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- Hybelius, Jonna, 1993-, et al.
(författare)
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A unified Internet-delivered exposure treatment for undifferentiated somatic symptom disorder : single-group prospective feasibility trial
- 2022
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Ingår i: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Exposure-based psychological treatment appears to have beneficial effects for several patient groups that commonly report distress related to persistent somatic symptoms. Yet exposure-based treatment is rarely offered in routine care. This may be because existing treatment protocols have been developed for specific symptom clusters or specific unwanted responses to somatic symptoms, and many clinics do not have the resources to offer all these specialised treatments in parallel. In preparation for a randomised controlled trial, we investigated the feasibility of a new and unified Internet-delivered exposure treatment (OSF.io: cnbwj) for somatic symptom disorder regardless of somatic symptom domain (e.g. cardiopulmonary, fatigue, gastrointestinal, pain), combination of unwanted emotions (e.g. anger, anxiety, fear, shame) and whether somatic symptoms are medically explained or not. We hypothesised that a wide spectrum of subgroups would show interest, that the treatment would be rated as credible, that adherence would be adequate, that the measurement strategy would be acceptable and that there would be no serious adverse events.Methods: Single-group prospective cohort study where 33 self-referred adults with undifferentiated DSM-5 somatic symptom disorder took part in 8 weeks of unified Internet-delivered exposure treatment delivered via a web platform hosted by a medical university. Self-report questionnaires were administered online before treatment, each week during treatment, post treatment and 3 months after treatment.Results: Participants reported a broad spectrum of symptoms. The Credibility/Expectancy mean score was 34.5 (SD = 7.0, range: 18–47). Participants completed 91% (150/165) of all modules and 97% of the participants (32/33) completed at least two exposure exercises. The average participant rated the adequacy of the rationale as 8.4 (SD = 1.5) on a scale from 0 to 10. The post-treatment assessment was completed by 97% (32/33), and 84% (27/32) rated the measurement strategy as acceptable. The Client Satisfaction Questionnaire mean score was 25.3 (SD = 4.7, range: 17–32) and no serious adverse events were reported. Reductions in subjective somatic symptom burden (the Patient Health Questionnaire 15; d = 0.90) and symptom preoccupation (the somatic symptom disorder 12; d = 1.17) were large and sustained.Conclusions: Delivering a unified Internet-delivered exposure-based treatment protocol for individuals with undifferentiated somatic symptom disorder appears to be feasible.
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| 3. |
- Olsson, Jan-Eric, et al.
(författare)
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Psychometric analysis of the Swedish version of the General Medical Council's multi source feedback questionnaires
- 2017
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Ingår i: International Journal of Medical Education. - : International Journal of Medical Education. - 2042-6372. ; 8, s. 252-261
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To determine the internal consistency and the underlying components of our translated and adapted Swedish version of the General Medical Council's multisource feedback questionnaires (GMC questionnaires) for physicians and to confirm which aspects of good medical practice the latent variable structure reflected.Methods: From October 2015 to March 2016, residents in family medicine in Sweden were invited to participate in the study and to use the Swedish version to perform self-evaluations and acquire feedback from both their patients and colleagues. The validation focused on internal consistency and construct validity. Main outcome measures were Cronbach’s alpha coefficients, Principal Component Analysis, and Confirmatory Factor Analysis indices.Results: A total of 752 completed questionnaires from patients, colleagues, and residents were analysed. Of these, 213 comprised resident self-evaluations, 336 were feedback from residents’ patients, and 203 were feedback from residents’ colleagues. Cronbach’s alpha coefficients of the scores were 0.88 from patients, 0.93 from colleagues, and 0.84 in the self-evaluations. The Confirmatory Factor Analysis validated two models that fit the data reasonably well and reflected important aspects of good medical practice. The first model had two latent factors for patient-related items concerning empathy and consultation management, and the second model had five latent factors for colleague-related items, including knowledge and skills, attitude and approach, reflection and development, teaching, and trust.Conclusions: The current Swedish version seems to be a reliable and valid tool for formative assessment for resident physicians and their supervisors. This needs to be verified in larger samples.
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| 4. |
- Pettkó-Szandtner, Aladár, et al.
(författare)
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Activation of an alfalfa cyclin-dependent kinase inhibitor by calmodulin-like domain protein kinase.
- 2006
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Ingår i: Plant Journal. - 0960-7412. ; 46:1, s. 111-23
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Tidskriftsartikel (refereegranskat)abstract
- Kip-related proteins (KRPs) play a central role in the regulation of the cell cycle and differentiation through modulation of cyclin-dependent kinase (CDK) functions. We have identified a CDK inhibitor gene from Medicago truncatula (Mt) by a yeast two-hybrid screen. The KRPMt gene was expressed in all plant organs and cultured cells, and its transcripts accumulated after abscisic acid and NaCl treatment. The KRPMt protein exhibits seven conserved sequence domains and a PEST motif that is also detected in various Arabidopsis KRPs. In the yeast two-hybrid test, the KRPMt protein interacted with CDK (Medsa;CDKA;1) and D-type cyclins. However, in the pull-down assays, B-type CDK complexes were also detectable. Recombinant KRPMt differentially inhibited various alfalfa CDK complexes in phosphorylation assays. The immunoprecipitated Medsa;CDKA;1/A;2 complex was strongly inhibited, whereas the mitotic Medsa;CDKB2;1 complex was the most sensitive to inhibition. Function of Medsa;CDKB1;1 complex was not inhibited by the KRPMt protein. The mitotic Medsa;CYCB2 and Medsa;CYCA2;1 complexes responded weakly to this inhibitor protein. Kinase complexes from G2/M cells showed increased sensitivity towards the inhibitor compared with those isolated from G1/S-phase cells. In vitro phosphorylation of Medicago retinoblastoma-related protein was also reduced in the presence of KRPMt. Phosphorylation of this inhibitor protein by the recombinant calmodulin-like domain protein kinase (MsCPK3) resulted in enhanced inhibition of CDK function. The data presented emphasize the selective sensitivity of various cyclin-dependent kinase complexes to this inhibitor protein, and suggest a role for CDK inhibitors and CPKs in cross-talk between Ca2+ signalling and regulation of cell-cycle progression in plants.
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| 5. |
- Toth-Pal, Eva
(författare)
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Computer decision support systems for opportunistic health screening and for chronic heart failure management in primary health care
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There are growing demands for effective management of chronic diseases and preventive services in primary health care (PHC). Computer decision support systems (CDSS) have been shown to improve the quality of care, but they are still underused. Further knowledge is needed about the obstacles and facilitators related both to the CDSSs and to the process of implementing them in order to benefit from their full potential. A computer generated on-screen physician reminder program for opportunistic health screening was designed and implemented at a PHC centre (study I). The program was completely integrated with the electronic patient record system (EPR) and the battery of screening tests was adjusted to the individual patient on the basis of previous diagnoses, treatments and test results for seven screening areas. Of 914 patients over 70 years of age, 602 (66%) participated in the screening. The rates for pathological findings ranged from 2- 23% and new diagnoses were found in 1-4%. In a controlled study (study II) the results from the health screening in study I were compared with corresponding data from 1989 patients at three neighbouring PHC centres. There was a significant increase (13 75%) in tests performed on the participants and in pathological test results for systolic blood pressure and serum cobalamin, and an increase in new diagnoses was found for cobalamin deficiency. The influence of a guideline-based CDSS on five general practitioners' (GPs) management of 48 of their own patient cases of chronic heart failure was explored in a descriptive questionnaire study (study III). The CDSS was accessible on the Internet without connection to the EPR. The results showed that the GPs' confidence in the diagnosis changed in 25% of the cases, and they considered further investigations in 31% of the cases and medication changes in 19%. The support from the CDSS perceived by the GPs seemed to be substantial in 35% of the cases. The implementation process of the CDSS used in study III was followed in a qualitative study (study IV). Different methods for data collection were used; repeated interviews with the GPs, observations of patient visits, patient interviews, and detection of usage. The results of a qualitative content analysis showed that GPs' attitudes and characteristics constituted different profiles that seemed to be associated with the degree of acceptance of the CDSS. Those profiles were related to conceptions about the GPs' professional role and their attitudes towards the computer's function in disease management and in decision making. Additional barriers were insufficient level of computer skills and time constraints in everyday work. In conclusion, a computer-reminder program, completely integrated with an electronic patient record system, seems to be an effective method for increasing the delivery of preventive services in PHC. The system may be particularly clinically useful in screening areas that have thus far not been satisfactorily implemented, and when introducing new screening services. Applying a guideline-based CDSS for chronic heart failure may have a significant influence on GPs' disease management. It is possible to identify groups of GPs with definable needs during the implementation of a CDSS, thereby making it easier to meet those needs with individually tailored interventions.
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| 6. |
- Tran, Carrie, et al.
(författare)
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A virtual patient model for students’ interprofessional learning in primary healthcare
- 2020
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:9
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesInterprofessional education is important for increasing the quality of patient care, but organising it in primary healthcare is still challenging. The aim of this study was to develop and assess a virtual patient model for primary healthcare and to investigate students' perceptions of learning with this interprofessional virtual patient model.MethodsThe virtual patient case described a patient with several medical conditions who had returned home after surgery. The virtual patient included text files, short videos, and links to illustrate different health professions' roles in home care. Ten interprofessional groups with 39 students assessed the virtual patient from four different study programmes: nursing, physiotherapy, medicine, and occupational therapy. The students answered a questionnaire about how they perceived the usability of the virtual patient and participated in group interviews. Qualitative content analysis was used to analyse the data from the semi-structured group interviews.ResultsThe analysis of the interviews resulted in four main categories: The virtual patient model facilitated the learning process; It was beneficial to have students from different programmes in the group when working with the virtual patient; Working with the virtual patient helped the students to understand the roles and competencies of their own and other professions and All professions are needed in clinical work in order to help the patient. The students perceived that the mixture of text and multimedia made the virtual patient seem authentic and stimulated their group discussions, which they valued most. The students gave generally high points for usability in the questionnaire, but they also gave input for improvement of the program in their comments.ConclusionsThe interprofessional virtual patient model facilitated interactions and discussions between students and may be a useful complement for interprofessional education in clinical contexts and might be a suitable tool in preparing students for future teamwork.
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| 8. |
- Tran, Carrie, et al.
(författare)
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Medical students’ learning about other professions using an interprofessional virtual patient while remotely connected with their study group : Mixed Methods Study
- 2023
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; :9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Collaboration with other professions is essential in health care education to prepare students for future clinical teamwork. However, health care education still struggles to incorporate interprofessional education. Distance learning and virtual patients (VPs) may be useful additional methods to increase students' possibilities for interprofessional learning.Objective: This study had two aims. The first was to assess if an interprofessional VP case could facilitate medical students' learning about team collaboration in online groups. The second was to assess how students experienced learning with the VP when remotely connected with their group.Methods: A mixed methods design was used. The VP case was a 73-year-old man who needed help from different health professions in his home after a hip fracture. Questionnaires were answered by the students before and directly after each session. Qualitative group interviews were performed with each group of students directly after the VP sessions, and the interviews were analyzed using qualitative content analysis.Results: A total of 49 third-year medical students divided into 15 groups participated in the study. Each group had 2 to 5 students who worked together with the interprofessional VP without a teacher's guidance. In the analysis of the group interviews, a single theme was identified: the interprofessional VP promoted student interaction and gave insight into team collaboration. Two categories were found: (1) the structure of the VP facilitated students' learning and (2) students perceived the collaboration in their remotely connected groups as functioning well and being effective. The results from the questionnaires showed that the students had gained insights into the roles and competencies of other health care professions.Conclusions: This study demonstrates that an interprofessional VP enabled insights into team collaboration and increased understanding of other professions among student groups comprising only medical students. The interprofessional VP seemed to benefit students' learning in an online, remote-learning context. Although our VP was not used as an interprofessional student activity according to the common definition of interprofessional education, the results imply that it still contributed to students' interprofessional learning.
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