| 11. |
- Strand, Mattias
(författare)
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Self-admission as a treatment tool in severe anorexia nervosa
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Self-admission to psychiatric inpatient treatment is an innovative collaborative approach to healthcare rationing that invites patients to play a more active role in deciding when they need a higher level of care. In self-admission, patients with a history of high utilization of inpatient treatment are offered the choice to decide for themselves when an episode of brief hospital admission—usually 3-7 days at a time—is warranted. Self-admission has been offered in mental healthcare in Scandinavian countries and the Netherlands for over a decade as a tool in the treatment of severe and enduring mental illnesses such as schizophrenia, bipolar disorder, and borderline personality disorder. In self-admission, high-utilizers of healthcare are offered “fast lane” access to earmarked beds to make use of as they see fit, without waiting time and risk of being sent home by a psychiatric emergency service. Patients eligible for self-admission typically present with a history of multiple and prolonged episodes of hospital admission. By encouraging self-monitoring of their mental health status and promoting swift help seeking, the delay between the first signs of deterioration and subsequent hospital admission can theoretic-ally be minimized, ultimately reducing the total time spent in hospital—if patients are invited to act early in response to subjective cues that might not prompt admission if assessed through a regular emergency service, they can potentially avoid further deterioration and lengthier hospital admissions. This thesis is an evaluation of the self-admission program targeted to patients with severe ano-rexia nervosa at the Stockholm Centre for Eating Disorders, employing a mixed methods approach integrating qualitative, quantitative, and health economic components. For the quali-tative component of the thesis, 16 participants were interviewed about their experiences in the self-admission program. For the quantitative component, outcomes in terms of healthcare uti-lization, eating disorder morbidity, health-related quality of life, and sick leave for 29 partici-pants were compared to a group of 113 non-participants matched according to age, duration of illness, and body mass index. For the health economics component, the healthcare resources reallocated within the program were analyzed relative to the reduction in days spent in inpatient treatment seen among these 29 participants, in order to identify any potential crowding out effects. In sum, the findings show that self-admission to inpatient treatment is a viable and effective treatment tool for individuals with severe anorexia nervosa in terms of strengthening patient autonomy and reducing the total number of days spent hospitalized. The introduction of the self-admission program led to a more than 50% decrease in the total number of days that partici-pants spent in inpatient treatment during 12 months in the program. In comparison, only small and statistically non-significant changes over time were observed in low- and moderate-utiliza-tion comparison groups. However, no significant effects were seen in terms of the number of days spent in involuntary inpatient treatment or the number of visits to the outpatient clinic. Moreover, the introduction of self-admission did not have any significant or clinically relevant effects on participants’ self-rated eating disorder morbidity or body mass index. In terms of health-related quality of life, mixed results were seen. Whereas participant interviews pointed to marked improvements in agency, motivation, and autonomy that made a real difference in patients’ everyday lives, these changes were not mirrored by improvements on health-related quality of life as measured by standard quantitative self-rating instruments. A beneficial ten-dency was seen for participants in terms of number of days on sick leave; this finding, however, did not reach statistical significance. Importantly, the reallocation of hospital beds earmarked for self-admission was offset by an overall reduced need for inpatient treatment among partici-pants, resulting in a net increase in available hospital beds for non-participants. These findings imply that self-admission in anorexia nervosa may be most useful as a tool within a recovery model framework—an approach where the primary goal is not necessarily to achieve full symptom remission and recovery in a traditional sense, but instead to improve symptom management, strengthen the overall levels of functioning and social inclusion, and maintain a community-based treatment focus. Thus, the self-admission model underscores how hospitalization can serve as a complement to community treatment rather than a substitute. For patients with longstanding illness and pervasive difficulties in maintaining community-based treatment contacts, self-admission can be used as a tool in striving for a higher level of function-ing in everyday life. Not least, the self-admission approach may help promote an understanding of the hospital ward as a safe and helpful sanctuary in times of need rather than a place implicitly associated with crisis and coercion. In its proper context, the self-admission model holds the potential to transform the delivery of healthcare from crisis-driven to pre-emptive, and to strengthen autonomy for severely ill patients.
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| 12. |
- Strand, Mattias, et al.
(författare)
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Self-admission in the treatment of eating disorders : an analysis of healthcare resource reallocation
- 2021
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Self-admission to psychiatric inpatient treatment is an innovative approach to healthcare rationing, based on reallocation of existing resources rather than on increased funding. In self-admission, patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. Previous findings on patients with severe eating disorders indicate that self-admission reduces participants' need for inpatient treatment, but that it does not alone lead to symptom remission.METHODS: The aim of this study was to evaluate if, from a service provider perspective, the resource reallocation associated with self-admission is justified. The analysis makes use of data from a cohort study evaluating the one-year outcomes of self-admission at the Stockholm Centre for Eating Disorders.RESULTS: Participants in the program reduced their need for regular specialist inpatient treatment by 67%. Thereby, hospital beds were made available for non-participants due to the removal of a yearly average of 13.2 high-utilizers from the regular waiting list. A sensitivity analysis showed that this "win-win situation" occurred within the entire 95% confidence interval of the inpatient treatment utilization reduction.CONCLUSIONS: For healthcare systems relying on rationing by waiting list, self-admission has the potential to reduce the need for hospitalization for patients with longstanding eating disorders, while also offering benefits in the form of increased available resources for other patients requiring hospitalization.TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02937259 (retrospectively registered 10/15/2016).
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| 13. |
- Strand, Mattias, et al.
(författare)
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Self-admission to inpatient treatment in anorexia nervosa : Impact on healthcare utilization, eating disorder morbidity, and quality of life
- 2020
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Ingår i: International Journal of Eating Disorders. - : John Wiley & Sons. - 0276-3478 .- 1098-108X. ; 53:10, s. 1685-1695
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Little evidence exists concerning the optimal model of inpatient care for patients with longstanding anorexia nervosa (AN). Self-admission has been developed as a treatment tool whereby patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. The aim of this study was to evaluate the impact of a self-admission program on healthcare utilization, eating disorder morbidity, health-related quality of life (HRQoL), and sick leave for patients with AN.Method: In this cohort study, 29 participants with AN in a Swedish self-admission program were compared to 113 patients with longstanding illness but low previous utilization of inpatient treatment, matched based on age, illness duration, and body-mass index (BMI). Data on healthcare utilization, eating disorder morbidity, and sick leave were obtained from national population and eating disorder quality registers.Results: Participants displayed a >50% reduction in time spent hospitalized at 12-month follow-up, compared to nonsignificant changes in the comparison group. A sensitivity analysis comparing participants to a moderate-utilization comparison subgroup strengthened this observation. In contrast, the approach did not affect participants' BMI or eating disorder morbidity. Regarding HRQoL, mixed results were observed. In terms of sick leave, a beneficial but nonsignificant pattern was seen for participants.Discussion: These findings indicate that self-admission is a viable and helpful tool within a recovery model framework, even though it does not lead to symptom remission. In its proper context, self-admission could potentially transform healthcare from crisis-driven to pre-emptive, and promote autonomy for severely ill patients.
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| 14. |
- Strand, Mattias, et al.
(författare)
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The Cultural Formulation Interview as a clinical tool in the assessment of eating disorders : a pilot study
- 2024
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Cultural Formulation Interview (CFI) in the DSM-5 is a person-centered instrument for systematically appraising the impact of sociocultural factors in psychiatric assessment. The CFI has been shown to be feasible, acceptable, and useful in various clinical contexts. However, to this date there is only one published report describing the use of the CFI with patients with eating disorders.Aims: To explore the potential benefits and challenges of utilizing the CFI in the assessment of eating disorders.Methods: As an addendum to an ongoing qualitative study about barriers to treatment for eating disorders for individuals with a migration background in Sweden, we utilized the CFI in the assessment of adult patients (n=8) in specialist eating disorder treatment. Interview data were analyzed employing a thematic analysis framework. Participants provided feedback using a standard form for evaluation of the CFI.Results: Certain CFI questions proved especially meaningful in this context. In response to the CFI question about patient explanatory models, previously unrecognized ideas about causation emerged. These included perfectionism—a known risk factor for eating disorders—based on immigrant parents’ career expectations and experiences of strict family control over life choices. In response to the CFI questions on cultural identity and its impact, the participants provided rich descriptions including important themes such as religion, racism, and ambiguities associated with being a second-generation immigrant. The final CFI question, eliciting concern about the patient-clinician relationship, revealed numerous examples of prejudice and unfamiliarity with migrant groups among healthcare providers.Implications: The CFI can be useful in the assessment of patients with eating disorders and should be further explored as a standard tool in specialist eating disorder services.
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| 15. |
- Strand, Mattias, 1975-, et al.
(författare)
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Using external data in a BI solution to optimise waste management
- 2020
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Ingår i: Journal of Decision Systems. - : Taylor & Francis Group. - 1246-0125 .- 2116-7052. ; 29:1, s. 53-68
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Tidskriftsartikel (refereegranskat)abstract
- BI solutions are constantly being developed to support decision-making at various organisational levels. These solutions facilitate the compilation, aggregation and summarisation of large volumes of data. Consequently, the business value created by these systems is increasing as they sustain more and more advanced analytics, ranging from descriptive analytics, to predictive analytics, to prescriptive analytics. However, most organisations work primarily with internal data. Despite many references in the literature to the value hidden in external data, details on how such data can be used are scarce. In this paper, we present the results of an extensive action case study at a public waste management company. The results illustrate how external data from several external data sources, integrated into an up-and-running BI solution, are used jointly to allow for descriptive and predictive analytics, as well as prescriptive analytics. In addition, details of these analytical values are given and related to organisational benefits.
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| 16. |
- Su, Yanhui, et al.
(författare)
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Data-driven Method for Mobile Game Publishing Marketing Promotion
- 2021
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Ingår i: Proceedings 2021 IEEE International Conference on e-Business Engineering ICEBE 2021. - : IEEE. - 9781665444187 - 9781665444194 ; , s. 35-42
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Konferensbidrag (refereegranskat)abstract
- Marketing is vital for game businesses. However, it is hard to reach the target audiences and choose the right marketing strategies for different user acquisition channels in mobile game publishing. This paper shows how business intelligence can guide independent (indie) mobile game developers to do marketing promotion based on a data-driven method. We apply and extend the ARM funnel model from social game publishing to mobile game publishing and provide a data-driven method to evaluate the marketing promotion performance. First, in order to address indie game marketing challenges, we propose a data-driven method by defining key metrics and applying two different analysis methods for assessing mobile game marketing promotion. Second, we apply our data-driven method to an indie mobile game project and guide the indie game studio to determine the potential marketing promotion issues. Third, we also provide suggestions on improving marketing performance based on analysis results, especially by differentiating between channels. Finally, we summarize how our method can be generalized and used to guide indie mobile game marketing promotion, find high-quality channels for user acquisition, improve the marketing promotion effect, and discuss future research work.
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| 17. |
- Thorvald, Peter, 1980-, et al.
(författare)
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The Augmented Welder Profile : Augmenting Craftmanship with Digital and Collaborative Tools
- 2023
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Ingår i: Augmented, Virtual and Mixed Reality Simulation. - New York : AHFE International Open Access. - 9781958651940 ; , s. 9-18
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Konferensbidrag (refereegranskat)abstract
- More and more applications of Augmented Reality (AR) in manufacturing industries are introduced every day and while recent research has shown that one of the more popular applications, high volume assembly instructions, might not offer the best setting for this technology, many other applications exist that do. For assembly, remote guidance or training, rare assemblies, low takt time and high mix production, do still show promise. This article introduces the role of the Augmented Welder, a role utilizing AR technology for the programming of a welding robot. An operator support system in the form of a custom application programmed in Unity and visualized with a pair of Hololens2, connected to an ABB robot through RobotStudio. The robot is equipped with a welding gun dummy. The operator can, through the Hololens2, set safety boundaries, introduce work pieces, place targets in a 3D space, simulate the robot path, send the program to the robot, and activate the physical robot, among other things. We performed a modified pluralistic walkthrough to evaluate the operator support system both with respect to our application but also to search valuable insight to the general use of AR in the use of such applications. Results showed that while the subjects were generally positive towards the support system, several issues were identified and raised by various degrees of severity. The primary issues arose around the navigation and interaction with 2D menus and 3D objects in a 3D Mixed Reality (MR) space. The absence of physics confused the subjects as they could not interact with the virtual objects as they would have with physical objects. The lack of physics simply meant that they didn't act the same. Furthermore the interaction with 2D menus in a 3D space was both reported and observed as being very difficult as the 2D representations probably led to problems with depth perception. The general results of the debriefing indicated that using AR for robot programming was challenging although some of this can be attributed to the fact that this was the participants first use of such a system. The users indicated that the menus were appropriate and that the interaction was intuitive while the navigation within the system was not experienced as natural which confirms the above-mentioned issues with menus disappearing from the line of sight and feedback around generated target points being absent.
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