| 1. |
- Borg, Sixten, et al.
(författare)
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Patient-reported outcome and experience measures for diabetes: development of scale models, differences between patient groups and relationships with cardiovascular and diabetes complication risk factors, in a combined registry and survey study in Sweden
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The Swedish National Diabetes Register (NDR) has developed a diabetes-specific questionnaire to collect information on individuals' management of their diabetes, collaboration with healthcare providers and the disease’s impact on daily life. Our main objective was to develop measures of well-being, abilities to manage diabetes and judgements of diabetes care, and to detect and quantify differences using the NDR questionnaire.Design, setting and participants The questionnaire was analysed with using responses from 3689 participants with type 1 and 2 diabetes, randomly sampled from the NDR population, combined with register data on patient characteristics and cardiovascular and diabetes complication risk factors.Methods We used item response theory to develop scales for measuring well-being, abilities to manage diabetes and judgements of diabetes care (scores). Test–retest reliability on the scale level was analysed with intraclass correlation. Associations between scores and risk factor levels were investigated with subgroup analyses and correlations.Results We obtained scales with satisfactory measurement properties, covering patient reported outcome measures such as general well-being and being free of worries, and patient reported experience measure, for example, access and continuity in diabetes care. All scales had acceptable test–retest reliability and could detect differences between diabetes types, age, gender and treatment subgroups. In several aspects, for example, freedom of worries, type 1 patients report lower than type 2, and younger patients lower than older. Associations were found between some scores and glycated haemoglobin, but none with systolic blood pressure or low-density lipoprotein cholesterol. Clinicians report positive experience of using scores, visually presented, in the patient dialogue.Conclusions The questionnaire measures and detects differences in patient well-being, abilities and judgements of diabetes care, and identifies areas for improvement. To further improve diabetes care, we conclude that patient-reported measures are important supplements to cardiovascular and diabetes complication risk factors, reflecting patient experiences of living with diabetes and diabetes care.
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| 2. |
- Högberg, Anders, 1968-, et al.
(författare)
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Uppdragsarkeologiska möjligheter : Nya sätt att tänka om en samtidsverksamhet i en framtidsbransch
- 2021
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Ingår i: In Situ Archaeologica. - Göteborg : University of Gothenburg. - 2000-4044 .- 2002-7656. ; 15, s. 5-30
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Tidskriftsartikel (refereegranskat)abstract
- In this text we discuss how Swedish contract archaeology can develop its social engagement by creating new areas of relevance to society, beyond the general activities of disseminating results. We do so by giving concrete examples of how this can be done, using archaeological excavations as a starting point. The examples include engaging the local community in future planning for a social sustainable living environment, collaboration with the tourism sector, development of teaching materials for secondary schools, memory training for people with acquired brain damage, and school programs focusing on a socially sustainable and inclusive society. The purpose of the text is to inspire change, by showing development opportunities for future contract archaeology that will benefit both performers and recipients, and contribute to society’s multifaceted needs.
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| 3. |
- Svedbo Engström, Maria, 1968-, et al.
(författare)
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Implementing the Digital Diabetes Questionnaire as a clinical tool in routine diabetes care : Focus group discussions with patients and health care professionals
- 2022
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Ingår i: JMIR Diabetes. - : JMIR Publications Inc.. - 2371-4379. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Diabetes Questionnaire is a digital patient-reported outcome and experience measure for adults living with diabetes. The Diabetes Questionnaire is intended for use in routine clinical visits in diabetes care and to enable patient perspectives to be integrated into the Swedish National Diabetes Register. The Diabetes Questionnaire was developed on the basis of patients' perspectives, and evidence for its measurement qualities has been demonstrated. Patients receive an invitation to complete the questionnaire before clinical visits, and the patient and health care professional (HCP) can discuss the findings, which are instantly displayed during the visit. Implementation processes for new tools in routine care need to be studied to understand the influence of contextual factors, the support needed, and how patients and HCPs experience clinical use.OBJECTIVE: The aim of this study was to describe patients' and HCPs' experiences of initiating the use of the digital Diabetes Questionnaire as a clinical tool in routine diabetes care, supported by a structured implementation strategy involving initial education, local facilitators, and regular follow-ups.METHODS: In this qualitative study, semistructured focus group discussions were conducted 12 months after the use of the Diabetes Questionnaire was initiated. Participants were diabetes specialist nurses and physicians (20 participants in 4 groups) at hospital-based outpatient clinics or primary health care clinics and adults with type 1 or type 2 diabetes (15 participants in 4 groups). The audiotaped transcripts were analyzed using inductive qualitative content analysis.RESULTS: The results revealed 2 main categories that integrated patients' and HCPs' experiences, which together formed an overarching theme: While implementation demands new approaches, the Diabetes Questionnaire provides a broader perspective. The first main category (The Diabetes Questionnaire supports person-centered clinical visits) comprised comments expressing that the digital Diabetes Questionnaire can initiate and encourage reflection in preparation for clinical visits, bring important topics to light during clinical visits, and broaden the scope of discussion by providing additional information. The second main category (The process of initiating the implementation of the Diabetes Questionnaire) comprised comments that described differences in engagement among HCPs and their managers, challenges of establishing new routines, experiences of support during implementation, thoughts about the Diabetes Questionnaire, need to change local administrative routines, and opportunities and concerns for continued use.CONCLUSIONS: The Diabetes Questionnaire can broaden the scope of health data in routine diabetes care. While implementation demands new approaches, patients and HCPs saw potential positive impacts of using the questionnaire at both the individual and group levels. Our results can inform further development of implementation strategies to support the clinical use of the questionnaire.
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| 4. |
- Bender, Johanna, 1975, et al.
(författare)
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Lipid cubic phases in topical drug delivery: Visualization of skin distribution using two-photon microscopy
- 2008
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Ingår i: Journal of Controlled Release. - : Elsevier BV. - 0168-3659 .- 1873-4995. ; 129:3, s. 163-169
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Tidskriftsartikel (refereegranskat)abstract
- The distribution of sulphorhodamine B (SRB), a fluorescent hydrophilic model drug, was investigated in human skin after passive diffusion using four different topical delivery systems. The delivery vehicles applied were two bicontinuous lipid cubic systems, a commercial ointment and water. The lipid cubic systems consisted of either monoolein (MO) or phytantriol (PT) and water. The formulations were applied on full-thickness human skin during 24 h. Thereafter the samples were investigated using two-photon microscopy (TPM). The TPM system consisted of an inverted microscope with a 40× water-immersion objective, laser scan-box, and a pulsed femtosecond titanium:sapphire laser operating at 780 nm. The fluorescence was detected using a 560 nm long-pass filter. Sequential optical sectioning was performed, resulting in images obtained at different tissue depths. TPM revealed that SRB mainly penetrates the skin via the intercellular lipid matrix. Samples exposed to the cubic phases showed a higher accumulation of SRB in micro-fissures, from which a fluorescent network of threadlike structures spread laterally in the tissue. These structures were also detected in some of the ointment samples, but not as frequent. The penetration of SRB into the stratum granulosum was deduced from the fluorescence of SRB present inside polygonal keratinocytes with cell nuclei. Higher SRB fluorescence was obtained in the outermost layer of the epidermis using the bicontinuous cubic phases, compared to when using the reference formulations. Thus, our results suggest that the dominating delivery route using the cubic phases is via micro-fissures caused by microscopic clustering of the keratinocytes in the skin. From these micro--fissures hydrophilic compounds, here modeled by SRB, can diffuse into the surrounding intercellular lipid matrix acting like a source for sustained release.
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| 5. |
- Björkman, Annica, et al.
(författare)
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Malpractice claimed calls within the Swedish Healthcare Direct: a descriptive – comparative case study
- 2021
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Ingår i: BMC Nursing. - : Springer. - 1472-6955. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMedical errors are reported as a malpractice claim, and it is of uttermost importance to learn from the errors to enhance patient safety. The Swedish national telephone helpline SHD is staffed by registered nurses; its aim is to provide qualified healthcare advice for all residents of Sweden; it handles normally about 5 million calls annually. The ongoing Covid-19 pandemic have increased call volume with approximate 30%. The aim of the present study was twofold: to describe all malpractice claims and healthcare providers’ reported measures regarding calls to Swedish Healthcare Direct (SHD) during the period January 2011–December 2018 and to compare these findings with results from a previous study covering the period January 2003–December 2010.MethodsThe study used a descriptive, retrospective and comparative design. A total sample of all reported malpractice claims regarding calls to SHD (n = 35) made during the period 2011–2018 was retrieved. Data were analysed and compared with all reported medical errors during the period 2003–2010 (n = 33).ResultsTelephone nurses’ failure to follow the computerized decision support system (CDSS) (n = 18) was identified as the main reason for error during the period 2011–2018, while failure to listen to the caller (n = 12) was the main reason during the period 2003–2010. Staff education (n = 21) and listening to one’s own calls (n = 16) were the most common measures taken within the organization during the period 2011–2018, compared to discussion in work groups (n = 13) during the period 2003–2010.ConclusionThe proportion of malpractice claims in relation to all patient contacts to SHD is still very low; it seems that only the most severe patient injuries are reported. The fact that telephone nurses’ failure to follow the CDSS is the most common reason for error is notable, as SHD and healthcare organizations stress the importance of using the CDSS to enhance patient safety. The healthcare organizations seem to have adopted a more systematic approach to handling malpractice claims regarding calls, e.g., allowing telephone nurses to listen to their own calls instead of having discussions in work groups in response to events. This enables nurses to understand the latent factors contributing to error and provides a learning opportunity.
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| 6. |
- Blomqvist, Sven, Universitetslektor, 1964-, et al.
(författare)
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Using augmented reality technology for balance training in the older adults : a feasibility pilot study
- 2021
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Impaired balance leading to falls is common in the older adults, and there is strong evidence that balance training reduces falls and increases independence. Reduced resources in health care will result in fewer people getting help with rehabilitation training. In this regard, the new technology augmented reality (AR) could be helpful. With AR, the older adults can receive help with instructions and get feedback on their progression in balance training. The purpose of this pilot study was to examine the feasibility of using AR-based visual-interactive tools in balance training of the older adults.; Methods: Seven older adults (66-88 years old) with impaired balance trained under supervision of a physiotherapist twice a week for six weeks using AR-based visual-interactive guidance, which was facilitated through a Microsoft HoloLens holographic display. Afterwards, participants and physiotherapists were interviewed about the new technology and their experience of the training. Also, fear of falling and balance ability were measured before and after training.; Results: Five participants experienced the new technology as positive in terms of increased motivation and feedback. Experiences were mixed regarding the physical and technical aspects of the HoloLens and the design of the HoloLens application. Participants also described issues that needed to be further improved, for example, the training program was difficult and monotonous. Further, the HoloLens hardware was felt to be heavy, the application's menu was difficult to control with different hand manoeuvres, and the calibration took a long time. Suggestions for improvements were described. Results of the balance tests and self-assessment instruments indicated no improvements in balance performance after AR training.; Conclusions: The study showed that training with the new technology is, to some extent, feasible for the older adults, but needs further development. Also, the technology seemed to stimulate increased motivation, which is a prerequisite for adherence to training. However, the new technology and training requires further development and testing in a larger context.
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| 9. |
- Elf, Marie, et al.
(författare)
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An assessment of briefs used for designing healthcare environments : a survey in Sweden
- 2012
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Ingår i: Construction Management and Economics. - : Taylor & Francis. - 0144-6193 .- 1466-433X. ; 30:10, s. 835-844
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Tidskriftsartikel (refereegranskat)abstract
- The brief is a central document in decision making during the early stages of the planning and construction (briefing/programming) of healthcare environments. Thus, the demand on the content and quality of these documents is high. This study aimed to assess the content and quality of initial briefs developed in Sweden to obtain an up-to-date picture of current practices of writing project statements in the early stages of designing healthcare environments. A study of 29 initial briefs was performed with a new instrument called the Content and Quality of Brief Instrument (CQB-I). The results showed that, in many cases, the documentation in the briefs was incomplete and that the information did not adequately address users’ needs. In addition, the briefs often did not include any measurable outcomes or explicitly evidence-based information. This study’s findings have implications for identifying areas for improvement in design teams’ documentation practices. Assessment can have a real impact on the quality of briefs and can raise awareness of the need to improve the briefing process itself. The present study is one of the first to assess the content and quality of briefs and provides a starting point for both practitioners and future researchers to explore the role of briefs in briefing process quality improvement.
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