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| 2. |
- Claeson, Magdalena, 1976, et al.
(författare)
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Multiple primary melanomas in Western Sweden; 1990-2013
- 2016
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Ingår i: 3rd International Conference on UV and Skin Cancer Prevention, Melbourne.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionIn Sweden, the incidence of cutaneous malignant melanoma rises yearly with 5.5% for men and 5.2% for women and has now reached world standard rates of 17.6 for men and 18.8 for women per 100,000 population. Over the past decades, the incidence of melanoma has been higher in Western Sweden than the national average. Previous international studies have shown that melanoma patients have an elevated risk of developing a new separate primary melanoma. This study aimed at describing multiple primary melanomas (MPMs) in Western Sweden with focus on the number of tumours detected, tumour characteristics and the time to diagnosis of a subsequent melanoma.MethodsData was extracted retrospectively from the Swedish Melanoma Registry and provided information on all invasive and in situ melanoma cases in Western Sweden (1.6 million inhabitants) from 1990 to 2013. Results Within the studied period, 12,152 patients developed 13,291 melanomas. 11,254 of the patients developed only a single primary melanoma. In total, 898 patients (7.4% of all melanoma patients) developed 2,037 MPMs. Preliminary results show that the median Breslow thickness for all invasive melanomas was below 1 mm. The median Breslow thickness for the MPMs was slightly thinner for the second and third invasive melanoma as compared to the first invasive melanoma. Further, there was a higher percentage of in situ tumours among the subsequent melanomas. The median time to diagnosis of a subsequent melanoma was approximately 3 years. DiscussionSubsequent primary melanomas in Western Sweden are most commonly diagnosed with a somewhat thinner Breslow thickness than the first primary melanoma. The comparatively high percentage of melanoma survivors developing MPMs and the short median time to diagnosis of a subsequent melanoma stresses the importance of follow-up for melanoma patients, particularly during the first years.
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| 4. |
- Elf, Marie, 1962, et al.
(författare)
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upporting pre-planning design phases of new dementia care environments through group-modeling
- 2012
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Ingår i: Operations Research Society, OR54.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Problem and rationale The pre-design phase, before architectural design details are presented is important for the success of the entire construction process. In this phase, it is important to identify the needs of the users and the organization. The present project describes a group-modeling project with system dynamics (SD) in the pre-design phase of a new dementia care environment. The aim was to support a dynamic design process that was oriented towards the users needs. SD uses models to create scenarios and experiment with different solutions to understand complex problems. The method is interactive and suited for group- modeling. The tools used are a construction of a diagram depicting the system and a mathematical model for scenario experiments. Methods and procedureThe group- modeling was performed during five workshops with stakeholders from the organization. The data for the model was collected through discussions with the modeling group, a questionnaire, literature reviews and documents. The process was documented by video-recording and field notes. The participants were interviewed at the end of the project. The data was analyzed by content analysis. ResultsResult show that the modeling process supported the group to explicitly express their goal regarding care. The modeling process moved the group discussions from space solutions and square meters to the goals of the care process. The model developed illustrates a modern perspective of dementia care. Conclusions Group-modeling using SD is interesting for the pre-design process. It can be feasible for linking strategic planning of the organization with the plan over the new healthcare environment since it moves the participants in the pre-design phase to focus on important issues about the care and away from a wish list of various needed spaces, commonly achieved in traditional planning processes.
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| 5. |
- Hallberg, Stefan, 1955, et al.
(författare)
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Developing a simulation model for the patient pathway of cutaneous malignant melanoma
- 2015
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Ingår i: Operations Research for Health Care. - : Elsevier BV. - 2211-6923. ; 6, s. 23-30
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Tidskriftsartikel (refereegranskat)abstract
- In this study, a system dynamic simulation model for a part of the patient pathway of cutaneous malignant melanoma was developed. A model was built that produced quantified out-put of diagnosed patients staged by severity, using System dynamic simulation. Data from the Swedish Melanoma Registry were combined with current scientific results and used in this analytical tool. Solutions to how these results are adapted into a simulation are described. The simulation model has the ability to generate alternative quantitative output of patient health in a population corresponding to realistic interventions in health care programmes as well as population and incidence development.
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| 6. |
- Holmström, Paul, 1948, et al.
(författare)
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A System Dynamics 'Flight Simulator‛ for the Evaluation of Policy Interventions in Patient Pathways for Cutaneous Malignant Melanoma
- 2012
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Ingår i: Operations Research Society Conference, OR54.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- A system dynamics simulation model was developed as part of building improved long-time planning and policy evaluation in the patient pathways for Cutaneous Malignant Melanoma. An “incidence generator” was used to create patient output sets dependent on different patient delays in seeking treatment. A “flight simulator” was built to test the scenarios against incidence rates, follow-up programmes etc, assessing the trajectories of healthcare costs over time. It is shown that costs escalate significantly unless patient delays addressed and follow-up programmes reviewed.
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| 7. |
- Holmström, Paul, 1948
(författare)
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Bringing System Dynamics into Action Research
- 2017
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- System Dynamics simulation is a computer-aided approach to policy analysis and design, often carried out by external experts in simulation. System Dynamics is particularly useful in complicated and complex situations, such as healthcare. However, research has shown that few models in healthcare are implemented.Within System Dynamics there are methods for group model building or participatory modelling, where simulation models generate insights for organizational learning. The aim of this thesis is to study how System Dynamics can be a useful tool for healthcare practitioners in action research settings, building more on the needs and issues of a group.Thirteen cases are described in detail to illustrate the what is similar and different from a process / action research perspective, so that general conclusions can be made.The thesis concludes that action research approaches are useful when more time is spent on initial stages identifying issues relevant to the participants. Using Causal Loop Diagrams creates shared maps and understanding of how issues are connected. The shared understanding is increased through experimentation and learning from simulation models so that the group can converge on solutions that they agree on and thus lower the threshold for implementation.
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| 8. |
- Holmström, Paul, 1948, et al.
(författare)
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Holmström, P. and S. Hallberg (2010). Att hantera verklighetens komplexitet med systemtänkande och verksamhetssimulering
- 2010
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Att modellera dynamikenDet verkligt intressanta är att, baserat på orsak-verkansdiagram, bygga en systemdynamisk modell. I en sådan mo- dell följer man utvecklingen över tid på t ex en klinik, en mottagning, en vårdcentral eller ett sjukhus. Till skillnad från enkla kalkylark är det möjligt att modellera cirkulära samband, vilket underlättar förståelsen av orsaker till pro- blem i en komplex verksamhet. Man använder en sådan tidsindelning att varierande värden synliggörs, som annars skulle ”drunkna” i genomsnittsberäkningar över längre tidsperioder.På de följande sidorna ger vi ett flertal exempel på både simuleringar och systemtänkande från hälso- och sjukvår- den. I simuleringsmodellerna kan man först bekräfta modellens trovärdighet genom att testa om den återspeglar den nuvarande verkligheten. Man kan sedan gå vidare och prova alternativa strategier, policies, metoder etc. för att skapa en bild av hur dessa interventioner kan tänkas påverka verksamheten i olika hänseenden.Vi skapar ett användar- och beslutsfattarvänligt gränssnitt där det finns reglage för variabler, tabeller för basdata och grafer på nyckeltal. På så sätt kan beslutsfattare testa och optimera policies utan att förlora sig i modellens bak- omliggande detaljer.Vi strävar också efter att arbeta med en snabb och interaktiv utvecklingsmetod, som innebär att vi får en ömsesidig lärprocess där kunden successivt förstår modelleringsmetodiken och dess användbarhet. Vi fördjupar oss i verk- samhetens processer och förstår dess reella behov. Arbetsgången kan ses som en lärcykel (PDSA: Plan-Do-Study- Act) där testandet görs i en simulering i lärande nätverk tillsammans med verksamhetens aktörer.
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| 9. |
- Holmström, Paul, 1948, et al.
(författare)
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Scoping group interventions for suitability in participatory modeling
- 2009
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Ingår i: OR (Operational Research) 51 Annual Conference. - University of Warwick.
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Konferensbidrag (refereegranskat)abstract
- Over the past two decades System Dynamics (SD) modeling has been used in strategic thinking, policy testing, and quality improvement work. Many modelers have used SD in participatory group-modeling situations both as a method for fact elicitation and for group learning of the system. Several authors have stated that the modelling process is problematic and especially modelling with multi-professional groups. We conducted a scoping review of the literature on methods for group process work to identify methods that can be useful for the SD field. The article includes a description of several well-accepted methods from other fields for the briefing process at the early stages of a participatory modeling process.
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| 10. |
- Holmström, Paul, 1948, et al.
(författare)
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Simulering för bättre beslut och policies
- 2006
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Ingår i: HEL, Hälso- och sjukvårdens ekonomi och logistik. ; , s. 288-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 11. |
- Holmström, Paul, 1948, et al.
(författare)
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Staff retention and job satisfaction at a hospital clinic - a case study
- 2004
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Ingår i: International System Dynamics Conference, Oxford.
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Konferensbidrag (refereegranskat)abstract
- In this study system dynamics has been used to explore staff retention and job satisfaction at a maternity department, which was in an unfavourable spiral of attrition after an expansion period. This raised the issue about how to stop this downward spiral. To understand and explore this a causal loop diagram and a system dynamics model were developed, integrating factors of attrition and hiring rates, workload and qualitative contents of the work. The causal loop diagram shows an unbalanced system, which may spiral favourably or unfavourably after a relatively small disturbance. The system dynamics model shows that an unfavourable spiral may be reversed by qualitative interventions. The conclusions are that system dynamics is an interesting method, which may increase the understanding of the factors determining staff retention, job satisfaction and work pressure in a hospital setting. There is need for further examination of the qualitative factors incorporated in the model.
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