| 1. |
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| 2. |
- Abbott, Allan, 1978-, et al.
(författare)
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Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context : an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial
- 2018
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP.Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context.Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated.Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and implementation in Sweden and associated national quality register data collection are potential future developments of the project.
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| 3. |
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| 4. |
- Braun, Tatjana, et al.
(författare)
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Archaeal actin from a hyperthermophile forms a single-stranded filament
- 2015
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Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : Proceedings of the National Academy of Sciences. - 0027-8424 .- 1091-6490. ; 112:30, s. 9340-9345
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Tidskriftsartikel (refereegranskat)abstract
- The prokaryotic origins of the actin cytoskeleton have been firmly established, but it has become clear that the bacterial actins form a wide variety of different filaments, different both from each other and from eukaryotic F-actin. We have used electron cryomicroscopy (cryo-EM) to examine the filaments formed by the protein crenactin (a crenarchaeal actin) from Pyrobaculum calidifontis, an organism that grows optimally at 90 degrees C. Although this protein only has similar to 20% sequence identity with eukaryotic actin, phylogenetic analyses have placed it much closer to eukaryotic actin than any of the bacterial homologs. It has been assumed that the crenactin filament is double-stranded, like F-actin, in part because it would be hard to imagine how a single-stranded filament would be stable at such high temperatures. We show that not only is the crenactin filament single-stranded, but that it is remarkably similar to each of the two strands in F-actin. A large insertion in the crenactin sequence would prevent the formation of an F-actin-like double-stranded filament. Further, analysis of two existing crystal structures reveals six different subunit-subunit interfaces that are filament-like, but each is different from the others in terms of significant rotations. This variability in the subunit-subunit interface, seen at atomic resolution in crystals, can explain the large variability in the crenactin filaments observed by cryo-EM and helps to explain the variability in twist that has been observed for eukaryotic actin filaments.
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| 5. |
- Collaboration, The PANDA, et al.
(författare)
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Feasibility studies of time-like proton electromagnetic form factors at PANDA at FAIR
- 2016
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Ingår i: European Physical Journal A. - : Springer Publishing Company. - 1434-6001 .- 1434-601X. ; 52:10
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Tidskriftsartikel (refereegranskat)abstract
- Simulation results for future measurements of electromagnetic proton form factors at P ¯ ANDA (FAIR) within the PandaRoot software framework are reported. The statistical precision with which the proton form factors can be determined is estimated. The signal channel p¯ p→ e+e- is studied on the basis of two different but consistent procedures. The suppression of the main background channel, i.e.p¯ p→ π+π-, is studied. Furthermore, the background versus signal efficiency, statistical and systematical uncertainties on the extracted proton form factors are evaluated using two different procedures. The results are consistent with those of a previous simulation study using an older, simplified framework. However, a slightly better precision is achieved in the PandaRoot study in a large range of momentum transfer, assuming the nominal beam conditions and detector performance.
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| 6. |
- Enthoven, Paul, 1955-, et al.
(författare)
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Patients experiences of the BetterBack model of care for low back pain in primary care : a qualitative interview study
- 2021
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to describe patient experiences of received primary care for low back pain (LBP) according to the BetterBack Model of Care (MoC) with a focus on illness beliefs and self-management enablement. Methods: Individual interviews were conducted with 15 adults 4-14 months after receiving treatment according to the BetterBack MoC for LBP in primary care in Sweden. Data were analysed using content analysis. Results: When analysing the data, the following theme emerged; "Participant understanding of their treatment for low back pain and self-management strategies-a matter of support systems", comprising the following categories: "Knowledge translation", "Interaction and dialogue", "The health care professional support" and "Form organization". Participants experienced that they had better knowledge about their LBP and received tools to better manage their health condition. The participants expressed good communication with the treating physiotherapist and provided suggestions to further improve the treatment of LBP. Conclusions: Participants experienced that they had gained new knowledge about their health problems and after the treatment they had the tools to handle their back problems. This suggests that the BetterBack MoC may be used as a basis for a support system to provide valuable tools for self-management for patients with low back pain.
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| 7. |
- Enthoven, Paul, et al.
(författare)
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Physiotherapists' experiences of implementation of the BetterBack model of care for low back pain in primary care - a focus group interview study
- 2024
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Ingår i: Physiotherapy Theory and Practice. - : TAYLOR & FRANCIS INC. - 0959-3985 .- 1532-5040.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The BetterBack model of care (MoC), a best practice physiotherapy MoC for low back pain (LBP), was implemented in Swedish primary care to improve management of patients with LBP and provide patients with support tools to better self-manage episodes of LBP.Purpose: The objective was to describe how physiotherapists in primary care experienced the implementation of the BetterBack MoC for LBP.MethodsFocus group interviews were conducted with physiotherapists in 2018-2019, 14-18 months after the introduction of the BetterBack MoC. Data were analyzed using qualitative content analysis.Results: Five focus group interviews with 23 (15 female and 8 male) physiotherapists, age range 24-61 years were analyzed. A supportive organization and adaptation to the local culture, combined with health care professionals' attitudes and collaboration between physiotherapists emerged as important factors for a successful implementation and for long-term sustainability of the MoC. Physiotherapists had differing opinions if the implementation led to change in clinical practice. Improved confidence in how to manage patients with LBP was expressed by physiotherapists.Conclusions: Several barriers and facilitators influence the implementation of a best practice physiotherapy MoC for LBP in primary care, which need to be considered in future implementation and sustainability processes.
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| 8. |
- Finné, Martin, et al.
(författare)
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Last Interglacial Climate in Northern Sweden-Insights from a Speleothem Record
- 2019
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Ingår i: Quaternary. - : MDPI AG. - 2571-550X. ; 2:3
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Tidskriftsartikel (refereegranskat)abstract
- Continental records with absolute dates of the timing and progression of climatic conditions during the Last Interglacial (LIG) from northern Europe are rare. Speleothems from northern Europe have a large potential as archives for LIG environmental conditions since they were formed in sheltered environments and may be preserved beneath ice sheets. Here, we present delta C-13 and delta O-18 values from speleothem Kf-21, from Korallgrottan in Jamtland (northwest Sweden). Kf-21 is dated with five MC-ICPMS U-Th dates with errors smaller than similar to 1 ka. Kf-21 started forming at similar to 130.2 ka and the main growth phase with relatively constant growth rates lasted from 127.3 ka to 124.4 ka, after which calcite formation ceased. Both delta C-13 and delta O-18 show rapid shifts but also trends, with a range of values within their Holocene counterparts from Korallgrottan. Our results indicate an early onset of the LIG in northern Europe with ice-free conditions at similar to 130 ka. Higher growth rates combined with more negative delta O-18 values between similar to 127.3 and 126.8 ka, interpreted here as warmer and more humid conditions, as well as indications of a millennial-scale cold spell centered at 126.2 ka, resemble findings from speleothem records from other parts of Europe, highlighting that these were regional scale climatic patterns.
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| 9. |
- Fors, Maria, et al.
(författare)
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Are illness perceptions and patient self-care enablement mediators of treatment effect in best practice physiotherapy low back pain care? Secondary mediation analyses in the BetterBack trial
- 2023
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Ingår i: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040. ; , s. 1-14
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: A best practice physiotherapy model of care (BetterBack MoC) for low back pain (LBP) aimed to improve patients' illness perceptions and self-care enablement, according to the Common-Sense Model of Self-Regulation (CSM).OBJECTIVE: To confirm if illness perceptions and patient self-care enablement, in line with the CSM, are mediators of treatment effects on disability and pain of the BetterBack MoC for patients with LBP compared to routine primary care. A secondary aim was to explore if illness perceptions and patient self-care enablement are mediators of guideline adherent care.METHODS: Pre-planned single mediation analyses tested whether hypothesized mediators at 3 months mediated the treatment effect of the MoC (n = 264) compared to routine care (n = 203) on disability and pain at 6 months. Secondary mediation analyses compared guideline adherent care with non-adherent care.RESULTS: No indirect effects were identified. The BetterBack intervention did not have superior effects over routine care on the hypothesized mediators. Illness perceptions and self-care enablement were significantly associated with disability and pain at 6 months. Secondary analyses showed significant indirect effects of guideline adherent care through tested mediators.CONCLUSION: Despite no indirect effects, patients' illness perceptions and self-care enablement were associated with disability and back pain intensity outcomes and are potentially relevant treatment targets.
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| 10. |
- Fors, Maria, 1987-, et al.
(författare)
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The association between patients' illness perceptions and longitudinal clinical outcome in patients with low back pain
- 2022
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Ingår i: PAIN Reports. - Philadelphia, PA, United States : Lippincott Williams & Wilkins. - 2471-2531. ; 7:3
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Illness perception is suggested to influence outcome in patients with low back pain (LBP). It is unknown if specific illness perceptions are of more importance for longitudinal outcomes, including development of self-management strategies.Objectives: This study explores whether patients' initial illness perceptions were associated with disability, pain, health-related quality of life, and self-care enablement outcomes in patients with LBP after 3 and 12 months.Methods: Four hundred sixty-seven consecutive patients seeking physiotherapeutic primary care for LBP were eligible to participate in this prospective cohort study, providing data at baseline and after 3 and 12 months (mean age 45 years, 56% women). Multiple linear regression analysis was used to explore whether patients' illness perceptions at baseline were associated with outcome in the Oswestry Disability Index (ODI), Numeric Rating Scale–LBP (NRS-LBP), EuroQol Five Dimensions, and Patient Enablement Instrument (PEI).Results: Stronger beliefs that the back problem will last a long time at baseline were associated with worse outcome in ODI, NRS-LBP, and PEI at 3 and 12 months and in EuroQol Five Dimensions at 12 months. Negative beliefs regarding treatment's ability to improve LBP were associated with worse outcome in NRS-LBP and PEI at 3 and 12 months and in ODI at 12 months.Conclusions: Illness perceptions regarding prognosis and treatment's ability to improve symptoms were the most prominent perceptions explaining several longitudinal clinical outcomes. These expectations should be addressed in an early stage in the delivery of interventions for LBP. These expectations were also important for patients' development of coping and self-management strategies.
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| 11. |
- Hälleberg Nyman, Maria, 1968-, et al.
(författare)
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Older women's perceptions of HPV self-sampling and HPV-sampling performed by a midwife : a phenomenographic study
- 2024
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cervical cancer is a global disease and it is well established that cervical cancer is caused by human papillomavirus (HPV). In Sweden self-sampling for HPV is now used as a complement to sampling performed by a midwife. However, there is a lack of knowledge on how older women perceive the self-sampling compared to the sampling performed by a midwife. Therefore, the aim of the study was to describe how women, aged 64 years and older, perceived the process of self-sampling and sampling performed by a midwife for HPV-testing.METHODS: Eighteen women were included in a qualitative interview study, and a phenomenographic approach was used for the analysis of the interviews.RESULTS: Three descriptive categories emerged: Confidence in sampling, Facilitating participation and Being informed. Within the categories, eight conceptions emerged describing the variation relating to how the women perceived the process of self-sampling and sampling performed by a midwife.CONCLUSIONS: Women in this study describe confidence in self-sampling for HPV-testing and that the self-sampling was saving time and money, both for themselves and for society. Information in relation to an HPV-positive test result is of importance and it must be kept in mind that women affected by HPV may feel guilt and shame, which health care professionals should pay attention to. This knowledge can be used in education of health care staff.
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| 12. |
- Johansson, Kajsa, et al.
(författare)
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Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care-a randomized clinical trial
- 2011
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Ingår i: Family Practice. - : Oxford University Press. - 0263-2136 .- 1460-2229. ; 28:4, s. 355-365
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Tidskriftsartikel (refereegranskat)abstract
- bjective. To compare the efficacy of subacromial corticosteroids injected by a GP with physiotherapy combining acupuncture and home exercises as treatments for SIS. less thanbrgreater than less thanbrgreater thanMethods. A randomized clinical trial was performed in primary health care. Patients diagnosed with SIS were randomized to either subacromial corticosteroid injection (s) or 10 acupuncture treatments combined with home- exercises. The main outcomes were pain and shoulder function (Adolfsson-Lysholm shoulder assessment score). Secondary outcomes were health-related quality of life (HRQL) (EuroQol-five dimension self-report questionnaire) and the patients global assessment of change. All patients were assessed at baseline and after 6 weeks and 3, 6 and 12 months. less thanbrgreater than less thanbrgreater thanResults. One hundred and seventeen patients with SIS were included, of which 91 complied with the study protocol. There were no significant differences between treatments with regard to pain, shoulder function and HRQL in change over time. However, both treatment groups improved significantly from baseline over time. less thanbrgreater than less thanbrgreater thanConclusions. Both subacromial corticosteroid injection and a series of acupuncture treatments combined with home exercises significantly decreased pain and improved shoulder function in patients with SIS, but neither treatment was significantly superior to the other.
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| 13. |
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| 14. |
- Olsson, Helena, et al.
(författare)
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Dental pulp capping : effect of Emdogain Gel on experimentally exposed human pulps
- 2005
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Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 38:3, s. 186-194
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate the effect of Emdogain Gel (Biora AB, Malmo, Sweden), consisting of a enamel matrix derivative (EMD) in a propylene glycol alginate (PGA) vehicle, on experimentally exposed human pulps and to register postoperative symptoms. METHODOLOGY: Nine pairs of contralateral premolars scheduled for extraction on orthodontic indications were included. Following a superficial pulp amputation performed with a small (016) diamond bur, either EMDgel or a mix of calcium hydroxide and sterile saline was placed at random in contact with the pulp wound. The subjects made records of symptoms and were also interviewed about pain/discomfort by a blinded examiner. After 12 weeks the teeth were extracted, prepared and subjected to light microscopic examination in which the inflammation and newly formed hard tissue in the pulp were analysed. Immunohistochemistry was performed using affinity-purified rabbit anti-EMD polyclonal antibodies. RESULTS: Postoperative symptoms were less frequent in the EMDgel-treated than in the calcium hydroxide-treated teeth, especially during the first six weeks. In the EMDgel-treated teeth, new tissue partly filled the space initially occupied by the gel and hard tissue was formed alongside the exposed dentine surfaces and in patches in the adjacent pulp tissue. EMD was detected in the areas where new hard tissue had been formed. The wound area of the EMDgel-treated teeth exhibited inflammation in the majority of the teeth whereas less inflammation was seen in the calcium hydroxide-treated teeth where the hard tissue was formed as a bridge. CONCLUSIONS: In the EMDgel-treated teeth, postoperative symptoms were less frequent and the amount and pattern of hard tissue formation were markedly different than in the teeth treated with calcium hydroxide. However, the operative procedure and the formulation with EMD in a PGA vehicle do not seem to be effective for the formation of a hard tissue barrier.
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| 15. |
- Ris, Inge, et al.
(författare)
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Adapting the determinants of implementation behavior questionnaire to evaluate implementation of a structured low back pain programme using mixed-methods
- 2021
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Ingår i: Health Science Reports. - : John Wiley & Sons. - 2398-8835. ; 4:2
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: Best-practice low back pain (LBP) primary care programmes have been developed based on evidence-based clinical guidelines and implemented in Sweden and Denmark. The theoretical domains framework (TDF) was utilized in the design of the implementation strategy. Based on the TDF domains, the Determinants of Implementation Behavior Questionnaire (DIBQ) has been developed to evaluate implementation determinants, but its feasibility and validity need to be tested and adapted to study specific contexts. This study aimed to tailor the DIBQ for evaluation of implementation for LBP primary care programmes. The objectives were to (a) translate the DIBQ into Swedish and Danish, (b) adapt the DIBQ into DIBQ-tailored (DIBQ-t) to study content validity, (c) test the DIBQ-t for feasibility, and (d) perform validity testing of DIBQ-t.Methods: We used a mixed-methods design. First, forward translation of the DIBQ, then adaptation into DIBQ-t using qualitative face validity and quantitative content validity was done. Finally, to determine feasibility and construct validity using confirmatory factor analyses, we used data from DIBQ-t collected after the programmes' 2-day course.Results: The final DIBQ-t included 28 items describing 10 of the original 18 DIBQ domains and was considered feasible. A total of 598 clinicians out of 609 responded to the DIBQ-t, with only 2‰ of the items missing. The confirmatory factor analyses showed a good fit after removing two items with the lowest domain loading. The DIBQ-t maintained linkage to all domains within the Behavioral Change Wheel. The clinicians' expectations, according to the DIBQ-t, indicate facilitating determinants outweighing barriers at the initiation of implementation processes.Conclusions: The study resulted in a feasible and valid version of a questionnaire for evaluating clinicians' expectations regarding implementation determinants of best-practice LBP primary care programmes.
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| 16. |
- Schröder, Arne, 1974-, et al.
(författare)
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Invasion success depends on invader body size in a size-structured mixed predation-competition system
- 2009
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Ingår i: Journal of Animal Ecology. - : John Wiley & Sons, Inc. - 0021-8790 .- 1365-2656. ; 78:6, s. 1152-1162
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Tidskriftsartikel (refereegranskat)abstract
- 1. The size of an individual is an important determinant of its trophic position and the type of interactions it engages in with other heterospecific and conspecific individuals. Consequently an individual's ecological role in a community changes with its body size over ontogeny, leading to that trophic interactions between individuals are a size-dependent and ontogenetically variable mixture of competition and predation. 2. Because differently sized individuals thus experience different biotic environments, invasion success may be determined by the body size of the invaders. Invasion outcome may also depend on the productivity of the system as productivity influences the biotic environment. 3. In a laboratory experiment with two poeciliid fishes the body size of the invading individuals and the daily amount of food supplied were manipulated. 4. Large invaders established persistent populations and drove the resident population to extinction in 10 out of 12 cases, while small invaders failed in 10 out of 12 trials. Stable coexistence was virtually absent. Invasion outcome was independent of productivity. 5. Further analyses suggest that small invaders experienced a competitive recruitment bottleneck imposed on them by the resident population. In contrast, large invaders preyed on the juveniles of the resident population. This predation allowed the large invaders to establish successfully by decreasing the resident population densities and thus breaking the bottleneck. 6. The results strongly suggest that the size distribution of invaders affects their ability to invade, an implication so far neglected in life-history omnivory systems. The findings are further in agreement with predictions of life-history omnivory theory, that size-structured interactions demote coexistence along a productivity gradient.
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| 17. |
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| 18. |
- Schröder, Karin, 1966-, et al.
(författare)
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Effectiveness and Quality of Implementing a Best Practice Model of Care for Low Back Pain (BetterBack) Compared with Routine Care in Physiotherapy : A Hybrid Type 2 Trial
- 2021
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:6, s. 1230-
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Tidskriftsartikel (refereegranskat)abstract
- Low back pain (LBP) occurs in all ages and first-line treatment by physiotherapists is common. The main aim of the current study was to evaluate the effectiveness of implementing a best practice model of care for LBP (intervention group—BetterBackJ MoC) compared to routine physiotherapy care (control group) regarding longitudinal patient reported outcomes. The BetterBackJ MoC contains clinical guideline recommendations and support tools to facilitate clinician adherence to guidelines. A secondary exploratory aim was to compare patient outcomes based on the fidelity of fulfilling a clinical practice quality index regarding physiotherapist care. A stepped cluster randomized design nested patients with LBP in the three clusters which were allocated to control (n = 203) or intervention (n = 264). Patient reported measures were collected at baseline, 3, 6 and 12 months and analyzed with mixed model regression. The primary outcome was between-group changes from baseline to 3 months for pain intensity and disability. Implementation of the BetterBackJ MoC did not show any between-group differences in the primary outcomes compared with routine care. However, the intervention group showed significantly higher satisfaction at 3 months and clinically meaningful greater improvement in LBP illness perception at 3 months and quality of life at 3 and 6 months but not in patient enablement and global impression of change compared with the control group. Physiotherapists’ care that adhered to all clinical practice quality indices resulted in an improvement of most patient reported outcomes with a clinically meaningful greater improved LBP illness perception at 3 month and quality of life at 3 and 6 months, significantly greater improvement in LBP illness perception, pain and satisfaction at 3 and 6 months and significantly better enablement at all time points as well as better global improvement outcomes at 3 months compared with non-adherent care. This highlights the importance of clinical guideline based primary care for improving patient reported LBP outcomes.
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| 19. |
- Schröder, Karin, et al.
(författare)
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Försörjningstrygghet för mängdmateriel : En studie av förutsättningar vid fredstida grundberedskap och höjd beredskap
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det poängteras i inriktningsbeslutet att enskilt viktigast under försvarsinriktningsperioden 2016 t.o.m. 2020 är att öka den operativa förmågan i krigsförbanden och att säkerställa den samlade förmågan i totalförsvaret.”1 Erfarenhetsmässigt vet vi att logistiken inte sällan har en gränssättande inverkan på operativ förmåga2 och med den nya styrningen ställs krav på försörjningstrygghet i såväl fredstida grundberedskap som vid höjd beredskap. Behovet av försörjningstrygghet för mängdmateriel och hur denna ska skapas är i dagsläget inte tydligt i fred och framförallt inte vid höjd beredskap vilket kan få konsekvenser för krigsförbandens operativa förmåga nu och framöver. I denna rapport beskrivs och analyseras en försörjningskedja för mängdmateriel översiktligt och de huvudsakliga utmaningar som försvarsmyndigheterna möter i arbetet med att uppnå en tillräcklig försörjningstrygghet i grundberedskap och vid höjd beredskap diskuteras.De huvudsakliga utmaningar som behöver adresseras för uppfyllande av målbilden handlar dels om det strategiska planeringsarbetet i omvandlingen av försörjningskedjan och dels om upphandling, ledtider och lagernivåer på mängdmateriel. Intervjuer, dokumentstudier samt studiebesök pekar på en hög grad av kompetens på området försörjningstrygghet i myndigheterna. Styrningen behöver dock stödja pågående arbete mot en fortsatt god utveckling för att uppnå en tillräcklig försörjningstrygghet. Förslag lämnas på riktade åtgärder och rekommendationer för att uppnå kostnadseffektiv försörjningstrygghet via exempelvis riskhantering och kategoristyrning för mängdmateriel.1 Försvarsdepartementet, Regeringsbeslut 7, Inriktning för Försvarsmaktens verksamhet för åren 2016 till och med 2020, Fö2015/00953/MFI, 2015-06-252 Försvarsmakten t.ex. Grundsyn logistik, 09 833:67228, 2007-04-24 och Handbok Logistik vid insats 2016, FM2015-689:8, 2016-07-01
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| 20. |
- Schröder, Karin, 1966-
(författare)
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Implementing BetterBack – a Best Practice Physiotherapy Healthcare Model for Low Back Pain : Clinician and Patient Evaluation
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Low back pain (LBP) occurs in all ages, and first-line treatment by physiotherapists (PTs) is common. However, national evidence-based LBP clinical guidelines are still lacking in Sweden. To facilitate guideline uptake, we developed and with a multifaceted strategy implemented a best practice physiotherapy healthcare model (BetterBack☺ MoC) with the aim of supporting management of LBP in primary care. The overall aim of this thesis was to evaluate a multifaceted implementation strategy and a best practice physiotherapy healthcare model for LBP.Methods: This thesis is based on one methodological study and three experimental trials with PTs and patients with LBP. In Paper I a mixed method design was used to translate, tailor, validate and feasibility-test the Determinants of Implementation Behaviour Questionnaire (DIBQ). This tailored DIBQ Questionnaire (DIBQ-t) was used to evaluate potential barriers/facilitators during the implementation process together with evaluation of PTs’ confidence, attitudes and beliefs in managing LBP. In a stepped cluster randomised controlled trial, PTs and their patients in three clusters were allocated to intervention group (after implementation of BetterBack☺ MoC) or control group (routine physiotherapy care). The proportions of guideline-adherent care were compared between groups (Paper III). This evaluation was based on PTs’ adherence to eight clinical practice recommendations and three clinical practice quality indices (CPQI). The overall CPQI containing the five most prioritised recommendations are: no referral to specialist care; no referral to medical imaging for benign LBP; use of educational interventions; use of exercise interventions; and no use of non-evidence-based physiotherapy. Finally, in Paper IV patient-reported outcome measures (PROMs) were compared between intervention (after the implementation of BetterBack☺ MoC) and routine care. In Paper IV an additional secondary analysis was performed, comparing PROMs based on whether or not PTs had delivered care that met all five criteria of the overall CPQI or not.Results: A tailored, feasible and valid questionnaire was developed, DIBQ-t to be used for evaluation of the implementation of LBP primary care programmes. After implementation workshop, PTs’ (n = 116) confidence increased, and PTs’ attitudes and beliefs shifted towards a more biopsychosocial orientation. PTs had high expectations of the BetterBack☺ MoC, which decreased after using the MoC. When evaluating received treatment for 500 patients with LBP, a more frequent delivery of guideline-adherent care was seen after implementation (n = 278) compared to routine care (n = 222). The overall CPQI containing the five prioritised recommendations was fulfilled in 59% of all patients in intervention versus 26% in routine care group. Analysis of adherence to specific recommendations showed a significantly improved use of stratification of number of PT visits and patient educational interventions, frequent use of exercise was maintained, and use of non-evidence-based treatment and medical imaging decreased after implementation. The primary outcome, i.e. referral to specialist consultation, was low in both groups, with no between-group differences. After implementation of the BetterBack☺ MoC, no between-group differences in PROMs were seen except for greater satisfaction with LBP care, greater improvement in illness perception and better health-related quality of life, compared with routine care. However, when PTs’ care adhered to all five CPQI criteria, a greater improvement of most patient-reported outcomes was seen compared to patient care that did not adhere to all five CPQI criteria. Conclusions: The implementation of a best practice physiotherapy healthcare model (BetterBack☺ MoC) for LBP improved both clinician and patient outcomes. PTs increased use of guideline-adherent care, confidence and biopsychosocial orientation in managing LBP. Patients reported improved satisfaction, illness perception and health-related quality of life. The implementation did not decrease referral to specialist consultation from an initial low level; nor did it improve patients’ disability and pain more than routine care. However, when guideline-adherent care was fulfilled, most PROMs improved. It is therefore important to highlight the importance of guideline-based primary care for improving patient-reported LBP outcomes.
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| 21. |
- Schröder, Karin, 1966-, et al.
(författare)
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Improved adherence to clinical guidelines for low back pain after implementation of the BetterBack model of care: A stepped cluster randomized controlled trial within a hybrid type 2 trial
- 2023
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Ingår i: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 39:7, s. 1376-1390
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND The BetterBack model of care (MoC) for low back pain (LBP) was recently developed in Swedish physiotherapy (PT) primary care.OBJECTIVE To evaluate if PTs’ adherence to LBP clinical practice guidelines (CPGs) improves after implementation of the BetterBack MoC (intervention).METHODS This was a stepped, single-blinded cluster randomized controlled trial. Patients nested in the three clusters were allocated to routine care (n = 222) or intervention (n = 278). The primary outcome was referral to specialist consultation. This was among five best practice recommendations divided into an assessment quality index (no referral to specialist consultation and no medical imaging) and a treatment quality index (use of educational interventions; use of exercise interventions; no use of non-evidence-based physiotherapy). For overall adherence, patients had to be treated with all five recommendations fulfilled. Logistic regression was used for between-group comparisons.RESULTS The proportion of patients receiving referral to specialist consultation during the PT treatment period was low in both groups with no between-group differences. However, patients in the intervention group showed significantly higher assessment quality index, treatment quality index and overall adherence compared to routine care. Adherence to the separate recommendations showed improved stratified number of visits, use of exercise was maintained high, patient educational intervention increased and use of non-evidence-based physiotherapy decreased. A reduction of medical imaging during the physiotherapy treatment period was also observed.CONCLUSIONS The adoption of CPGs could be substantially improved by introducing a MoC through PT training and supportive materials.
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| 22. |
- Singh, B. P., et al.
(författare)
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Experimental access to Transition Distribution Amplitudes with the PANDA experiment at FAIR
- 2015
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Ingår i: European Physical Journal A. Hadrons and Nuclei. - : Springer Science and Business Media LLC. - 1434-6001 .- 1434-601X. ; 51:8
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Tidskriftsartikel (refereegranskat)abstract
- Baryon-to-meson Transition Distribution Amplitudes (TDAs) encoding valuable new information on hadron structure appear as building blocks in the collinear factorized description for several types of hard exclusive reactions. In this paper, we address the possibility of accessing nucleon-to-pion (pi N) TDAs from (p) over barp -> e(+)e(-)pi(0) reaction with the future PANDA detector at the FAIR facility. At high center-of-mass energy and high invariant mass squared of the lepton pair q(2), the amplitude of the signal channel (p) over barp -> e(+)e(-)pi(0) admits a QCD factorized description in terms of pi N TDAs and nucleon Distribution Amplitudes (DAs) in the forward aid backward kinematic regimes. Assuming the validity of this factorized description, we perform feasibility studies for measuring (p) over barp -> e(+)e(-)pi(0) with the PANDA detector. Detailed simulations on signal reconstruction efficiency as well as on rejection of the most severe background channel, i.e. (p) over barp -> pi(+)pi(-)pi(0) were performed for the center-of-mass energy squared s = 5 GeV2 and s = 10 GeV2, in the kinematic regions 3.0 < q(2) < 4.3 GeV2 and 5 < q(2) < 9 GeV2, respectively, with a neutral pion scattered in the forward or backward cone vertical bar cos theta(pi 0)vertical bar > 0.5 in the proton-antiproton center-of-mass frame. Results of the simulation show that the particle identification capabilities of the PANDA detector will allow to achieve a background rejection factor of 5 . 10(7) (1 . 10(7)) at low (high) q(2) for s = 5 GeV2, and of 1 . 10(8) (6 . 10(6)) at low (high) q(2) for s = 10 GeV2, while keeping the signal reconstruction efficiency at around 40%. At both energies, a clean lepton signal can be reconstructed with the expected statistics corresponding to 2 of integrated luminosity. The cross sections obtained from the simulations are used to show that a test of QCD collinear factorization can be done at the lowest order by measuring scaling laws and angular distributions. The future measurement of the signal channel cross section with PANDA will provide a new test of the perturbative QCD description of a novel class of hard exclusive reactions and will open the possibility of experimentally accessing pi N TDAs.
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| 23. |
- Sjöberg, Karin, et al.
(författare)
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Multi-decadal surface ozone trends at globally distributed remote locations.
- 2020
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Ingår i: Elementa. - : University of California Press. - 2325-1026. ; 8:23
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Tidskriftsartikel (refereegranskat)abstract
- Extracting globally representative trend information from lower tropospheric ozone observations is extremely difficult due to the highly variable distribution and interannual variability of ozone, and the ongoing shift of ozone precursor emissions from high latitudes to low latitudes. Here we report surface ozone trends at 27 globally distributed remote locations (20 in the Northern Hemisphere, 7 in the Southern Hemisphere), focusing on continuous time series that extend from the present back to at least 1995. While these sites are only representative of less than 25% of the global surface area, this analysis provides a range of regional long-term ozone trends for the evaluation of global chemistry-climate models. Trends are based on monthly mean ozone anomalies, and all sites have at least 20 years of data, which improves the likelihood that a robust trend value is due to changes in ozone precursor emissions and/or forced climate change rather than naturally occurring climate variability. Since 1995, the Northern Hemisphere sites are nearly evenly split between positive and negative ozone trends, while 5 of 7 Southern Hemisphere sites have positive trends. Positive trends are in the range of 0.5–2 ppbv decade–1, with ozone increasing at Mauna Loa by roughly 50% since the late 1950s. Two high elevation Alpine sites, discussed by previous assessments, exhibit decreasing ozone trends in contrast to the positive trend observed by IAGOS commercial aircraft in the European lower free-troposphere. The Alpine sites frequently sample polluted European boundary layer air, especially in summer, and can only be representative of lower free tropospheric ozone if the data are carefully filtered to avoid boundary layer air. The highly variable ozone trends at these 27 surface sites are not necessarily indicative of free tropospheric trends, which have been overwhelmingly positive since the mid-1990s, as shown by recent studies of ozonesonde and aircraft observations.
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| 24. |
- Stenmarker, Emelie, et al.
(författare)
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Health-related quality of life, culture and communication: a comparative study in children with cancer in Argentina and Sweden.
- 2018
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Ingår i: Journal of patient-reported outcomes. - : Springer Science and Business Media LLC. - 2509-8020. ; 2:1
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Tidskriftsartikel (refereegranskat)abstract
- Malignant disorders in childhood are life-threatening conditions, and issues regarding the children's health-related quality of life (HRQOL) are crucial in paediatric oncology. The overall aim of this study was to explore HRQOL in children with cancer in two countries, Argentina and Sweden, which have different cultural contexts. The specific aims were: to determine HRQOL by gender, age, diagnosis, treatment modality, time since diagnosis, and parental education/employment across cultures. Further aims were to assess the child/parent relationship in HRQOL and the influence of demographic variables in psychosocial and physical HRQOL in each country.A cross-sectional study was performed in 2014, including 58 children (24 females, 34 males) and 62 parents/guardians. The instrument, the Pediatric Quality of Life Inventory™ (PedsQL™, generic, cancer and fatigue modules), and medical records were used. The response rate was 97%.The mean age of the children was 8.67years (SD 5.1, range 2-18years) and the mean time on treatment was 10.7months (SD 8.7, range 1-30months). The most common diagnosis was leukaemia (57%). In Argentina, in comparison with Sweden, a higher estimation of generic HRQOL was reported among adolescents (p=0.022) and more cancer-related problems among school-age children (p<0.0001). Children and parents in both countries confirmed the major problem with fatigue and multimodality therapy regimes, but lower levels of fatigue were reported in Argentina. Adolescents and children with solid tumours appeared as vulnerable groups. In Sweden, children whose mothers had post-secondary education reported less cancer-related problems (p=0.031). Good relationships were found between child/parent reports in Argentina regarding the fatigue module (p=0.034) and physical subscale (p=0.014), and in Sweden regarding generic health (p=0.004), including psychosocial (p=0.006) and physical subscales (p=0.042), and cancer (p=0.001), and fatigue (p<0.0001) modules. In Sweden, psychosocial health (OR 7.5; p=0.007) and physical health (OR 6.2; p=0.011) were positively influenced by being a school-age child.Fatigue is as a major problem across cultures. Still, being in school facilitates recovery. Good relationships in psychosocial HRQOL highlight professional challenges regarding severe issues and open communication, and the need of performing comparative studies of HRQOL of children with cancer from different cultural backgrounds.
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| 25. |
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