Obstetricians/Gynecologists’ Problems in Sickness Certification Consultations: Two Nationwide Surveys

Objective. To explore experiences by physicians working in obstetrics, gynecology, or maternal healthcare (O/Gs) of problems in sickness certification consultations and differences between two years. Material and Methods. Answers by O/Gs to two Swedish nationwide surveys, in 2008 (n=1037) and 2012 (n=992), were analyzed for frequencies and severity of problems and organizational support in sickness certification consultations. Results. One-third of O/Gs found sickness certifications problematic every week. The most frequent problem was patients requesting sick notes for reasons other than work incapacity due to disease/injury (2008: 21%; 2012: 16%). The most problematic were assessing work capacity (2008 and 2012: 52%) and having different opinion from that of the patient about need for sick leave (2008: 51%; 2012: 46%). In 2012, 27% used the national sickness certification guidelines weekly, compared to 9% in 2008. A larger proportion in 2012 than 2008 reported that the guidelines facilitated contacts with patients and different stakeholders. Conclusions. Although O/Gs perceived sickness certification as problematic, there was less perceived severity of problems in 2012 compared to 2008, possibly because interventions regarding sickness certification have been introduced in Sweden recent years. Still, more organizational support, for example, time and supervision, are needed to enhance O/Gs’ sickness certification practices

Планування ЗЕД на підприємствах малого та середнього бізнесу

Pheochromocytomas (PCC) and abdominal paragangliomas (PGL) display a highly diverse genetic background and recent gene expression profiling studies have shown that PCC and PGL (together PPGL) alter either kinase signaling pathways or the pseudo-hypoxia response pathway dependent of the genetic composition. Recurrent mutations in the Harvey rat sarcoma viral oncogene homolog (HRAS) have recently been verified in sporadic PPGLs. In order to further establish the HRAS mutation frequency and to characterize the associated expression profiles of HRAS mutated tumors, 156 PPGLs for exon 2 and 3 hotspot mutations in the HRAS gene was screened, and compared with microarray-based gene expression profiles for 93 of the cases. The activating HRAS mutations G13R, Q61R, and Q61K were found in 10/142 PCC (7.0%) and a Q61L mutation was revealed in 1/14 PGL (7.1%). All HRAS mutated cases included in the mRNA expression profiling grouped in Cluster 2, and 21 transcripts were identified as altered when comparing the mutated tumors with 91 HRAS wild-type PPGL. Somatic HRAS mutations were not revealed in cases with known PPGL susceptibility gene mutations and all HRAS mutated cases were benign. The HRAS mutation prevalence of all PPGL published up to date is 5.2% (49/950), and 8.8% (48/548) among cases without a known PPGL susceptibility gene mutation. The findings support a role of HRAS mutations as a somatic driver event in benign PPGL without other known susceptibility gene mutations. HRAS mutated PPGL cluster together with NF1- and RET-mutated tumors associated with activation of kinase-signaling pathways.Funding Agencies|Swedish Cancer Foundation; StratCan; Swedish Research Council; Cancer Research Foundations of Radiumhemmet; Karolinska Institutet; Stockholm County Council</p

Co-Designing with Extreme Users: A Framework for User Participation in Design Processes

The demand for user participation in design processes is increasing, and there is a need to formulate guidance on how to involve disabled users and their representative organisations. Their participation contributes an extreme user perspective to the design process. The aim of this study was to develop an empirically grounded framework for user participation in co-design processes, involving the users with wide range of characteristics. The study was theoretically grounded in ‘participatory design’ and ‘value sensitive design’ and used an exploratory study design with online workshops to iteratively collect and analyse data. All participants collaborated on an online Miro-board to identify themes and formulate guiding principles for the framework. We propose a framework consisting of three themes: participation fundamentals, participation ethics and participation practicalities, entailing 11 guiding principles. By applying this framework, the premises, methods and activities in the design process will be accessible to all participants, and user participation in design projects will become more transparent, equitable and easier to implement. It will enable all users, people with disabilities and others, to participate and contribute to a design that can be used by the widest range of people

Self-management from the perspective of people with stroke : an interview study

Objective: Self-management support can improve quality of life, mood, self-efficacy, and physical function following a stroke. Knowledge of how people with stroke understand and experience self-management in different contexts is crucial to developing effective self-management support. This study explored how people with stroke understand and practice self-management during the post-acute phase. Method: A descriptive study using qualitative content analysis to explore data from semistructured interviews Results: Eighteen participants were interviewed. Most participants interpreted self-management as ‘taking care of their business’ and ‘being independent”. However, they encountered difficulties performing daily activities, for which they felt unprepared. Although interest in implementing self-management support increases, participants did not report receiving specific advice from healthcare professionals. Conclusion: People continue to feel unprepared to manage everyday activities after hospital discharge and must largely work things out for themselves. There is an overlooked opportunity to start the process of self-management support earlier in the stroke pathway, with healthcare professionals and people with stroke combining their skills, ideas and expertise. This would enable confidence to self-management to flourish rather than decrease during the transition from hospital to home. Practical implications: Individual tailored self-management support could help people with stroke more successfully manage their daily lives post-stroke. © 2023 The Author

Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study

Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients' confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided. The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context. We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design. Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022. This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management. DERR1-10.2196/37672. [Abstract copyright: ©Marie Elf, Erika Klockar, Maya Kylén, Lena von Koch, Charlotte Ytterberg, Lars Wallin, Tracy Finch, Catharina Gustavsson, Fiona Jones. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 06.05.2022.

På vilka grunder planerar lärare sin matematikundervisning – En studie om hur tre lärare planerar sin matematikundervisning i år 1.

Efter erfarenheter från vår verksamhetsförlagda utbildning har vi upptäckt att matematikundervisningen i skolan kan se avsevärt annorlunda ut beroende på vilken skola man undervisar på. Vi ville undersöka vilka utgångspunkter olika lärare har när de planerar sin undervisning. Vårt syfte med arbetet har varit att undersöka hur tre lärare planerade sin matematikundervisning i år 1, samt att genom elevdiagnoser se om lärarnas bild av elevernas individuella kunskaper överensstämde med verkligheten. Som metod har vi använt oss av intervjuer med lärare och diagnoser av elevers kunskaper. Vi har valt att diagnostisera eleverna med skolverkets material Diamant. Vi valde att genomföra förkunskapsdiagnosen AF samt AG 1 som behandlar additioner och subtraktioner inom talområdet 0-9. Två av lärarna var relativt läromedelstyrda och följde upplägget i läroboken medan den tredje läraren arbetade utan lärobok. Vi såg en koppling mellan lärarnas planering och elevernas diagnosresultat. De två lärarna som följde lärobokens upplägg ansåg inte att en terminsplanering för år 1 var nödvändig, medan den tredje läraren som arbetade mycket konkretiserande planerade upp hela terminen med syfte och mål för varje delmoment. Resultatet från diagnoserna visade att elever vars lärare hade en välstrukturerad terminsplanering också uppvisade ett godare resultat på diagnosen. Även om vår studie inte ger en generell bild över hur olika lärare bedriver sin undervisning anser vi ändå att det krävs en strukturerad planering. Denna planering ska vara utformad för både elever och lärare i syfte att uppnå de nationella målen för matematikämnet.

Self-management of Persistent Neck Pain : A Multi-component Group Intervention in Primary Health Care

The overall aim of this thesis was to evaluate effects of a multi-component pain and stress self-management group intervention (PASS) and to explore plausible predictors associated with short-term and long-term treatment effects among patients with persistent tension-type neck pain in primary health care (PHC). Study I was a pilot study in order to explore feasibility of the study design and methods. It included 37 participants randomly assigned to the intervention (n=18) or treatment-as-usual (n=19). Study II-III was a pragmatic randomized controlled trial that compared effects of the PASS and individually administered physiotherapy (IAPT) on patients with persistent tension-type neck pain in PHC. Study II evaluated short-term effects over a 20-week follow-up. Study III evaluated long-term effects on maintenance over a follow-up period of 2 years. Studies included 156 participants randomly assigned to PASS (n=77) or IAPT (n=79). Study IV explored predictive factors for favorable outcome in disability regarding participants assigned to PASS. The results showed that PASS had better effects than IAPT regarding coping with pain, in terms of patients’ ability to control pain, self-efficacy regarding activities interfered with by pain, disability and catastrophizing, over the 20-week follow-up, and treatment effects were largely maintained over a 2-year follow-up. Post-treatment scores in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability 2 years post-treatment following PASS. Pre-treatment characteristics explained only a minor proportion of variance in disability, and were assumed weakly associated with treatment success and long-term outcome. Key components for enhancement of long-term efficacy in pain self-management coping efforts were adequately targeted by PASS. It is suggested important to strengthen self-efficacy beliefs in regard to pain coping, to reduce disability and enhance pain self-management in the treatment of persistent neck pain, and to induce long-term maintenance of treatment gains on disability following a pain self-management intervention

Self-efficacy in Activities of daily living and symptom management in people with dizziness : a focus group study

BACKGROUND: Self-efficacy is associated with health status, health behaviour and health behaviour change in various chronic health conditions. PURPOSE: To describe self-efficacy in relation to Activities of daily living and symptom management in people with dizziness. MATERIAL AND METHODS: Thirteen women and three men, aged 45-82 years, with persistent dizziness (duration 4 months to 30 years) were recruited from an outpatient physiotherapy unit. A qualitative study was conducted using four focus groups and one individual interview and was then analysed with qualitative content analysis. RESULTS: The participants conveyed, in-depth information concerning two predefined main categories. Self-efficacy in Activities of daily living was related to challenging body positions and motions, environments, social activities, work tasks, and complex cognitive behaviours. Self-efficacy in symptom management was related to distress and aggravated symptoms, unfamiliar environment, and unknown people. CONCLUSIONS: People with dizziness describe how self-efficacy for specific activities varies according to the perceived difficulty of the task, the context of the activity, and day-to-day variations in general wellbeing. The results underscore the importance of targeting self-efficacy in the rehabilitation of people with dizziness. Our findings can guide the rehabilitation process by providing a deeper understanding of self-efficacy judgements in relation to Activities of daily living and symptom management in people with dizziness. Implication for rehabilitation This study adds important in-depth knowledge to the rehabilitation area on self-efficacy beliefs in relation to Activities of daily living and symptom management in people with dizziness. Self-efficacy for specific activities varies according to the perceived difficulty of the task, the context in which the activity takes place and day-to-day variations in perceived general well-being. The results can be used as a topic list to guide rehabilitation efforts in exploring and intervening aspects of people's everyday activities that are affected by low self-efficacy judgements. Activities perceived to be crucial to everyday life and important for well-being should be targeted in rehabilitation to increase self-efficacy and thereby activity performance and participation in people with dizziness

Care needs and care measures in heart failure in the palliative phase

Bakgrund: Hjärtsvikt är en allvarlig sjukdom med hög mortalitet och förr eller senare uppstår behov av palliativ vård.  Syftet med studien var att beskriva omvårdnadsbehov samt omvårdnadsåtgärder vid hjärtsvikt i palliativt skede. Metod: Den metod som användes var systematisk litteraturstudie. Nio artiklar inkluderades. De granskades och huvudkategorier med underkategorier bildades. Resultat: De sex kategorier som framkom var; Brister i kommunikation, information och stöd; Existentiella; Dyspné; Fatigue och depression; Ångest och Minskad rörelseförmåga. Patienternas behov var symtomlindring, god omvårdnad och bättre kommunikation vid vård i livets slutskede. Konklusion: Distriktsköterskan fungerade som en länk åt patienten. Samarbete med andra professioner var önskvärt. Kunskap, information, symtomlindring och god vård spelade en viktig roll i omvårdnaden av patienter med hjärtsvikt. De resultat som framkom ger en vägvisning om vilka faktorer som spelar roll för omvårdnaden av patienter med hjärtsvikt i palliativt skede.Background: Heart failure is a serious illness with high mortality and sooner or later arises the need for palliative care. The aim of this study was to describe the care needs and care measurses for patients with heart failure in a palliative stage. Method: the method used was a systematic literature study. Nine articles were included. They were reviewed then categories and subcathegories was formed. Results: The six categories that emerged were deficits in communication, information and support; Existential; Dyspnea; Fatigue and Depression; Anxiety and Reduced mobility. Patients’ needs where symptom relief, good care and better communication at the end of life. Conclusion: The districtnurse acts as a link to the patient. Cooperation with other professions is desirable. Knowledge, information, symptom relief and good care play an important role in the care of patients with heart failure. The result that emerged gives a guidance on which factors play an important role in care of patients with heart failure in the palliative phase

Pain self-management intervention supports successful attainment of self-selected rehabilitation goals-secondary analysis of a randomized controlled trial

Objectives (i) Describe patients' self-selected activity-related rehabilitation goals, and (ii) compare attainment of these rehabilitation goals among people with persistent tension-type neck pain receiving a group-based pain and stress self-management intervention (PASS) or individual physiotherapy (IPT). Methods Before intervention and random allocation to PASS or IPT, 156 people (PASS n = 77, IPT n = 79), listed three self-selected activity-related rehabilitation goals by use of the Patient Goal Priority Questionnaire (PGPQ). For each activity goal, participants rated limitations in activity performance, self-efficacy and fear of activity performance, readiness to change to improve performance, and expectations of future activity performance. At follow-ups (10 weeks, 20 weeks, 1 year and 2 years after inclusion), participants also responded to a question on changes made to improve activity performance. Mann-Whitney U test was used to evaluate between-group differences. Results There were between-group differences in favour of PASS in the attainment of self-selected rehabilitation goals with regard to activity limitations and satisfaction with activity performance at all follow-ups. Conclusions PASS was more successful than IPT for the attainment of self-selected rehabilitation goals, improvements in activity limitations and satisfaction with activity performance as measured by PGPQ. The PASS programme emphasized the importance of applying active pain- and stress-coping techniques in personal 'risk situations' for pain flare-ups, which appear to support people with persistent tension-type neck pain to make changes in their lives to improve activity performance. Patient or Public Contribution Patient engagement in rehabilitation by self-selected goals was investigated, but patients were not involved in the design or conduct of the study