| 1. |
- Ahmed, Haseeb, et al.
(author)
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Planned Behavior, Social Networks, and Perceived Risks: Understanding Farmers' Behavior toward Precision Dairy Technologies
- 2024
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In: Journal of Dairy Science. - 0022-0302 .- 1525-3198. ; 107, s. 2968-2982
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Journal article (peer-reviewed)abstract
- Precision dairy tools (PDT) can provide timely information on individual cow's physiological and behavioral parameters, which can lead to more efficient management of the dairy farm. Although the economic rationale behind the adoption of PDT has been extensively discussed in the literature, the socio-psychological aspects related to the adoption of these technologies have received far less attention. Therefore, this paper proposes a socio-psychological model that builds upon the theory of planned behavior and develops hypotheses regarding cognitive constructs, their interaction with the farmers' perceived risks and social networks, and their overall influence on adoption. These hypotheses are tested using a generalized structural equation model for (a) the adoption of automatic milking systems (AMS) on the farms and (b) the PDT that are usually adopted with the AMS. Results show that adoption of these technologies is affected directly by intention, and the effects of subjective norms, perceived control, and attitudes on adoption are mediated through intention. A unit increase in perceived control score is associated with an increase in marginal probability of adoption of AMS and PDT by 0.05 and 0.19, respectively. Subjective norms are associated with an increase in marginal probability of adoption of AMS and PDT by 0.009 and 0.05, respectively. These results suggest that perceived control exerts a stronger influence on adoption of AMS and PDT, particularly compared with their subjective norms. Technology-related social networks are associated with an increase in marginal probability of adoption of AMS and PDT by 0.026 and 0.10, respectively. Perceived risks related to AMS and PDT negatively affect probability of adoption by 0.042 and 0.16, respectively, by having negative effects on attitudes, perceived self-confidence, and intentions. These results imply that integrating farmers within knowledge-sharing networks, minimizing perceived risks associated with these technologies, and enhancing farmers' confidence in their ability to use these technologies can significantly enhance uptake.
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| 2. |
- Ekman, Nina, et al.
(author)
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A state-of-the-art review of direct observation tools for assessing competency in person-centred care
- 2020
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In: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 109
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Research review (peer-reviewed)abstract
- BACKGROUND: Direct observation is a common assessment strategy in health education and training, in which trainees are observed and assessed while undertaking authentic patient care and clinical activities. A variety of direct observation tools have been developed for assessing competency in delivering person-centred care (PCC), yet to our knowledge no review of such tools exists.OBJECTIVE: To review and evaluate direct observation tools developed to assess health professionals' competency in delivering PCC.DESIGN: State-of-the-art review DATA SOURCES: Electronic literature searches were conducted in PubMed, ERIC, CINAHL, and Web of Science for English-language articles describing the development and testing of direct observation tools for assessing PCC published until March 2017.REVIEW METHODS: Three authors independently assessed the records for eligibility. Duplicates were removed and articles were excluded that were irrelevant based on title and/or abstract. All remaining articles were read in full text. A data extraction form was developed to cover and extract information about the tools. The articles were examined for any conceptual or theoretical frameworks underlying tool development and coverage of recognized PCC dimensions was evaluated against a standard framework. The psychometric performance of the tools was obtained directly from the original articles.RESULT: 16 tools were identified: five assessed PCC holistically and 11 assessed PCC within specific skill domains. Conceptual/theoretical underpinnings of the tools were generally unclear. Coverage of PCC domains varied markedly between tools. Most tools reported assessments of inter-rater reliability, internal consistency reliability and concurrent validity; however, intra-rater reliability, content and construct validity were rarely reported. Predictive and discriminant validity were not assessed.CONCLUSION: Differences in scope, coverage and content of the tools likely reflect the complexity of PCC and lack of consensus in defining this concept. Although all may serve formative purposes, evidence supporting their use in summative evaluations is limited. Patients were not involved in the development of any tool, which seems intrinsically paradoxical given the aims of PCC. The tools may be useful for providing trainee feedback; however, rigorously tested and patient-derived tools are needed for high-stakes use.
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| 3. |
- Ekman, Nina
(author)
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Development and testing af an observation-based method to assess person-centeredness in healthcare
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Person-centred care (PCC) has been designated and endorsed as a core competency needed for health care professionals (HCP) to meet the evolving challenges facing health care. The aim of this thesis was to develop and test an observation-based method for assessing clinician competency in the delivery of PCC. Study I reviewed existing PCC direct observation tools (DOT). Few of the identified 16 tools specified their conceptual base, assessed PCC holistically, were rigorously tested for reliability and validity, and none involved patients in their development. Study II aimed to identify observable indictors of PCC through interviews with 12 patients, relatives and HCPs with experience of PCC for potential inclusion in a new DOT. Deductive content analysis was performed based on the Gothenburg Centre for Person-centred Care (GPCC) PCC framework (gPCC). Patients´ first impressions were considered to impact the content, course and outcomes of the interaction and nonverbal behaviours were seen to play a major role in shaping patients’ impressions of HCPs. Study III explored the content and usability of a preliminary DOT assessing PCC competency in four main areas, subdivided in 13 domains and each illustrated by one or more behavioral indicators. Content and usability of the tool were explored using think aloud and probing techniques in 11 patients and HCPs. In general, the participants judged the tool to be easy to use and to satisfactorily cover major PCC activities outlined in the gPCC. Study IV evaluated the inter-rater reliability of a revised version of the DOT. Six HCPs with no training in using the DOT each rated 10 video recorded patient-HCP interactions. Intraclass correlations were fair to excellent range for 13 of the 15 domains. In conclusion, the tool appears promising for formative use in guiding and structuring observation-based assessments and providing feedback to trainees; however, further evaluations are required to support high-stakes usage.
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| 4. |
- Ekman, Nina, et al.
(author)
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Observable indicators of person-centred care: an interview study with patients, relatives and professionals
- 2022
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In: BMJ Open. - : BMJ. - 2044-6055. ; 12:4
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Journal article (peer-reviewed)abstract
- Objective To identify key observable indicators of person-centred care (PCC) from interviews with patients, relatives and professionals with experience of receiving or working with PCC. Design A qualitative interview study using deductive content analysis. Setting Primary and hospital care settings in Western Sweden. Participants Twelve participants with extensive experience of receiving or working with PCC were interviewed: two patients, two patients representative with long-term conditions, one relative and informal carer, three registered nurses, one physician, two occupational therapists and one social worker/researcher. Results Nine observable indicators were identified and subsumed under three predetermined categories: initiating, working and safeguarding the partnership. The first category comprised three subcategories: welcoming, interested and courteous reception; agreeing on structure and aims of the conversation; and eliciting patients' wishes for involvement of significant others. The second category comprised four subcategories: attentive, empathic and encouraging manner; promoting mutual understanding; promoting patient engagement; and encouraging and friendly body language. The last category consisted of two subcategories: collaboration and transparency in documentation and verifying that patient's and professional's views, goals and wants are correctly documented. Conclusion Our results underline the need for health professionals to actively and conscientiously convey to patients their interest in and respect for the patient as a person and their willingness to collaborate as partners in their care from the very outset of the interaction. Non-verbal behaviours were seen to play a major role in shaping patients' impressions of health professionals. Given that patients' first impressions were considered to impact the content, course and outcomes of the interaction, more research attention should be given to their implications for the effective delivery of PCC.
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| 5. |
- Enlund, Mats, et al.
(author)
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Survival after primary breast cancer surgery following propofol or sevoflurane general anesthesia-A retrospective, multicenter, database analysis of 6305 Swedish patients
- 2020
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In: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 64:8, s. 1048-1054
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Journal article (peer-reviewed)abstract
- Background: Retrospective studies indicate that the choice of anesthetic can affect long-term cancer survival. Propofol seems to have an advantage over sevoflurane. However, this is questioned for breast cancer. We gathered a large cohort of breast cancer surgery patients from seven Swedish hospitals and hypothesized that general anesthesia with propofol would be superior to sevoflurane anesthesia regarding long-term breast cancer survival.Methods: We identified all patients who were anaesthetized for breast cancer surgery between 2006 and 2012. The patients were matched to the Swedish Breast Cancer Quality Register, to retrieve tumor characteristics, prognostic factors, and adjuvant treatment as well as date of death. Overall survival between patients undergoing sevoflurane and propofol anesthesia was analyzed with different statistical approaches: (a) multiple Cox regression models adjusted for demographic, oncological, and multiple control variables, (b) propensity score matching on the same variables, but also including the participating centers as a cofactor in a separate analysis.Results: The database analysis identified 6305 patients. The 5-year survival rates were 91.0% and 81.8% for the propofol and sevoflurane group, respectively, in the final model (P = .126). Depending on the statistical adjustment method used, different results were obtained, from a non-significant to a "proposed" and even a "determined" difference in survival that favored propofol, with a maximum of 9.2 percentage points higher survival rate at 5 years (hazard ratio 1.46, 95% CI 1.10-1.95).Conclusions: It seems that propofol may have a survival advantage compared with sevoflurane among breast cancer patients, but the inherent weaknesses of retrospective analyses were made apparent.
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| 6. |
- Strenn, Nina, 1984, et al.
(author)
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Influence of genetic variations in IL1B on brain region volumes in bipolar patients and controls.
- 2021
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In: Psychiatry research. - : Elsevier BV. - 1872-7123 .- 0165-1781. ; 296
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Journal article (peer-reviewed)abstract
- Involvement of the immune system has been implicated in the etiology and pathophysiology of mood disorders, including bipolar disorder. Neuroimaging studies have reported structural brain pathology in bipolar disorder patients, and both levels of and genetic variants in cytokines have been associated with altered volumes of brain regions. The aim of this study was to investigate associations between single nucleotide polymorphisms in the gene coding for the pro-inflammatory cytokine interleukin-1 beta (IL1B) and whole brain grey matter volume, as well as volumes of several brain regions shown to be of importance in mood disorders. Structural magnetic resonance imaging and vertex-based morphometry were used to obtain volume of different brain regions in subjects with bipolar disorder (n=188) and healthy controls (n=54). Four IL1B polymorphisms were genotyped: rs1143623, rs1143627, and rs16944 in the promoter region together with the synonymous variant rs1143634 in the IL1B gene. The genotype distribution did not differ between bipolar subjects and controls. The T allele at rs16944 and the C allele at rs1143627 were associated with increased volumes of the putamen of the left hemisphere in patients and controls, which lends support to the role of this immune system mediator for brain structure.
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