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  • 1.
    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.

  • 2. 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.

  • 3.
    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.

  • 4.
    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.

  • 5.
    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.

  • 6. 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, Assesment 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.

  • 7. 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.

  • 8. 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)
  • 9.
    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.

  • 10.
    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.

  • 11.
    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.

  • 12.
    Brouwers, Lisa
    et al.
    KTH, Superseded Departments, Computer and Systems Sciences, DSV.
    Ekenberg, Love
    KTH, Superseded Departments, Computer and Systems Sciences, DSV.
    Hansson, Karin
    KTH, Superseded Departments, 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.

  • 13.
    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.

  • 14.
    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.

  • 15.
    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)
  • 16.
    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)
  • 17.
    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)
  • 18.
    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)
  • 19.
    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.

  • 20.
    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)
  • 21.
    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.

  • 22.
    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.

  • 23.
    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)
  • 24.
    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)
  • 25.
    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)
  • 26.
    Fölster, Stefan
    et al.
    KTH, School of Industrial Engineering and Management (ITM), Industrial Economics and Management (Dept.), Entrepreneurship and innovation. Reforminstitutet.
    Nordenström, J.
    Replik från Stefan fölster och jörgen nordenström: Framåtblickande läkare kan återta initiativet2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 23-24Article in journal (Refereed)
  • 27.
    Granlund, Anna
    et al.
    Mälardalens högskola, Innovation och produktrealisering.
    Wiktorsson, Magnus
    Mälardalens högskola, Innovation och produktrealisering.
    Automation in Healthcare Internal Logistics: A Case Study on Practice and Potential2013In: International Journal of Innovation and Technology Management (IJITM), ISSN 0219-8770, Vol. 10, no 2Article in journal (Refereed)
    Abstract [en]

    The current demographic development puts even greater demands on the healthcare sector which already struggle with scarce resources and constant pressure of cost reductions. This paper aims at through a multiple case study describe how automation of hospital internal logistics can be a tool in improving the efficiency. The results include several potential implementations for patient transports, waste handling and small goods transports. However, organizational issues as lack of ownership and a strategic view render difficulties and needs to be dealt with. The authors conclude that transfer of knowledge and technology used in manufacturing industry would be beneficial. 

  • 28.
    Grünloh, Christiane
    et al.
    KTH, School of Electrical Engineering and Computer Science (EECS), Media Technology and Interaction Design, MID. Institute of Informatics, Technische Hochschule Köln, University of Applied Sciences, Gummersbach, Germany.
    Myreteg, Gunilla
    Uppsala University, Department of Business Studies.
    Cajander, Åsa
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction..
    Rexhepi, Hanife
    University of Skövde, School of Informatics. The Informatics Research Centre.
    “Why Do They Need to Check Me?” Patient Participation Through eHealth and the Doctor-Patient Relationship: Qualitative Study2018In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 1, article id e11Article in journal (Refereed)
    Abstract [en]

    Background: Roles in the doctor-patient relationship are changing and patient participation in health care is increasingly emphasized. Electronic health (eHealth) services such as patient accessible electronic health records (PAEHRs) have been implemented to support patient participation. Little is known about practical use of PAEHR and its effect on roles of doctors and patients. Objective: This qualitative study aimed to investigate how physicians view the idea of patient participation, in particular in relation to the PAEHR system. Hereby, the paper aims to contribute to a deeper understanding of physicians’ constructions of PAEHR, roles in the doctor-patient relationship, and levels and limits of involvement. Methods: A total of 12 semistructured interviews were conducted with physicians in different fields. Interviews were transcribed, translated, and a theoretically informed thematic analysis was performed. Results: Two important aspects were identified that are related to the doctor-patient relationship: roles and involvement. The physicians viewed their role as being the ones to take on the responsibility, determining treatment options, and to be someone who should be trusted. In relation to the patient’s role, lack of skills (technical or regarding medical jargon), motives to read, and patients’ characteristics were aspects identified in the interviews. Patients were often referred to as static entities disregarding their potential to develop skills and knowledge over time. Involvement captures aspects that support or hinder patients to take an active role in their care. Conclusions: Literature of at least two decades suggests an overall agreement that the paternalistic approach in health care is inappropriate, and a collaborative process with patients should be adopted. Although the physicians in this study stated that they, in principle, were in favor of patient participation, the analysis found little support in their descriptions of their daily practice that participation is actualized. As seen from the results, paternalistic practices are still present, even if professionals might not be aware of this. This can create a conflict between patients who strive to become more informed and their questions being interpreted as signs of critique and mistrust toward the physician. We thus believe that the full potential of PAEHRs is not reached yet and argue that the concept of patient empowerment is problematic as it triggers an interpretation of “power” in health care as a zero-sum, which is not helpful for the maintenance of the relationship between the actors. Patient involvement is often discussed merely in relation to decision making; however, this study emphasizes the need to include also sensemaking and learning activities. This would provide an alternative understanding of patients asking questions, not in terms of “monitoring the doctor” but to make sense of the situation.

  • 29. Gustafson, P.
    et al.
    Ahlberg, J.
    Ekstedt, Mirjam
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management. Karolinska Institutet, Sweden.
    Lindh, M.
    Härenstam, K. P.
    Rutberg, H.
    Säkrare svensk sjukvård kräver sammanhållet och uthålligt arbete2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 25-26Article in journal (Refereed)
    Abstract [en]

    Despite a development in Swedish patient safety work in recent years, unambiguous results are missing. Here we propose some activities that will result in improved patient safety. Patients and employees are a strong driving force, and should be given a more important role. The level of education in patient safety must be raised in all levels in the system. Efective systems for learning, sharing and follow-up need to be reinforced. The understanding on how the health-care system adapts to varying circumstances, resilience, needs development. The knowledge basis of what constitutes and creates safety in psychiatry, paediatric care, primary care, and in care of the elderly must be developed.

  • 30.
    Hansson, Sven Ove
    KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy.
    Medical Ethics and New Public Management in Sweden2014In: Cambridge Quarterly of Healthcare Ethics, ISSN 0963-1801, E-ISSN 1469-2147, Vol. 23, no 3, p. 261-267Article in journal (Refereed)
    Abstract [en]

    In order to shorten queues to healthcare, the Swedish government has introduced a yearly "queue billion" that is paid out to the county councils in proportion to how successful they are in reducing queues. However, only the queues for first visits are covered. Evidence has accumulated that queues for return visits have become longer. This affects the chronically and severely ill. Swedish physicians, and the Swedish Medical Association, have strongly criticized the queue billion and have claimed that it conflicts with medical ethics. Instead they demand that their professional judgments on priority setting and medical urgency be respected. This discussion provides an interesting illustration of some of the limitations of new public management and also more generally of the complicated relationships between medical ethics and public policy.

  • 31.
    Hidefjäll, Patrik
    KTH, School of Technology and Health (STH).
    Ensuring The Value Of A Medical Device Innovation Prior To Market Launch2012In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 15, no 7, p. A490-A490Article in journal (Other academic)
  • 32.
    Hidefjäll, Patrik
    KTH, School of Technology and Health (STH).
    Stakeholder Involvement In Health Technology Assessment (HTA) Of Novel Medical Devices2012In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 15, no 7, p. A324-A324Article in journal (Other academic)
  • 33.
    Howick, Jeremy
    et al.
    University of Oxford.
    Mebius, Alexander
    Philosophy and History, KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy. University of Oxford, UK.
    Randomized trials and observational studies: the current philosophical controversy2016In: Handbook of the Philosophy of Medicine / [ed] Schramme, Thomas and Steven Edwards, Springer, 2016, p. 873-886Chapter in book (Refereed)
    Abstract [en]

    The supposed superiority of randomized over non-randomized studies is used to justify claims about therapeutic effectiveness of medical interventions and also inclusion criteria for many systematic reviews of therapeutic interventions. However, the view that randomized trials provide better evidence has been challenged by philosophers of science. In addition, empirical evidence for average differences between randomized trials and observational studies (which we would expect if one method were superior) has proven difficult to find. This chapter reviews the controversy surrounding the relative merits of randomized trials and observational studies. It is concluded that while (well-conducted) observational can often provide the same level of evidential support as randomized trials, merits of (well-conducted) randomized trials warrant claims about their superiority, especially where results from the two methods are contradictory.

  • 34. Kondori, F. A.
    et al.
    Liu, L.
    Li, Haibo
    KTH, School of Computer Science and Communication (CSC), Media Technology and Interaction Design, MID.
    Telelife: An immersive media experience for rehabilitation2014In: 2014 Asia-Pacific Signal and Information Processing Association Annual Summit and Conference, APSIPA 2014, IEEE conference proceedings, 2014Conference paper (Refereed)
    Abstract [en]

    In recent years, emergence of telerehabilitation systems for home-based therapy has altered healthcare systems. Telerehabilitation enables therapists to observe patients status via Internet, thus a patient does not have to visit rehabilitation facilities for every rehabilitation session. Despite the fact that telerehabilitation provides great opportunities, there are two major issues that affect effectiveness of telerehabilitation: relegation of the patient at home, and loss of direct supervision of the therapist. Since patients have no actual interaction with other persons during the rehabilitation period, they will become isolated and gradually lose their social skills. Moreover, without direct supervision of therapists, rehabilitation exercises can be performed with bad compensation strategies that lead to a poor quality recovery. To resolve these issues, we propose telelife, a new concept for future rehabilitation systems. The idea is to use media technology to create a totally new immersive media experience for rehabilitation. In telerehabilitation patients locally execute exercises, and therapists remotely monitor patients' status. In telelife patients, however, remotely perform exercises and therapists locally monitor. Thus, not only telelife enables rehabilitation at distance, but also improves the patients' social competences, and provides direct supervision of therapists. In this paper we introduce telelife to enhance telerehabilitation, and investigate technical challenges and possible methods to achieve telelife.

  • 35.
    Lagerstedt, Marianne
    KTH, School of Technology and Health (STH), Medical Engineering.
    Mot nätverkssjukvård i komplex miljö: - behov av en vetenskaplig syn på ledning för säker vård och effektiv resursanvändning2016Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Since 2008 advanced home healthcare agencies (ASiH) in a larger Swedish county council has underwent a transformation, to become part of a coming concept: networked healthcare (NVS). NVS means that intermediate multi-organizational healthcare (IMV) will be produced often in the home, and from 2013 to an increasing number of patients in different age groups with different diagnoses and medical conditions - in large variability of needs. At the same time IMV has proved to be not simply practical to implement in a resource-efficient and patientsafe way. Based on theories from Command and Control Science the safetyproblem that arise in connection with IMV is a sign of the less known increasing need of the direction and coordination support that IMV requires.

    With a casestudy based research approach with interactive elements, different qualitative methods has been used in two phases between 2008 - 2013. The first phase is characterized by a phenomenological approach, while the second phase has a critical hermeneutic approach. Research methods includes fieldvisits with informal discussions, in-depth interviews, validation with respondents and two different methodologies for textanalysis.

    The main result shows that practical aggravating circumstances for safe care consists of lesser known and from 2013 increasing problems with direction and coordination, through expanded advanced IMV in the home as a part of NVS concept. This also as a result of inadequate and inappropriate direction and coordination support for IMV.

    The thesis concludes that the NVS represents a resource intensive health care concept, which requires a new view on the management issue and a network-related methodology for direction and coordination. This is to promote ethical, equitable, patientsafe and dignified advanced IMV so an optimized use of resources can be implemented, through shared responsibility and coordination in patientuniquely designed networkconstellations as a given work model.

  • 36.
    Larsson, Tore J
    KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB.
    Accident information and priorities for injury prevention1990Doctoral thesis, comprehensive summary (Other academic)
  • 37.
    Larsson, Tore J
    KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB.
    Occupational Trauma: Measurement, intervention and control1999In: Work Life 2000 Conference: Invited paper, Springer , 1999, p. 164-182Conference paper (Refereed)
  • 38.
    Larsson, Tore J
    KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB.
    Safety Management - Technology and health: Invited keynote lecture2004In: Health and Safety at Public Works, 2004Conference paper (Refereed)
  • 39.
    Larsson, Tore J
    KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB.
    The Politics of Risk2007Conference paper (Refereed)
  • 40.
    Larsson, Tore J
    KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB.
    To target prevention and support the management of occupational risk: Invited Keynote Lecture2005In: Bold Perspectives, Shared Objectives, 2005Conference paper (Refereed)
    Abstract [en]

    ABSTRACT

    The prevention of occupationally related trauma and disease requires reliable measurement systems in order to target the relevant exposures and injury problems and prioritise resources. Social and workers' compensation insurance data, with exposure, coverage, accident process, medical severity and other outcome information, represents the most credible basis for decisions on preventative action.

    The registration and measurement system for occupational trauma and disease, based on the ACC New Zealand paradigm, has been developed by the Swedish Labour Market Insurances, and is also the basis for the new EU occupational injury registration system

    Some different target areas for occupational injury prevention, and examples of successful intervention activities, are reported from Swedish and Australian systems.

    To support the industrial management of safety requires good and industry-relevant measurement systems for occupational risk and the consequences of occupational trauma and disease. The development of such specific recording and measurement systems in Swedish branches of industry is based on union-employer consensus about occupational risk and a joint approach to safety management. Aggregate statistical information is of limited use for applied prevention; the accident and injury data must be more specific and detailed in order to be turned into credible decision support systems (DSS).

    Some different examples of industry-based safety management and decision support systems from Sweden are presented.

    Results from a study on the relation between best-of-sector industrial safety management and shareholder value on the ASX are also presented.

    1

  • 41.
    Larsson, Tore J
    et al.
    KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB.
    Normark, M
    AFA Insurances Sweden.
    Oldertz, Cecilia
    AFA Insurances Sweden.
    Tezic, K
    AFA Insurances Sweden.
    Allvarliga arbetsskador och långvarig sjukfrånvaro 2011: Severe work-related injury and long-term absence from work in 2011 (In Swedish)2011Report (Other academic)
  • 42.
    Larsson, Tore J
    et al.
    KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB.
    Oldertz, Cecilia
    AFA Insurances, Sweden.
    Hazardous Exposures and Injury Types Associated with the Use of Industrial Lift Trucks in Sweden 2005-20072011In: Safety Science Monitor, ISSN 1443-8844, Vol. 15, no 3Article in journal (Refereed)
  • 43.
    Larsson, Tore J
    et al.
    KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB.
    Wilson, Kay
    Centralgalaxen Bygg, Sweden.
    Leray, Henri
    Centralgalaxen Bygg, Sweden.
    The Challenge of Health and Safety Promotion at Work: Balance training for fitness and falls prevention among Swedish construction workers2010In: Safety Science Monitor, ISSN 1443-8844, Vol. 14, no 2Article in journal (Refereed)
  • 44.
    Larsson, Tore Johan
    et al.
    KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB. KTH, School of Technology and Health (STH), Design, Work Environment, Safety and Health, DASH.
    Hagvide, Mona-Lisa
    Svanborg, Maria
    Borell, Lena
    Falls prevention through community intervention: A Swedish example2009In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 48, no 2, p. 204-208Article in journal (Refereed)
    Abstract [en]

    In order to control and reduce fall-related injuries, particularly among women over the age of 55, a safety management and falls prevention campaign was structured and implemented during 2006-2007 in the small industrial town of Sodertalje, Sweden. A local campaign was launched to recruit falls prevention agents, to inform key target groups in the local community, and to educate older people about fall risks. A survey showed that the campaign had a greater impact among professionals with a special relation to fall risk than among the general population. Medical records were used in the evaluation of the outcomes. The results show that between 2005 and 2007 there was a drop of fractures related to falls in the council: an overall drop of 16.7% in the population; among men 55 or older a drop of 12%, among women 55 or older a drop of 15%, among home-dwelling women 55 or older a drop of 5.7% and among women in special accommodation a drop of 44.4%. Expressed in terms of years lost to disability (YLD), the overall drop in hip fractures treated at the local hospital between 2005 and 2007 was 48%. A comparison with National medical records for the same period shows the drop for the intervention area to be much larger than that for Sweden as a whole, although the effect was not statistically significant. The study demonstrates the advantages of a broad, community-based approach to injury prevention.

  • 45.
    Laya, Andrés
    KTH, School of Information and Communication Technology (ICT), Communication Systems, CoS, Radio Systems Laboratory (RS Lab).
    Challenges Adopting Internet-of-Things for Healthcare in SwedenManuscript (preprint) (Other academic)
    Abstract [en]

    PURPOSE: To review how public and private organizations innovate at the convergence of the ICT and the healthcare industries with services based on connected devices in Sweden.

     

    DESIGN/METHODOLOGY/APPROACH: Country case study, using aggregation of primary and secondary data about challenges associated to the adoption of new solutions in the public health and social care systems; taking a business ecosystem approach.

     

    FINDINGS: There are four key challenges affecting innovation based on connected devices and distinctive development patterns of services based on connected devices. For each development pattern, the paper identifies different ways to handle the existing challenges, and it is followed by different types of actors in the business ecosystem.

     

    ORIGINALITY/VALUE: The key contribution of this study is to show how innovative initiatives are addressing the existing challenges by following one of the three distinctive development patterns in Sweden—the public sector, the private sector, or the wellbeing sector.

  • 46.
    Laya, Andrés
    et al.
    KTH, School of Information and Communication Technology (ICT), Communication Systems, CoS, Radio Systems Laboratory (RS Lab).
    Markendahl, Jan
    KTH, School of Information and Communication Technology (ICT), Communication Systems, CoS, Radio Systems Laboratory (RS Lab).
    Lundberg, Stefan
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Network-Centric Business Models for Health, Social Care and Wellbeing Solutions in the Internet of ThingsManuscript (preprint) (Other academic)
    Abstract [en]

    In this multiple case study we analyze solutions based on connected devices in the context of health, social care and wellbeing. Based on the consideration that a solution is a combination of services and products, we build on the notion that business models can be studied at a firm- and a network-level. These two levels are used to motivate the reasons why solutions emerging at the intersection of the healthcare and the ICT industries benefit from collaboration among different actors. We conclude that the firm- and the network-level development of business models provide alignment in the business network and are useful to establish the relation that technological component have with overall solutions. Our findings suggest that some component bring novelty in the final offer with affecting the ongoing operation, while other component aim at improving the internal working processes, with minimal effects on the final offer to end users. We discuss the benefits of a network-level perspective for each case.

  • 47.
    Mebius, Alexander
    KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology, Philosophy.
    Philosophical controversies in the evaluation of medical treatments: With a focus on the evidential roles of randomization and mechanisms in Evidence-Based Medicine2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis examines philosophical controversies surrounding the evaluation of medical treatments, with a focus on the evidential roles of randomised trials and mechanisms in Evidence-Based Medicine. Current 'best practice' usually involves excluding non-randomised trial evidence from systematic reviews in cases where randomised trials are available for inclusion in the reviews. The first paper challenges this practice and evaluates whether adding of evidence from non-randomised trials might improve the quality and precision of some systematic reviews. The second paper compares the alleged methodological benefits of randomised trials over observational studies for investigating treatment benefits. It suggests that claims about the superiority of well-conducted randomised controlled trials over well-conducted observational studies are justified, especially when results from the two methods are contradictory. The third paper argues that postulating the unpredictability paradox in systematic reviews when no detectable empirical differences can be found requires further justification. The fourth paper examines the problem of absence causation in the context of explaining causal mechanisms and argues that a recent solution (Barros 2013) is incomplete and requires further justification. Solving the problem by describing absences as causes of 'mechanism failure' fails to take into account the effects of absences that lead to vacillating levels of mechanism functionality (i.e. differences in effectiveness or efficiency). The fifth paper criticises literature that has emphasised functioning versus 'broken' or 'non-functioning' mechanisms emphasising that many diseases result from increased or decreased mechanism function, rather than complete loss of function. Mechanistic explanations must account for differences in the effectiveness of performed functions, yet current philosophical mechanistic explanations do not achieve this. The last paper argues that the standard of evidence embodied in the ICE theory of technological function (i.e. testimonial evidence and evidence of mechanisms) is too permissive for evaluating whether the proposed functions of medical technologies have been adequately assessed and correctly ascribed. It argues that high-quality evidence from clinical studies is necessary to justify functional ascriptions to health care technologies.

  • 48. Nordenström, J.
    et al.
    Fölster, Stefan
    KTH, School of Industrial Engineering and Management (ITM), Industrial Economics and Management (Dept.), Entrepreneurship and innovation. Reforminstitutet, Sweden.
    Värdeskapande styrning kan återupprätta läkares inflytande: Främjar vårdens kvalitet och patienternas behov2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 20-21Article in journal (Refereed)
  • 49. Rasti, Reza
    et al.
    Nanjebe, Deborah
    Karlström, Jonas
    Muchunguzi, Charles
    Mwanga-Amumpaire, Juliet
    Gantelius, Jesper
    KTH, School of Biotechnology (BIO), Proteomics and Nanobiotechnology. KTH, Centres, Science for Life Laboratory, SciLifeLab.
    Mårtensson, Andreas
    Rivas, Lourdes
    Galban, Francesc
    Reuterswärd, Philippa
    KTH, School of Biotechnology (BIO), Proteomics and Nanobiotechnology. KTH, Centres, Science for Life Laboratory, SciLifeLab.
    Andersson Svahn, Helene
    KTH, School of Biotechnology (BIO), Proteomics and Nanobiotechnology. KTH, Centres, Science for Life Laboratory, SciLifeLab.
    Alvesson, Helle M.
    Boum, Yap, II
    Alfven, Tobias
    Health care workers' perceptions of point-of-care testing in a low-income country-A qualitative study in Southwestern Uganda2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 7, article id e0182005Article in journal (Refereed)
    Abstract [en]

    Background Point-of-care (POC) tests have become increasingly available and more widely used in recent years. They have been of particular importance to low-income settings, enabling them with clinical capacities that had previously been limited. POC testing programs hold a great potential for significant improvement in low-income health systems. However, as most POC tests are developed in high-income countries, disengagement between developers and end-users inhibit their full potential. This study explores perceptions of POC test end-users in a low-income setting, aiming to support the development of novel POC tests for low-income countries. Methods A qualitative study was conducted in Mbarara District, Southwestern Uganda, in October 2014. Fifty health care workers were included in seven focus groups, comprising midwives, laboratory technicians, clinical and medical officers, junior and senior nurses, and medical doctors. Discussions were audio-recorded and transcribed verbatim. Transcripts were coded through a data-driven approach for qualitative content analysis. Results Nineteen different POC tests were identified as currently being in use. While participants displayed being widely accustomed to and appreciative of the use of POC tests, they also assessed the use and characteristics of current tests as imperfect. An ideal POC test was characterized as being adapted to local conditions, thoughtfully implemented in the specific health system, and capable of improving the care of patients. Tests for specific medical conditions were requested. Opinions differed with regard to the ideal distribution of POC tests in the local health system. Conclusion POC tests are commonly used and greatly appreciated in this study setting. However, there are dissatisfactions with current POC tests and their use. To maximize benefit, stakeholders need to include end-user perspectives in the development and implementation of POC tests. Insights from this study will influence our ongoing efforts to develop POC tests that will be particularly usable in low-income settings.

  • 50.
    Ravn, Anders
    KTH, School of Industrial Engineering and Management (ITM), Industrial Economics and Management (Dept.).
    Distribution channel strategy design: Application and implementation in healthcare2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Healthcare is a very important and intimate service virtually all people use at least at some occasion in a lifetime. It is also highly complex and variable with heterogeneous patients requiring individualised attention in order to be effectively treated. This requires large resources in terms of labour, knowledge, skill, and time which is why in the past, improving productivity has been difficult. Information and communications technology, ICT, has been seen to have potential to improve productivity in e.g. diagnosing, devising treatment plans, communicating with patients and clinical staff, and record-keeping if applied correctly. During mainly the 1990s, the banking sector changed its distribution channel strategy to focus increasingly on Internet banking rather than local branches. If parallels are drawn between the two, such as comparing local branches to clinics, what can a rheumatology department learn?

    A case study was conducted at Karolinska University Hospital's Department of Rheumatology. Existing communication pathways associated with the clinic-patient communication were identified, theory and knowledge of the banking sector change was compiled and some current efforts of ICT integration in healthcare were briefly reviewed. Finally, the project sought to provide a future vision for communications in rheumatology. Examples of risks and difficulties considered were legal issues, patient safety and the current compensation for the clinics, which today represent a major limitation for strategy formulation.

    The study identified several key issue areas to consider when implementing ICT in healthcare and the importance of aligning ICT with workflow. Parts of the banks strategic choices are also applicable in healthcare, e.g. using a multi-channel strategy where different customer segments are targeted with different channels. Further, a unified customer management system containing input from patient as well as provider is highly recommended, together with an online portal increasing accessibility for patients. Most importantly, all distribution channels and ICT systems considered for use should be thoroughly integrated with day-to-day workflow.

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