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  • 1.
    Adamiak, Grazyna Teresa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Påverkan av organisatoriska och miljömässiga faktorer på tillgänglighet till akutsjukvården2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The settings investigated were departments of internal medicine (IM), orthopaedics and surgery in acute care hospitals in Sweden. The objective was to identify exogenous and endogenous determinants of accessibility of health care. Both qualitative and quantitative analysis of utilisation was performed on national and regional level of data aggregation. The study proposes that accessibility to acute health services is influenced by exogenous factors, partly outside the control of health care professionals, such as season, physical proximity and overall supply. Organisational properties such as availability of inpatient beds, hospital and physician specialisation and the degree of system integration between provides of emergency care have effects on the quality of care. The novel finding is the strong association between acute readmissions and remaining inpatient utilisation indicating effects of bed supply on global use within IM. These conclusions follow:

    § structural changes on system level work as a method of prioritisation between patient groups by changes in criteria of accessibility;

    § the natural and organisational environments determine waiting times in EDs in hospitals by fluctuations of demand;

    § geographical accessibility coincides with the supply in terms of over- or underutilisation mirrored in the outcome of medical care;

    § effective access is determined by the divide of resources between inpatient and outpatient care and the total supply of inpatient care;

    § increasing demands on inpatient care in IM may be derived from deficiencies in the care of chronically ill, elderly patients;

    § transition of information and communication among care givers and patients varies in efficiency depending on vehicles for coordination and system integration;

    § the level of training of the admitting physician has effects on effective accessibility to inpatient care.

    There are conflicts between accessibility, efficiency and appropriateness of settings calling for attention to capacity to benefit in addition to needs as priority criteria.

    List of papers
    1. Integrated care for the elderly.: The background and effects of the reform of Swedish care of the elderly.
    Open this publication in new window or tab >>Integrated care for the elderly.: The background and effects of the reform of Swedish care of the elderly.
    2000 In: International Journal of Integrated Care, ISSN 1568-4156, no 1Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-91354 (URN)
    Available from: 2004-02-13 Created: 2004-02-13Bibliographically approved
    2. Lack of inegration and seasonal variation in demand explained performance problems and waiting times for patients at emergency departments: A 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals
    Open this publication in new window or tab >>Lack of inegration and seasonal variation in demand explained performance problems and waiting times for patients at emergency departments: A 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals
    2001 In: Health Policy, Vol. 55, p. 187-207Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-91355 (URN)
    Available from: 2004-02-13 Created: 2004-02-13Bibliographically approved
    3. Impact of proximity and hospital specialisation on appropriateness of emergency readmissions
    Open this publication in new window or tab >>Impact of proximity and hospital specialisation on appropriateness of emergency readmissions
    (English)In: Journal of Evaluation in Clinical PracticeArticle in journal (Refereed) Accepted
    Identifiers
    urn:nbn:se:uu:diva-91356 (URN)
    Available from: 2004-02-13 Created: 2004-02-13 Last updated: 2010-05-24Bibliographically approved
    4. Situation in Sweden
    Open this publication in new window or tab >>Situation in Sweden
    2003 In: Integrated Care in Europe.: Description and comparison of integrated care in six EU countries., 2003, p. 41-68Chapter in book (Other academic) Published
    Identifiers
    urn:nbn:se:uu:diva-91357 (URN)90 352 2605-4 (ISBN)
    Available from: 2004-02-13 Created: 2004-02-13Bibliographically approved
    5. The impact of physician training level on emergency readmissions within internal medicine
    Open this publication in new window or tab >>The impact of physician training level on emergency readmissions within internal medicine
    2004 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 20, no 4, p. 516-23Article in journal (Refereed) Published
    Abstract [en]

    Objectives: The research question was whether training level of admitting physicians and referrals from practitioners in primary health care (PHC) are risk factors for emergency readmission within 30 days to internal medicine.

    Methods: This report is a prospective multicenter study carried out during 1 month in 1997 in seven departments of internal medicine in the County of Stockholm, Sweden. Two of the units were at university hospitals, three at county hospitals and two in district hospitals. The study area is metropolitan–suburban with 1,762,924 residents. Data were analyzed by multiple logistic regression.

    Results: A total of 5,131 admissions, thereby 408 unplanned readmissions (8 percent) were registered (69.8 percent of 7,348 true inpatient episodes). The risk of emergency readmission increased with patient's age and independently 1.40 times (95 percent confidence interval [CI], 1.13–1.74) when residents decided on hospitalization. Congestive heart failure as primary or comorbid condition was the main reason for unplanned readmission. Referrals from PHC were associated with risk decrease (odds ratio, 0.53; 95 percent CI, 0.38–0.73).

    Conclusion: The causes of unplanned hospital readmissions are mixed. Patient contact with primary health care appears to reduce the recurrence. In addition to the diagnoses of cardiac failure, training level of admitting physicians in emergency departments was an independent risk factor for early readmission. Our conclusion is that it is cost-effective to have all decisions on admission to hospital care confirmed by senior doctors. Inappropriate selection of patients to inpatient care contributes to poor patient outcomes and reduces cost-effectiveness and quality of care.

    Keywords
    Emergency readmission; Clinical experience; Training level; Internal medicine; Referrals.
    Identifiers
    urn:nbn:se:uu:diva-91358 (URN)10.1017/S0266462304001448 (DOI)
    Available from: 2004-02-13 Created: 2004-02-13 Last updated: 2017-12-14Bibliographically approved
  • 2.
    Adamiak, Grazyna Teresa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Karlberg, Ingvar
    Situation in Sweden2003In: Integrated Care in Europe.: Description and comparison of integrated care in six EU countries., 2003, p. 41-68Chapter in book (Other academic)
  • 3.
    Adamiak, Grazyna Teresa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Karlberg, Ingvar
    The impact of physician training level on emergency readmissions within internal medicine2004In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 20, no 4, p. 516-23Article in journal (Refereed)
    Abstract [en]

    Objectives: The research question was whether training level of admitting physicians and referrals from practitioners in primary health care (PHC) are risk factors for emergency readmission within 30 days to internal medicine.

    Methods: This report is a prospective multicenter study carried out during 1 month in 1997 in seven departments of internal medicine in the County of Stockholm, Sweden. Two of the units were at university hospitals, three at county hospitals and two in district hospitals. The study area is metropolitan–suburban with 1,762,924 residents. Data were analyzed by multiple logistic regression.

    Results: A total of 5,131 admissions, thereby 408 unplanned readmissions (8 percent) were registered (69.8 percent of 7,348 true inpatient episodes). The risk of emergency readmission increased with patient's age and independently 1.40 times (95 percent confidence interval [CI], 1.13–1.74) when residents decided on hospitalization. Congestive heart failure as primary or comorbid condition was the main reason for unplanned readmission. Referrals from PHC were associated with risk decrease (odds ratio, 0.53; 95 percent CI, 0.38–0.73).

    Conclusion: The causes of unplanned hospital readmissions are mixed. Patient contact with primary health care appears to reduce the recurrence. In addition to the diagnoses of cardiac failure, training level of admitting physicians in emergency departments was an independent risk factor for early readmission. Our conclusion is that it is cost-effective to have all decisions on admission to hospital care confirmed by senior doctors. Inappropriate selection of patients to inpatient care contributes to poor patient outcomes and reduces cost-effectiveness and quality of care.

  • 4.
    Adamiak, Grazyna Teresa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Karlberg, Ingvar
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Impact of proximity and hospital specialisation on appropriateness of emergency readmissionsIn: Journal of Evaluation in Clinical PracticeArticle in journal (Refereed)
  • 5.
    Ahlstedt, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Eriksson Lindvall, Carin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden; School of Nursing, University of Adelaide, Australia.
    What makes registered nurses remain in work? An ethnographic study2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89, p. 32-38Article in journal (Refereed)
    Abstract [en]

    Background: Registered nurses' work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. Objectives: The aim of the study was to explore registered nurses' workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. Design: A qualitative explorative study with an ethnographic approach. Methods: Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. Results: Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses' work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses' development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. Conclusion: This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation.

  • 6. Allander, E
    et al.
    Bjurulf, P
    Isacsson, SO
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Svanström, L
    Westrin, CG
    Skilj mellan besluts- och forskningsregister!1985In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 82, p. 4383-84Article in journal (Refereed)
  • 7. Andersen, R
    et al.
    Anderson, OW
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Perception of the response to symptoms of illness in Sweden and the United States1968In: Medical Care, Vol. 6, p. 18-30Article in journal (Refereed)
  • 8. Andersen, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Changes in response to symptoms of illness in the United States and Sweden1979In: Health Handbook / [ed] George K Chacko, 1979, p. 942-55Chapter in book (Other academic)
  • 9. Andersen, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Comparative health systems - Part IV - Specific studies in several countries: Changes in response to symptoms of illness in the United States and Sweden1975In: Inquiry, ISSN 0046-9580, E-ISSN 1945-7243, Vol. 12, no 2 SUPPL, p. 116-27Article in journal (Refereed)
  • 10. Andersen, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Anderson, OW
    Medical care use in Sweden and the United States: A comparative analysis of systems and behavior1970In: Center for Health Administation Studies, University of Chicago, Research Series, Vol. 27Article, review/survey (Refereed)
  • 11. Andersen, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Eklund, G
    Uses of the Automatic Interaction Detector (AID) program for analyzing health survey data1971In: Health Services Research, ISSN 0017-9124, E-ISSN 1475-6773, Vol. 6, no 2, p. 165-83Article in journal (Refereed)
  • 12.
    Andersson, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Röing, Marta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Ehrsson, Ylva Tiblom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    It's a question of endurance: patients with head and neck cancer experiences of 18F-FDG PET/CT in a fixation mask2017In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 29, p. 85-90, article id S1462-3889(17)30082-0Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study aimed to explore how patients with head and neck cancer experienced undergoing an (18)F-fluoro-deoxy-glucose positrons emissions tomography/computed tomography ((18)F-FDG PET/CT) examination in a fixation mask.

    METHOD: Interviews were conducted with nine patients with known or suspected head and neck cancer who were scheduled for the examination for the first time. The phenomenological method according to van Manen and his four lifeworld existentials; lived space, lived body, lived time, and lived relation was used to analyse the interviews.

    RESULTS: The thoughts and feelings of the patients during the PET/CT examination varied, some found it very difficult, while others did not. However, for all the patients, it was an experience that required some form of coping to maintain composure for example distraction.

    CONCLUSIONS: PET/CT examnation in a fixation mask may be strenuous for some patients. Patients need more detailed information, including suggestions for coping behaviours, prior to the examination, as well as higher level of support during and after the examination. The results of this study may be used to improve patient care and optimize the procedure of PET/CT examination in a fixation mask.

  • 13.
    Andersson, Grazyna Teresa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Karlberg, Ingvar
    Integrated care for the elderly.: The background and effects of the reform of Swedish care of the elderly.2000In: International Journal of Integrated Care, ISSN 1568-4156, no 1Article in journal (Refereed)
  • 14.
    Andersson, Grazyna Teresa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Karlberg, Ingvar
    Lack of inegration and seasonal variation in demand explained performance problems and waiting times for patients at emergency departments: A 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals2001In: Health Policy, Vol. 55, p. 187-207Article in journal (Refereed)
  • 15.
    Anderzén, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hansson, Ann-Sophie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Johansson, Per
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics. Uppsala University, Units outside the University, Office of Labour Market Policy Evaluation.
    Lindahl, Erica
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics. Uppsala University, Units outside the University, Office of Labour Market Policy Evaluation.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Samverkan i Resursteam: effekter på organisation, hälsa och sjukskrivning2008Report (Other academic)
    Abstract [sv]

    Vi utvärderar samverkansformen Resursteam, som bedrivits som ett försök för att minska långa sjukskrivningar. Resursteam innebär att ett team med hand-läggare från Försäkringskassan, husläkare, sjukgymnast och beteendevetare, vid regelbundna möten bedömer sjukskrivna personers rehabiliteringsbehov och ger förslag på åtgärder. Det övergripande syftet är att skatta effekten av Resursteam på den försäkrades sjukskrivningslängd och självskattade hälsa. Vi har genomfört (i) en kartläggning av verksamheten, (ii) en enkätstudie till sjuk-skrivna som deltagit i Resursteam och till jämförelsepersoner samt (ii) skattat effekten av Resursteam på självskattad hälsa och sjukskrivning. Resultaten är entydiga och visar på inga eller negativa effekter för de personer som ingått i Resursteam. Som exempel kan nämnas att tiden i sjukskrivning förlängs med cirka 20 procent i genomsnitt.

  • 16.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Larsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Defining operating room efficiency from the perspective of the staff member and the supervisor2011In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, no 3, p. 220-221Article in journal (Refereed)
  • 17.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Larsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    How operating room efficiency is understood in a surgical team: a qualitative study2011In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, no 1, p. 100-106Article in journal (Refereed)
    Abstract [en]

    Objective. Building surgical teams is one attempt to ensure the health-care system becomes more efficient, but how is 'efficiency'understood or interpreted? The aim was to study how organized surgical team members and their leaders understood operating room efficiency.

    Design. Qualitative study.

    Settings. A 1100-bed Swedish university hospital.

    Participants. Eleven participants, nine team members from the same team and their two leaders were interviewed.

    Methods. The analysis was performed according to phenomenography, a research approach that aims to discover variationsin peoples' understanding of a henomenon.

    Results. Seven ways of understanding operating room efficiency were identified: doing one's best from one's prerequisites,enjoying work and adjusting it to the situation, interacting group performing parallel tasks, working with minimal resources to produce desired results, fast work with preserved quality, long-term effects for patient care and a relative concept. When talking about the quality and benefits of delivered care, most team members invoked the patient as the central focus. Despite seven ways of understanding efficiency between the team members, they described their team as efficient. The nurses and assistant nurses were involved in the production and discussed working in a timely manner more than the leaders.

    Conclusions. The seven ways of understanding operating room efficiency appear to represent both organization-oriented andindividual-oriented understanding of that concept in surgical teams. The patient is in focus and efficiency is understood as maintaining quality of care and measuring benefits of care for the patients.

  • 18.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Larsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Job satisfaction or production? How staff and leadership understand operating room efficiency: a qualitative study2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 10, p. 1423-1428Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: How to increase efficiency in operating departments has been widely studied. However, there is no overall definition of efficiency. Supervisors urging staff to work efficiently may meet strong reactions due to staff believing that demands for efficiency means just stress at work. Differences in how efficiency is understood may constitute an obstacle to supervisors' efforts to promote it. This study aimed to explore how staff and leadership understand operating room efficiency. METHODS: Twenty-one members of staff and supervisors in an operating department in a Swedish county hospital were interviewed. The analysis was performed with a phenomenographic approach that aims to discover the variations in how a phenomenon is understood by a group of people. RESULTS: Six categories were found in the understanding of operation room efficiency: (A) having the right qualifications; (B) enjoying work; (C) planning and having good control and overview; (D) each professional performing the correct tasks; (E) completing a work assignment; and (F) producing as much as possible per time unit. The most significant finding was that most of the nurses and assistant nurses understood efficiency as individual knowledge and experience emphasizing the importance of the work process, whereas the supervisors and physicians understood efficiency in terms of production per time unit or completing an assignment. CONCLUSIONS: The concept 'operating room efficiency' is understood in different ways by leadership and staff members. Supervisors who are aware of this variation will have better prerequisites for defining the concept and for creating a common platform towards becoming efficient.

  • 19.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Larsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Norlén, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Mahteme, Haile
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy2011In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 37, no 10, p. 897-903Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can prolong survival in selected patients with peritoneal carcinomatosis (PC). However, there is little data on patients' recovery process after this complex treatment. This study aimed to describe the in-hospital postoperative recovery and factors related to the recovery of patients who undergo CRS and HIPEC.

    METHOD:

    A retrospective audit of the electronic health record (EHR) was undertaken for 76 PC patients (42 women, 34 men) treated primarily with CRS and HIPEC between 2005 and 2006 in Sweden.

    RESULTS:

    Oral intake, regaining bowel functions and mobilisation usually occurred between 7 and 11 days postoperatively. Patients experienced nausea for up to 13 days postoperatively. Forty-two patients were satisfied with their pain management, which usually took the form of epidural anaesthesia and which continued for about one week post-surgery. Sleep disturbance was observed in 51 patients and psychological problems in 49 patients during the first three postoperative weeks. Tumour burden, stoma formation, use of CPAP, primary diagnosis, and the length of stay in the ICU were factors related to an early recovery process.

    CONCLUSION:

    Drinking, eating, regaining bowel functions and mobilisation were re-established within 11 days of CRS and HIPEC. Tumour burden, stoma formation, use of CPAP, primary diagnosis and the length of stay in the ICU all had an impact on postoperative recovery, and should be discussed with the patients preoperatively and taken into consideration in designing an individualised patient care plan, in order to attain a more efficient recovery.

  • 20.
    Arnetz, Judith E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Arnetz, Bengt B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Development and evaluation of a questionnaire for measuring patient views of involvement in myocardial infarction care2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 3, p. 229-238Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Patients' involvement in their healthcare has been associated with improved treatment outcomes in chronic illness. Less is known about the affects of patient involvement on the outcomes of acute illness, such as myocardial infarction. A better understanding of patients' views and behaviour during hospitalization might improve clinical practice and enhance patient involvement.

    AIM

    The aim of this study was to develop and evaluate a questionnaire for measuring patients' perceptions of their involvement during hospitalization for myocardial infarction care.

    METHODS

    Focus groups with myocardial infarction patients provided the basis for the construction of the questionnaire. Questionnaire validity and reliability were evaluated in a small pilot study and a larger cross-sectional study among myocardial infarction patients at eleven Swedish hospitals.

    RESULTS

    The questionnaire demonstrated good validity and reliability, with six factors measuring patient views and behaviour regarding involvement.

    CONCLUSION

    The questionnaire appears to be a useful tool for evaluating the perceptions and behaviour of patients regarding patient involvement in myocardial infarction care. Use of this questionnaire may provide insight regarding areas of patient-staff interaction that need improvement. Pinpointing such areas may lead to improved patient involvement, satisfaction with care, and treatment outcomes.

  • 21.
    Arnetz, Judith E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Arnetz, Bengt B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Staff views and behaviour regarding patient involvement in myocardial infarction care: development and evaluation of a questionnaire2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 1, p. 27-35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Healthcare legislation in several nations now dictates the responsibility of health care professionals to involve patients in decisions concerning care and treatment. However, few studies have examined the impact of patient involvement on the work of health care professionals. A better understanding of staff views and behaviour might enhance patient involvement.

    AIM

    The aim of this study was to develop and validate a questionnaire for measuring views and behaviour regarding patient involvement among physicians and nursing staff caring for patients with myocardial infarction.

    METHODS

    Focus groups among cardiology staff provided the basis for the construction of the questionnaire. Questionnaire validity and reliability were evaluated in a small pilot study and a larger cross-sectional study among cardiology staff at twelve Swedish hospitals.

    RESULTS

    The questionnaire demonstrated good validity and reliability, with two factors measuring staff views and four measuring behaviour.

    CONCLUSION

    The questionnaire appears to be a useful tool for evaluating the perceptions and behaviour of physicians and nursing staff regarding patient involvement in myocardial infarction care. Use of this questionnaire may provide insight regarding areas of staff-patient interaction that need improvement, as well as implications of patient involvement for the work of each professional group on cardiology wards.

  • 22.
    Arnetz, Judith E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
    Spångberg, Kalle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
    Wang, Yun
    Ager, Joel
    Arnetz, Bengt B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Is patient involvement during hospitalization for acute myocardial infarction associated with post-discharge treatment outcome?: an exploratory study2010In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 13, no 3, p. 298-311Article in journal (Refereed)
    Abstract [en]

    Objective To investigate whether patient involvement during hospitalization for acute myocardial infarction (MI) was associated with health and behavioural outcomes 6–10 weeks after hospital discharge.

    Background Patient involvement has been associated with improved health outcomes in chronic disease, but less research has focused on the effects of patient involvement in acute conditions, such as MI.

    Design Self-administered questionnaire study. Questionnaire results were run against medical outcome data in a national database of cardiac patients.

    Setting and participants Cardiac patients (n = 591) on their first follow-up visit after hospitalization for MI at 11 Swedish hospitals.

    Main outcome measures Patient ratings of three questionnaire scales related to involvement; cardiovascular symptoms, medication compliance, participation in cardiac rehabilitation, and achievement of secondary preventive goals.

    Results More positive patient ratings of involvement were significantly associated with fewer cardiovascular symptoms 6–10 weeks after hospital discharge. In contrast, patients who attended cardiac rehabilitation and achieved the goals for smoking cessation and systolic blood pressure were significantly less satisfied with their involvement. No association was found between involvement ratings and medication compliance.

    Conclusion This study represents a first attempt to examine associations between patient involvement in the acute phase of illness and short-term health outcomes. Some significant associations between involvement and health and behavioural outcomes after acute MI were found. However, higher involvement ratings were not consistently associated with more desirable outcomes, and involvement during hospitalization was not associated with MI patient health and behaviour 6–10 weeks after hospital discharge to the extent hypothesized.

  • 23.
    Arving, Cecilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Creating a new profession in cancer nursing?: Experiences of working as a psychosocial nurse in cancer care2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, p. 2939-2947Article in journal (Refereed)
    Abstract [en]

    Aims. To describe the nature of being a psychosocial nurse in cancer care.

    Background. Psychosocial nurses in cancer care are a new profession in cancer nursing in Sweden, with potential to offer unique support to patients regarding somatic and psychological needs. This new profession is hitherto unexplored.

    Design. A qualitative inductive interview approach was used.

    Methods. A strategic sample of five nurses working as psychosocial nurses in cancer care in Sweden was interviewed. A thematic stepwise analysis was performed.

    Results. The analysis revealed the twofold experience of being a psychosocial nurse in cancer care. The nurses felt as if they had two professions: nurse and therapist. They used skills from both professions to help the person, who had cancer and a psychosocial problem. It was stimulating to be able to combine the knowledge and practices of two professions. It was also difficult because they felt an uncertainty about what their roles and responsibilities really were.

    Conclusions. This new profession seems to need role descriptions and formal education so that psychosocial nurses receive respect and appreciation in their new and relatively unknown work in cancer care.

    Relevance to clinical practices. The adjustment to the cancer disease and treatment side effects can be difficult for the patients and their families, which has highlighted the need for psychosocial support. To meet this need the health care system has to provide such support. Nurses are available and can be successfully educated to handle psychosocial problems among cancer patients. A new profession among nurses is emerging, which the present study aimed at describing. The present findings have potential to make healthcare professionals grasp what the core of psychosocial cancer nursing is, as well as its potential and pitfalls.

  • 24.
    Athlin, Åsa Muntlin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Univ Uppsala Hosp, Dept Emergency Care & Internal Med, Entrance 40, S-75185 Uppsala, Sweden.;Univ Adelaide, Sch Nursing, Adelaide, SA, Australia..
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Fac Hlth & Occupat Studies, Dept Hlth & Caring Sci, Gavle, Sweden.;Lishui Univ, Sch Med & Hlth, Dept Nursing, Lishui, Peoples R China..
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Uppsala Hosp, Qual Dept, Uppsala, Sweden..
    Baath, Carina
    Karlstad Univ, Fac Hlth Sci & Technol, Dept Hlth Sci, Karlstad, Sweden.;Cty Council Varmland, Karlstad, Sweden..
    Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action?: A descriptive and explorative study2016In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 134Article in journal (Refereed)
    Abstract [en]

    Background: Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain. Methods: Existing data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden. Results: A total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47-64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay. Discussion and Conclusions: In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain.

  • 25.
    Athlin, Åsa Muntlin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Farrokhnia, N.
    Schwarz, U. von Thiele
    Introduction of multi-professional teamwork: a promising approach towards a more patient-centred care in the emergency department2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, p. 274-275Article in journal (Other academic)
  • 26.
    Athlin, Åsa Muntlin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Univ Adelaide, Sch Nursing, Adelaide, SA, Australia..
    Juhlin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Jangland, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
    Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 1, p. 89-95Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectivesEvidence-informed healthcare is the fundament for prac-tice, whereby guidelines based on the best available evidence should assist health profes-sionals in managing patients. Patients seeking care for acute abdominal pain form acommon group in acute care settings worldwide, for whom decision-making and timelytreatment are of paramount importance. There is ambiguity about the existence, use andcontent of guidelines for patients with acute abdomen. The objective was to describe andcompare guidelines and management of patients with acute abdomen in different settingsacross the acute care delivery chain in Sweden.MethodA national cross-sectional design was used. Twenty-nine ambulance stations, 17emergency departments and 33 surgical wards covering all six Swedish health regions wereincluded, and 23 guidelines were quality appraised using the validated Appraisal of Guide-lines for Research & Evaluation II tool.ResultsThere is a lack of guidelines in use for the management of this large group of pa-tients between and within different healthcare areas across the acute care delivery chain.The quality appraisal identified that several guidelines were of poor quality, especiallythe in-hospital ones. Further, range orders for analgesics are common in the ambulance ser-vices and the surgical wards, but are seldom present in the emergency departments. Also,education in pain management is more common in the ambulance services. Thesefindingsare noteworthy as, hypothetically, the same patient could be treated in three different waysduring the same care episode.ConclusionsThere is an urgent need to develop high-quality evidence-based clinicalguidelines for this patient group, with the entire care process in focus

  • 27. Backlund, L B
    et al.
    Algvere, P V
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    New blindness in diabetes reduced by 7% per year1997In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 38, no 4, p. 1632-1632Article in journal (Refereed)
  • 28. Backlund, L.B.
    et al.
    Algvere, P.V.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Early detection of diabetic retinopathy by mobile retinal photography service working in partnership with primary health care teams1998In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 15, no S3, p. S32-S37Article in journal (Refereed)
    Abstract [en]

    Community-wide fundus photography was organized for early detection of diabetic retinopathy (DR) by mobile teams. High-quality three-field Kodachrome fundus photography, performed according to the London Protocol through dilated pupils was offered free of charge to primary care; images were taken in the community and assessed centrally. Data are presented from the first 80 primary health care centres (PHCCs) participating, serving 990 000 (about 60 %) of inhabitants in Stockholm County. Beginning in 1990, 6863 diabetes patients were invited by PHCCs; 5490 (80 %) attended. We reached 77 % of persons with known diabetes; only 37 % had had their eyes examined during the preceding 2 years. For 97 % of patients, images were assessable. DR was present in 34 % of patients (non-proliferative DR not requiring further assessment 29 %, non-proliferative DR requiring further assessment 1.1 %, proliferative DR 0.5 % and macular involvement 3.6 %). Re-examination after 2 years was offered to 64 %; follow-up photography after 1 year to 24 %. Fluorescein angiography and/or photocoagulation treatment was performed in 3.6 %. This method of early diagnosis is feasible, acceptable, and reached twice as many patients as did the usual referral-based system of care. We now plan to extend this service to cover the whole county.

  • 29.
    Bardage, Cecilia
    et al.
    Dept of Rational Use of Medicines, Medical Products Agency, P.O. Box 26, SE-751 03, Uppsala, Sweden.
    Westerlund, Tommy
    Dept of Rational Use of Medicines, Medical Products Agency, P.O. Box 26, SE-751 03, Uppsala, Sweden.
    Barzi, Sahra
    Dept of Rational Use of Medicines, Medical Products Agency, P.O. Box 26, SE-751 03, Uppsala, Sweden.
    Bernsten, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Non-prescription medicines for pain and fever: A comparison of recommendations and counseling from staff in pharmacy and general sales stores2013In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 110, no 1, p. 76-83Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study is to map and analyze the content and quality of theencounter when customers buy non-prescription medicines for pain and fever.

    Methods: 297 pharmacies and 801 general sales stores (GSS) in Sweden were selected. A"Mystery shopper" exercise was conducted. Three scenarios were used and a total of 366units were selected for each scenario. There were in total 625 observers: 208 in the childwith fever scenario, 225 in the Reliv scenario, and 192 in the painkiller during pregnancyscenario. Data collection: 21st September to 20th November 2011.

    Results: In two out of three visits to GSS, the staff proposed a medicine for a heavily pregnantwoman. The staff suggested in 9% of the visits a medicine that is inappropriate in latepregnancy. The corresponding percentage in pharmacies was 1%.Both pharmacies and GSS proposed, in 6% a medicine that is inappropriate for babies toa feverish child. Only 16% of the pharmacists and 14% of the staff in GSS asked for the ageof the child.General sales staff recommended in 10% ibuprofen and in 4% an acetylsalicylic acid productwhen an acetaminophen preparation was requested. The corresponding percentage inthe pharmacy were 4% ibuprofen, 2% diclofenac, and 1% an acetylsalicylic acid product.

    Conclusions: The staff in GSS and pharmacies do not pay sufficient attention to the heterogeneityof painkillers, which lead to inappropriate recommendations.

  • 30. Barenthin, I
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    A two-wave interview study of frequency of dental visits and dental complaints1979In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 7, no 3, p. 128-32Article in journal (Refereed)
    Abstract [en]

    A panel of 268 persons were interviewed twice at an interval of 2 years concerning their visits to dentists and their dental status. The answers they gave on the two occasions agreed well, except for the year of the last visit if it had taken place long ago. This was true both for the people who had gone to the dentist between the interviews and for those who had not. The panel was also asked whether they had any dental complaints. Sixteen percent of them reported complaints at one or both interviews. Complaints were more common among persons who did not often go to the dentist. The persons with complaints did not always get rid of them by going to a dentist. It is concluded that interview data be used for investigating the dental health and behavior of people who do not often go to the dentist, and that dentists are more successful in maintaining good dental health in people who have no dental complaints than in people who report having complaints.

  • 31.
    Bastholm Rahmner, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Andersén-Karlsson, E
    Arnhjort, T
    Eliasson, M
    Ovesjö, M-L
    Gustafsson, L-L
    Jacobsson, L
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sjöviker, S
    Tomson, G
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Physicians perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system2004In: International journal of health care quality assurance incorporating leadership in helath services, ISSN 1366-0756, E-ISSN 2051-3135, Vol. 17, no 4, p. 173-179Article in journal (Refereed)
    Abstract [en]

    Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi-structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way – a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer-independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.

  • 32. Bastholm Rahmner, Pia
    et al.
    Eiermann, Birgit
    Korkmaz, Seher
    Gustafsson, Lars L.
    Gruven, Magnus
    Maxwell, Simon
    Eichle, Hans-Georg
    Vég, Anikó
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Physicians' reported needs of drug information at point of care in Sweden2012In: British Journal of Clinical Pharmacology, ISSN 0306-5251, E-ISSN 1365-2125, Vol. 73, no 1, p. 115-125Article in journal (Refereed)
    Abstract [en]

    AIMS Relevant and easily accessible drug information at point-of-care is essential for physicians' decision making when prescribing. However, the information available by using Clinical Decision Support Systems (CDSSs) often does not meet physicians' requirements. The Summary of Product Characteristics (SmPC) is statutory information about drugs. However, the current structure, content and format of SmPCs make it difficult to incorporate them into CDSSs and link them to relevant patient information from the Electronic Health Records. The aim of the study was to evaluate the perceived needs for drug information among physicians in Sweden. METHODS We recruited three focus group discussions with 18 physicians covering different specialities. The information from the groups was combined with a questionnaire administered at the beginning of the group discussions. RESULTS Physicians reported their needs for knowledge databases at the point of drug prescribing. This included more consistent information about existing and new drugs. They also wished to receive automatically generated alerts for severe drug-drug interactions and adverse effects, and to have functions for calculating glomerular filtration rate to enable appropriate dose adjustments to be made for elderly patients and those with impaired renal function. Additionally, features enhancing electronic communication with colleagues and making drug information more searchable were suggested. CONCLUSIONS The results from the current study showed the need for knowledge databases which provide consistent information about new and existing drugs. Most of the required information from physicians appeared to be possible to transfer from current SmPCs to CDSSs. However, inconsistencies in the SmPC information have to be reduced to enhance their utility.

  • 33.
    Bastholm Rahmner, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Gustafsson, Lars L.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Tomson, Goran
    Whose job is it anyway?: Swedish general practitioners' perception of their responsibility for the patient's drug list.2010In: Annals of Family Medicine, ISSN 1544-1709, E-ISSN 1544-1717, Vol. 8, no 1, p. 40-46Article in journal (Refereed)
    Abstract [en]

    PURPOSE

    Information about the patient's current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners' (GPs) understandings of who is responsible for the patient's drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed.

    METHODS

    We conducted a descriptive qualitative study among 20 Swedish physicians. We recruited the informants purposively and captured their view on responsibility by semistructured interviews. Data were analyzed using a phenomenographic approach.

    RESULTS

    We found variation in understandings about who is responsible for the patient's drug list and, in particular, how the GPs use different strategies to manage this responsibility. Five categories emerged: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information. The relation between categories is illustrated in an outcome space, which displays how the GPs reason in relation to managing drug lists.

    CONCLUSIONS

    The understanding of the GP's responsibility for the patient's drug list varied, which may be a threat to safe patient care. We propose that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.

  • 34.
    Bastholm Rahmner, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Gustafsson, Lars L.
    Larsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Tomson, Göran
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Variations in understanding the drug-prescribing process: a qualitative study among Swedish GPs2009In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 26, no 2, p. 121-127Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A majority of doctor-patient meetings result in the patient getting a prescription. This underlines the need for a high-quality prescription process. While studies have been made on single therapeutic drug groups, a complete study of the physicians' general thought process that comprises the prescription of all drugs still remains to be made. OBJECTIVE: To identify variations in ways of understanding drug prescribing among GPs. METHODS: A descriptive qualitative study was conducted with 20 Swedish physicians. Informants were recruited purposively and their understandings about prescribing were studied in semi-structured interviews. Data were analysed using a phenomenographic approach. RESULTS: Five categories were identified as follows: (A) GP prescribed safe, reliable and well-documented drugs for obvious complaints; (B) GP sought to convince the patient of the most effective drug treatment; (C) GP chose the best drug treatment taking into consideration the patient's entire life situation; (D) GP used clinical judgement and close follow-up to minimize unnecessary drug prescribing and (E) GP prescribed drugs which are cheap for society and environmentally friendly. The categories are interrelated, but have different foci: the biomedical, the patient and the society. Each GP had more than one view but none included all five. The findings also indicate that complexity increases when a drug is prescribed for primary or secondary prevention. CONCLUSIONS: GPs understand prescribing differently despite similar external circumstances. The most significant factor to influence prescribing behaviour was the physician's patient relation approach. GPs may need to reflect on difficulties they face while prescribing to enhance their understandings.

  • 35. Bastholm Rahmner, Pia
    et al.
    Tomson, Göran
    Karolinska Institutet.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Gustafsson, Lars L
    Karolinska Institutet.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    "Limit work to here and now": A focus group study on how emergency physicians view their work in relation to patients' drug treatment2008In: International Journal of Qualitative Studies on Helath and Well-being, ISSN 1748-2623, Vol. 3, no 3, p. 155-164Article in journal (Refereed)
    Abstract [en]

    Patients come to the emergency department (ED) with complex medication and some patients present symptoms of adverse drug effects. Drug treatment is a complex process for physicians to handle. The aim of this study was to explore how a group of ED physicians view their work in relation to patients’ drug treatment. Three semi-structured focus group discussions with 12 physicians in an ED in Sweden were conducted and analysed thematically. The core theme was ‘‘limit work to here and now’’. Three descriptive themes were identified in relation to the main theme; (1) focussing to cope with work; (2) decision making on limited patient-specific information; and (3) actively seeking learning moments. The findings show that the physicians actively seek learning moments in work. Signing their own notes in the computerized medical record is a way of getting feedback on the treatment they have initiated and it was seen as a large part of their clinical education. If we want to support the physicians with new technology for safer drug treatment, such as a computerized drug prescribing support system, the support system should be adapted to the different learning styles and needs.

  • 36. Bengmark, S
    et al.
    Schersten, T
    Sterky, G
    Liljedahl, S O
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wedel, H
    [Length of stay after gallstone operations]1979In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 76, no 45, p. 3989-94Article in journal (Refereed)
  • 37. Berfenstam, R
    et al.
    Berg, B
    Boström, H
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Waern, U
    [Levels of outpatient care: A study within the framework of the Tierp project]1976In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 73, no 3, p. 127-30Article in journal (Refereed)
  • 38. Berfenstam, R
    et al.
    Berg, B
    Boström, H
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Waern, U
    Vårdnivåer i öppen vård: Kort-rapport nr 3 från Tierpsprojektet1978Report (Other academic)
  • 39. Berfenstam, R
    et al.
    Berg, B
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sjukvårdskonsumtion i Tierpsområdet april-maj 1973: En personbaserad studie av olika slag av sjukvårdskontakter i en definierad befolkning1976Report (Other academic)
  • 40. Berfenstam, R
    et al.
    Hammarström, A
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Åberg, H
    [Sources of error in medical care statistics: Cerebrovascular lesions and hypertension]1980In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 77, no 46, p. 4255-57Article in journal (Refereed)
  • 41. Berfenstam, R
    et al.
    Jonsson, E
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sterky, G
    Thurburn, T
    Wennström, G
    Hälsoekonomi: Ett samlat synsätt på fördelning av resurser för hälsa1979Report (Other academic)
  • 42. Berfenstam, R
    et al.
    Lagerberg, D
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Victim characteristics in fatal home accidents: Alcohol, mental disorder, and suicidal intent in officially registered accidents in the home1969In: Acta socio-medica Scandinavica, ISSN 0044-6041, Vol. 1, no 3, p. 145-64Article in journal (Refereed)
  • 43. Berfenstam, R
    et al.
    Petersson, O
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Evaluation research and measurement of benefits of health services (eds)1978In: Scandinavian journal of social medicine. Supplementum, ISSN 0301-7311, Vol. Suppl 13Article in journal (Refereed)
  • 44. Berfenstam, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    [Health care research examines use and quality]1977In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 74, no 40, p. 3432-34Article in journal (Refereed)
  • 45. Berfenstam, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Initiativrapport: Omvårdnadsforskning1979In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 76, p. 103-05Article in journal (Refereed)
  • 46. Berfenstam, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    [International comparison gives useful perspectives in hospital care]1969In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 66, no 20, p. 2111-19Article in journal (Refereed)
  • 47. Berfenstam, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Kort-rapport nr 2 från Tierpsprojektet1977Report (Other academic)
  • 48. Berfenstam, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Samverkan mellan medicinsk och social vård: Några erfarenheter från försöksverksamheten i Tierp1976In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 53, p. 365-72Article in journal (Refereed)
  • 49. Berfenstam, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sjukdomsstatistik på försäkringsmaterial: PM återgiven i "Diagnostik - nyhet som kommer från RFV"1966In: Tidskrift för Allmän Försäkring, Vol. 5, p. 286-94Article in journal (Refereed)
  • 50. Berfenstam, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sjukvårdskonsumtionen i Tierpsområdet 1971: En personbaserad studie av olika slag av sjukvårdskontakter i en definierad befolkning1974Report (Other academic)
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