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  • 1.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden;University of Borås, Sweden.
    Kowalczyk, Emma
    Helsingborg County Hospital, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    Wireklint Sundström, Birgitta
    University of Borås, Sweden.
    Emergency Medical Services physicians’ perceptions of ambulance nurses’ responsibility for referring patients to primary care and self-care - a Swedish national survey2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no Suppl 1, p. A6-A6Article in journal (Refereed)
    Abstract [en]

    Background: Based on guidelines developed by EMS physicians, registered nurses in the Swedish ambulance services sometimes by-pass the emergency department and refer non-urgent patients to primary care and self-care. However, these referrals are associated with problems that may jeopardize patient safety and patient participation.

    Aim: To identify the EMS physicians’ perceptions of ambulance nurses’ responsibilities and prerequisites to refer patients to primary care and self-care.

    Methods: A national survey of all EMS physicians (n=51) using study specific questions with close-ended and open response options, analysed with descriptive statistics and thematic analysis.

    Results: The response rate was 78% (n=40). The majority of the physicians (95%) perceived that nurses should be able to refer patients to primary care and self-care. One fourth (25%) perceived specialist nurses in ambulance care as the most appropriate professionals. The majority of the physicians (65%) perceived that referral to primary care maintain patient safety, whereas fewer (50%) assessed the referral as safe for the patient. All perceived that feedback should be given to nurses when the referral was incorrect. The majority perceived it important to extend the nurses’ authority to refer to primary care (63%) and self-care (55%).

    Conclusion: There is no consensus among the EMS physicians regarding responsibilities and conditions for nurses’ referral of patients. Registered nurses with basic education are expected to be able to refer, while there is varying opinion regarding requirements of specialist trained ambulance nurses to refer patients. Professional experience as a nurse is perceived more important than formal education.

  • 2.
    Brüggemann, A. Jelmer
    et al.
    Linköpings universitet.
    Swahnberg, Katarina
    Linköpings universitet.
    Patients’ silence towards the healthcare system after ethical transgressions by staff: associations with patient characteristics in a cross-sectional study among Swedish female patients2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 6Article in journal (Refereed)
    Abstract [en]

    Objectives: To identify which patient characteristics are associated with silence towards the healthcare system after experiences of abusive or ethically wrongful transgressive behaviour by healthcare staff.

    Design: Cross-sectional questionnaire study using the Transgressions of Ethical Principles in Health Care Questionnaire.

    Setting: A women's clinic in the south of Sweden.

    Participants: Selection criteria were: consecutive female patients coming for an outpatient appointment, ≥18-year-old, with the ability to speak and understand the Swedish language, and a known address.

    Questionnaires were answered by 534 women (60%) who had visited the clinic, of which 293 were included in the present study sample.

    Primary outcome measure: How many times the respondent remained silent towards the healthcare system relative to the number of times the respondent spoke up.

    Results: Associations were found between patients’ silence towards the healthcare system and young age as well as lower self-rated knowledge of patient rights. Both variables showed independent effects on patients’ silence in a multivariate model. No associations were found with social status, country of birth, health or other abuse.

    Conclusions: The results offer opportunities for designing interventions to stimulate patients to speak up and open up the clinical climate, for which the responsibility lies in the hands of staff; but more research is needed.

  • 3.
    Flink, Maria
    et al.
    Karolinska Institutet;Karolinska University Hospital.
    Lindblad, Marlene
    Karolinska Institutet;KTH Royal Institute of Technology.
    Frykholm, Oscar
    Karolinska Institutet.
    Kneck, Asa
    Karolinska Institutet.
    Nilsen, Per
    Linköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital.
    Ekstedt, Mirjam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet;KTH Royal Institute of Technology.
    The Supporting Patient Activation in Transition to Home (sPATH) intervention: a study protocol of a randomised controlled trial using motivational interviewing to decrease re-hospitalisation for patients with COPD or heart failure2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 7, article id e014178Article in journal (Refereed)
    Abstract [en]

    Introduction Deficient hospital discharging and patients struggling to handle postdischarge self-management have been identified as potential causes of re-hospitalisation rates. Despite an increased interest in interventions aiming to reduce re-hospitalisation rates, there is yet no best evidence on how to support patients in being active participants in their self-management postdischarge. The aim of this paper is to describe the study protocol for an upcoming randomised controlled trial (RCT) of the Supporting Patient in Activation to Home (sPATH) intervention. Methods/analysis The described study is a randomised, controlled, analysis-blinded, two-site trial, with primary outcome re-hospitalisation within 90 days. In total, 290 participants aged 18 years or older with chronic obstructive pulmonary disease or congestive heart failure who are admitted to hospital and who are living in an own home will be eligible for inclusion into an intervention (n=145) or control group (n= 145). Patients who need an interpreter to communicate in Swedish, or who have a diagnosis of dementia or cognitive impairment, will be excluded from inclusion. The sPATH intervention, developed with a theoretical base in the self-determination theory, consists of five postdischarge motivational interviewing sessions (face to face or by phone). The intervention covers the self-management areas medication management, follow-up/care plan, symptoms/signs of worsening condition and relations/contacts with healthcare providers. This RCT will add to the literature on evidence to support patient activation in postdischarge selfmanagement. Ethics and dissemination The study is approved by the Regional Research Ethics Committee (No. 2014/149831/ 2) in Stockholm, Sweden. The results of the study will be published in peer-reviewed journals and presented at international and national scientific conferences.

  • 4.
    Ge, Li
    et al.
    Fujian Univ Tradit Chinese Med, Peoples Republic of China.
    Wikby, Kerstin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Rask, Mikael
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Fujian Univ Tradit Chinese Med, Peoples Republic of China.
    Lived experience of women with gestational diabetes mellitus living in China: a qualitative interview study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 11, article id e017648Article in journal (Refereed)
    Abstract [en]

    Objective To explore the lived experience of women with gestational diabetes mellitus (GDM) living in China in order to add knowledge about how the Chinese women suffer from GDM. Design A qualitative interpretive interview study. Data were collected with a snowball sampling technique. Phenomenological hermeneutics was used as the analysis method based on Ricoeur's phenomenological hermeneutical interpretation theory. Setting The study was performed at the participants' work places, or at the obstetric clinics or wards at two provincial hospitals and one municipal hospital in the southeast of China. Participants Inclusion criteria were age >= 18 years, diagnosis of GDM without other pregnancy complications, in 34th gestational weeks-postpartum 4th weeks and speaking Mandarin Chinese without speech impediment. 62 women, who met the inclusion criteria, took part in the study. Results The lived experience of the women with GDM living in China was formulated into a main theme: 'longing for caring care'. The main theme was derived from four themes: being stricken by GDM, wishing to receive caring GDM care, being left alone to struggle with GDM and trying to adjust and adapt to life with GDM. Conclusion The eagerness for caring care in China was highlighted. The lack of caring care could be one of the possible reasons why the professional-patient relations were deteriorating in China. It could be useful for health providers and health policymakers to receive education and training about caring care. Using the health metaphor of balance and 'patient participation' and 'patient-centred' approaches may benefit women with GDM and thus improve the quality of care in China.

  • 5.
    Grandahl, Maria
    et al.
    Uppsala university.
    Rosenblad, Andreas
    Uppsala University.
    Stenhammar, Christina
    Uppsala university.
    Tydén, Tanja
    Uppsala university.
    Westerling, Ragnar
    Uppsala university.
    Larsson, Margareta
    Uppsala university.
    Oscarsson, Marie
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Uppsala university.
    Andrén, Bengt
    Uppsala University.
    Dalianis, Tina
    Karolinska Institutet.
    Neveus, Tryggve
    Uppsala University.
    School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e009875Article in journal (Refereed)
    Abstract [en]

    Objective: To improve primary prevention of human papillomavirus (HPV) infection by promoting vaccination and increased condom use among upper secondary school students. Design: Cluster randomised controlled trial. Setting: 18 upper secondary schools in Sweden. Participants: Schools were first randomised to the intervention or the control group, after which individual classes were randomised so as to be included or not. Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse, 751 (90.2%) agreed to participate and 741 (89.1%) students completed the study. Interventions: The intervention was based on the Health Belief Model (HBM). According to HBM, a person’s health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 min face-to-face structured information about HPV, including cancer risks and HPV prevention, by propagating condom use and HPV vaccination. Students in the intervention and the control groups completed questionnaires at baseline and after 3 months. Main outcome measures: Intention to use condom with a new partner and beliefs about primary prevention of HPV, and also specifically vaccinationstatus and increased condom use. Results: All statistical analyses were performed at the individual level. The intervention had a significant effect on the intention to use condom (p=0.004). There was also a significant effect on HBM total score ( p=0.003), with a 2.559 points higher score for the intervention group compared to the controls. The influence on the HBM parameters susceptibility and severity was also significant (p<0.001 for both variables). The intervention also influenced behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls ( p=0.02). No harms were reported. Conclusions: The school-based intervention had favourable effects on the beliefs about primary prevention of HPV, and increased the HPV vaccination rates in a diverse population of adolescents.

  • 6.
    Göras, Camilla
    et al.
    Örebro university, Sweden;Falun Central Hospital, Sweden;Centre for Clinical Research, Falun, Sweden.
    Olin, Karolina
    Karolinska Institutet, Sweden;Turku University Hospital, Finland.
    Unbeck, Maria
    Karolinska University Hospital, Sweden;Karolinska Institutet, Sweden.
    Pukk-Härenstam, Karin
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Ehrenberg, Anna
    Dalarna University, Sweden.
    Tessma, Mesfin Kassaye
    Karolinska Institutet, Sweden.
    Nilsson, Ulrica
    Karolinska Institutet, Sweden.
    Ekstedt, Mirjam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet, Sweden.
    Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, p. 1-12, article id e026410Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR.

    DESIGN: Prospective observational study using the Work Observation Method By Activity Timing tool.

    SETTING: An OR department at a county hospital in Sweden.

    PARTICIPANTS: OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9).

    RESULTS: The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication.

    CONCLUSIONS: The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system.

    TRIAL REGISTRATION NUMBER: 2016/264.

  • 7.
    Harris, Michael
    et al.
    University of Bath, UK;University of Bern, Switzerland.
    Vedsted, Peter
    Aarhus University, Denmark.
    Esteva, Magdalena
    Balearic Islands Health Research Institute (IdISBa), Spain.
    Murchie, Peter
    University of Aberdeen, UK.
    Aubin-Auger, Isabelle
    Université Paris Diderot, France.
    Azuri, Joseph
    Tel Aviv University, Israel.
    Brekke, Mette
    University of Oslo, Norway.
    Buczkowski, Krzysztof
    Nicolaus Copernicus University, Poland.
    Buono, Nicola
    National Society of Medical Education in General Practice (SNaMID), Italy.
    Costiug, Emiliana
    Iuliu Hatieganu University of Medicine and Pharmacy, Romania.
    Dinant, Geert-Jan
    Maastricht University, Netherlands.
    Foreva, Gergana
    Medical Center BROD, Plovdiv, Bulgaria.
    Gašparović Babić, Svjetlana
    The Teaching Institute of Public Health of Primorsko-goranska County, Croatia.
    Hoffman, Robert
    Tel Aviv University, Israel.
    Jakob, Eva
    Centro de Saúde Sarria, Spain.
    Koskela, Tuomas H
    University of Tampere, Finland.
    Marzo-Castillejo, Mercè
    Institut Catala De La Salut, Spain.
    Neves, Ana Luísa
    Imperial College London, UK;University of Porto, Porto, Portugal.
    Petek, Davorina
    University of Ljubljana, Slovenia.
    Petek Ster, Marija
    University of Ljubljana, Slovenia.
    Sawicka-Powierza, Jolanta
    Medical University of Bialystok, Poland.
    Schneider, Antonius
    Technische Universität München, Germany.
    Smyrnakis, Emmanouil
    Aristotle University of Thessaloniki, Greece.
    Streit, Sven
    University of Bern, Switzerland.
    Thulesius, Hans
    Lund University, Sweden.
    Weltermann, Birgitta
    University of Bonn, Germany.
    Taylor, Gordon
    University of Bath, UK.
    Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion: a European cross-sectional survey.2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 9, p. 1-13, article id e022904Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Cancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners' (PCPs') referral decisions is lacking.This study analyses health system factors potentially influencing PCPs' referral decision-making when consulting with patients who may have cancer, and how these vary between European countries.

    DESIGN: Based on a content-validity consensus, a list of 45 items relating to a PCP's decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs' referral decision-making.

    SETTING: A primary care study; 25 participating centres in 20 European countries.

    PARTICIPANTS: 1830 PCPs completed the survey. The median response rate for participating centres was 20.7%.

    OUTCOME MEASURES: The factors derived from items related to PCPs' referral decision-making. Mean factor scores were produced for each country, allowing comparisons.

    RESULTS: Factor analysis identified five underlying factors: PCPs' ability to refer; degree of direct patient access to secondary care; PCPs' perceptions of being under pressure; expectations of PCPs' role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses.

    CONCLUSIONS: Five healthcare system factors influencing PCPs' referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes.

  • 8.
    Heinonen, Essi
    et al.
    Karolinska Institutet;Karolinska University Hospital.
    Szymanska-von Schultz, Barbara
    Karolinska Institutet;Karolinska University Hospital.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet;Stockholm Hlth Care Reg.
    Nasiell, Josefine
    Karolinska Institutet;Karolinska University Hospital.
    Andersson, Ewa
    Karolinska Institutet.
    Bergmark, Mikaela
    Stockholm Hlth Care Reg.
    Blomdahl-Wetterholm, Margareta
    Stockholm Hlth Care Reg.
    Forsberg, Lisa
    Forsell, Erik
    Karolinska Institutet;Stockholm Hlth Care Reg.
    Forsgren, Anna
    Karolinska Institutet.
    Froojd, Sandra
    Stockholm Hlth Care Reg.
    Goldman, Amy
    Stockholm Hlth Care Reg.
    Nordenadler, Eva-Mari
    Stockholm Hlth Care Reg.
    Sklivanioti, Myrto
    Stockholm Hlth Care Reg.
    Blennow, Mats
    Karolinska Institutet;Karolinska University Hospital.
    Wide, Katarina
    Karolinska Institutet;Karolinska University Hospital.
    Gustafsson, Lars L.
    Karolinska Institutet;Karolinska University Hospital.
    MAGDALENA: study protocol of a randomised, placebo-controlled trial on cognitive development at 2 years of age in children exposed to SSRI in utero2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id e023281Article in journal (Refereed)
    Abstract [en]

    Introduction Ten per cent of all pregnant women are depressed. Standard therapy of pregnant women with moderate depression is selective serotonin reuptakeinhibitors (SSRI). Observational studies on neurodevelopment after fetal SSRI exposure show conflicting results. Our primary objective is to compare the cognitive development in children exposed to sertraline and maternal depression with those exposed to maternal depression and placebo in utero. We hypothesise that there is a significant neurodevelopmental difference between the groups. As a secondary objective, we study the add-on effect of sertraline to internet-based cognitive behavioural therapy (ICBT) to treat moderate depression during pregnancy. Methods and analysis MAGDALENA is a randomised, placebo-controlled, double-blinded trial in Stockholm Healthcare Region with 2.3 million inhabitants. The women are recruited in weeks 9-21 of pregnancy either through Antenatal Health Clinics or through social media. They are to be diagnosed with moderate depression without ongoing antidepressive therapy or any serious comorbidity. The women in the intervention arm receive sertraline combined with a 12-week period of ICBT; the control arm is treated with placebo and ICBT. We assess the cognitive development in the offspring at the age of 2 years using Bayley Scales of Infant and Toddler Development, third edition (BSID-III). We aim at recruiting 200 women, 100 women in each treatment arm, to ensure statistical power to detect a clinically relevant difference between the groups. Ethics and dissemination This randomised trial will provide long-sought evidence about the effects of SSRI and maternal depression during pregnancy on the neurodevelopment in the offspring. The study is approved by the Regional Ethical Review Board at Karolinska Institutet in Stockholm and the Swedish Medical Products Agency. It is registered with the European Clinical Trials Database (EudraCT), Number: 2013-004444-31. Results will be disseminated at scientific conferences, published in peer-reviewed journals and made available to the public.

  • 9.
    Jafari, Javad
    et al.
    Karolinska Institutet, Sweden.
    Karimi Moonaghi, Hosein
    Mashhad University of Medical Sciences, Iran.
    Zary, Nabil
    Karolinska Institutet, Sweden;Nanyang Technological University, Singapore.
    Masiello, Italo
    Södersjukhuset, Sweden;Karolinska Institutet, Sweden.
    Exploring educational needs and design aspects of internet-enabled patient education for persons with diabetes: a qualitative interview study.2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, p. 1-7, article id e013282Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of this article is to explorethe educational needs and design aspects ofpersonalised internet-enabled education for patientswith diabetes in Iran.Design: Data were collected using semistructuredinterviews and then qualitatively analysed usinginductive content analysis.Participants: 9 patients with type 2 diabetes wereincluded. Inclusion criteria were access to andknowledge on how to use the internet. The selectionensured representation based on gender, age,occupation and educational background.Setting: The sample population was patients withdiabetes who were admitted to an outpatient diabetesclinic in Mashhad, a large city of Iran with about 3million inhabitants.Results: 4 core categories emerged from the data: (1)seeking knowledge about diabetes, including specificknowledge acquisition, patient’s interactions andlearning requirements; (2) teaching and learning,including using different teaching methods anddifferent ways to learn about the disease; (3)facilitators, including internet and mobile phone use tolearn about the disease; and (4) barriers, including lackof internet access, uncertainty of access to the internetand lack of website in the local language and alsoperceived cultural barriers, such as patients’ fears ofthe internet, lack of time and awareness.Conclusions: This study provides a betterunderstanding of the patient’s educational expectationsand technical needs in relation to internet-enablededucation. This knowledge will inform the developmentof functional mock-ups in the next research phaseusing a design-based research approach in order todesign internet-enabled patient education for selfmanagementof diabetes.

  • 10.
    Lindblad, Marlene
    et al.
    KTH Royal Instute of Technology, Sweden;Ersta Sköndal Bräcke University College, Sweden.
    Flink, Maria
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Ekstedt, Mirjam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet, Sweden.
    Exploring patient safety in Swedish specialised home healthcare: an interview study with multidisciplinary teams and clinical managers2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 12, p. 1-7, article id e024068Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Home healthcare is the fastest growing arena in the healthcare system but patient safety research in this context is limited. The aim was to explore how patient safety in Swedish specialised home healthcare is described and adressed from multidisciplinary teams' and clinical managers' perspectives.

    DESIGN: An explorative qualitative study.

    SETTING: Multidisciplinary teams and clinical managers were recruited from three specialised home healthcare organisations in Sweden.

    METHODS: Nine focus group interviews with multidisciplinary teams and six individual interviews with clinical managers were conducted, in total 51 participants. The data were transcribed verbatim and analysed using qualitative content analysis.

    RESULTS: Patient safety was inherent in the well-established care ideology which shaped a common mindset between members in the multidisciplinary teams and clinical managers. This patient safety culture was challenged by the emerging complexity in which priority had to be given to standardised guidelines, quality assessments and management of information in maladapted communication systems and demands for required competence and skills. The multiple guidelines and quality assessments that aimed to promote patient safety from a macro-perspective, constrained the freedom, on a meso-level and micro-level, to adapt to challenges based on the care ideology.

    CONCLUSION: Patient safety in home healthcare is dependent on adaptability at the management level; the team members' ability to adapt to the varying conditions and on patients being capable of adjusting their homes and behaviours to reduce safety risks. A strong culture related to a patient's value as a person where patients' and families' active participation and preferences guide the decisions, could be both a facilitator and a barrier to patient safety, depending on which value is given highest priority.

  • 11.
    Liu, Jenny
    et al.
    Karolinska Institutet;Södersjukhuset.
    Masiello, Italo
    Karolinska Institutet;Södersjukhuset.
    Ponzer, Sari
    Karolinska Institutet;Södersjukhuset.
    Farrokhnia, Nasim
    Karolinska Institutet;Södersjukhuset.
    Can interprofessional teamwork reduce patient throughput times?: A longitudinal single-centre study of three different triage processes at a Swedish emergency department2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 4, article id e019744Article in journal (Refereed)
    Abstract [en]

    Objective To determine the impact on emergency department (ED) throughput times and proportion of patients who leave without being seen by a physician (LWBS) of two triage interventions, where comprehensive nurse-led triage was first replaced by senior physician-led triage and then by interprofessional teamwork. Design Single-centre before-and-after study. Setting Adult ED of a Swedish urban hospital. Participants Patients arriving on weekdays 08: 00 to 21: 00 during three 1-year periods in the interval May 2012 to November 2015. A total of 185 806 arrivals were included. Interventions Senior physicians replaced triage nurses May 2013 to May 2014. Interprofessional teamwork replaced the triage process on weekdays 08: 00 to 21: 00 November 2014 to November 2015. Main outcome measures Primary outcomes were the median time to physician (TTP) and the median length of stay (LOS). Secondary outcome was the LWBS rate. Results The crude median LOS was shortest for teamwork, 228 min (95% Cl 226.4 to 230.5) compared with 232 min (95% Cl 230.8 to 233.9) for nurse-led and 250 min (95% Cl 248.5 to 252.6) for physician-led triage. The adjusted LOS for the teamwork period was 16 min shorter than for nurse-led triage and 23 min shorter than for physician-led triage. The median TTP was shortest for physician-led triage, 56 min (95% Cl 54.5 to 56.6) compared with 116 min (95% Cl 114.4 to 117.5) for nurse-led triage and 74 min (95% Cl 72.7 to 74.8) for teamwork. The LWBS rate was 1.9% for nurse-led triage, 1.2% for physician-led triage and 3.2% for teamwork. All outcome measure differences had two-tailed p values< 0.01. Conclusions Interprofessional teamwork had the shortest length of stay, a shorter time to physician than nurse-led triage, but a higher LWBS rate. Interprofessional teamwork may be a useful approach to reducing ED throughput times.

  • 12.
    Magneli, Martin
    et al.
    Karolinska Institutet, Sweden;Danderyd University Hospital, Sweden.
    Unbeck, Maria
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Rogmark, Cecilia
    Skåne University Hospital, Sweden.
    Rolfson, Ola
    University of Gothenburg, Sweden.
    Hommel, Ami
    Malmö University, Sweden;Skåne University Hospital, Sweden.
    Samuelsson, Bodil
    Karolinska Institutet, Sweden.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sjöstrand, Desiree
    Skånevård Kryh, Sweden.
    Gordon, Max
    Karolinska Institutet, Sweden;Danderyd University Hospital, Sweden.
    Sköldenberg, Olof
    Karolinska Institutet, Sweden;Danderyd University Hospital, Sweden.
    Validation of adverse events after hip arthroplasty: a Swedish multi-centre cohort study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 3, p. 1-9, article id e02377Article in journal (Refereed)
    Abstract [en]

    Objectives Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument’s ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties.

    Design Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data.

    Setting 24 different hospitals in four major regions of Sweden.

    Participants 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients.

    Primary and secondary outcome measures The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate.

    Results The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47).

    Conclusions The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.

  • 13.
    Marques, Ana Patrícia
    et al.
    Nova University of Lisbon, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Perelman, Julian
    Nova University of Lisbon, Portugal.
    Aguiar, Pedro
    Nova University of Lisbon, Portugal.
    Rocha-Sousa, Amândio
    University of Porto, Portugal.
    Santana, Rui
    Nova University of Lisbon, Portugal.
    Diffusion of anti-VEGF injections in the Portuguese National Health System2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 11, p. 11-Article in journal (Refereed)
    Abstract [en]

    Objectives

    To analyse the temporal and geographical diffusion of antivascular endothelial growth factor (anti-VEGF) interventions, and its determinants in a National Health System (NHS).

    Setting

    NHS Portuguese hospitals.

    Participants

    All inpatient and day cases related to eye diseases at all Portuguese public hospitals for the period 2002–2012 were selected on the basis of four International Classification of Diseases 9th revision, Clinical Modification (ICD-9-CM) codes for procedures: 1474, 1475, 1479 and 149.

    Primary and secondary outcome measures

    We measured anti-VEGF treatment rates by year and county. The determinants of the geographical diffusion were investigated using generalised linear modelling.

    Results

    We analysed all hospital discharges from all NHS hospitals in Portugal (98 408 hospital discharges corresponding to 57 984 patients). National rates of hospitals episodes for the codes for procedures used were low before anti-VEGF approval in 2007 (less than 12% of hospital discharges). Between 2007 and 2012, the rates of hospital episodes related to the introduction of anti-VEGF injections increased by 27% per year. Patients from areas without ophthalmology departments received fewer treatments than those from areas with ophthalmology departments. The availability of an ophthalmology department in the county increased the rates of hospital episodes by 243%, and a 100-persons greater density per km2 raised the rates by 11%.

    Conclusions

    Our study shows a large but unequal diffusion of anti-VEGF treatments despite the universal coverage and very low copayments. The technological innovation in ophthalmology may thus produce unexpected inequalities related to financial constraints unless the implementation of innovative techniques is planned and regulated

  • 14.
    Muzrif, Munas M.
    et al.
    Univ Sri Jayawardenapura, Sri Lanka.
    Perera, Dinusha
    Univ Sri Jayawardenapura, Sri Lanka.
    Wijewardena, Kumudu
    Univ Sri Jayawardenapura, Sri Lanka.
    Schei, Berit
    Norwegian Univ Sci & Technol NTNU, Norway;Trondheim Reg & Univ Hosp, Norway.
    Swahnberg, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Domestic violence: a cross-sectional study among pregnant women in different regions of Sri Lanka2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 2, article id e017745Article in journal (Refereed)
    Abstract [en]

    Objectives The aims of this study were to assess the regional differences in domestic violence among pregnant women in the capital district and in the tea plantation sector of Sri Lanka, to explore potential contributory factors and to assess whether healthcare workers addressed domestic violence and disclosure among survivors. Design A cross-sectional study was carried out using interviewer-administered Abuse Assessment Screen. Setting Fifty-seven antenatal clinic centres in the capital district and 30 in the tea plantation sector. Participants Pregnant women between 6 and 40 weeks of gestational age. In the capital district, 1375 women were recruited from antenatal clinic centres in the urban (n= 25) and in the rural areas (n= 32), and 800 women from 30 centres in the tea plantation sector. The response rate in the capital district was 95.6% and 96.7% in the tea plantation sector. Results Among the total sample of pregnant women (n= 2088), the prevalence of 'ever abused' was 38.6%, and the prevalence of 'currently abused' was 15.9%. 'Ever abused' (31.5% vs 50.8%) and 'currently abused' (10% vs 25.8%) were significantly higher (P< 0.001) among the women living in the tea plantation sector. 'Ever abused' was associated with living in the tea plantation sector, being employed, living far from gender-based violence care centre and of Muslim ethnicity, after adjusting for age, education and family income. Only 38.8% of all participants had been asked by healthcare workers about abuse. Living in the tea plantation sector and lower level of education were associated with not being asked. Among those who reported 'ever abused', only 8.7% had disclosed the experience to a healthcare worker. Conclusion Domestic violence was prevalent and highest among women in the tea plantation sector compared with the capital district. The capacity of healthcare workers in addressing domestic violence should be increased.

  • 15.
    Rose, Peter W.
    et al.
    Univ Oxford, UK.
    Rubin, Greg
    Univ Durham, UK.
    Perera-Salazar, Rafael
    Univ Oxford, UK.
    Almberg, Sigrun Saur
    Norwegian Univ Sci & Technol, Norway.
    Barisic, Andriana
    Canc Care Ontario, Canada.
    Dawes, Martin
    Univ British Columbia, Canada.
    Grunfeld, Eva
    Ontario Inst Canc Res, Canada;Univ Toronto, Canada.
    Hart, Nigel
    Queens Univ Belfast, UK.
    Nea, Richard D.
    Bangor Univ, UK.
    Pirotta, Marie
    Primary Hlth Care Res Evaluat & Dev, Australia.
    Sisler, Jeffrey
    Univ Manitoba, Canada.
    Konrad, Gerald
    Univ Manitoba, Canada.
    Toftegaard, Berit Skjodeberg
    Aarhus Univ, Denmark.
    Thulesius, Hans
    Region Kronoberg, Sweden..
    Vedsted, Peter
    Aarhus Univ, Denmark.
    Young, Jane
    Univ Sydney, Australia.
    Hamilton, Willie
    Univ Exeter, UK.
    Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 5, p. 1-14, article id e007212Article in journal (Refereed)
    Abstract [en]

    Objectives: The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences. Design: A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer. Participants: 2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden. Primary and secondary outcome measures: Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate. Results: 4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables. Conclusions: We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer-either directly, or by specialist referral, to improve outcomes.

  • 16.
    Schildmeijer, Kristina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Nilsson, Lena
    Linköpings Universitetssjukhus.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköpings Universitet.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, p. e003131-Article in journal (Refereed)
    Abstract [en]

    Objectives The aim was to describe the strengths and weaknesses, from team member perspectives, of working with the Global Trigger Tool (GTT) method of retrospective record review to identify adverse events causing patient harm.

    Design A qualitative, descriptive approach with focus group interviews using content analysis.

    Setting 5 Swedish hospitals in 2011.

    Participants 5 GTT teams, with 5 physicians and 11 registered nurses.

    Intervention 5 focus group interviews were carried out with the five teams. Interviews were taped and transcribed verbatim.

    Results 8 categories emerged relating to the strengths and weaknesses of the GTT method. The categories found were: Usefulness of the GTT, Application of the GTT, Triggers, Preventability of harm, Team composition, Team tasks, Team members’ knowledge development and Documentation. Gradually, changes in the methodology were made by the teams, for example, the teams reported how the registered nurses divided up the charts into two sets, each being read respectively. The teams described the method as important and well functioning. Not only the most important, but also the most difficult, was the task of bringing the results back to the clinic. The teams found it easier to discuss findings at their own clinics.

    Conclusions The GTT method functions well for identifying adverse events and is strengthened by its adaptability to different specialties. However, small, gradual methodological changes together with continuingly developed expertise and adaption to looking at harm from a patient's perspective may contribute to large differences in assessment over time.

  • 17.
    Schildmeijer, Kristina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Unbeck, Maria
    Danderyd Hospital;Karolinska Institutet.
    Ekstedt, Mirjam
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet.
    Lindblad, Marléne
    Royal Institute of Technology;Ersta Sköndal University College.
    Nilsson, Lena
    Linköping University.
    Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 1, article id e019267Article in journal (Refereed)
    Abstract [en]

    Objective Home healthcare is an increasingly common part of healthcare. The patients are often aged, frail and have multiple diseases, and multiple caregivers are involved in their treatment. This study explores the origin, incidence, types and preventability of adverse events (AEs) that occur in patients receiving home healthcare.

    Design A study using retrospective record review and trigger tool methodology. setting and methods Ten teams with experience of home healthcare from nine regions across Sweden reviewed home healthcare records in a two-stage procedure using 38 prede ned triggers in four modules. A random sample of records from 600 patients (aged 18 years or older) receiving home healthcare during 2015 were reviewed. Primary and secondary outcome measures The cumulative incidence of AEs found in patients receiving home healthcare; secondary measures were origin, types, severity of harm and preventability of the AEs.

    results The patients were aged 20–79 years, 280 men and 320 women. The review teams identi ed 356 AEs in 226 (37.7%; 95% CI 33.0 to 42.8) of the home healthcare records. Of these, 255 (71.6%; 95% CI 63.2 to 80.8) were assessed as being preventable, and most (246, 69.1%; 95% CI 60.9 to 78.2) required extra healthcare visits or led to a prolonged period of healthcare. Most of the AEs (271, 76.1%; 95% CI 67.5 to 85.6) originated in home healthcare; the rest were detected during home healthcare but were related to care outside home healthcare. The most common AEs were healthcare-associated infections, falls and pressure ulcers.

    conclusions AEs in patients receiving home healthcare are common, mostly preventable and often cause temporary harm requiring extra healthcare resources. The most frequent types of AEs must be addressed and reduced through improvements in interprofessional collaboration. This is an important area for future studies. 

  • 18.
    Sekulic, Damir
    et al.
    University of Split, Croatia.
    Sisic, Nedim
    University of Split, Croatia ; University of Zenica, Bosnia and Herzegovina.
    Terzic, Admir
    High School Hasan Kikic, Bosnia and Herzegovina ; University of Tuzla, Bosnia and Herzegovina.
    Jasarevic, Indira
    University of Tuzla, Bosnia and Herzegovina.
    Ostojic, Ljerka
    University of Split, Croatia ; University of Mostar, Bosnia and Herzegovina ; Academy of Medical Sciences of Bosnia and Herzegovina, Bosnia and Herzegovina.
    Pojskić, Haris
    Mid Sweden University.
    Zenic, Natasa
    University of Split, Croatia.
    Sport and scholastic factors in relation to smoking and smoking initiation in older adolescents: a prospective cohort study in Bosnia and Herzegovina2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 3, p. 1-9, article id e014066Article in journal (Refereed)
    Abstract [en]

    Objective Sport and scholastic factors are known to be associated with cigarette smoking in adolescence, but little is known about the causality of this association. The aim of this study was to prospectively explore the relationships of different sport and scholastic factors with smoking prevalence initiation in older adolescents from Bosnia and Herzegovina.

    Methods In this 2-year prospective cohort study, there were 872 adolescent participants (16 years at baseline; 46% females). The study consisted of baseline tests at the beginning of the third year (September 2013) and follow-up at the end of the fourth year of high school (late May to early June 2015). The independent variables were scholastic and sport-related factors. The dependent variables were (1) smoking at baseline, (2) smoking at follow-up and (3) smoking initiation over the course of the study. Logistic regressions controlling for age, gender and socioeconomic status were applied to define the relationships between independent and dependent variables.

    Results School absence at the baseline study was a significant predictor of smoking initiation during the course of the study (OR 1.4, 95% CI 1.1 to 1.8). Those who reported quitting sports at baseline showed an increased risk of smoking at the end of the study (OR 1.4, 95% CI 1.1 to 2.0) and of smoking initiation (OR 1.8, 95% CI 1.3 to 2.0). Adolescents who reported lower competitive achievements in sport were at a higher risk of (1) smoking at baseline (OR 1.5, 95% CI 1.1 to 2.1), (2) smoking at follow-up (OR 1.5, 95% CI 1.1 to 2.1) and (3) smoking initiation (OR 1.6, 95% CI 1.1 to 2.6).

    Conclusions In developing accurate antismoking public health policies for older adolescents, the most vulnerable groups should be targeted. The results showed that most participants initiated smoking before 16 years of age. Therefore, further investigations should evaluate the predictors of smoking in younger ages.

  • 19.
    Simmons, Johanna
    et al.
    Linköping University.
    Brüggemann, Adrianus Jelmer
    Linköping University.
    Swahnberg, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Disclosing victimisation to healthcare professionals in Sweden: A constructivist grounded theory study of experiences among men exposed to interpersonal violence2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, article id e010847Article in journal (Refereed)
    Abstract [en]

    Objective: To develop a theoretical model concerning male victims' processes of disclosing experiences of victimisation to healthcare professionals in Sweden.

    Design: Qualitative interview study.

    Setting: Informants were recruited from the general population and a primary healthcare centre in Sweden.

    Participants: Informants were recruited by means of theoretical sampling among respondents in a previous quantitative study. Eligible for this study were men reporting sexual, physical and/or emotional violence victimisation by any perpetrator and reporting that they either had talked to a healthcare provider about their victimisation or had wanted to do so.

    Method: Constructivist grounded theory. 12 interviews were performed and saturation was reached after 9.

    Results: Several factors influencing the process of disclosing victimisation can be recognised from previous studies concerning female victims, including shame, fear of negative consequences of disclosing, specifics of the patient-provider relationship and time constraints within the healthcare system. However, this study extends previous knowledge by identifying strong negative effects of adherence to masculinity norms for victimised men and healthcare professionals on the process of disclosing. It is also emphasised that the process of disclosing cannot be separated from other, even seemingly unrelated, circumstances in the men's lives.

    Conclusions: The process of disclosing victimisation to healthcare professionals was a complex process involving the men's experiences of victimisation, adherence to gender norms, their life circumstances and the dynamics of the actual healthcare encounter.

  • 20.
    Swahnberg, Katarina
    et al.
    Linköpings universitet.
    Wijma, Barbro
    Linköpings universitet.
    Staff's perception of abuse in healthcare: a Swedish qualitative study2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 5, p. e001111-Article in journal (Refereed)
    Abstract [en]

    Objective: The study aim was to apprehend staff's perception of abuse in healthcare (AHC) after an intervention based on ‘Forum Play’, and make comparisons to preintervention interviews and interviews with male and female patients. AHC can be described as a failing encounter from the patient's perspective.

    Design: Qualitative interview follow-up study.

    Setting: A Swedish Women's Clinic.

    Participants: In a preintervention study 21 staff members were interviewed. Eligible for the follow-up study were 14 informants who had participated in the intervention. Four declined participation leaving ten informants for this study.

    Intervention: During January 2008–January 2009, all staff members (N=136) were invited to participate in Forum Play workshops. Seventy-four participants took part in at least 1 of the 17 half-day workshops.

    Primary outcome measures: Staffs perception of AHC.

    Results: The core category, ‘a summoning stone in the shoe’, was constructed of five categories: ‘Dehumanising the patient’, ‘Unacceptable: you are bound to act!’, ‘Ubiquitous’, ‘Unintentional’ and ‘Relative’. Forum Play had demonstrated possibilities to act even in seemingly ‘impossible’ situations, and that the taboo status of AHC was altered at the clinic. When our results were compared to those in the preintervention study, we found an increasedawareness about AHC, more concrete examples of AHC, a stronger empathy for patients, andfewer explanations, justifications and trivialisations of AHC.

    Conclusion: In this follow-up study staff's perception of AHC was closer to the patient's perspective. Compared to the preintervention interviews staff showed a greater willingness not only to acknowledge AHC, but also to take on a responsibility to act in order to stop or prevent AHC. Explanations for this stance could be that Forum Play had showed staff that there were possibilities to act, and that the taboo status of AHC had been broken at the clinic.

  • 21.
    Wickström, Hanna L.
    et al.
    Lund University;Blekinge Wound Healing Centre.
    Oien, Rut Frank
    Blekinge Wound Healing Centre;Blekinge Centre of Competence.
    Fagerström, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Blekinge Centre of Competence.
    Anderberg, Peter
    Blekinge Institute of Technology.
    Jakobsson, Ulf
    Lund Uniersity.
    Midlov, Patrik J.
    Lund University.
    Comparing video consultation with inperson assessment for Swedish patients with hard-to-heal ulcers: registry-based studies of healing time and of waiting time2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 2, article id e017623Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate differences in ulcer healing time and waiting time between video consultation and inperson assessment for patients with hard-to-heal ulcers. Setting Patients treated at Blekinge Wound Healing Centre, a primary care centre covering the whole of Blekinge county (150 000 inhabitants), were compared with patients registered and treated according to the Registry of Ulcer Treatment, a Swedish national web-based quality registry. Participants In the study for analysing ulcer healing time, the study group consisted of 100 patients diagnosed through video consultation between October 2014 and September 2016. The control group for analysing healing time consisted of 1888 patients diagnosed through inperson assessment during the same period. In the study for analysing waiting time, the same study group (n=100) was compared with 100 patients diagnosed through inperson assessment. Primary and secondary outcome measures Differences in ulcer healing time were analysed using the log-rank test. Differences in waiting time were analysed using the Mann-Whitney U test. Results Median healing time was 59 days (95% CI 40 to 78) in the study group and 82 days (95% CI 75 to 89) in the control group (P<0.001). Median waiting time was 25 days (range: 1-83 days) in the study group and 32 days (range: 3-294 days) for patients diagnosed through inperson assessment (P=0.017). There were no significant differences between the study group and the control group regarding age, gender or ulcer size. Conclusions Healing time and waiting time were significantly shorter for patients diagnosed through video consultation compared with those diagnosed through inperson assessment.

  • 22.
    Zenic, Natasa
    et al.
    University of Split, Croatia.
    Ostojic, Ljerka
    University of Split, Croatia ; University of Mostar, Bosnia and Herzegovina ; Academy of Medical Sciences of Bosnia and Herzegovina, Bosnia and Herzegovina.
    Sisic, Nedim
    University of Split, Croatia.
    Pojskić, Haris
    Mid Sweden University.
    Peric, Mia
    University of Split, Croatia.
    Uljevic, Ognjen
    University of Split, Croatia.
    Sekulic, Damir
    University of Split, Croatia.
    Examination of the community-specific prevalence of and factors associated with substance use and misuse among Rural and Urban adolescents: a cross-sectional analysis in Bosnia and Herzegovina2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 11, p. 1-9, article id e009446Article in journal (Refereed)
    Abstract [en]

    Objective The community of residence (ie, urban vs rural) is one of the known factors of influence on substance use and misuse (SUM). The aim of this study was to explore the community-specific prevalence of SUM and the associations that exist between scholastic, familial, sports and sociodemographic factors with SUM in adolescents from Bosnia and Herzegovina.

    Methods In this cross-sectional study, which was completed between November and December 2014, the participants were 957 adolescents (aged 17 to 18 years) from Bosnia and Herzegovina (485; 50.6% females). The independent variables were sociodemographic, academic, sport and familial factors. The dependent variables consisted of questions on cigarette smoking and alcohol consumption. We have calculated differences between groups of participants (gender, community), while the logistic regressions were applied to define associations between the independent and dependent variables.

    Results In the urban community, cigarette smoking is more prevalent in girls (OR=2.05; 95% CI 1.27 to 3.35), while harmful drinking is more prevalent in boys (OR=2.07; 95% CI 1.59 to 2.73). When data are weighted by gender and community, harmful drinking is more prevalent in urban boys (OR=1.97; 95% CI 1.31 to 2.95), cigarette smoking is more frequent in rural boys (OR=1.61; 95% CI 1.04 to 2.39), and urban girls misuse substances to a greater extent than rural girls (OR=1.70; 95% CI 1.16 to 2.51,OR=2.85; 95% CI 1.88 to 4.31,OR=2.78; 95% CI 1.67 to 4.61 for cigarette smoking, harmful drinking and simultaneous smoking-drinking, respectively). Academic failure is strongly associated with a higher likelihood of SUM. The associations between parental factors and SUM are more evident in urban youth. Sports factors are specifically correlated with SUM for urban girls.

    Conclusions Living in an urban environment should be considered as a higher risk factor for SUM in girls. Parental variables are more strongly associated with SUM among urban youth, most probably because of the higher parental involvement in children’ personal lives in urban communities (ie, college plans, for example). Specific indicators should be monitored in the prevention of SUM.

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