| 1. |
- Jäderlund Hagstedt, Lovisa, et al.
(författare)
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Impact of the Covid-19 pandemic on use of Video consultations in a Swedish Primary care setting
- 2022
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Ingår i: Proceedings of the 18th Scandinavian Conference on Health Informatics. - : Linköping University Electronic Press. - 9789179293444 ; , s. 212-213
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Konferensbidrag (refereegranskat)abstract
- The objective is to describe how the uptake of online video consultations was affected by the Covid-19 pandemic, using data from a Swedish primary care setting. There seem to be a relationship between the use of video consultations and spread of Covid-19, especially in 2020 when the use varied more with the contagion waves. In 2021 the use was more consistent over time. In summary, the Covid-19 pandemic had a direct impact on the adoption of video consultations in our primary care setting, yet after the initial high use, it appears to have stabilized on a lower level.
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| 2. |
- Johansson Östbring, Malin, 1980-, et al.
(författare)
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Effects of a pharmaceutical care intervention on clinical outcomes and patient adherence in coronary heart disease : the MIMeRiC randomized controlled trial
- 2021
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Ingår i: BMC Cardiovascular Disorders. - : BioMed Central. - 1471-2261 .- 1471-2261. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In the treatment of coronary heart disease, secondary prevention goals are still often unmet and poor adherence to prescribed drugs has been suggested as one of the reasons. We aimed to investigate whether pharmaceutical care by a pharmacist at the cardiology clinic trained in motivational interviewing improves clinical outcomes and patient adherence.METHODS: This was a prospective, randomized, controlled, outcomes-blinded trial designed to compare pharmaceutical care follow-up with standard care. After standard follow-up at the cardiology clinic, patients in the intervention group were seen by a clinical pharmacist two to five times as required over seven months. Pharmacists were trained to use motivational interviewing in the consultations and they tailored their support to each patient's clinical needs and beliefs about medicines. The primary study end-point was the proportion of patients who reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. The key secondary outcome was patient adherence to lipid-lowering therapy at 15 months after discharge, and other secondary outcomes were the effects on patient adherence to other preventive drugs, systolic blood pressure, disease-specific quality of life, and healthcare use.RESULTS: 316 patients were included. The proportion of patients who reached the target for low-density lipoprotein cholesterol were 37.0% in the intervention group and 44.2% in the control group (P = .263). More intervention than control patients were adherent to cholesterol-lowering drugs (88 vs 77%; P = .033) and aspirin (97 vs 91%; P = .036) but not to beta-blocking agents or renin-angiotensin-aldosterone system inhibitors.CONCLUSIONS: Our intervention had no positive effects on risk factors for CHD, but it increased patient adherence. Further investigation of the intervention process is needed to explore the difference in results between patient adherence and medication effects. Longer follow-up of healthcare use and mortality will determine if the increased adherence per se eventually will have a meaningful effect on patient health.TRIAL REGISTRATION: ClinicalTrials.gov NCT02102503, 03/04/2014 retrospectively registered.
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| 3. |
- Johansson Östbring, Malin, 1980-
(författare)
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Pharmaceutical care in coronary heart disease
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In coronary heart disease (CHD), pharmaceutical care implies that health care professionals cooperate with the patient to optimize drug therapy primarily for secondary prevention. Low adherence and discontinuation of drugs are common among patients with CHD, and this is associated with increased morbidity and mortality. The achievement of guidelines-recommended treatment goals for risk factors is disappointingly low in secondary prevention.Aim: To study clinical and patient related aspects of pharmaceutical care for secondary prevention in patients with CHD.Method: A pharmacist used medication review and motivational interviewing to impact patients’ beliefs about medicines and adherence in a pilot study. This intervention was further developed and tested in a randomized controlled trial (RCT) in 316 patients with verified CHD who were planned for follow-up at the cardiology clinic in Kalmar. The primary study outcome was the proportion ofpatients who reached the treatment goal for low-density lipoprotein (LDL)cholesterol. Patients’ adherence to cholesterol-lowering drugs according to a combination of refilled prescriptions and self-report was the key secondary outcome. In the RCT, pharmacists individualized both the dose and the content of thesupport based on the patient’s need. A process evaluation was planned alongside the trial to investigate implementation and mechanisms of impact such as pharmacists’ actions and effects on patients’ medication beliefs. In a separate qualitative study, we interviewed patients with CHD who had used their medicines for at least 12 months.Results: At 15 months follow-up of the RCT, the primary outcome measure did not differ between groups. The intervention improved patient adherence to cholesterol-lowering medicines; 88% vs 77% of the patients were adherent, possibly because the intervention lowered patients’ concerns about medicines. In 84% of the intervention patients at least one actual drug-related problem (DRP) was identified, and for 90% of those DRPs actions were taken to resolve the problems. Analyses of the interviews with patients revealed that patients´ experiences with medicines varied greatly - from trivial to troublesome – and these were classified into one of seven categories: a sense of security, unproblematic, learning to live with it, taking responsibility for it, somewhat uncertain, troublesome, or distressing.Conclusion: Pharmaceutical care improved the patients’ use of medicines in CHD but did not increase treatment goal achievement for LDL-cholesterol. Overall, the findings of this thesis emphasize that when support in managing medications is offered to patients, it should encompass various aspects of medicine-taking: safety, knowledge, beliefs, practical handling, impact on day-to-day life, and the patient’s medication experience.
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| 4. |
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| 5. |
- Petersson, Göran
(författare)
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Hållbar digitalisering för hälsan
- 2021
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Ingår i: Medicinsk informatik. - Stockholm : Liber. - 9789147134083 ; , s. 430-443
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 6. |
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| 7. |
- Qvarfordt, Maria, 1982-, et al.
(författare)
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Web-based education of the elderly improves drug utilization literacy : a randomized controlled trial
- 2021
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Ingår i: Health Informatics Journal. - : Sage Publications. - 1460-4582 .- 1741-2811. ; 27:1, s. 1-15
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore the effects of web-based education in the field of drug utilization on elderly individuals’ knowledge of, concerns about and self-assessed understanding of drug utilization. The 260 included participants were randomized to a control group or an intervention group. To assess drug utilization literacy, we used a questionnaire containing 20 multiple-choice questions on drug utilization and ten statements about drug utilization (to which participants graded their response using a Likert scale: two about common concerns and eight about their self-assessed understanding of drug utilization). The Beliefs about Medicines Questionnaire-General was also used. The intervention group scored higher on the knowledge questions (p < 0.001) and on six of the eight statements about self-assessed understanding of drug utilization at the first check after 2 weeks (p < 0.05). At a second check 6 months later, the difference remained for the knowledge questions, but there was no difference in self-assessed understanding of drug utilization between the groups. There were no differences in the concerns about drug utilization or beliefs about medication at any time. We conclude that a web-based education can improve drug utilization literacy in elderly individuals and might contribute to the safer use of medications.
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| 8. |
- Gottliebsen, Kristian, et al.
(författare)
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Limited evidence of benefits of patient operated intelligent primary care triage tools : findings of a literature review
- 2020
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Ingår i: BMJ Health & Care Informatics. - : BMJ Publishing Group Ltd. - 2632-1009. ; 27:1, s. 1-7
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Forskningsöversikt (refereegranskat)abstract
- Introduction There is consistent evidence that the workload in general practices is substantially increasing. The digitalisation of healthcare including the use of artificial intelligence has been suggested as a solution to this problem. We wanted to explore the features of intelligent online triage tools in primary care by conducting a literature review.Method A systematic literature search strategy was formulated and conducted in the PubMed database and the Cochrane Library. Articles were selected according to inclusion/exclusion criteria. Results and data were systematically extracted and thematically analysed. 17 articles of that reported large multimethod studies or smaller diagnostic accuracy tests on clinical vignettes were included. Reviews and expert opinions were also considered.Results There was limited evidence on the actual effects and performance of triage tools in primary care. Several aspects can guide further development: concepts of system design, system implementation and diagnostic performance. The most important findings were: a need to formulate evaluation guidelines and regulations; their assumed potential has not yet been met; a risk of increased or redistribution of workloads and the available symptom checker systems seem overly risk averse and should be tested in real-life settings.Conclusion This review identified several features associated with the design and implementation of intelligent online triage tools in a primary care context, although most of the investigated systems seemed underdeveloped and offered limited benefits. Current online triage systems should not be used by individuals who have reasonable access to traditional healthcare. Systems used should be strictly evaluated and regulated like other medical products.
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| 9. |
- Fagerström, Martin, 1979, et al.
(författare)
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MODELLING AND TESTING THE CRASH BEHAVIOUR OF COMPOSITE VEHICLES COMPONENTS
- 2019
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In the current contribution we will present the latest developments in the project “Modelling crash behaviour in future lightweight composite vehicles – Step 2”, involving 11 Swedish partners. On the material modelling side, a fully three-dimensional model to describe fibre kinking has recently been developed. The model is physically based and considers the fibre rotation during kink-band formation under large deformations. The FE implementation of the model is straightforward which allows for easy implementation. The validation of the model for stiffness and strength shows good correlation with the experiments. The influence of initial misalignments on the stiffness is well captured, the strength defined at the onset of unstable fibre rotation, is well predicted, and, in addition, the crushing response shows very good agreement with experimental results in terms of morphology in the crushing zone, as well as in the load response. To allow for computational efficiency, we have also developed and implemented (as a user element in LS-DYNA) an adaptive modelling strategy which allows for laminates to be initially modelled with only one element over the thickness.The user element kinematics can be adaptively enriched by introducing new degrees of freedom during the simulation to allow for more accurate stress predictions in critical regions by introducing discrete material interfaces, and for the modelling of delamination crack growth by introducing discrete crack surfaces interconnected with a cohesive zone law. In this work, special care has been taken to develop a robust method for explicit crash analysis. In the element, we also able to consider the correct intralaminar fracture toughness regularisation for various spatial discretisations. To assess and validate the models developed in the project, we have also conducted a series of bending and crushing experiments on component level. Three-point bending tests (in total 45 beams) have been conducted for three different carbon-epoxy material systems (pre-preg and vacuum infused), two different span lengths and two different lay-ups at several impact speeds. Similarly, crushing tests have been conducted for the same material systems by crushing tubes (in total 35 tubes) at various angles, with two different lay-ups and at two different loading speeds (quasi-static and dynamic). We believe that these tests serve as a very strong basis for any crash model validation.
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| 10. |
- Throfast, Victoria, et al.
(författare)
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e-Learning for the elderly on drug utilization : a pilot study
- 2019
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Ingår i: Health Informatics Journal. - : Sage Publications. - 1460-4582 .- 1741-2811. ; 25:2, s. 227-239
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Tidskriftsartikel (refereegranskat)abstract
- This study explores the attitudes of elderly people to the use of electronic educational technology (e-learning) on drug utilization, with particular emphasis on the layout, usability, content, and level of knowledge in the tool. e-Learning modules were evaluated by a group of elderly people (aged ⩾65 years, n = 16) via a questionnaire comprising closed and open-ended questions. Both qualitative and quantitative analyses of the responses showed mostly positive reviews. The results indicate that the e-learning modules are a suitable tool for distributing information and education and that they can be managed by elderly individuals who are familiar with computers, allowing them to learn more about medication use.
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