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- Hellstrand, Stefan, 1955, et al.
(författare)
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A new approach to quantifying the sustainability effects of healthcare: Applied to the diabetic foot
- 2019
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Ingår i: The Foot and Ankle Online Journal. - 1941-6806. ; 12:3
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Tidskriftsartikel (refereegranskat)abstract
- A vital role for any society is to deliver health care considering: 1) the planetary boundaries, 2) the complexity of systems and 3) the 17 sustainable development goals (SDGs). The aim is to explore the feasibility of a method to quantify the sustainability effects in health-care services. A toolbox was explored in the prevention and care of foot complications in diabetes. People with diabetes run the risk of developing foot ulcers and undergoing amputations. Three relationships between ecosystems and human health and health-care systems were identified as: (i) The economic resources for health care have previously appropriated ecological resources in the economic process. (ii) Health-care systems consume natural resources. (iii) Ecosystems and the landscape affect human well-being. Some types of landscape support human well-being, while others do not. This category also includes the impact of emissions on human health. Diabetes is one of the non-communicable diseases with high mortality and foot complications. With health-promoting interventions, the risk of developing foot ulcers and undergoing amputations can be halved. The toolbox that was used could manage the complexity of systems. Several of the 17 SDGs can be calculated in the prevention of complications in diabetes: quality of life improves, while the costs of healthcare and the burden on the economy caused by people not being able to work decrease. The appropriation of natural resources and the wasted assimilated capacity for the same welfare level decreases, thereby offering an option to deliver health care within the planetary boundaries.
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| 2. |
- Jarl, Gustav, 1978-, et al.
(författare)
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Nordic clinical guidelines for orthotic treatment of osteoarthritis of the knee: A systematic review using the AGREE II instrument
- 2019
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Ingår i: Prosthetics and Orthotics International. - : Ovid Technologies (Wolters Kluwer Health). - 0309-3646 .- 1746-1553. ; 43:5, s. 556-563
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Tidskriftsartikel (refereegranskat)abstract
- © The International Society for Prosthetics and Orthotics 2019. Background: High-quality clinical practice guidelines are necessary for effective use of resources both at an individual patient- and national-level. Nordic clinical practice guidelines recommendations for orthotic treatment of knee osteoarthritis vary and little is known about their quality. Objectives: The aim of the study was to critically evaluate the quality of clinical practice guidelines in orthotic management of knee osteoarthritis in the Nordic countries. Study Design: Systematic review. Methods: Four national clinical practice guidelines for treatment of knee osteoarthritis were assessed for methodological rigour and transparency by four independent assessors using the AGREE II instrument. Summary domain scores and inter-rater agreement (Kendall’s W) were calculated. Results: Domain scores indicate that many guidelines have not sufficiently addressed stakeholder involvement (average score: 55%), applicability (20%) and editorial independence (33%) in the development process. Inter-rater agreement for assessors indicated ‘good’ agreement for clinical practice guidelines from Finland, Norway and Sweden (W = 0.653, p < 0.001; W = 0.512, p = 0.003 and W = 0.532, p = 0.002, respectively) and ‘strong’ agreement for the clinical practice guideline from Denmark (W = 0.800, p < 0.001). Conclusion: Quality of clinical practice guidelines for orthotic treatment of knee osteoarthritis in the Nordic region is variable. Future guideline development should focus on improving methodology by involving relevant stakeholders (e.g. certified prosthetist/orthotists (CPOs)), specifying conflicts of interest and providing guidance for implementation. Clinical relevance: The current review suggests that, for the Nordic region, there are areas of improvement which can be addressed, which ensure clinical practice guidelines are developed under stringent conditions and based on sound methods. These improvements would ensure knee osteoarthritis patients are receiving orthotic interventions based on appropriate guidance from published guidelines.
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