. The context of a visit for a gynaecological examination is relevant and questions will make it possible for the professionals to strengthen the woman. Another reason was that sexuality is an essential part of life. Those women who felt that it would not feel natural to be asked questions about sexuality and sexual abuse considered that the context is wrong and that such questions will encroach on the woman's personal sphere. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: women's responses indicate that there are good reasons for midwives and doctors to raise questions about sexuality and sexual abuse when they meet young women. Taking opportunity to find those who have sexual problems and/or experience of sexual abuse could reduce the suffering of these women and lead to an economic gain to society. The provision of training and supervision for midwives and doctors is important to enhance the quality of conversations about sexual matters. In order to deal with such issues, it is necessary to have knowledge of sexual health, relationships and violence, as well as a professional stance and a good conversational technique.
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| 6. |
- Rothlind, Erica, et al.
(author)
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Circling the undefined - A grounded theory study of intercultural consultations in Swedish primary care
- 2018
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:8
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Journal article (peer-reviewed)abstract
- Well-functioning physician-patient communication is central to primary care consultations. An increasing demand on primary care in many countries to manage a culturally diverse population has highlighted the need for improved communication skills in intercultural consultations. In previous studies, intercultural consultations in primary care have often been described as complex for various reasons, but studies exploring physician-patient interactions contributing to the understanding of why they are complex are lacking. Therefore, the aim of this study was to explore intercultural physician-patient communication in primary care consultations, generating a conceptual model of the interpersonal interactions as described by both the patients and the physicians. Using grounded theory methodology, 15 residents in family medicine and 30 foreign-born patients, the latter with Arabic and Somali as native languages, were interviewed. The analysis generated a conceptual model named circling the undefined, where a silent agreement on issues fundamental to the core of the consultation was inadequately presumed and the communicative behaviors used did not contribute to clarity. This could be a possible contributory cause of the perceived complexity of intercultural consultations. Identifying what takes place on an interpersonal level in intercultural consultations might be a first step towards building a common ground for increased mutual understanding, thereby bringing us one step closer to sharing, rather than circling the undefined.
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| 7. |
- Kling, Teresia, 1985, et al.
(author)
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Integrative Modeling Reveals Annexin A2-mediated Epigenetic Control of Mesenchymal Glioblastoma
- 2016
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In: Ebiomedicine. - : Elsevier BV. - 2352-3964. ; 12, s. 72-85
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Journal article (peer-reviewed)abstract
- Glioblastomas are characterized by transcriptionally distinct subtypes, but despite possible clinical relevance, their regulation remains poorly understood. The commonly used molecular classification systems for GBM all identify a subtype with high expression of mesenchymal marker transcripts, strongly associated with invasive growth. We used a comprehensive data-driven network modeling technique (augmented sparse inverse covariance selection, aSICS) to define separate genomic, epigenetic, and transcriptional regulators of glioblastoma subtypes. Our model identified Annexin A2 (ANXA2) as a novel methylation-controlled positive regulator of the mesenchymal subtype. Subsequent evaluation in two independent cohorts established ANXA2 expression as a prognostic factor that is dependent on ANXA2 promoter methylation. ANXA2 knockdown in primary glioblastoma stem cell-like cultures suppressed known mesenchymal master regulators, and abrogated cell proliferation and invasion. Our results place ANXA2 at the apex of a regulatory cascade that determines glioblastoma mesenchymal transformation and validate aSICS as a general methodology to uncover regulators of cancer subtypes. (C) 2016 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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| 8. |
- Höglund Carlsson, Lotta, et al.
(author)
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Prenatal ultrasound and childhood autism : long-term follow-up after a randomized controlled trial of first- vs second-trimester ultrasound
- 2016
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In: Ultrasound in Obstetrics and Gynecology. - : John Wiley & Sons. - 0960-7692 .- 1469-0705. ; 48:3, s. 285-288
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Journal article (peer-reviewed)abstract
- Objective: To analyze whether the frequency of autism spectrum disorder (ASD) in a cohort of Swedish children differs between those exposed to ultrasound in the 12th week and those exposed to ultrasound in the 18th week of gestation.Methods: The study cohort consisted of approximately 30 000 children born between 1999 and 2003 to mothers who had been randomized to a prenatal ultrasound examination at either 12 or 18weeks' gestation as part of the framework for a study on nuchal translucency screening. The outcome measure in the present study was the rate of ASD diagnoses among the children. Information on ASD diagnoses was based on data from the Swedish social insurance agency concerning childcare allowance granted for ASD.Results: Between 1999 and 2003, a total of 14 726 children were born to women who underwent a 12-week ultrasound examination and 14 596 to women who underwent an 18-week ultrasound examination. Of these, 181 (1.2%) and 176 (1.2%) children, respectively, had been diagnosed with ASD. There was no difference in ASD frequency between the early and late ultrasound groups.Conclusions: Women subjected to at least one prenatal ultrasound examination at either 12 or 18weeks' gestation had children with similar rates of ASD. However, this result reflects routine care 10-15 years ago in Sweden. Today, higher intensity ultrasound scans are performed more frequently, at earlier stages during pregnancy and for non-medical purposes, implying longer exposure time for the fetus. This change in the use of ultrasound necessitates further follow-up study of the possible effects that high exposure to ultrasound during the gestational period has on the developing brain.
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| 9. |
- Umefjord, Göran, et al.
(author)
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Reasons for consulting a doctor on the Internet : Web survey of users of an Ask the Doctor service
- 2003
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In: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 5:4, s. e26-
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Journal article (other academic/artistic)abstract
- BACKGROUND: In 1998 the Swedish noncommercial public health service Infomedica opened an Ask the Doctor service on its Internet portal. At no charge, anyone with Internet access can use this service to ask questions about personal health-related and disease-related matters. OBJECTIVE: To study why individuals choose to consult previously-unknown doctors on the Internet. METHODS: Between November 1, 2001, and January 31, 2002 a Web survey of the 3622 Ask the Doctor service users, 1036 men (29%) and 2586 (71%) women, was conducted. We excluded 186 queries from users. The results are based on quantitative and qualitative analysis of the answers to the question "Why did you choose to ask a question at Infomedica's 'Ask the Doctor' service?" RESULTS: 1223 surveys were completed (response rate 36 %). Of the participants in the survey 322 (26%) were male and 901 (74%) female. As major reasons for choosing to consult previously-unknown doctors on the Internet participants indicated: convenience (52%), anonymity (36%), "doctors too busy" (21%), difficult to find time to visit a doctor (16%), difficulty to get an appointment (13%), feeling uncomfortable when seeing a doctor (9%), and not being able to afford a doctors' visit (3%). Further motives elicited through a qualitative analysis of free-text answers were: seeking a second opinion, discontent with previous doctors and a wish for a primary evaluation of a medical problem, asking embarrassing or sensitive questions, seeking information on behalf of relatives, preferring written communication, and (from responses by expatriates, travelers, and others) living far away from regular health care. CONCLUSIONS: We found that that an Internet based Ask the Doctor service is primarily consulted because it is convenient, but it may also be of value for individuals with needs that regular health care services have not been able to meet.
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| 10. |
- Hägerlind, E., et al.
(author)
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Near infrared and skin impedance spectroscopy : a possible support in the diagnostic process of skin tumours in primary health care
- 2015
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In: Skin research and technology. - : John Wiley & Sons. - 0909-752X .- 1600-0846. ; 21:4, s. 493-499
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Journal article (peer-reviewed)abstract
- Background/purpose: The global incidence of skin cancer has increased drastically in recent decades, especially in Australia and Northern Europe. Early detection is crucial for good prognosis and high survival rates. In general, primary care physicians have considerably lower sensitivity and specificity rates for detection of skin cancer, compared to dermatologists. A probable main reason for this is that current diagnostic tools are subjective in nature, and therefore diagnostic skills highly depend on experience. Illustratively, in Sweden, approximately 155500 benign skin lesions are excised unnecessarily every year. An objective instrument, added to the clinical examination, might improve the diagnostic accuracy, and thus promote earlier detection of malignant skin tumours, as well as reduce medical costs associated with unnecessary biopsies and excisions. The general aim of this study was to investigate the usefulness of the combination of near infrared (NIR) and skin impedance spectroscopy as a supportive tool in the diagnosis and evaluation of skin tumours in primary health care.Methods: Near infrared and skin impedance data were collected by performing measurements on suspect malignant, premalignant and benign tumours in the skin of patients seeking primary health care for skin tumour evaluation. The obtained data were analysed using multivariate analysis and compared with the diagnosis received by the conventional diagnostic process.Results: The observed sensitivity and specificity rates were both 100%, when discriminating malignant and premalignant skin tumours from benign skin tumours, and the observed sensitivity and specificity for separating malignant skin tumours from premalignant and benign skin tumours were also 100%, respectively.Conclusion: The results of this study indicate that the NIR and skin impedance spectroscopy may be a useful supportive tool for the general practitioner in the diagnosis and evaluation of skin tumours in primary health care, as a complement to the visual assessment.
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