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- Bozorg, Soran Rabin, 1993-
(författare)
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Various Aspects of Gastrointestinal Disease : Examining Validity and Health Economic Outcomes
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Recent years have seen significant research advances within the gastroenterological field. Some of these consist of the recognition of serrated polyps as a precursor to colorectal cancer, and the realization of the health economic burden associated with gastrointestinal diseases.Aim: In this thesis, we aim to validate the specificity of serrated polyps in the ESPRESSO cohort (Paper I). We also aim to estimate work loss in patients with celiac disease, including the temporal relationship of work loss before and after diagnosis (Paper II).Method: By using the ESPRESSO cohort, we collected data on patients with serrated polyps and patients with celiac disease. In Paper I, the specificity of serrated polyps in the ESPRESSO cohort were validated by a structured retrospective review of patient chart. In Paper II, we estimated work loss in patients with celiac disease as compared withgeneral-population comparators matched on age, sex, county of residence and year of diagnosis.Result: The presence of a serrated polyp was confirmed in 101 out of 106 individuals identified through the ESPRESSO cohort, yielding a positive predictive value of 95% (95% confidence interval: 89-98%). Patients with celiac disase had 42.5 lost work days as compared to 28.6 days in comparators (mean difference, 14.7; 95% confidence interval, 13.2-16.2), corresponding to a relative increase of 49%. Excess work loss in patients with celiac disease was observed even 5 years before diagnosis and remained eleveated during the years after diagnosis this loss. Notebly, the excess work loss was concentrated to a small proportion while most celiac patients did not have any work loss before or after diagnosis. Conclusion: The ESPRESSO cohort has a high specificity for serrated polyps. Patients with celiac disease miss more work days than the general population even before diagnosis, and this loss persists after diagnosis.
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| 2. |
- Ek, Bosse, 1951-
(författare)
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Prioritering vid utlarmning i prehospital vård
- 2014
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, emergency medical dispatch centres (EMD) cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Increased knowledge about the triage in the prehospital care can make it possible to optimize the use of resources. Traditionally nurses have an important role in triage on emergency departments and in telephone advisory. In Sweden there is a trend towards more triage by nurses at EMDs. It is important to survey experiences of nurses’ of prioritization at EMDs.Aim: The overall aim in this thesis was to measure effectivity in prioritisation of ambulance dispatches, and to elucidate experiences from these prioritizations and decisions.Method: In study I sensitivity and specificity in 4086 dispatches was calculated, by comparison of the priority given by the EMD and the assessment performed by the ambulance-nurse according to Medical Emergency Triage and Treatment System. In study II were 15 nurses interviewed about their experiences from prioritizations at an EMD.Result: The result showed that 84,5 % of the dispatches were correct prioritised and that the sensitivity was high (94,5 %) but the specificity was low (15,4 %). Content analysis was performed and two themes emerged: “Having a profession with opportunities and obstacles” and “Meeting serious and difficult situations”. Conclusions are that over- prioritizations are made concerning patients with low or no need of medical care. Also that nurses with experience from emergency care, who are allowed to make their own decisions independent of the medical index, can improve and nuance the prioritization of resources in prehospital care. However, there is an obvious risk that their assessments will tend to be on the safe side. Important for avoiding this is improving internal support systems at the EMDs and also striving for a blame-free culture, where the nurses are not pushed by threats of being reported.
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| 3. |
- Selim, Marianne, 1954-
(författare)
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Från anlogt till digitalt : digitaliseringen av svensk radiologi i ett produktions- och organisationsperspektiv
- 2015
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Syfte: Att beskriva den organisationsförändring som fem röntgenkliniker i Sverige genomgick i samband med att radiologin digitaliserades.Frågeställningar:Hur förändrades antalet genomförda radiologiska undersökningar och undersökningstyper från tidpunkten två år före digitaliseringen till två, fyra och sex år efter digitaliseringen?Hur förändrades antalet arbetade timmar och fördelningen av arbetade timmar mellan de olika personalkategorierna från tidpunkten två år före digitaliseringen till två, fyra och sex år efter digitaliseringen?Hur förändrades arbetsuppgifterna inom och mellan de olika personalkategorierna på röntgenklinikerna efter digitaliseringen?Hur beskriver personal med en nyckelfunktion genomförandet av digitaliseringen och eventuell förändring av arbetet efter digitaliseringen?Metod: Kvantitativ och kvalitativ metod har använts och kombinerats för att besvara studiens frågeställningar. Fem svenska röntgenkliniker ingick i studien och material avseende produktionsutfall samlades in från respektive röntgenklinik. Totalt intervjuades 22 personer, med tre till sex intervjuer per röntgenklinik.Teoretiska ramverk: För att försöka förstå de positiva fynden, avseende utökade antalet undersökningar och minskning av arbetade timmar, efter digitaliseringen, genomfördes vid en av röntgenklinikerna en fallstudie med ytterligare två frågeställningar: Hur genomfördes digitaliseringen? Hur har uppföljningen vad avser arbetsflöden, genomförandet och förändringar i detalj genomförts efter digitaliseringen? Delar av Bramson m.fl. (2005) perspektiv och Kotter och Cohens (2002) framgångsfaktorer har applicerats vid analysen av det resultatet.Resultat: Samtliga röntgenkliniker uppvisade en liten ökning av antalet radiologiska undersökningar, medan datortomografi- och magnetkameraundersökningarna ökade markant under den studerade tiden. Efter digitaliseringen genomförs således fler komplicerade undersökningar, vilket anses ha medfört en kvalitativt bättre och säkrare diagnosticering. Övriga undersökningstyper uppvisar varierande resultat. Vid tre av röntgenklinikerna minskade den totala arbetade tiden, och vid två ökade den. Antalet arbetade timmar ökade för röntgenläkare och röntgensjuksköterskor, men minskade för sekreterare och undersköterskor under den studerade tiden. Generellt utför röntgenläkarna och röntgensjuksköterskorna fler arbetsuppgifter efter digitaliseringen, och många av de traditionella arbetsuppgifterna för sekreterare och undersköterskor har försvunnit eller tagits över av datorn. Bättre tillgänglighet, förhöjd kvalitet och utökad diagnostik, tydligare arbetslistor som styr arbetsflödet, förbättrad ergonomi och miljö samt samordning med andra har möjliggjorts efter digitaliseringen. Utifrån intervjuerna i fallstudien framkom teman som beskriver: information, superanvändare, utbildning, tydliga arbetsflöden och rutiner, personalbehov och motivation, liksom ett tydligt ledarskap som genomsyrat förändringsprocessen. Dessa teman är, enligt Bramson och Bramson (2005) och Kotter och Cohen (2002), viktiga att beakta för att lyckas med en förändring.Konklusion: Ingen av de intervjuade vill återgå till ett analogt arbetssätt. Digitaliseringen har inneburit att mycket förändrats för de berörda personalkategorierna, men fördelarna anses uppväga nackdelarna. För att lyckas med en förändring bör Bramsons perspektiv och Kotters framgångsfaktorer tas i beaktande.
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| 4. |
- Svanberg, Mikael, 1958-
(författare)
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Psykologiska faktorer vid rehabilitering av patienter med långvarig smärta
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain is common and a burden for both the individual and society. In chronic pain, the pain has lost its function as a warning system and instead has become a disease in itself. Neurobiologically, several areas of the brain are involved, but to gain a broader understanding of the long-term pain, the biopsychosocial model is the best starting point. In line with thisand many scientific studies since the late 90's, psychological factors have proven to be an important factor in the development and maintenance of chronic pain. Interdisciplinary multimodal rehabilitation programs (IMMRP) are the treatment currently given to patients with long-term pain in the specialized pain rehabilitation. When the IMMRP has been reviewed, patients have shown improvement over time, but it is not possible to say whether it is the IMMRP or which parts of the IMMRP that explain the improvement (1).In this licentiate thesis, I have studied the importance of psychological factors in the rehabilitation of patients with chronic pain. This has been done in three studies reported in three published articles. All the studies have been close to the clinic and have been performed on patients in the specialized pain rehabilitation care in Sweden.The first article studied the effect of the multimodal investigation (MMI). More specifically, it was investigated whether alliance building and feelings of validation in patients with chronic pain affected their acceptance of pain, pain management, catastrophic thoughts, and depression. This was performed in a "single case" study on six patients in MMI. The results showed that despite good alliance and sense of validation, acceptance increased only in one patient and no improvement was seen in pain management, catastrophizing, and depression.In study two, subgroups of patients with chronic pain were studied. The subgroup analysis showed that patients referred for IMMRP could be divided into groups with different profiles regarding emotional problems and pain avoidance. These profiles were important for how the patients relatedto their pain and the results of IMMRP. The results of the study can increase the understanding of which patients should be selected for IMMRP and how the treatment can be adapted to the patients' needs.In study three, opioid treatment in patients with long-term pain who were referred to IMMRP was studied. The result showed that opioid prescribing was common and 55% of the participants received at least one prescription for opioids during the two years after the first assessment. It also turns out that there was a connection between individual patient characteristics (especially pain and depressive symptoms) and opioid prescription. Understanding how individual patient characteristics relate to prescribing patterns and long-term opioid use is an important prerequisite for managing opioid prescribing and the basics for preventing overuse. Overall, this licentiate thesis shows that MMU has no therapeutic effect on patients with long-term pain. It also shows that patients with chronic pain are a heterogeneous group that can be divided into subgroups based on psychological characteristics. The subgroups, in turn, had different ways of managing their pain and absorbing the treatment offered. In addition, it emerged that opioid prescribing was common among patients with long-term pain and that there was a link between opioids and patient characteristics.
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