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- Adelsjö, Igor
(författare)
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Medication communication with older adults experiencing chronic illness and polypharmacy
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Populations in many high-income countries are ageing, with an ever-increasing proportion of the population aged 65 years or older. Despite increasingly better health in older people, susceptibility to chronic illness increase with age. As life expectancy increases, the length of time people can live with chronic illness increases correspondingly, mainly due to improved medication treatments. Decreased number of hospital beds per capita and length of stay in hospital has gained primary care an increasing role in the healthcare system, with higher demands on patients and their knowledge and abilities to manage medications and self-management.Aim: The overarching aim of this thesis was to explore how medication regimens are communicated in primary care consultations and in written discharge letters.Methods: In Study I, passive participant observations of primary care consultations were audio-recorded, transcribed and analysed using content analysis. Study II had a convergent mixed methods design. An assessment matrix, constructed based on previous research, was used to assess and quantify discharge letter content. The quantified discharge letter content, questionnaires and register data were used to calculate correlations between discharge letter content and readmission rate as well as self-rated quality of care transition. Finally, associations between discharge letter content and time to readmission were calculated both univariable and multivariable. In addition to discharge letter content, several other potential independent variables were included in the multivariable analysis.Results: Both studies show that physicians were prone to give information about medications and blood-samples or other examinations performed in advance to the consultation (Study I) or during the hospital admission (Study II). The physicians were, however, less prone to inform patients about self-management and lifestyle changes, symptoms to be aware of, and what to do in case they would appear. Communication was occasionally hindered by misunderstandings, e.g., when vague expressions or words with ambiguous meaning was used. Ambiguities e.g., arose due to dialectal disparity. Although physicians mainly communicated in plain language with patients, medication names imposed a significant problem for patients and in communication about medications. Discharge letter content was not associated to readmissions, the only significant predictor variables for time to readmission were previous admission the past 180 days and birth outside the Nordic countries. Discharge letters with more content were, on the other hand, correlated to worse self-estimated quality of care transition from hospital to home (Study II).Conclusions: Physicians informed patients about tests and examinations performed in the past time, and comprehensive information was provided about medications, both during consultations and in discharge letters. However, information about symptoms to be aware of and measures to take in case they would appear was scarce in consultations and discharge letters. In conversations where lifestyle changes were raised, the topic was quickly dropped without recommendations or offering support if the patient showed unconcern. Lifestyle changes in relation to chronic illness and medications were rarely discussed. Improved lifestyle as a means of reducing the need for medications was not discussed or informed about in discharge letters. Discharge letter content did not have any impact on readmissions.
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- Amann, Peter, et al.
(författare)
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A dedicated photoelectron spectroscopy instrument for studies of catalytic reactions at pressures exceeding 1 bar
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Here, we present a new high-pressure x-ray photoelectron spectroscopy system dedicated to probing catalytic reactions under realistic conditions at pressures exceeding 1 bar. The instrument builds around the concept of a “virtual cell” in which a gasflow is directed onto the sample surface creating a local high pressure on top of the sample. This allows the instrument to maintain a low pressure of a few mbars in the main chamber, while simultaneously keeping a local pressure of around 1 bar. Synchrotron radiation based grazing incidence photoemission within ± 5° is used to enhance the surface sensitivity in the experiment. The aperture, separating the high-pressure region from the differential pumping of the electron spectrometer, consists of multiple, evenly spaced, mm sized holes matching the footprint of the x-ray beam on the sample surface. As the photo-emitted electrons are subject to strong scattering in the gas phase and the resulting signal is therefore highly dependent on the sample to aperture distance, the latter is controlled with high precision using a fully integrated manipulator that allows for sample movement with step sizes of 10 nm between 0 and –5 mm with very low vibrational amplitude. The instrumental features allows acquisition of metallic bulk spectra at He pressures up to 2.5 bar and also allows for following C1s spectra under realistic gas mixtures of CO + H2with various temperatures up to 500°C. This capability opens for studies of catalytic reactions in operandi.
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- Andersson, Ulrika, et al.
(författare)
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PERSON-CENTREDNESS IN HYPERTENSION MANAGEMENT USING INFORMATION TECHNOLOGY (PERHIT) : A RANDOMISED CONTROLLED TRIAL IN PRIMARY HEALTH CARE
- 2022
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Ingår i: Journal of Hypertension. - : Ovid Technologies (Wolters Kluwer Health). - 1473-5598 .- 0263-6352. ; 40, s. 197-197
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVE: Few studies address results from use of new technology and patient participation in hypertension management. The PERHIT Study is a multicentre randomised controlled trial with the aim to evaluate the effects of a person-centred approach using a web-based, interactive self-management system through the patient´s own mobile phone on blood-pressure and well-being. Primary aim is the degree of achieved blood pressure (BP) control after eight weeks and one year. In addition, person-centeredness, usefulness, daily life activities in relation to BP values, awareness of risk and health care costs are studied. DESIGN AND METHOD: The PERHIT study was performed in four regions in southern Sweden. Following inclusion, more than 900 patients from 31 primary health care centres were randomised to two groups. In the intervention group (INT), patients were provided with a web-based self-management support system including a home-BP monitor. For eight consecutive weeks, they measured BP and performed self-reports regarding well-being, symptoms, lifestyle, medication intake and side effects every evening via their mobile phone. They could also receive motivational messages and reminders throughout the intervention period. Both patients and professionals had access to graphic feedback of reported values through a secure web portal. Patients in the control (CON) group received standard treatment as usual. RESULTS: The primary outcome (BP < 140/90 mmHg) was achieved by 48.5% and 47.1% in the INT, and by 40.4% and 40.9% in the CON group after 8 weeks (p = 0.016) and 12 months (p = 0.067), respectively. Both patients and professionals experienced the system as a useful resource for communication regarding BP and lifestyle. They described that it could be used to support a constructive and person-centred partnership between patients and professionals. CONCLUSIONS: Blood pressure control was significantly better after eight weeks, but not after one year, following an intervention based on use of mobile phones, feedback and interaction between patients and primary care professionals compared to standard care. The system can be a tool toward a new way of working and help patients reach a controlled BP and play a role in a more person-centred and individually adapted hypertension management.
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- Backlund, Sandra
(författare)
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Efficient improvement of energy efficiency in small and medium- sized Swedish firms
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This is a dissertation about efficient implementation of energy efficiency measures in small and medium-sized Swedish firms. The aim is to investigate the potential for economically efficient implementation of energy efficiency improvement measures in small and medium-sized firms. The thesis contains five papers that analyse different aspects that have been put forth in policy documents and academic debate as methods to improve energy efficiency in non-energy intensive sectors.By reading policy documents, interviewing representatives of small and medium- sized firms and energy auditors as well as analysing data from the Swedish energy audit program, different aspects of energy management practices, energy services and energy audits are considered. The thesis is the product of an interdisciplinary context but economic theory is at the foundation of the analysis and has helped formulate questions and hypotheses that have been tested and explored with the data.The results show that while the potential for improving energy efficiency in the small and medium- sized sector in Sweden is large there are challenges to realizing it in each individual firm. There is potential for improving energy efficiency in the sector and not just for investments in new technology but also for adjusting existing machinery and changing behaviour, but costs for investigating the potential and implementing the measures are large relative to the improvement potential in each company. Energy management practices in this sector are lacking and energy services will only be demanded if reduction in production cost is estimated larger than transaction costs of the service. The Swedish energy audit program has led to the implementation of energy efficiency improvements in the participating firms but compared to other policy instruments it has been a less cost-efficient way to improve energy efficiency in Sweden.
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- Bengtsson Ryberg, Johanna, et al.
(författare)
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The Effects of Wind Power on Human Interests : A Synthesis
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- PrefaceThere is a great need for knowledge concerning the impacts of wind power on humans, landscapes, the marine environment, birds, bats and other mammals.Previous studies of these environmental impacts have lacked an overall view of the effects. This has led to deficiencies in the processes surrounding the establishment of new wind farms. Vindval is a knowledge programme undertaken as a collaboration between the Swedish Energy Agency and the Swedish Environmental Protection Agency. Its aim is to gather and communicate scientific knowledge about the impacts of wind power on people and the natural environment. The programme continues until 2013.Vindval comprises some 30 individual research projects, together with four synthesis projects. Syntheses are prepared by experts, who compile and assess overall research results and experience regarding the effects of wind power in four different areas – humans, birds/bats, marine life and terrestrial mammals.The results of this research and synthesis work will provide a basis for environmental impact assessments and for the planning and permitting processes associated with wind power installations. Vindval requires high standards in the review and approval of research proposals, in order to ensure high-quality reports. The same high standards apply to the reporting, approval and publication of research results from the projects.This report was written by Johanna Bengtsson Ryberg, Gösta Bluhm, Karl Bolin, Bosse Bodén, Kristina Ek, Karin Hammarlund, Marianne Henningsson, Inga-Lena Hannukka, Carina Johansson, Sofia Jönsson, Sanna Mels, Tom Mels, Mats Nilsson, Erik Skärbäck, Patrik Söderholm, Åsa Waldo, Ingegärd Widerström, Niklas Åkerman.This report is a translation of the previous report in Swedish “Vindkraftens påverkan på människors intressen” (Naturvårdsverket report no 6497). Translated by Sofia Jönsson.The contents of the report are the responsibility of the authors.
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