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  • 1.
    Abourraja, Mohamed Nezar
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Marzano, Luca
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Raghothama, Jayanth
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Boodaghian Asl, Arsineh
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Darwich, Adam S.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Meijer, Sebastiaan
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Lethvall, Sven
    Uppsala University Hospital,Uppsala,Sweden.
    Falk, Nina
    Uppsala University Hospital,Uppsala,Sweden.
    A Data-Driven Discrete Event Simulation Model to Improve Emergency Department Logistics2022In: Proceedings of the 2022 Winter Simulation Conference, Institute of Electrical and Electronics Engineers (IEEE) , 2022Conference paper (Refereed)
    Abstract [en]

    Demands for health care are becoming overwhelming for healthcare systems around the world regarding theavailability of resources, particularly, in emergency departments (EDs) that are continuously open and mustserve immediately any patient who comes in. Efficient management of EDs and their resources is requiredmore than ever. This could be achieved either by optimizing resource utilization or by the improvement ofhospital layout. This paper investigates, through data-driven simulation alternative designs of workflowsand layouts to operate the ED of the Uppsala University Hospital in Sweden. Results are analyzed tounderstand the requirements across the hospital for reduced waiting times in the ED. The main observationrevealed that introducing a new ward dedicated to patients having complex diagnoses with a capacity ofless than 20 beds leads to lower waiting times. Furthermore, the use of data-mining was of great help inreducing the efforts of building the simulation model.

  • 2.
    Abourraja, Mohamed Nezar
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Meijer, Sebastiaan
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Boukachour, Jaouad
    Normandie University, UNIHAVRE, 76600 Le Havre, France.
    A model-driven design approach for Ro-Ro and container terminals: from requirements analysis down to simulation model implementation2021In: 20th International Conference on Modeling and Applied Simulation, MAS 2021, Cal-Tek Srl , 2021, p. 9-20Conference paper (Refereed)
    Abstract [en]

    Modeling, one of the main pillars of good scientific research, is a long-standing multidisciplinary activity to understand and analyze complex systems. In this paper, the focus is directed toward conceptual modeling of multi-terminal seaports specialized in handling and treatment of intermodal transport units (ITU). These systems are complex with highly dynamic and stochastic behaviors and actors, therefore, studying them as a coherent whole or just analyzing one part by taking into account the high degree of integration among the different aspects and actors linked by a flow of activities, information, and interactions is a bet lost in advance without a well-defined design process. Several design approaches and methodologies have been proposed over the years, but nonetheless, there is still no agreement on how to conduct modeling of complex systems because they are of different kinds. In this line, this paper proposes a top-down approach for container and Ro-Ro terminals largely inspired by the Unified Process Methodology and refined through several research projects that we have been involved in. It gives some recommendations and guidelines as well as a helpful way to successfully build modular and consistent simulation models. To prove its efficiency, it was applied to a case study and the resulting models were validated by the subject matter's experts.

  • 3.
    Agasteen Anantharaj, Kingsly Anand
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH).
    Improving management of patient flow at Radiology Department using Simulation Models2021Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The Swedish healthcare system is considered to have good healthcare productivity and efficiency with moderate cost but seems to have some future challenges. Sweden is moving towards the aging population as it requires development in medical care techniques and technologies to provide care to elderly patients. This increases the pressure on the healthcare system. Hence, the number of patients in the hospital increase, as a result, the flow of patients within the wards are increased. Furthermore, the pandemic has increased the number of people admitted to hospitals. As a consequence, even for high-priority cases, the wait times are rising.

    The Skaraborg Hospital Group, SHG, and other general hospitals, in particular, are focusing on how to handle patient flow at various levels within departments and clinics by improving patient flow quality. Production and capacity preparation (PCP) is a commonly used industry tool for resolving bottlenecks. Hence, this method needs to be adopted within the hospital and by the healthcare sector to a larger extent.

    Since many patients from different specialty departments use the Radiology department's facilities, it is often a "bottleneck" in inpatient traffic at hospitals. Furthermore, the influx of patients with covid-19 has increased the department's workload.

    This master's thesis aims to assist the Radiology department in improving their production and capacity planning to increase unit flow performance. The project involves supporting key staff in the department in estimating demand to align different patient movements with equipment and personnel services. Improving radiology department flow efficiency can lead to more even and healthy patient flows around the hospital, reducing "buffers" of patients and longer stays at different specialist clinics.

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  • 4.
    Akay, Altug
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Dragomir, Andrei
    Erlandsson, Björn-Erik
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    A Novel-Data Mining Platform to Monitor the Outcomes of Erlontinib (Tarceva) using Social Media2014In: XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013, Springer, 2014, p. 1394-1397Conference paper (Refereed)
    Abstract [en]

    A novel data-mining method was developed to gauge the experiences of the oncology drug Tarceva. Self-organizing maps were used to analyze forum posts numerically to infer user opinion of drug Tarceva. The result is a word list compilation correlating positive and negative word cluster groups and a web of influential users on Tarceva. The implica-tions could open new research avenues into rapid data collec-tion, feedback, and analysis that would enable improved solu-tions for public health.

  • 5.
    Albaaj, Hussein
    et al.
    Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
    Attergrim, Jonatan
    Department of Global Public Health, Karolinska Institutet, Solna, Sweden; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Strömmer, Lovisa
    Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Brattström, Olof
    Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Jacobsson, Martin
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Wihlke, Gunilla
    Trauma and Reparative Medicine, Karolinska University Hospital, Solna, Sweden.
    Västerbo, Liselott
    Trauma and Reparative Medicine, Karolinska University Hospital, Solna, Sweden.
    Joneborg, Elias
    Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
    Gerdin Wärnberg, Martin
    Department of Global Public Health, Karolinska Institutet, Solna, Sweden; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Patient and process factors associated with opportunities for improvement in trauma care: a registry-based study2023In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, E-ISSN 1757-7241, Vol. 31, no 1, article id 87Article in journal (Refereed)
    Abstract [en]

    Background Trauma is one of the leading causes of morbidity and mortality worldwide. Morbidity and mortality review of selected patient cases is used to improve the quality of trauma care by identifying opportunities for improvement (OFI). The aim of this study was to assess how patient and process factors are associated with OFI in trauma care.

    Methods We conducted a registry-based study using all patients between 2017 and 2021 from the Karolinska University Hospital who had been reviewed regarding the presence of OFI as defined by a morbidity and mortality conference. We used bi- and multivariable logistic regression to assess the associations between the following patient and process factors and OFI: age, sex, respiratory rate, systolic blood pressure, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), survival at 30 days, highest hospital care level, arrival on working hours, arrival on weekends, intubation status and time to first computed tomography (CT).

    Results OFI was identified in 300 (5.8%) out of 5182 patients. Age, missing Glasgow Coma Scale, time to first CT, highest hospital care level and ISS were statistically significantly associated with OFI.

    Conclusion Several patient and process factors were found to be associated with OFI, indicating that patients with moderate to severe trauma and those with delays to first CT are at the highest odds of OFI.

  • 6.
    Alkhatib, Najla
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    A Simulation Game Approach for Improving Access to Specialized Healthcare Services in Sweden2024Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    In Sweden, where a decentralized healthcare system is applied, all patients are registered at a primary healthcare center. To access most of the publicly funded specialized care clinics, patients need to be referred by a general physician at the primary healthcare center. However, long waiting times and queues to access specialized care clinics in Sweden, has been a serious problem and concern for decades. Addressing this issue is important for improving patients’ transition to specialized care and the functionality of the Swedish healthcare system. The aim of this thesis is to explore the Swedish healthcare system to analyze the transition of patients to specialized care clinics and identify the reasons for long waiting times and queues. This was done by analyzing the Swedish healthcare system and develop a serious game prototype which models the process of access to specialized care within the Swedish healthcare system. The prototype was used to understand the delay that happens in patients’ transition and access process to specialized care services.  A system analysis including a literature review is conducted to gain an understanding of the Swedish healthcare system and gather data to be used in the designed prototype. The outcome of the system analysis is a visual representation of the Swedish healthcare system including laws and stakeholders. A game frame is developed from the system analysis. Maps, tables, and a flow-diagram are developed to visualize patients’ access to specialized care. All of this was used to design the game prototype. The final prototype is developed through an iterative process, where several prototypes are designed and tested through game sessions with experts. The prototypes are evaluated after each game session. Finally, learning and findings gained from the prototypes design and the game sessions are documented. This includes reasons for long waiting times for a first visit at a specialized care clinic such as the structure of the Swedish healthcare system, mainly that the PHC is the foundation of the system. Staff shortages, and the need for a referral to access most of the specialized clinics are also discussed and stated along with other reasons. 

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  • 7. Alsved, Malin
    et al.
    Wang, Cong
    KTH, School of Architecture and the Built Environment (ABE), Civil and Architectural Engineering, Fluid and Climate Technology.
    Civilis, Anette
    Sadrizadeh, Sasan
    KTH, School of Architecture and the Built Environment (ABE), Civil and Architectural Engineering, Fluid and Climate Technology.
    Ekolind, Peter
    Skredsvik, Henrik
    Höjerback, Peter
    Jakobsson, Jonas
    Löndahl, Jakob
    Experimental and computational evaluation of airborne bacteria in hospital operating rooms with high airflows2018In: Proceedings of The 5th Working & Indoor Aerosols Conference 18-20 April 2018; Cassino, Italy, 2018Conference paper (Refereed)
    Abstract [en]

    Post-operative infections after surgery can be decreased by the use of efficient ventilation with clean air. In this study, we investigated three types of operating room ventilation: turbulent mixed airflow(TMA), laminar airflow (LAF) and a new type of ventilation named temperature controlled airflow(TcAF). Measurements of airborne bacteria were made during surgery and compared with values calculated by computational fluid dynamics (CFD). The results show that LAF and TcAF are most efficient in removing bacteria around the patient. With LAF, there are large differences in bacterial loads, depending on location in the room.

  • 8.
    Aminoff, Hedvig
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    Meijer, Sebastiaan
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Context and Complexity in Telemedicine Evaluation: Work Domain Analysis in a Surgical Setting2021In: JMIR Perioperative Medicine, E-ISSN 2561-9128, Vol. 4, no 2, p. e26580-e26580Article in journal (Refereed)
    Abstract [en]

    Many promising telemedicine innovations fail to be accepted and used over time, and there are longstanding questions about howto best evaluate telemedicine services and other health information technologies. In response to these challenges, there is a growinginterest in how to take the sociotechnical complexity of health care into account during design, implementation, and evaluation.This paper discusses the methodological implications of this complexity and how the sociotechnical context holds the key tounderstanding the effects and outcomes of telemedicine. Examples from a work domain analysis of a surgical setting, where atelemedicine service for remote surgical consultation was to be introduced, are used to show how abstracted functional modelingcan provide a structured and rigorous means to analyze and represent the implementation context in complex health care settings.

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  • 9.
    Andreasson, Jörgen
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Ahlstrom, Linda
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    The importance of healthcare managers’ organizational preconditions and support resources for their appraisal of planned change and its outcomes2017In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 6, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Healthcare managers are expected to lead and manage planned organizational change intended to improve healthcare process quality. However, their complex working conditions offer limited decision control, and healthcare managers often feel ill prepared and inadequately supported to perform their duties. Healthcare managers have previously described their need for organizational support, but we lack knowledge of the preconditions and resources that help managers implement planned change.Methods: This prospective cohort study examined healthcare managers at three Swedish hospitals implementing lean production and two Swedish hospitals implementing their own improvement model. Questionnaire data from 2012, 2103, and 2014 were used in following up. We used t-tests and a linear mixed model design in analysing the data.Results: Healthcare managers who perceived strong support from managers, employees, colleagues, and the organization and managers with the longest managerial experience had the least negative appraisal of change. Managers who perceived strong support from employees, management, and the organizational structure perceived higher levels of healthcare process quality.Conclusions: Long managerial experience and strong support from managers, employees, and the organization are important formanagers’ appraisal of, work on, and successful implementation of planned change. Top management must therefore ensure that the healthcare managers have sufficient managerial experience and support before they delegate to them the responsibility to implement planned change.

  • 10.
    Andreasson, Jörgen
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Health care managers' views on and approaches to implementing models for improving care processes2016In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 2Article in journal (Refereed)
    Abstract [en]

    Aim: To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes. Background: In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome. Method: In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory. Results: 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work. Conclusion and implications for nursing management: Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management.

  • 11.
    Angelis, Jannis
    et al.
    KTH, School of Industrial Engineering and Management (ITM), Industrial Economics and Management (Dept.), Industrial Management.
    Glenngård, A.H.
    Jordahl, H.
    Management practices and the quality of primary care2019In: Public Money & Management, ISSN 0954-0962, E-ISSN 1467-9302Article in journal (Refereed)
    Abstract [en]

    Using the World Management Survey method, the authors mapped and analysed management quality in Swedish primary care centres. On average, private sector providers were better managed than public providers. Centres with a high overall social deprivation among enrolled patients also tended to have higher management quality. Management quality was positively associated with accessibility (length of waiting times), but not with patient-reported experience.

  • 12.
    Arman, Rebecka
    et al.
    Sahlgrenska akademin, Göteborgs universitet.
    Dellve, Lotta
    Sahlgrenska akademin, Göteborgs universitet.
    Wikström, Ewa
    Sahlgrenska akademin, Göteborgs universitet.
    Törnström, Linda
    Sahlgrenska akademin, Göteborgs universitet.
    What health care managers do: Applying Mintzberg’s structured observation method2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, no 6, p. 718-729Article in journal (Refereed)
    Abstract [en]

     Aim The aim of the present study was to explore and describe what characterizes first-and second-line health care managers' use of time. Background Many Swedish health care managers experience difficulties managing their time. Methods Structured and unstructured observations were used. Ten first-and second-line managers in different health care settings were studied in detail from 3.5 and 4 days each. Duration and frequency of different types of work activities were analysed. Results The individual variation was considerable. The managers' days consisted to a large degree of short activities (<9 minutes). On average, nearly half of the managers' time was spent in meetings. Most of the managers' time was spent with subordinates and <1% was spent alone with their superiors. Sixteen per cent of their time was spent on administration and only a small fraction on explicit strategic work. Conclusions The individual variations in time use patterns suggest the possibility of interventions to support changes in time use patterns. Implications for nursing management A reliable description of what managers do paves the way for analyses of what they should do to be effective.

  • 13.
    Bamyr Hanssen, Soziar
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    Ohanyan, Rosemarie
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    Konsekvenserna av (EU) 2017/746- förordningen på tillverkning och användning av medicintekniska produkter för in vitro-diagnostik inom Karolinska Universitetssjukhuset2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In collaboration with the Karolinska University Hospital, this research was carried out with the aim of executing a consequence analysis of the new regulation (EU) 2017/746. The consequences of the regulation regarding access, distribution, manufacturing and in-house production of in vitro diagnostic products were examined for various departments at the Karolinska University Hospital.

    This was investigated through an extensive literature study and interviews that were conducted digitally and through email. Of the departments examined, attention was drawn to the fact that only Lab & Primary Health Care and the Karolinska University Laboratory were affected by the new regulation.

    The availability of products may be affected as a consequence of the new requirements for risk classification and the notified bodies. If the manufacturer does not meet the new requirements, this may lead to a shortage of materials and products, which can affect Lab & Primary Care and the Karolinska University Laboratory.

    Lab & Primary Health Care will be affected by the requirements for distribution in the new regulation if they decide to distribute new in vitro diagnostic products to other businesses. The Karolinska University Laboratory has a production that they currently CE mark according to the old directive and an in-house production. In order for the Karolinska University Laboratory to continue its own production, it is required that they meet the requirements imposed on in-house production in the new regulation. With continued CE marking of the products, they will be classified as manufacturers and need to meet its requirements.

    In summary, it can be stated that both Lab & Primary Health Care and the Karolinska University Laboratory have three paths to go; distribute, produce in-house or manufacture in vitro diagnostic products. Depending on the decision they make, they are classified differently according to the new regulation (distributors, in-house manufacturers or manufacturers) and thus have different requirements to follow.

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  • 14.
    Belin, Matts-Åke
    et al.
    matts-ake.belin@trafikverket.se.
    Tillgren, P.
    Vedung, E.
    Vision Zero: a road safety policy innovation2012In: International Journal of Injury Control and Safety Promotion, ISSN 17457319, Vol. 19, no 2, p. 171-179Article in journal (Refereed)
  • 15. Bergman, Caroline
    et al.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics. University of Borås, Sweden.
    Skagert, Katrin
    Exploring communication processes in workplace meetings: A mixed methods study in a Swedish healthcare organization2016In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 54, no 3, p. 533-541Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An efficient team and a good organizational climate not only improve employee health but also the health and safety of the patients. Building up trust, a good organizational climate and a healthy workplace requires effective communication processes. In Sweden, workplace meetings as settings for communication processes are regulated by a collective labor agreement. However, little is known about how these meetings are organized in which communication processes can be strengthened. OBJECTIVE: The aim of this study was to explore communication processes during workplace meetings in a Swedish healthcare organization. METHODS: A qualitatively driven, mixed methods design was used with data collected by observations, interviews, focus group interviews and mirroring feedback seminars. Data were analyzed using descriptive statistics and conventional content analysis. RESULTS: The communication flow and the organization of the observed meetings varied in terms of physical setting, frequency, time allocated and duration. The topics for the workplace meetings were mainly functional with a focus on clinical processes. Overall, the meetings were viewed not only as an opportunity to communicate information top down but also a means by which employees could influence decision-making and development at the workplace. CONCLUSIONS: Workplace meetings have very distinct health-promoting value. It emerged that information and the opportunity to influence decisions related to workplace development are important to the workers. These aspects also affect the outcome of the care provided.

  • 16. Boman, Inga-Lill
    et al.
    Lundberg, Stefan
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Starkhammar, Sofia
    Nygard, Louise
    Exploring the usability of a videophone mock-up for persons with dementia and their significant others2014In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 14, p. 49-Article in journal (Refereed)
    Abstract [en]

    Background: Persons with dementia might have considerable difficulties in using an ordinary telephone. Being able to use the telephone can be very important in order to maintain their social network, getting stimulation and for reaching help when needed. Therefore, persons with dementia might need an easy-to-use videophone to prevent social isolation and to feel safe and independent. This study reports the evaluation of the usability of a touch-screen videophone mock-up for persons with dementia and their significant others. Methods: Four persons with dementia and their significant others tested the videophone mock-up at a living laboratory. In order to gain knowledge of the participants' with dementia ability to use their own computers and telephones, interviews and observations were conducted. Results: Overall, the participants had a very positive attitude towards the videophone. The participants with dementia perceived that it was useful, enjoyable and easy to use, although they initially had difficulties in understanding how to handle some functions, thus indicating that the design needs to be further developed to be more intuitive. Conclusions: The findings suggest that the videophone has the potential to enable telephone calls without assistance and add quality in communication.

  • 17. Borg, S.
    et al.
    Gerdtham, U. G.
    Rydén, Tobias
    KTH, School of Engineering Sciences (SCI), Mathematics (Dept.), Mathematical Statistics.
    Munkholm, P.
    Odes, S.
    Langholz, E.
    Moum, B.
    Annese, V
    Bagnoli, S.
    Beltrami, M.
    Clofent, J.
    Friger, M.
    Milla, M.
    Mouzas, I
    O'Morain, C.
    Politi, P.
    Riis, L.
    Stockbrugger, R.
    Tsianos, E.
    Vardi, H.
    Lindgren, S.
    Estimation Of A Markov Chain For Crohn's Disease And Classification Of Patients Into Disease Phenotypes, In Eight Countries Using Individual Longitudinal Data Aggregated Over Time2012In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 15, no 7, p. A466-A467Article in journal (Other academic)
  • 18.
    Broman, Elina
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    Model for Process Time Analysis in Magnetic Resonance Imaging: Workflow Optimization to Reduce Access Time2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Magnetic Resonance Imaging (MRI) can be used in many clinical situations, but they are limited by high costs and time-consuming properties. Most focus has been on improving the technical side of MRI, and not as much on process improvements. Long access times to MRI examinations can be the cause of inefficient workflows of the departments, which can cause adverse effects for the patients. A market research of the Swedish radiology departments that perform MRI examinations resulted in a wide range of median access times, ranging from approximately 21 days to 130 days. This indicates potential for improvement in their workflows. To improve workflows, they need to be analysed and measured. A model for process time efficiency analysis in MRI departments was created in this project which can assess 5 different metrics. These metrics are number of examinations, examination time, turnover time, scanner utility, and scheduling consistency.

    Potential improvement strategies to reduce the access times associated with the metrics in the model is discussed. Examination time is mostly affected by the technique and the examination protocol but making the change to an abbreviated version of the protocol has the potential to significantly reduce examination time. This is especially useful for screening purposes. Reduction in turnover time can be achieved by analysing the process in between examinations and making suitable changes in preparation of patients and examinations, and in architecture for a more streamlined throughput. The scheduling process has a large impact on efficiency and reduction in access times and increasing utility rate. It is important for the scheduling process to be flexible to increase efficiency. As a result of this report, the conclusion is that a benchmarking project could be conducted on Swedish radiology departments to determine best practices in workflows.

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    Model for Process Time Analysis in Magnetic Resonance Imaging
  • 19.
    Brorsson, Anna
    et al.
    Karolinska Institutet.
    Öhman, Annika
    Karolinska Institutet.
    Lundberg, Stefan
    KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB.
    Nygård, Louise
    Karolinska Institutet.
    Accessibility in public space as perceived by people with Alzheimer´s disease2011In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, no aug 11Article in journal (Refereed)
    Abstract [en]

    Most people with dementia remain living at home as long as possible after being diagnosed, and hence their lives also include activities in the public space. The aim of this study was to illuminate experiences of accessibility in public space in people with Alzheimer’s disease. A qualitative grounded theory approach with repeated in-depth interviews was used. The core category, accessibility as a constantly changing experience, was characterized by changes in the relationship between informants and public space. Changes in the relationship took place in activities and use of place and related to familiarity and comfort, individual motives and interests, and planning and protecting. Other changes occurred in places and problematic situations related to everyday technologies, crowded places with high tempo and noise, and change of landmarks. These changes reduced feelings of accessibility and increased difficulties in carrying out activities in public space. These findings may be helpful when providing support, and supporting community living.

  • 20.
    Brouwers, Lisa
    KTH, School of Information and Communication Technology (ICT), Computer and Systems Sciences, DSV.
    MicroPox: a Large-scale and Spatially Explicit Microsimulation Model for Smallpox Transmission2005In: The Proceedings of the 15th International Conference on Health Sciences Simulation, 2005, p. 70-76Conference paper (Refereed)
    Abstract [en]

    The motivation for this microsimulation model is the need to analyze and compare effects of implementing potential intervention policies against smallpox. By including contact patterns and spatial information extracted from governmental registers, we strive to make the simulation model more realistic than traditional transmission models, and thus better suited as a policy tool. MicroPox, the probabilistic large-scale microsimulation model described in this article uses real but anonymized data for the entire Swedish population. Since the unique data set contains family relations and workplace data for all Swedes, we have been able to incorporate many of their close social contacts, the type of contacts that are important for the transmission of smallpox. The level of detail of the data makes it possible to capture a large amount of the heterogeneity of the contact structure; most people have a small number of contacts, while a few have a large number. As the data set also contains geographic coordinates for all workplaces and dwellings, we were able to make the model spatially explicit. Besides a description of the model, the article also describes a preliminary experiment in which 50 initially infected persons spread the disease among 2,500,000 people, mainly located in Stockholm, Sweden.

  • 21.
    Brouwers, Lisa
    et al.
    KTH, School of Information and Communication Technology (ICT), Communication: Services and Infrastucture, Software and Computer Systems, SCS.
    Cakici, Baki
    KTH, School of Information and Communication Technology (ICT), Communication: Services and Infrastucture, Software and Computer Systems, SCS.
    Camitz, Martin
    Karolinska Institutet, MEB.
    Tegnell, Anders
    Socialstyrelsen.
    Boman, Magnus
    KTH, School of Information and Communication Technology (ICT), Communication: Services and Infrastucture, Software and Computer Systems, SCS.
    Economic consequences to society of pandemic H1N1 influenza 2009: preliminary results for Sweden2009In: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 14, no 37, p. 19333-Article in journal (Refereed)
    Abstract [en]

    Experiments using a microsimulation platform show that vaccination against pandemic H1N1 influenza is highly cost-effective. Swedish society may reduce the costs of pandemic by about SEK 2.5 billion (approximately EUR 250 million) if at least 60 per cent of the population is vaccinated, even if costs related to death cases are excluded. The cost reduction primarily results from reduced absenteeism. These results are preliminary and based on comprehensive assumptions about the infectiousness and morbidity of the pandemic, which are uncertain in the current situation.

  • 22.
    Brouwers, Lisa
    et al.
    KTH, Superseded Departments (pre-2005), Computer and Systems Sciences, DSV.
    Ekenberg, Love
    KTH, Superseded Departments (pre-2005), Computer and Systems Sciences, DSV.
    Hansson, Karin
    KTH, Superseded Departments (pre-2005), Computer and Systems Sciences, DSV.
    Danielson, Mats
    Multi-criteria decision-making of policy strategies with public-private re-insurance systems2004In: Risk, Decision, and Policy, ISSN 1357-5309, E-ISSN 1466-4534, Vol. 9, no 1, p. 23-45Article in journal (Refereed)
    Abstract [en]

    This article describes an integrated flood catastrophe model as well as some results of a case study made in the Upper Tisza region in north-eastern Hungary: the Palad-Csecsei basin. The background data was provided through the Hungarian Academy of Sciences and complemented by interviews with different stakeholders in the region. Based on these data, for which a large degree of uncertainty is prevailing, we demonstrate how an implementation of a simulation and decision analytical model can provide insights into the effects of imposing different policy options for a flood risk management program in the region. We focus herein primarily on general options for designing a public-private insurance and reinsurance system for Hungary. Obviously, this is a multi-criteria and multi-stakeholder problem and cannot be solved using standard approaches. It should, however, be emphasised that the main purpose of this article is not to provide any definite recommendations, but rather to explore a set of policy packages that could gain a consensus among the stakeholders.

  • 23. Cademartori, L.
    et al.
    Galatà, G.
    Monaco, C. L.
    Maratea, M.
    Mochi, M.
    Schouten, Marco
    KTH, School of Electrical Engineering and Computer Science (EECS).
    An ASP-based Approach to Master Surgical Scheduling2022In: CEUR Workshop Proceedings, CEUR-WS , 2022, p. 313-328Conference paper (Refereed)
    Abstract [en]

    The problem of finding Master Surgical Schedules (MSS) consists of scheduling different specialties to the operating rooms of a hospital clinic. To produce a proper MSS, each specialty must be assigned to some operating rooms. The number of assignments is different for each specialty and can vary during the considered planning horizon. Realizing a satisfying schedule is of upmost importance for a hospital clinic. A poorly scheduled MSS may lead to unbalanced specialties availability and increase patients' waiting list, negatively affecting both the administrative costs of the hospital and the patient satisfaction. In this paper, we present a compact solution based on Answer Set Programming (ASP) to the MSS problem. We tested our solution on different scenarios: experiments show that our ASP solution provides satisfying results in short time, also when compared to other logic-based formalisms. Finally, we describe a web application we have developed for easy usage of our solution. 

  • 24.
    Cakici, Baki
    KTH, School of Information and Communication Technology (ICT), Communication: Services and Infrastucture, Software and Computer Systems, SCS.
    Disease surveillance systems2011Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Recent advances in information and communication technologies have made the development and operation of complex disease surveillance systems technically feasible, and many systems have been proposed to interpret diverse data sources for health-related signals. Implementing these systems for daily use and efficiently interpreting their output, however, remains a technical challenge.

    This thesis presents a method for understanding disease surveillance systems structurally, examines four existing systems, and discusses the implications of developing such systems. The discussion is followed by two papers. The first paper describes the design of a national outbreak detection system for daily disease surveillance. It is currently in use at the Swedish Institute for Communicable Disease Control. The source code has been licenced under GNU v3 and is freely available. The second paper discusses methodological issues in computational epidemiology, and presents the lessons learned from a software development project in which a spatially explicit micro-meso-macro model for the entire Swedish population was built based on registry data.

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    cakici-lic-2011
  • 25.
    Chang, Fangyuan
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Technology in Health Care.
    Socio-technical Transformations in Care Practices: Investigating the Implementation of Social Alarm Systems in Nursing Homes2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The worldwide shortage of qualified care workers along with the increasing need for elderly care services has restrained the capacity of nursing homes to offer their residents high-quality care services. Along with digitalization, policymakers believe that technological advancements can improve the efficiency of care and streamline care work, thus helping to alleviate the challenge above. These investments include the creation of new care services by adopting innovations such as social robots, and the update of existing care services by replacing analogue technologies with digital versions, such as social alarm systems. While numerous studies have discussed the implementation of new digital technologies, the digitalization of existing care services has received less attention.This dissertation conducts empirical investigations on the digitalization of social alarm systems in four Swedish nursing homes. By applying theories of social shaping of technology with a focus on socio-technical transformations in care practices, it asks how implementation of the new social alarm systems is socially shaped in care practices. The social alarm system is an established technology that aims to enable users to call for help in emergencies. Based on a literature review of the central theme (Paper I), the dissertation examines discrepancies between planned and actual implementation outcomes (Paper II), differences within a team during project executing (Paper III), and the relationship between individuals’ actual use of technology and the assumptions inscribed in the system and the diverse care concepts in nursing homes (Paper IV). The methodological basis of the dissertation comprises analysis of implementation documents, observations of healthcare professionals’ daily work, interviews with employees of both technology companies and nursing homes, questionnaires completed by healthcare professionals, and a literature review.The results reveal that technology implementation is far from predictable outside the care context. During the implementation process, people from different groups have distinct goals, focus on different facets, and develop diverse approaches for integrating the system into daily work. Frontline professionals determine their ways of using the new social alarm system based on their personal and situational understanding of technology scripts and care concepts under given contexts. The results contribute to theoretical clarifications as well as practical possibilities and limitations to guide the implementation of social alarm systems in nursing homes. The findings indicate that the introduction of a digital social alarm system brings various changes. The digitalization of social alarm services in nursing homes can benefit from a clear positioning of the new system, a common ground for sufficient communication between actors involved, and an in-depth interpretation of local environments, as well as flexible and continuous implementation strategies.

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  • 26.
    Chang, Fangyuan
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Technology in Health Care.
    Eriksson, Andrea
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Ergonomics.
    Östlund, Britt
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Technology in Health Care.
    Discrepancies Between Expected and Actual Implementation: the Process Evaluation of PERS Integration in Nursing Homes2020In: International Journal of Environmental Research and Public Health, E-ISSN 1660-4601, Vol. 17, no 4245Article in journal (Refereed)
    Abstract [en]

    Recent studies prove that when implementing new technology technology-driven and one-size-fits-all approaches are problematic. This study focuses on the process of implementing personal emergency response system (PERS) at nursing homes. The aim is to understand why the implementation of PERS has not met initial expectations. Multiple methods were used in two Swedish nursing homes, including document analysis, questionnaires (n = 42), participant observation (67 h), and individual interviews (n = 12). A logic model was used to ascertain the discrepancies that emerged between expected and actual implementation, and the domestication theory was used to discuss the underlying meanings of the discrepancies. The discrepancies primarily focused on staff competence, system readiness, work routines, and implementation duration. Corresponding reasons were largely relevant to management issues regarding training, the procurement systems, individual and collective responsibilities as well as invisible work. The uptake of technology in daily practice is far more nuanced than a technology implementation plan might imply. We point out the importance of preparing for implementation, adjusting to new practices, and leaving space and time for facilitating implementation. The findings will be of use to implementers, service providers, and organizational managers to evaluate various measures in the implementation process, enabling them to perform technology implementation faster and more efficiently.

  • 27.
    Chang, Fangyuan
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Technology in Health Care.
    Kuoppamäki, Sanna
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Technology in Health Care.
    Östlund, Britt
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Technology in Health Care.
    Technology scripts in care practice: A case study of assistant nurses’ use of a social alarm system in Swedish nursing homesManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Technologies such as social alarm systems contain expectations about how they should be integrated and used in practice. These expectations, also called technology scripts, usually fail to consider all the complexity in care practice. Shifting the focus from technology scripts to care practice, this paper examines how a social alarm system is used in assistant nurses’ care practices in nursing homes.

    Methods: The paper draws on observations of assistant nurses’ daily tasks (32 hours) and semi-structured interviews with assistant nurses (n=12) in two Swedish nursing homes. The observation data were used to understand the care contexts and assistant nurses’ technology-mediated care practices, while interviews were used to deeply understand assistant nurses’ perceptions of the system, their care practices, and which aspects they considered during the provision of care.

    Results: We show the complexities involved in integrating a social alarm system into care practices based on assistant nurses’ situational and personal interpretations of both technology scripts and quality of care. In technology-mediated care practices, consisting of receiving alarms from residents, checking alarms, responding to alarms and documenting finished alarms, the assistant nurses defined technology scripts according to their expected requirements and outcomes, and meanwhile considered the quality of care by evaluating the priority of practical, moral or relational care in the situations at hand. Through further negotiations with the defined scripts and the considered quality of care, the assistant nurses decided on the final way of using (or not using) the system in practice.

    Conclusion: Results from our survey portray the complexity of technology in care practices. The findings contribute to increased understanding of technology-mediated care practices in nursing homes, and research on technology scripts in normative settings.

  • 28.
    Chang, Fangyuan
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Technology in Health Care.
    Östlund, Britt
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Technology in Health Care.
    Kuoppamäki, Sanna
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Technology in Health Care.
    Domesticating Social Alarm Systems in Nursing Homes: A Qualitative Study of Understanding Differences in the Perspectives between Middle Managers and Assistant NursesManuscript (preprint) (Other academic)
    Abstract [en]

    Background: New social alarm solutions are viewed as a promising approach to alleviating the global challenge of an aging population and a shortage of care staff. However, the implementation of social alarm systems in nursing homes has proven both complex and difficult. Current studies have recognized the benefits of involving actors such as assistant nurses and middle managers in advancing these implementations, however the differences in their perspectives during the implementation of these novel technologies have received less attention.Methods: Based in domestication theory, this paper aims to better understand the perspectives of middle managers and assistant nurses during four domestication phases. We interviewed middle managers (n = 5) and assistant nurses (n = 17) working in nursing homes to understand the two groups’ perceptions and practices during the implementation of social alarm systems.Results: During the four domestication phases, a total of four differences in perspectives emerged between the groups, including (a) system conceptualization; (b) spatial employment of social alarm devices; (c) treatment of unexpected implementation issues; and (d) evaluation of inconsistent competence in technology use. Our findings elaborate how individuals from the two groups have distinct goals, focus on different facets, and develop diverse coping strategies over time. Taking a closer look into middle managers’ and assistant nurses’ ways of overcoming these differences, we propose a tentative concept: “collective domestication“ to call for more studies about collective practices during technology domestication within organizations.Conclusion: Our findings reveal a divide between middle managers and assistant nurses in terms of domesticating social alarm systems and stress the potential of learning from each other to facilitate the whole process. Further studies could focus on the role of collective practices during different domestication phases to enhance the understanding of technology implementation in the contexts of complex interactions across groups.

  • 29.
    Crockett, Katie
    et al.
    School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada.
    Lovo, Stacey
    School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada.
    Irvine, Alison
    School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada.
    Trask, Catherine M.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Ergonomics. Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, SK, Canada.
    Oosman, Sarah
    School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada.
    McKinney, Veronica
    College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
    McDonald, Terrence
    Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
    Sari, Nazmi
    Department of Economics, University of Saskatchewan, Saskatoon, SK, Canada.
    Carnegie, Bertha
    University of Saskatchewan, Saskatoon, SK, Canada.
    Custer, Marie
    University of Saskatchewan, Saskatoon, SK, Canada.
    McIntosh, Stacey
    University of Saskatchewan, Saskatoon, SK, Canada.
    Bath, Brenna
    School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada; Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, SK, Canada.
    Healthcare Access Challenges and Facilitators for Back Pain Across the Rural-Urban Continuum in Saskatchewan, Canada: Cross-Sectional Results From a Provincial-Wide Telephone Survey2023In: Health Services Insights, E-ISSN 1178-6329, Vol. 16Article in journal (Refereed)
    Abstract [en]

    Background: Chronic back pain is a common musculoskeletal disorder, disproportionately affecting rural and Indigenous people. Saskatchewan has a relatively high proportion of rural and Indigenous residents; therefore, understanding barriers and facilitators to accessing healthcare are needed to improve healthcare service delivery. Methods: A provincial-wide telephone survey explored experiences and perceived healthcare access barriers and facilitators among 384 Saskatchewan residents who experienced chronic low back pain. Chi-squared tests were performed to determine if people who lived in urban versus rural areas differed in the proportion who had accessed services from various healthcare practitioners. T-test and Mann-Whitney U analyses were conducted to determine differences between urban and rural, and Indigenous and non-Indigenous respondents. Results: Of 384 residents surveyed, 234 (60.9%) reported living in a rural location; 21 (5.5%) identified as Indigenous. Wait times (47%), cost (40%), travel (39%), and not knowing how to seek help (37%) were the most common barriers for Saskatchewan residents seeking care, with travel being the only barrier that was significantly different between rural and urban respondents (P ⩽.001). Not knowing where to go to access care or what would help their low back pain (P =.03), lack of cultural sensitivity (P =.007), and comfort discussing problems with health care professionals (P =.26) were greater barriers for Indigenous than non-Indigenous participants. Top facilitators (>50% of respondents) included publicly funded healthcare, locally accessible healthcare services, and having supportive healthcare providers who facilitate referral to appropriate care, with urban respondents considering the latter 2 as greater facilitators than rural respondents. Telehealth or virtual care (P =.013) and having healthcare options nearby in their community (P =.045) were greater facilitators among Indigenous participants compared to non-Indigenous respondents. Conclusions: Rural, urban, Indigenous, and non-Indigenous people report overlapping and unique barriers and facilitators to accessing care for chronic low back pain. Understanding perceived access experiences will assist in developing more effective care models for specific communities or regions.

  • 30.
    Dahn, Marcus Anthony
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    Investigation of Procurement Practices for Welfare Technologies in Municipalities in Sweden2020Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Major demographical changes, such as aging population, constantly increases the demand for healthand social care services and technologies. The concept of welfare technologies is a response to meet this demand, since it increases independency, activity, participation and safety for people that has or is at risk of developing a disability. The procurement process of welfare technology is described as ineffective and problematic and is one of the major bottlenecks in implementing this type of technology. The aim of this study was to explore how the practical procurement process of welfare technology is performed in Swedish municipalities, an area which is currently under-researched. Moreover, the main problematic areas in the procurement, and their causes were investigated, which was carried out through qualitative semi-structured interviews with municipal actors. Data was collected from 3 municipalities, with 8 interview participants in total. The collected data from these interviews was transcribed, using intelligent verbatim, and analyzed inductively in the framework of qualitative content analysis. The data analysis yielded 7 main categories of problematic areas in the procurement process, along with 47 sub-categories. The main issues discussed were related to insufficient resources, such as competence, time and money, too little focus on the userneed, and difficulties with integrating welfare technology with other technical systems. A set of concrete advices for how to target some of the identified problems was generated, along with a couple guidelines for how to streamline the procurement process of welfare technology. It is argued in this report that the municipal organization of this process needs to be looked over, which cannot solely occur within municipalities, but must also be decided from a higher political level.

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  • 31.
    Danko, Charlott
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    Traceability of Medical Devices Used During Surgeries: A Study of the Current Traceability System at the Karolinska University Hospital in Solna and Research of Improvement2020Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The last few decades' development of technology has greatly affected healthcare. The implementation of technology in healthcare has advanced and improved it immensely, but it has also brought a new level of complexity. One of the modern issues introduced to healthcare is the traceability of medical devices. The main reason why traceability is becoming a more important matter in regards to healthcare is because of patient safety. Patient safety is one of the greatest priorities in healthcare but is constantly challenged by new innovations. Enabling traceability of medical devices is a part of the process of ensuring patient safety.

    The aim of this master thesis project was to research how medical devices used in surgeries are traced and how the routine can be improved. The idea of this thesis was based on the application of two new regulations, Regulation (EU) 745/2017 and Regulation (EU) 746/2017, both with the purpose of improving traceability. Qualitative methods such as observations, surveys, and interviews were used for this project. To gain multiple perspectives on the issue, different target groups were defined for the collection of data. The qualitative data was then analysed and conclusions based on the data could be drawn.

    The results of this project showed that the current traceability routine is lacking and that there is a lot of potential for improvements. The computer systems that manages information regarding medical devices can enable proper traceability if combined with other systems. Improvements of features in the systems are suggested, as well as an idea of an integrated system that combines functionalities of other software. Some of the project's challenges are discussed and suggestions for how to further develop the research are presented.

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  • 32.
    Darwich, Adam S.
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Polasek, Thomas M.
    Aronson, Jeffrey K.
    Ogungbenro, Kayode
    Wright, Daniel F.B.
    Achour, Brahim
    Reny, Jean-Luc
    Daali, Youssef
    Eiermann, Birgit
    Cook, Jack
    Lesko, Lawrence
    McLachlan, Andrew J.
    Rostami-Hodjegan, Amin
    Model-Informed Precision Dosing: Background, Requirements, Validation, Implementation, and Forward Trajectory of Individualizing Drug Therapy2021In: Annual Review of Pharmacology and Toxicology, ISSN 0362-1642, E-ISSN 1545-4304, Vol. 61, no 36, p. 1-21Article in journal (Refereed)
    Abstract [en]

    Model-informed precision dosing (MIPD) has become synonymous with modern approaches forindividualizing drug therapy, in which the characteristics of each patient are considered as opposedto applying a one-size-fits-all alternative. This review provides a brief account of the currentknowledge, practices, and opinions on MIPD while defining an achievable vision for MIPDin clinical care based on available evidence.We begin with a historical perspective on variabilityin dose requirements and then discuss technical aspects of MIPD, including the need for clinicaldecision support tools, practical validation, and implementation of MIPD in health care.Wealso discuss novel ways to characterize patient variability beyond the common perceptions of geneticcontrol. Finally, we address current debates on MIPD from the perspectives of the new drugdevelopment, health-care economics, and drug regulations.

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  • 33.
    De Maria, Carmelo
    et al.
    Univ Pisa, Res Ctr E Piaggio, Largo Lucio Lazzarino 1, I-56122 Pisa, Italy.;Univ Pisa, Dept Ingn Informaz, Pisa, Italy..
    Di Pietro, Licia
    Univ Pisa, Res Ctr E Piaggio, Largo Lucio Lazzarino 1, I-56122 Pisa, Italy..
    Lantada, Andres Diaz
    Univ Politecn Madrid, Mech Engn Dept, Madrid, Spain..
    Madete, June
    Kenyatta Univ, Dept Elect & Elect Engn, Nairobi, Kenya..
    Makobore, Philippa Ngaju
    Ugandan Ind Res Inst, Kampala, Uganda..
    Mridha, Mannan
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Ravizza, Alice
    BioInd Pk Silvano Fumero, Turin, Italy..
    Torop, Janno
    Univ Tartu, Inst Technol, Tartu, Estonia..
    Ahluwalia, Arti
    Univ Pisa, Res Ctr E Piaggio, Largo Lucio Lazzarino 1, I-56122 Pisa, Italy.;Univ Pisa, Dept Ingn Informaz, Pisa, Italy..
    Safe innovation: On medical device legislation in Europe and Africa2018In: Health Policy and Technology, ISSN 2211-8837, E-ISSN 2211-8845, Vol. 7, no 2, p. 156-165Article in journal (Refereed)
    Abstract [en]

    Objectives: The principal motivation for regulating medical devices is to protect patients and users. Complying with regulations may result in an increase in development, manufacturing and service costs for medical companies and ultimately for healthcare providers and patients, limiting the access to adequate medical equipment. On the other hand, poor regulatory control has resulted in the use of substandard devices. This study aims at comparing the certification route that manufactures have to respect for marketing a medical device in some African Countries and in European Union. Methods: We examined and compared the current and future regulations on medical devices in the European Union and in some countries in Africa. Contextually we proposed future approaches to open design strategies supported by emerging technologies as a means to enhance economically sustainable healthcare system driven by innovation. Results: African medical device regulations have an affinity to European directives, despite the fact that the latter are particularly strict. Several states have also implemented or harmonized directives to medical device regulation, or have expressed interest in establishing them in their legislation. Open Source Medical Devices hold a great promise to reduce costs but do need a high level of supervision, to control their quality and to guarantee their respect for safety standards. Conclusion: Harmonization across the two continents could be leveraged to optimize the costs of device manufacture and sale. Regulated open design strategies can enhance economically sustainable innovation. (C) 2018 Fellowship of Postgraduate Medicine.

  • 34.
    Delilovic, Lejla
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    A Review of Success and FailureFactors of using Patient-GeneratedHealth Data for Chronically Ill Patients2020Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Our population is becoming older and with that, the development of chronic diseasesis is also expected to increase. A chronic illness is a long-term illness which lasts throughout a lifetime, or at least for a very long time. A large part of healthcare resources is already devoted to treating chronically ill patients. These patients are often dependent of both care and medication to maintain a meaningful life. To gain a holistic view of these patients health condition by one/two appointments with physicians yearly is not sufficient in order to conclude a certain health-state. The course of disease for these patients changes daily and require follow-up on disease progression continuously to adapt an appropriate treatment plan. Collecting patient-generated health data (PGHD) facilitates in the process of retrieving moreevidence for better assessment of the disease development. While there is obvious importance and benefit of using of PGHD, this data is not commonly used in healthcare.  Further investigation is needed to understand how PGHD can be more useful.

    This pilot study provides knowledge of the success and failure factors of using PGHD for mainly chronically ill patients, but can be applied to other patient-groups as well.

    The aim of this thesis work was to collect information about what suppliers, governmental organizations and healthcare professionals require for using PGHD in healthcare setting in a greater extent in the future. Methods used to gather information were participatory interviews in combination with qualitative interview questions. Pattern recognition has been created through a thematic analysis andcluster mapping. The data collection resulted in four areas of improvement; patient behaviour, healthcare organization, digitized health data and equipment.

    The result shows overall a positive attitude towards the concept of PGHD by all sectors asked in this project. Stakeholders agree on that PGHD can generate positive outcomes for chronically ill patients. The belief of improving workflow in healthcare with PGHD was also positive. The valuable possibilities generated with PGHD are tailored careflows, improved evaluation of disease status and enhanced quality of care and well-being among others. Additionally, several ongoing projects are taking place, which demonstrate great interest in the area. However, before PGHD can be prescribed by healthcare, studies have to be performed including development of national guidelines for reporting PGHD, building a secure infrastructure and introducing new work routines. Future work will be applying AI-analysis of reported PGHD to facilitate the work of caregivers and development of secure storing solutions for instance with block-chain technology.

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  • 35.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Imbalanced logics of communicating with media in open management of health care service in Sweden: the managers perspectives and approaches2014Conference paper (Other academic)
  • 36.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Andreasson, Jörgen
    KTH.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Strömgren, Marcus
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Nyorientering av svensk sjukvård: Verksamhetstjänande implementeringslogiker bygger mer hållbart engagemang och utveckling - i praktiken2016Report (Other academic)
  • 37.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Fredman, Margareta
    Kullén Engström, Agneta
    Lean i hälso- och sjukvården2013In: Lean i Arbetslivet / [ed] Per Sederblad, Stockholm: Liber, 2013, 1, p. 142-161Chapter in book (Other academic)
  • 38.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Galvin, Kathleen
    Hull University, UK.
    Crafting life-world led leadership2014Conference paper (Other academic)
  • 39.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Strömgren, Marcus
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Holden, Richard
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Lean implementation at different levels in Swedish hospitals: the importance for working conditions and stress2015In: International Journal of Human Factors and Ergonomics, ISSN 2045-7812, Vol. 3, no 3-4, p. 235-253Article in journal (Refereed)
    Abstract [en]

    Healthcare organisations in Sweden are reorienting toward horizontal organisation around care processes. This paper's aim was to investigate how implementation approaches for improvements of care processes in line with lean production (LP), at hospital strategic and operative levels, are associated with working conditions and stress-related health among the employees. Five hospitals working with improvements to care processes were studied using questionnaires to employees (n = 1,303) and interviews at strategic and operative levels at baseline and follow-up. The process redesign implementation strategies varied between the strategic and operative levels. There were associations between a higher degree of LP at operative level and increased work resources and decreased work demands. Physical, cognitive and mental stress-related symptoms were only weakly associated with strategic or operative LP initiatives. There was evidence of more beneficial or improved working conditions in relation to higher degree of LP at operative levels.

  • 40.
    Dzubur, Sabina
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    Modeling of Healthcare Delivery in Sweden2023Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    A large part of Swedish medical care is expected to be provided from the primary health centers. However, these centers are experiencing challenges in terms of shortages of personnel, an increased volume of patients, higher workload, increasing queue lengths, and increasing costs. Addressing these issues at the primary health centers is important for both improving the operation at the local centers and the functionality of the Swedish healthcare system. This thesis aims to explore the primary health center operation, focusing on a typical public primary health center in Stockholm. This is done to find parameters that affect the flow of patients and develop a graphical model that serves as a foundation for further model development, simulations and optimization of good health. To address the complex and dynamic primary health center system, a system dynamics approach is adopted. A literature review was conducted to gain an understanding of the primary health center environment and to identify parameters that impact the primary health centers ability to operate and/or affect the quality of service towards patients. The model development involved constructing cases and extracting parameters that change over time. The parameter relationships were determined through interpretation and are supported by literature. The model was qualitatively validated with the assistance of expert feedback. The presented result is determined to capture the basic operation of the primary health center and the model can be used as a foundation for further simulations.

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  • 41.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Dahlgren, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management. Karolinska institutet, Sweden.
    Säker vård även i hemmet en framtida utmaning2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 22, p. 1-2Article in journal (Refereed)
  • 42.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Stenberg, Una
    Olsson, Mariann
    Ruland, Cornelia M.
    Health Care Professionals' Perspectives of the Experiences of Family Caregivers During In-Patient Cancer Care2014In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 20, no 4, p. 462-486Article in journal (Refereed)
    Abstract [en]

    Being a family member of a patient who is being treated in an acute care setting for cancer often involves a number of challenges. Our study describes Norwegian cancer care health professionals' perceptions of family members who served as family caregivers (FCs) and their need for support during the in-hospital cancer treatment of their ill family member. Focus group discussions were conducted with a multidisciplinary team of 24 experienced social workers, physicians, and nurses who were closely involved in the patients' in-hospital cancer treatment and care. Drawing on qualitative hermeneutic analysis, four main themes describe health professionals' perceptions of FCs during the patient's in-hospital cancer care: an asset and additional burden, infinitely strong and struggling with helplessness, being an outsider in the center of care, and being in different temporalities. We conclude that it is a challenge for health care professionals to support the family and create room for FC's needs in acute cancer care. System changes are needed in health care, so that the patient/FC dyad is viewed as a unit of care in a dual process of caregiving, which would enable FCs to be given space and inclusion in care, with their own needs simultaneously considered alongside those of the patient.

  • 43.
    Elinder, Goran
    et al.
    Karolinska Inst, Dept Pediat, Stockholm, Sweden..
    Eriksson, Anders
    Umea Univ, Dept Community Med & Rehabil, Forens Med, Umea, Sweden.;Natl Board Forens Med, Stockholm, Sweden..
    Hallberg, Boubou
    Karolinska Inst, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Pediat & Neonatol, Stockholm, Sweden..
    Lynoe, Niels
    Karolinska Inst, Med Eth, Stockholm, Sweden..
    Sundgren, Pia Maly
    Lund Univ, Diagnost Radiol, Lund, Sweden.;Skane Univ Hosp, Dept Neuroradiol, Lund, Sweden..
    Rosen, Mans
    Karolinska Inst, Hlth Technol Assessment, Stockholm, Sweden..
    Engstrom, Ingemar
    Univ Orebro, Univ Hlth Care Res Ctr, Fac Med & Hlth, Child & Adolecent Psychiat, Orebro, Sweden..
    Erlandsson, Björn-Erik
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Human Communication Science.
    Traumatic shaking: The role of the triad in medical investigations of suspected traumatic shaking2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, p. 3-23Article, review/survey (Refereed)
    Abstract [en]

    The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language in SBU's reports are adjusted to a wide audience. SBU's Board of Directors has approved the conclusions in this report. The systematic review showed the following graded results: There is limited scientific evidence that the triad (Three components of a whole. The triad associated with SBS usually comprises subdural haematoma, retinal haemorrhages and encephalopathy.) and therefore, its components can be associated with traumatic shaking (low-quality evidence). There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low-quality evidence). Limited scientific evidence (low-quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support. Insufficient scientific evidence (very low-quality evidence) represents either a lack of studies or situations when available studies are of low quality or show contradictory results. Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.

  • 44.
    Eneberg, Magnus
    KTH, School of Industrial Engineering and Management (ITM), Machine Design (Dept.), Product and Service Design.
    Säker och användarcentrerad vård och omsorg i hemmiljö: medarbetarens perspektiv på hinder och möjligheter för utveckling och ökad samordning2023Report (Other (popular science, discussion, etc.))
    Abstract [sv]

    I rapporten presenteras resultaten från projektet Säker och användarcentrerad vård och omsorg i hemmiljö med deltagare från KTH, Region Stockholm, Stockholms stad, Capio Primärvård AB och Cuviva AB. Syftet med projektet har varit att bidra till ökad samordning i vård- och omsorgssystemet kring sköra äldre som erhåller vård och omsorg i sin hemmiljö. Studien visar på ett antal hinder som gör det utmanande att implementera nya arbetsmetoder och lösningar. Bland annat identifierades målkonflikter mellan såväl organisationer som mellan professioner och deras respektive drivkrafter, ansvar och befogenhet. Studien visar även på ett behov av översyn kring styrmetoder såsom ersättningsmodeller, uppföljning, granskning och hur lagar tolkas. Baserat på insikterna från projektet identifierades ett antal områden för utveckling som är tänkta att ske i framtida samverkan mellan de olika deltagande organisationerna. 

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    rapport
  • 45.
    Engdahl, Ylva
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    HOPE Platform Digital Toolfor Type 2 Diabetes: Supporting Newly Diagnosed Patients in Self-Care2021Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Type 2 diabetes is a chronic disease whose incidence has increased with more than 200% during the past 20 years. The increasing number of type 2 diabetes patients could result in more patients suffering from lower quality of life and life threatening complications. Furthermore, the growing need of care will increase the load on healthcare. To counteract this effect, digital tools could be used to put more care responsibility on the patient. 

    The aim of this project was to find and implement the relevant features for a digital type 2 diabetes tool for newly diagnosed patients. The final goal was to encourage self-care, reduce anxiety and thus improve quality of life, while decreasing the risk of complications.

    The research process of this project consisted of five phases: literature study (to find relevant features and their clinical evidence), interviews (to find the desires of patients and practitioners), data analysis (to prioritise features), development of the features and evaluation of the tool. 

    The results showed that important features were documentation of blood glucose measurements, patient education, data transfer, communication and care plan overview, but even more importantwas the possibility to individualise the tool for different patients. The evaluation indicated that a clear care plan overview that was easy to understand could help the patient prioritise care activities. Furthermore, patients could be encouraged by reminders, seeing improvements and having continuous communication with healthcare. It was found that for positive clinical outcomes, high usability is essential. To reach patient acceptance the tool must be relevant and easy to use. It must also give valuable output, such as decision support for self-care or new knowledge. To reach practitioner acceptance the tool should be based on evidence based methods and integrate well with existing systems. 

    Finally it was concluded that the knowledge and technology needed to build a successful tool is already present, they only need to be put together and formulated in a way which is understandable and useful for both patients, caregivers and developers. 

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  • 46.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Samverkan i förbättringsarbete inom sjukvård2014In: Om samverkan: för utveckling av hälsa och välfärd / [ed] Runo Axelsson och Susanna Bihari Axelsson, Lund: Studentlitteratur, 2014, 1, p. 91-106Chapter in book (Other academic)
  • 47.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Strömgren, Marcus
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Experiences of Implementing Occupational Health Services Driven Intervention Methods for Sustainable Leadership in Health Care2016In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 28, p. 50-51Article in journal (Other academic)
  • 48.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Strömgren, Marcus
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Experiences of implementing OHS driven intervention methods for sustainable leadership in health care2015Conference paper (Refereed)
  • 49.
    Eriksson, Andrea
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Ergonomics.
    Vulkan, Patrik
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Ergonomics.
    Hur olika orsaker påverkar undersköterskor och sjuksköterskor val att sluta vid vårdavdelningar2020In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 97, no 1, p. 103-116Article in journal (Refereed)
    Abstract [en]

    Syftet var att studera de främsta orsakerna till varför under- och sjuksköterskor slutade vid vårdavdelningar vid ett svenskt sjukhus och få en förståelse för hur specifika händelser inklusive samspel mellan olika orsaker påverkat val att sluta.  Studien bygger på mixed method inklusive enkäter till och intervjuer med undersköterskor och sjuksköterskor som slutat vid fyra avdelningar vid ett svenskt sjukhus mellan åren 2012-2019. De främsta orsakerna till att sluta var personliga skäl, bristande arbetsförutsättningar, bristande möjligheter till återhämtning, lön, möjlighet till utveckling, ledningsbrister samt krav i arbetet. De kvalitativa analyserna i studien visade dock hur de personliga skälen samspelade med organisatoriska krav och förutsättningar. Resultaten pekar på vikten av att utveckla goda arbetsförhållanden för minskad intention att sluta och att ett viktigt led i att förebygga personalomsättning är att ledningen i större utsträckning tar hänsyn till under- och sjuksköterskors åsikter vid förändringsarbete.

  • 50.
    Eriksson, Per Gustav
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.
    Analysis of Physiotherapists Perceptions for Improvement of Digital Innovation2020Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    With the current challenges for the healthcare such as increased demand for care, financial and resource constraints along with rapid changes and complexity there is high believe in digital innovation and digitalisation to efficacy resources and aid in delivering a safer, more accessible and patient centred valuable care.

    There is a digitalisation that is ongoing, being used and implemented over several different areas of healthcare. Since healthcare can be seen as a complex adaptive system, there is a need to understand several agents. The aim is to gather more knowledge about perceptions within the physiotherapy staff and give recommendations and directions for improvements regarding digital innovation.

    Opinions about digital innovation have been gathered with open interviews and a semisystematic literature review with focus on physiotherapy. Too find subjective data the mixed method Q methodology was applied.

    The open interviews resulted in eight categories: digital innovation, digital innovation being used, digital innovation not used, management, obstacles, education, wishful thinking, applications and systems and associated opinions. The semi-systematic literature review showed on a rapid scientifically development, 25 articles was found and thematically analysed. 140 cited viewpoints and facts was merged with the results from the open interviews. Ten physiotherapists performed the q-sort consisting of 25 statements. Three factors were found. Interpreted as digital innovation optimism & patient oriented, digital innovation scepticism & management oriented and digital innovation sceptical optimism. Video-call technique is strongly encouraged by factor one contrary to factor two. Integrity is the major conflicting viewpoint between the factors. The result shows that gender can affect if a physiotherapist is either optimistic or sceptical to digital innovation. Using existing models such as UTAUT could improve acceptance about digital innovation. Education is perceived as important among all factors. Nine participants responded on baseline questions showing low knowledge of the term mHealth and little communication with IT departments.

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