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  • 1.
    Golsaeter, Marie
    et al.
    Futurum Acad Hlth & Care Reg Jonkoping Cty, Jonkoping, Sweden.;Jonkoping Univ, Sch Hlth Sci, CHILD Res Grp, Jonkoping, Sweden..
    Johansson, Lars-Olof
    Futurum Acad Hlth & Care Reg Jonkoping Cty, Jonkoping, Sweden..
    Harder, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    General practitioners' accounts of how to facilitate consultations with toddlers - an interview study2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 1, p. 3-9Article in journal (Refereed)
    Abstract [en]

    Objective: To describe general practitioners' (GPs') accounts of how to facilitate consultations with children aged 1-2 years. Design: A qualitative study based on focus group interviews. Setting and subjects: Five focus group interviews were conducted with a total of 25 GPs at Swedish primary health care (PHC) centres. The GPs regularly invited toddlers to consultations. Result: The GPs' accounts of how to facilitate consultations with toddlers revealed descriptions of making efforts to instil confidence in the situation to enable the consultation. Toddlers in need of health care always visit the GP with adults such as their parents, guardians or other relatives. Therefore, the GP directs efforts towards the adults and the child more or less simultaneously, as they both need to rely on the GP. The GPs describe how they instil confidence in the adults by establishing a mutual understanding that the consultation is necessary to secure the child's health. Regarding the child, the GP instils confidence by establishing a relationship in order to approach the child and accomplish bodily examinations. Conclusion: The result shows that GPs' encounters with children in consultations are two-sided. The GP needs to conduct bodily examinations to secure the child's health and development, but to do so he/she needs to establish purposeful relationships with the adults and the child by instilling confidence. This indicates that establishing relationships in the consultation is significant, and a way to achieve a child-centred consultation.

  • 2. Högberg, C
    et al.
    Karling, P
    Rutegård, J
    Ljung, Thomas
    Mid-Sweden University, Sweden.
    Lilja, M
    Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer2013In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 4, p. 209-214Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the value, risks, and shortcomings of immunochemical faecal occult blood tests (iFOBTs) in the diagnosis of colorectal cancer (CRC) and adenomas with high-grade dysplasia (HGD) in patients initially presenting to primary care. Design. A retrospective population-based study. Setting and subjects. All 495 cases of CRC and adenomas with HGD diagnosed in the county of Jamtland, Sweden from 2005 to 2009. Results. Of 495 patients 323 (65%) initially presented to primary care. IFOBTs were performed in 215 of 323 (67%) patients. The sensitivity of iFOBT for CRC and adenomas with HGD was 88% (83% when patients with a history of rectal bleeding were excluded). Of 34 patients with anaemia found en passant, 10 had negative iFOBTs. Time to diagnosis was longer for patients with negative iFOBTs (p < 0.0005). Conclusion. IFOBT might be helpful in selecting which patients to refer for colonoscopy. However, iFOBT has a limited sensitivity as a diagnostic test for CRC and adenomas with HGD. Relying only on iFOBT for colonoscopy referral could delay diagnosis, especially for patients with anaemia found en passant.

  • 3.
    Johansson-Pajala, Rose-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Jorsäter Blomgren, Kerstin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bastholm-Rahmner, P.
    Karolinska Institutet, Stockholm.
    Fastbom, J.
    Karolinska Institutet, Stockholm.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. City University London, United Kingdom.
    Nurses in municipal care of the elderly act as pharmacovigilant intermediaries: A qualitative study of medication management2016In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, p. 37-45Article in journal (Refereed)
    Abstract [en]

    Objective: To explore registered nurses experience of medication management in municipal care of the elderly in Sweden, with a focus on their pharmacovigilant activities. Design: A qualitative approach using focus-group discussions was chosen in order to provide in-depth information. Data were analysed by qualitative content analysis. Setting: Five focus groups in five different long-term care settings in two regions in Sweden. Subject: A total of 21 registered nurses (RNs), four men and 17 women, aged 27-65 years, with 4-34 years of nursing experience. Results: The findings reveal that RNs in municipal long-term care settings can be regarded as "vigilant intermediaries" in the patients drug treatments. They continuously control the work of staff and physicians and mediate between them, and also compensate for existing shortcomings, both organizational and in the work of health care professionals. RNs depend on other health care professionals to be able to monitor drug treatments and ensure medication safety. They assume expanded responsibilities, sometimes exceeding their formal competence, and try to cover for deficiencies in competence, experience, accessibility, and responsibility-taking. Conclusion: The RNs play a central but also complex role as "vigilant intermediaries" in the medication monitoring process, including the issue of responsibility. Improving RNs possibility to monitor their patients drug treatments would enable them to prevent adverse drug events in their daily practice. New strategies are justified to facilitate RNs pharmacovigilant activities. Key points This study contributes to the understanding of registered nurses (RNs) role in medication management in municipal care of the elderly (i.e. detecting, assessing, and preventing adverse drug events or any drug-related problems).RNs can be considered to be "vigilant intermediaries" in elderly patients drug treatments, working at a distance from staff, physicians, and patients. RNs occasionally take on responsibilities that exceed their formal competence, with the patients best interests in mind. In order to prevent adverse drug events in municipal care of the elderly, new strategies are justified to facilitate RNs pharmacovigilant activities. 

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  • 4.
    Lönnberg, Lena
    et al.
    Uppsala University, Sweden.
    Damberg, Mattias
    Uppsala University, Sweden.
    Revenäs, Åsa
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Region Västmanland, Ortopedkliniken Västerås; Uppsala University, Sweden.
    “It’s up to me”: the experience of patients at high risk of cardiovascular disease of lifestyle change2020In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 38, no 3, p. 340-351Article in journal (Refereed)
    Abstract [en]

    Objective: Despite knowledge of the effect of lifestyle changes in preventing cardiovascular disease, a large proportion of people have unhealthy lifestyle habits. The aim of our study is a) to explore the experiences of participants at high risk of CVD of lifestyle change after participation in a one-year structured lifestyle counselling programme and b) to link the techniques and strategies used by the participants to the processes of the transtheoretical model of behaviour change (TTM). Design: A qualitative explorative design was used to collect data on participants’ experiences. An abductive content analysis was conducted using the processes within TTM for the deductive analysis. Setting: Patients that participated in a one-year lifestyle counselling programme in Swedish primary care, were interviewed. Subjects: Eight men and eight women, aged 51–75 years, diagnosed with hypertension or type 2 diabetes mellitus. Main outcome measures: Experiences of lifestyle change in patients at high cardiovascular risk. Results: The analysis yielded four dimensions that assisted lifestyle change: ‘The value of knowledge’, ‘Taking control’, ‘Gaining trust in oneself’ and ‘Living with a chronic condition’. The theme ‘It’s up to me’ illustrated that lifestyle change was a personal matter and responsibility. Conclusion: Enhanced knowledge, self-efficacy, support from others and the individual’s insight that it was his/her own decisions and actions that mattered were core factors to adopt healthier lifestyle habits. Practice Implications: Although lifestyle change is a personal matter, the support provided by primary healthcare professionals and significant others is essential to increase self-efficacy and motivate lifestyle change.Key Points A large proportion of people persist to have unhealthy lifestyle habits also after receiving a diagnosis of hypertension or diabetes mellitus, type 2. This study contributes to enhanced knowledge of how patients experience lifestyle change after counselling in primary care. Both experiential and behavioural processes as defined by the transtheoretical model of behaviour change were used to make lifestyle changes by the patients in this study.

  • 5.
    Söderman, Mirkka
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wennman-Larsen, A
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden.
    Hoving, J L
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden.
    Alexanderson, L
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden.
    Friberg, E
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden.
    Interventions regarding physicians' sickness certification practice: a systematic literature review with meta-analyses2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 1, p. 104-114Article in journal (Refereed)
    Abstract [en]

    Objective A variety of interventions aiming to influence physicians' sickness certification practice have been conducted, most are, however, not evaluated scientifically. The aim of this systematic literature review was to obtain updated knowledge about interventions regarding physicians' sickness certification practice and to summarize their possible effects, in terms of sickness absence (SA) or return to work (RTW) among patients. Methods We searched PubMed and Web of Science up through 15 June 2020 and selected peer-reviewed studies that reported effects of controlled interventions that aimed to improve physicians' sickness certification practice and used SA or RTW among patients as outcome measures. Meta-analyses were conducted using random-effect models. Results Of the 1399 identified publications, 12 studies covering 9 interventions were assessed as relevant and included in the review. Most (70%) were from the Netherlands, two had a controlled, and seven a randomized controlled study design. All interventions included some type of training of physicians, and two interventions also included IT-support. Regarding the outcomes of SA/RTW, 30 different effect measures were used. In the meta-analyses, no statistically significant effect in favor of the interventions was observed for having any RTW (i.e. first, partial, or full) nor full RTW. Conclusions The individual studies showed that physicians' sickness certification practice might be influenced by interventions in both the intended and non-intended direction, however, no statistically significant effect was indicated by the meta-analysis. The included studies varied considerably concerning intervention content and effect measures.

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