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  • 51.
    Thulesius, Hans
    et al.
    Region Kronoberg.
    Lindgren, Anna C
    Olsson, Håkan L
    Håkansson, Anders
    Diagnosis and prognosis of breast and ovarian cancer--a population-based study of 234 women.2004In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 43, no 2, p. 175-81Article in journal (Refereed)
    Abstract [en]

    The diagnosis and prognosis for 135 women with breast cancer and 99 women with ovarian cancer in a well-defined geographical area, and a follow-up of 7-15 years are described, based on patients' records. Diagnosis was initiated in primary care for 53% of women with breast cancer, and for 57% of women with ovarian cancer. Median patient delay was 1 week for breast cancer, and 3.5 weeks for ovarian cancer patients, and median provider delay was 3 weeks for both groups. Crude, relative, and corrected 5-year survival was 73%, 91%, and 82% in breast cancer, and 40%, 49%, and 43% in ovarian cancer. Cox multiple regression analyses showed that stage IIIA and IV, and young age were associated with impaired disease-related survival in breast cancer. In patients with ovarian cancer, stages III and IV at diagnosis, old age, and systemic symptoms dominating at presentation were predictive of reduced disease-related survival while a family history of cancer was predictive of increased survival.

  • 52.
    Thulesius, Hans
    et al.
    Region Kronoberg.
    Petersson, Christer
    Petersson, Kerstin
    Håkansson, Anders
    Learner-centred education in end-of-life care improved well being in home care staff: a prospective controlled study.2002In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 16, no 4, p. 347-54Article in journal (Refereed)
    Abstract [en]

    The aim of this controlled study was to evaluate a 1-year learner-centred educational project in end-of-life care for home care staff in a rural district of Sweden. Another rural district in the same region served as a control area. A 20-item questionnaire measuring attitudes towards end-of-life care was designed, and the Hospital Anxiety and Depression (HAD) scale was used to measure mental well being. Increased agreement to 18 of 20 attitude statements was seen in the education group, while 2 of 20 items showed a decreased agreement in the control group. Test-retest reliability of the 20-item questionnaire was good (r=0.92). The total HAD score decreased from 8.3 pretest to 5.3 post-test in the education group (95% CI = 2.1 -3.7; P<0.001), and was 6.8 for both years in the control group. Our study shows that a comprehensive educational programme not only improved attitudes towards end-of-life care, but also the mental well being of the home care staff.

  • 53.
    Thulesius, Hans
    et al.
    Region Kronoberg.
    Pola, J
    Håkansson, A
    Diagnostic delay in pediatric malignancies--a population-based study.2000In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 39, no 7, p. 873-6Article in journal (Refereed)
    Abstract [en]

    This study describes the discovery and diagnosis of malignant tumors from a primary care perspective in a Swedish county. Between 1984 and 1995, 68 children between the ages 0-16 years were diagnosed with a malignant tumor giving an incidence of 14/100,000. Patient records from both primary care and hospital were analyzed for 64 children. Leukemia was diagnosed in 25 children, and brain tumors in 22 children. In 68% of the children the diagnostic process was initiated in primary care, and in 32% in specialist care. Median parent's delay (time from first symptoms to first consultation), and median doctor's delay (time from first consultation to diagnosis) were 5 and 3 weeks for children with brain tumors, and 1 and 0 weeks for children with leukemia. Median lag time (parent's + doctor's delay) was 9 weeks for patients with brain tumors and 3 weeks for children with leukemia.

  • 54.
    Thulesius, Hans
    et al.
    Lund University, Sweden.
    Sallin, Karl
    Lynoe, Niels
    Löfmark, Rurik
    Proximity morality in medical school--medical students forming physician morality "on the job": grounded theory analysis of a student survey.2007In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 7, article id 27Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The value of ethics education have been questioned. Therefore we did a student survey on attitudes about the teaching of ethics in Swedish medical schools.

    METHODS: Questionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed > 8000 words of open-ended responses and multiple-choice questions using classic grounded theory procedures.

    RESULTS: In this paper we suggest that medical students take a proximity morality stance towards their ethics education meaning that they want to form physician morality "on the job". This involves comprehensive ethics courses in which quality lectures provide "ethics grammar" and together with attitude exercises and vignette reflections nurture tutored group discussions. Goals of forming physician morality are to develop a professional identity, handling diversity of religious and existential worldviews, training students described as ethically naive, processing difficult clinical experiences, and desisting negative role modeling from physicians in clinical or teaching situations, some engaging in "ethics suppression" by controlling sensitive topic discussions and serving students politically correct attitudes.

    CONCLUSION: We found that medical students have a proximity morality attitude towards ethics education. Rather than being taught ethics they want to form their own physician morality through tutored group discussions in comprehensive ethics courses.

  • 55.
    Thulesius, Hans
    et al.
    Lund University, Sweden;Region Kronoberg, Sweden.
    Scott, Helen
    Grounded Theory Online, Chichester, UK.
    Helgesson, Gert
    Karolinska Institutet, Sweden.
    Lynöe, Niels
    Karolinska Institutet, Sweden.
    De-tabooing dying control - a grounded theory study.2013In: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 12, p. 1-8, article id 13Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dying is inescapable yet remains a neglected issue in modern health care. The research question in this study was "what is going on in the field of dying today?" What emerged was to eventually present a grounded theory of control of dying focusing specifically on how people react in relation to issues about euthanasia and physician-assisted suicide (PAS).

    METHODS: Classic grounded theory was used to analyze interviews with 55 laypersons and health care professionals in North America and Europe, surveys on attitudes to PAS among physicians and the Swedish general public, and scientific literature, North American discussion forum websites, and news sites.

    RESULTS: Open awareness of the nature and timing of a patient's death became common in health care during the 1960s in the Western world. Open dying awareness contexts can be seen as the start of a weakening of a taboo towards controlled dying called de-tabooing. The growth of the hospice movement and palliative care, but also the legalization of euthanasia and PAS in the Benelux countries, and PAS in Montana, Oregon and Washington further represents de-tabooing dying control. An attitude positioning between the taboo of dying control and a growing taboo against questioning patient autonomy and self-determination called de-paternalizing is another aspect of de-tabooing. When confronted with a taboo, people first react emotionally based on "gut feelings" - emotional positioning. This is followed by reasoning and label wrestling using euphemisms and dysphemisms - reflective positioning. Rarely is de-tabooing unconditional but enabled by stipulated positioning as in soft laws (palliative care guidelines) and hard laws (euthanasia/PAS legislation). From a global perspective three shapes of dying control emerge. First, suboptimal palliative care in closed awareness contexts seen in Asian, Islamic and Latin cultures, called closed dying. Second, palliative care and sedation therapy, but not euthanasia or PAS, is seen in Europe and North America, called open dying with reversible medical control. Third, palliative care, sedation therapy, and PAS or euthanasia occurs together in the Benelux countries, Oregon, Washington and Montana, called open dying with irreversible medical control.

    CONCLUSIONS: De-tabooing dying control is an assumed secular process starting with open awareness contexts of dying half a century ago, and continuing with the growth of the palliative care movement and later euthanasia and PAS legislation.

  • 56. Thulesius, Helle L
    et al.
    Thulesius, Hans
    Region Kronoberg.
    Jessen, Max
    Pharyngometric correlations with obstructive sleep apnea syndrome.2004In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 124, no 10, p. 1182-6Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The primary objective of this study was to investigate the relationship between obstructive sleep apnea syndrome (OSAS) and pharyngometric dimensions as clinical predictors of OSAS.

    MATERIAL AND METHODS: Pharyngometry included tonsil size, the breadth of the uvula (UB), the distance between the uvula and the posterior pharyngeal wall and open mouth standardized photographic measurement of the dimension of the free oropharynx (FOP). We also assessed modified Mallampati grade (MMP). In addition, clinical data on body weight, height, nasal obstruction and cardiovascular disease were included in our analysis.

    RESULTS: A total of 96 consecutive patients of both sexes with sleep disorders were investigated with somnography. Of these, 35 were considered to have OSAS, with an apnea-hypopnea index (AHI) of > or = 10. Body mass index (BMI), FOP, UB, the use of cardiovascular medication and hypertension were significantly related to AHI, and tonsil size showed borderline significance. Regression models were used to determine an OSAS index using the parameters BMI and FOP. The index had a positive predictive value of 82% and a negative predictive value of 77%.

    CONCLUSIONS: We showed that a photographic assessment of pharyngeal dimensions was significantly associated with OSAS. We also confirmed previous findings of associations between OSAS, BMI and cardiovascular morbidity.

  • 57.
    Thulesius, Helle L
    et al.
    Region Kronoberg.
    Thulesius, Hans
    Region Kronoberg.
    Jessen, Max
    Region Kronoberg.
    What happens to patients with nasal stuffiness and pathological rhinomanometry left without surgery?2009In: Rhinology, ISSN 0300-0729, E-ISSN 1996-8604, Vol. 47, no 1, p. 24-7Article in journal (Refereed)
    Abstract [en]

    In this study we explored long term outcomes of patients with nasal stuffiness and high nasal airway resistance (NAR) that did not undergo nasal surgery. The same investigation was repeated on average 8 years after a baseline investigation with an ENT-examination, a rhinomanometric survey and a rhinomanometry. We did follow-up investigations in 44 out of 59 non-operated patients with a pathological NAR on at least one side. At follow-up 2 persons (4%) had no complaints, 14 (32%) had reduced, 22 (50%) unchanged, and 6 (14%) increased complaints of nasal stuffiness. Rhinomanometry showed that NAR values decreased significantly between baseline and follow-up on both wider and narrower sides after decongestion. There was no correlation between subjective nasal complaints and NAR-values. In logistic regression models increasing age and allergy prevalence at baseline were significantly associated with having no, or reduced nasal stuffiness at follow-up. The results show that both NAR and subjective nasal stuffiness decreased with age. Consequently, we suggest that NAR normal values should be age adjusted. Also, a wait and see policy towards nasal stuffiness seems relevant since 36% of our patients had no or reduced nasal stuffiness while their NAR-values were reduced after 8 years.

  • 58.
    Unalan, Pemra C
    et al.
    Marmara Univ, Turkey.
    Uzuner, Arzu
    Marmara Univ, Turkey.
    Cifçili, Serap
    Marmara Univ, Turkey.
    Akman, Mehmet
    Marmara Univ, Turkey.
    Hancioğlu, Sertaç
    Yukaricigil Primary Care Unit, Turkey.
    Thulesius, Hans
    Region Kronoberg, Sweden;Lund university, Sweden.
    Using theatre in education in a traditional lecture oriented medical curriculum.2009In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 9, article id 73Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Lectures supported by theatrical performance may enhance learning and be an attractive alternative to traditional lectures. This study describes our experience with using theatre in education for medical students since 2001.

    METHODS: The volunteer students, coached by experienced students, were given a two-week preparation period to write and prepare different dramatized headache scenarios during three supervised meetings. A theatrical performance was followed by a student presentation about history taking and clinical findings in diagnosing headache. Finally, a group discussion led by students dealt with issues raised in the performance. The evaluation of the theatre in education lecture "A Primary Care Approach to Headache" was based on feedback from students.

    RESULTS: More than 90% of 43 responding students fully agreed with the statement "Theatrical performance made it easier to understand the topic". More than 90% disagreed with the statements "Lecture halls were not appropriate for this kind of interaction" and "Students as teachers were not appropriate". Open-ended questions showed that the lesson was thought of as fun, good and useful by most students. The headache questions in the final exam showed results that were similar to average exam results for other questions.

    CONCLUSION: Using theatrical performance in medical education was appreciated by most students and may facilitate learning and enhance empathy and team work communication skills.

  • 59.
    van der Ploeg, Milly A.
    et al.
    Leiden Univ, Netherlands.
    Streit, Sven
    Univ Bern, Switzerland.
    Achterberg, Wilco P.
    Leiden Univ, Netherlands.
    Beers, Erna
    Univ Amsterdam, Netherlands.
    Bohnen, Arthur M.
    Erasmus MC, Netherlands.
    Burman, Robert A.
    Vennesla Primary Hlth Care Ctr, Norway.
    Collins, Claire
    Irish Coll Gen Practitioners, Ireland.
    Franco, Fabio G.
    Hosp Israelita Albert Einstein, Brazil.
    Gerasimovska-Kitanovska, Biljana
    Univ St Cyril & Metodius, Macedonia.
    Gintere, Sandra
    Riga Stradins Univ, Latvia.
    Bravo, Raquel Gomez
    Univ Luxembourg, Luxembourg.
    Hoffmann, Kathryn
    Med Univ Vienna, Austria.
    Iftode, Claudia
    Timis Soc Family Med, Romania.
    Pestic, Sanda Kreitmayer
    Univ Tuzla, Bosnia-Herzegovina.
    Koskela, Tuomas H.
    Univ Tampere, Finland.
    Kurpas, Donata
    Wroclaw Med Univ, Poland.
    Maisonneuve, Hubert
    Univ Geneva, Switzerland.
    Mallen, Christan D.
    Keele Univ, UK.
    Merlo, Christoph
    Inst Primary & Community Care Lucerne IHAM, Switzerland.
    Mueller, Yolanda
    Inst Family Med Lausanne IUMF, Switzerland.
    Muth, Christiane
    Goethe Univ, Germany.
    Petrazzuoli, Ferdinando
    Lund University, Sweden;SNAMID Natl Soc Med Educ Gen Practice, Italy.
    Rodondi, Nicolas
    Univ Bern, Switzerland.
    Rosemann, Thomas
    Univ Zurich, Switzerland.
    Sattler, Martin
    SSLMG, Luxembourg.
    Schermer, Tjard
    Radboud Univ Nijmegen, Netherlands.
    Ster, Marija Petek
    Univ Ljubljana, Slovenia.
    Svadlenkova, Zuzana
    Ordinace Repy Sro, Czech Republic.
    Tatsioni, Athina
    Univ Ioannina, Greece.
    Thulesius, Hans
    Lund University, Sweden;Region Kronoberg, Sweden.
    Tkachenko, Victoria
    Shupyk Natl Med Acad Postgrad Educ, Ukraine.
    Torzsa, Peter
    Semmelweis Univ, Hungary.
    Tsopra, Rosy
    Univ Paris 13, France.
    Tuz, Canan
    Erzincan Univ, Turkey.
    Vaes, Bert
    Univ Leuven KU Leuven, Belgium.
    Viegas, Rita P. A.
    NOVA Med Sch, Portugal.
    Vinker, Shlomo
    Tel Aviv Univ, Israel.
    Wallis, Katharine A.
    Univ Auckland, New Zealand.
    Zeller, Andreas
    Univ Basel, Switzerland.
    Gussekloo, Jacobijn
    Leiden Univ, Netherlands.
    Poortvliet, Rosalinde K. E.
    Leiden Univ, Netherlands.
    Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries2019In: Journal of general internal medicine, ISSN 0884-8734, E-ISSN 1525-1497, Vol. 34, no 9, p. 1751-1757Article in journal (Refereed)
    Abstract [en]

    Background Statins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence general practitioners' (GPs) advice to stop statins in oldest-old patients. Objective To investigate the influence of a history of CVD, statin-related side effects, frailty and short life expectancy, on GPs' advice to stop statins in oldest-old patients. Design We invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment. Main Measures Cases varied in history of CVD, statin-related side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, non-curable cancer. Odds ratios adjusted for GP characteristics (ORadj) were calculated for GPs' advice to stop. Key Results Two thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45-47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89-90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (ORadj 13.8, 95%CI 12.6-15.1), with side effects compared to without ORadj 1.62 (95%CI 1.5-1.7) and with frailty (ORadj 4.1, 95%CI 3.8-4.4) compared to without. Shortened life expectancy increased advice to stop (ORadj 50.7, 95%CI 45.5-56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19-42) to 98% (95% CI 96-99). Conclusions The absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs' advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs' advice to stop statins.

  • 60.
    Waxegård, Gustaf
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Thulesius, Hans
    Region Kronoberg, Sweden;Lund University, Sweden.
    Integrating care for neurodevelopmental disorders by unpacking control: A grounded theory study2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, article id 31987Article in journal (Refereed)
    Abstract [en]

    Background: To establish integrated healthcare pathways for patients with neurodevelopmental disorders ( ND) such as autism spectrum disorder and attention-deficit hyperactivity disorder is challenging. This study sets out to investigate the main concerns for healthcare professionals when integrating ND care pathways and how they resolve these concerns. Methods: Using classic grounded theory ( Glaser), we analysed efforts to improve and integrate an ND care pathway for children and youth in a Swedish region over a period of 6 years. Data from 42 individual interviews with a range of ND professionals, nine group interviews with healthcare teams, participant observation, a 2-day dialogue conference, focus group meetings, regional media coverage, and reports from other Swedish regional ND projects were analysed. Results: The main concern for participants was to deal with overwhelming ND complexity by unpacking control, which is control over strategies to define patients' status and needs. Unpacking control is key to the professionals' strivings to expand constructive life space for patients, to squeeze health care to reach available care goals, to promote professional ideologies, and to uphold workplace integrity. Control-seeking behaviour in relation to ND unpacking is ubiquitous and complicates integration of ND care pathways. Conclusions: The Unpacking control theory expands central aspects of professions theory and may help to improve ND care development.

  • 61.
    Waxegård, Gustaf
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Thulesius, Hans
    Lund University, Swedn.
    Trust Testing in Care Pathways for Neurodevelopmental Disorders: A Grounded Theory Study2016In: The Grounded Theory Review, ISSN 1556-1542, E-ISSN 1556-1550, Vol. 15, no 1, p. 45-58Article in journal (Refereed)
    Abstract [en]

    Building care pathways for the expansive, heterogeneous, and complex field of neurodevelopmental disorders (ND) is challenging. This classic grounded theory study conceptualizes problems encountered and resolved by professionals in the unpacking— diagnosis and work up—of ND. A care pathway for ND in children and adolescents was observed for six years. Data include interviews, documentation of a dialogue-conference devoted to the ND care pathway, 100+ hours of participant observations, and coding of stakeholder actions. Trust testing explores whether professional unpacking collaboration can occur without being “stuck with the buck” and if other professionals can be approached to solve own unpacking priorities. ND complexity, scarce resources, and diverging stakeholder interests undermine the ability to make selfless collaborative professional choices in the care pathway. ND professionals and managers should pay as much attention to trust issues as they do to structures and patient flows. The trust testing theory may improve the understanding of ND care pathways further as a modified social dilemma framework. 

  • 62.
    Wilkens, Jens
    et al.
    The National Board of Health and Welfare, Sweden;Lund University, Sweden.
    Thulesius, Hans
    Lund University, Sweden.
    Schmidt, Ingrid
    The National Board of Health and Welfare, Sweden.
    Carlsson, Christina
    The National Board of Health and Welfare, Sweden;Lund university, Sweden.
    The 2015 National Cancer Program in Sweden: Introducing standardized care pathways in a decentralized system.2016In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 120, no 12, p. 1378-1382Article in journal (Refereed)
    Abstract [en]

    Starting in 2015, the Swedish government has initiated a national reform to standardize cancer patient pathways and thereby eventually speed up treatment of cancer. Cancer care in Sweden is characterized by high survival rates and a generally high quality albeit long waiting times. The objective with the new national program to standardize cancer care pathways is to reduce these waiting times, increase patient satisfaction with cancer care and reduce regional inequalities. A new time-point for measuring the start of a care process is introduced called well-founded suspicion, which is individually designed for each cancer diagnosis. While medical guidelines are well established earlier, the standardisation is achieved by defining time boundaries for each step in the process. The cancer reform program is a collaborative effort initiated and incentivized by the central government while multi-professional groups develop the time-bound standardized care pathways, which the regional authorities are responsible for implementing. The broad stakeholder engagement and time-bound guidelines are interesting approaches to study for other countries that need to streamline care processes.

12 51 - 62 of 62
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