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| 2. |
- Ahonen, Hanna, et al.
(författare)
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"The terrible dryness woke me up, I had some trouble breathing"-Critical situations related to oral health as described by CPAP-treated persons with obstructive sleep apnea
- 2022
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Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 31:6
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Tidskriftsartikel (refereegranskat)abstract
- Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.
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| 3. |
- Ahonen, Hanna, et al.
(författare)
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Views on oral health determinants as described by persons with continuous positive airway pressure‑treated obstructive sleep apnoea : a qualitative study
- 2023
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Ingår i: BMC Oral Health. - : BioMed Central (BMC). - 1472-6831. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Oral diseases have been associated with cardiovascular diseases, and persons with continuous positiveairway pressure [CPAP]-treated obstructive sleep apnoea [OSA] have an increased risk for negative consequences forboth oral and general health. CPAP treatment is often life-long and adherence to treatment is essential. Xerostomiais a common side-effect which can lead to treatment abandonment. Oral health is a changeable part of our generalhealth and well-being and exploring the views of oral health determinants from persons with experience of CPAP-treatment is important to prevent adverse oral health outcomes. The purpose of this study was to explore whatpersons with experience of CPAP-treated OSA view as determinants for their oral health. Methods Eighteen persons with long-term experience of CPAP-treated OSA were purposively selected. Data werecollected by semi-structured individual interviews. A code book based on the World Dental Federation’s [FDI] theo-retical framework for oral health was developed and used to analyse the data using directed content analysis. Thedomains in the framework’s component driving determinants were used as pre-determined categories. Using thedescription of driving determinants as a guide, meaning units were extracted from the interview transcripts throughan inductive approach. Then, by employing a deductive approach the code book was used to categorise the meaningunits into the pre-determined categories. Findings The views on oral health determinants described by the informants were compatible with the five domainsin the component driving determinants in the FDI’s theoretical framework. Ageing, heredity, and salivation (biologicaland genetic factors), influences from family and the wider society (social environment), location and re-localisation(physical environment), oral hygiene habits, motivation, willingness to change, professional support (health behav-iours), and availability, control, finances, and trust (access to care) were viewed as important oral health determinantsby the informants. Conclusion The study points to a variety of individual oral health-related experiences that oral healthcare profession-als could consider when designing interventions to reduce xerostomia and prevent adverse oral health outcomes forpersons undergoing long-term CPAP-treatment.
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| 4. |
- Neher, Margit, 1959-, et al.
(författare)
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Innovation in healthcare : leadership perceptions about the innovation characteristics of artificial intelligence—a qualitative interview study with healthcare leaders in Sweden
- 2023
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Ingår i: Implementation Science Communications. - London : BioMed Central (BMC). - 2662-2211. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the extensive hopes and expectations for value creation resulting from the implementation of artificial intelligence (AI) applications in healthcare, research has predominantly been technology-centric rather than focused on the many changes that are required in clinical practice for the technology to be successfully implemented. The importance of leaders in the successful implementation of innovations in healthcare is well recognised, yet their perspectives on the specific innovation characteristics of AI are still unknown. The aim of this study was therefore to explore the perceptions of leaders in healthcare concerning the innovation characteristics of AI intended to be implemented into their organisation.Methods: The study had a deductive qualitative design, using constructs from the innovation domain in the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted with 26 leaders in healthcare.Results: Participants perceived that AI could provide relative advantages when it came to care management, supporting clinical decisions, and the early detection of disease and risk of disease. The development of AI in the organisation itself was perceived as the main current innovation source. The evidence base behind AI technology was questioned, in relation to its transparency, potential quality improvement, and safety risks. Although the participants acknowledged AI to be superior to human action in terms of effectiveness and precision in some situations, they also expressed uncertainty about the adaptability and trialability of AI. Complexities such as the characteristics of the technology, the lack of conceptual consensus about AI, and the need for a variety of implementation strategies to accomplish transformative change in practice were identified, as were uncertainties about the costs involved in AI implementation.Conclusion: Healthcare leaders not only saw potential in the technology and its use in practice, but also felt that AI’s opacity limits its evidence strength and that complexities in relation to AI itself and its implementation influence its current use in healthcare practice. More research is needed based on actual experiences using AI applications in real-world situations and their impact on clinical practice. New theories, models, and frameworks may need to be developed to meet challenges related to the implementation of AI in healthcare. © 2023, The Author(s).
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| 5. |
- Neher, Margit, et al.
(författare)
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Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden : Interview Study
- 2022
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. OBJECTIVE: The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. METHODS: This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. RESULTS: Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers' conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. CONCLUSIONS: Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.
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| 6. |
- Neher, Margit, et al.
(författare)
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Preparedness to Implement Physical Activity and Rehabilitation Guidelines in Routine Primary Care Cancer Rehabilitation : Focus Group Interviews Exploring Rehabilitation Professionals' Perceptions
- 2021
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Ingår i: Journal of Cancer Education. - : Springer. - 0885-8195 .- 1543-0154. ; 36:4, s. 779-786
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Tidskriftsartikel (refereegranskat)abstract
- To explore primary care professionals' perceptions of physical activity and other cancer rehabilitation practice in cancer survivors, investigating the preparedness to implement guidelines regarding cancer rehabilitation. We collected qualitative data through seven semi-structured focus group interviews with 48 rehabilitation professionals, with mean 9 years of experience in primary care rehabilitation (32 physiotherapists, 15 occupational therapists, and 1 rehabilitation assistant) in a primary care setting. Data was analyzed using content analysis. Primary care rehabilitation professionals expressed limited experience of cancer survivors, experienced lack of knowledge of cancer-related disability, and had doubts concerning how to treat cancer survivors. They also experienced uncertainty about where to find collaboration and support in the healthcare system outside their own rehabilitation clinic. There is a need to combine different implementation strategies to tackle multiple barriers for effective cancer survivor rehabilitation in primary care, to boost individual rehabilitation professionals' knowledge and self-efficacy, to clarify roles and responsibilities for cancer rehabilitation across levels of care, and to develop and strengthen organizational bridges to provide adequate access to rehabilitation for cancer survivors.
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| 7. |
- Nilsen, Per, 1960-, et al.
(författare)
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A Framework to Guide Implementation of AI in Health Care : Protocol for a Cocreation Research Project
- 2023
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Ingår i: JMIR Research Protocols. - Toronto : JMIR Publications. - 1929-0748. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Artificial intelligence (AI) has the potential in health care to transform patient care and administrative processes, yet health care has been slow to adopt AI due to many types of barriers. Implementation science has shown the importance of structured implementation processes to overcome implementation barriers. However, there is a lack of knowledge and tools to guide such processes when implementing AI-based applications in health care.Objective: The aim of this protocol is to describe the development, testing, and evaluation of a framework, “Artificial Intelligence-Quality Implementation Framework” (AI-QIF), intended to guide decisions and activities related to the implementation of various AI-based applications in health care.Methods: The paper outlines the development of an AI implementation framework for broad use in health care based on the Quality Implementation Framework (QIF). QIF is a process model developed in implementation science. The model guides the user to consider implementation-related issues in a step-by-step design and plan and perform activities that support implementation. This framework was chosen for its adaptability, usability, broad scope, and detailed guidance concerning important activities and considerations for successful implementation. The development will proceed in 5 phases with primarily qualitative methods being used. The process starts with phase I, in which an AI-adapted version of QIF is created (AI-QIF). Phase II will produce a digital mockup of the AI-QIF. Phase III will involve the development of a prototype of the AI-QIF with an intuitive user interface. Phase IV is dedicated to usability testing of the prototype in health care environments. Phase V will focus on evaluating the usability and effectiveness of the AI-QIF. Cocreation is a guiding principle for the project and is an important aspect in 4 of the 5 development phases. The cocreation process will enable the use of both on research-based and practice-based knowledge.Results: The project is being conducted within the frame of a larger research program, with the overall objective of developing theoretically and empirically informed frameworks to support AI implementation in routine health care. The program was launched in 2021 and has carried out numerous research activities. The development of AI-QIF as a tool to guide the implementation of AI-based applications in health care will draw on knowledge and experience acquired from these activities. The framework is being developed over 2 years, from January 2023 to December 2024. It is under continuous development and refinement.Conclusions: The development of the AI implementation framework, AI-QIF, described in this study protocol aims to facilitate the implementation of AI-based applications in health care based on the premise that implementation processes benefit from being well-prepared and structured. The framework will be coproduced to enhance its relevance, validity, usefulness, and potential value for application in practice. © 2023 The Author(s).
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| 8. |
- Nilsen, Per, 1960-, et al.
(författare)
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A learning perspective on implementation
- 2022
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Ingår i: Implementation Science. - London : Routledge. - 9780367626136 ; , s. 169-170
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Bokkapitel (refereegranskat)
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| 9. |
- Nilsen, P., et al.
(författare)
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A learning perspective on implementation
- 2022
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Ingår i: Implementation Science. - London : Taylor & Francis. - 9780367626112 - 9780367626136 ; , s. 169-170
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- For many healthcare practitioners, implementing an evidence-based practice presents a few interlinked learning challenges: acquiring evidence-based practice skills to be able to problem-solve when faced with clinical uncertainty; adopting specific evidence-based practices, for example, interventions with proven effectiveness; and abandonment of non-evidence-based practices. The essay describes two modes of learning and uses these as lenses for analysing the challenges of implementing an evidence-based practice in healthcare. Adaptive learning involves a gradual shift from slower, deliberate behaviours to faster, smoother, and more efficient behaviours. Developmental learning is conceptualized as a process in the “opposite” direction, whereby more or less automatically enacted behaviours become deliberate and conscious. The mechanisms by which the two modes of learning occur are explained with reference to habit theory.
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| 10. |
- Nilsen, Per, 1960-, et al.
(författare)
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Implementation from a learning perspective
- 2020
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Ingår i: Handbook on implementation science. - Cheltenham, UK : Edward Elgar Publishing. - 9781788975988 - 9781788975995 ; , s. 409-421
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Bokkapitel (refereegranskat)abstract
- The Handbook on Implementation Science provides an overview of the field’s multidisciplinary history, theoretical approaches, key concepts, perspectives, and methods. By drawing on knowledge concerning learning, habits, organizational theory, improvement science, and policy research, the Handbook offers novel perspectives from a broad group of international experts in the field representing diverse disciplines. The editors seek to advance implementation science through careful consideration of current thinking and recommendations for future directions.
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