Communication about medication management during patient-physician consultations in primary care: a participant observation study

Objective - To explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations. Setting - Two primary care centres in southern Sweden. Participants - Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis. Results - Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further. Conclusion - Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity

Clinical use of cerebral oximetry in extremely preterm infants is feasible

Introduction: The research programme Safeguarding the Brains of our smallest Children (SafeBoosC) aims to test the benefits and harms of cerebral near-infrared spectroscopy (NIRS) oximetry in infants born before 28 weeks of gestation. In a phase II trial, infants will be randomised to visible cerebral NIRS oximetry with pre-specified treatment guidelines compared to standard care with blinded NIRS-monitoring. The primary outcome is duration multiplied with the extent outside the normal range of regional tissue oxygen saturation of haemoglobin (rStO2) of 55 to 85% in percentage hours (burden). This study was a pilot of the Visible ­Oximetry Group. Material and methods: This was an observational study including ten infants. Results: The median gestational age was 26 weeks + three days, and the median start-up time was 133 minutes after delivery. The median recording time was 69.7 hours, mean rStO2 was 64.2 ± 4.5%, median burden of hyper- and hy­poxia was 30.3% hours (range 2.8-112.3). Clinical staff responded to an out of range value 29 times – only once to values above 85%. In comparison, there were 83 periods of more than ten minutes with an rStO2 below 55% and four episodes with an rStO2 above 85%. These periods accounted for 72% of the total hypoxia burden. A total of 18 of the 29 interventions were adjustments of FiO2 which in 13 of the 18 times resulted in an out-of-range SpO2. Two infants suffered second-degree burns from the sensor. Five infants died. In all cases, this was unrelated to NIRS monitoring and treatment. Conclusion: The intervention of early cerebral NIRS monitoring proved feasible, but prolonged periods of hypoxia went untreated. Thus, a revision of the treatment guideline and an alarm system is required

Physicians' attitudes towards ePrescribing – evaluation of a Swedish full-scale implementation

<p>Abstract</p> <p>Background</p> <p>The penetration rate of Electronic Health Record (EHR) systems in health care is increasing. However, many different EHR-systems are used with varying ePrescription designs and functionalities. The aim of the present study was to evaluate experienced ePrescribers' attitudes towards ePrescribing for suggesting improvements.</p> <p>Methods</p> <p>Physicians (n = 431) from seven out of the 21 Swedish health care regions, using one of the six most widely implemented EHR-systems with integrated electronic prescribing modules, were recruited from primary care centers and hospital clinics of internal medicine, orthopaedics and surgery. The physicians received a web survey that comprised eight questions on background data and 19 items covering attitudes towards ePrescribing. Forty-two percent (n = 199) of the physicians answered the questionnaire; 90% (n = 180) of the respondents met the inclusion criteria and were included in the final analysis.</p> <p>Results</p> <p>A majority of the respondents regarded their EHR-system easy to use in general (81%), and for the prescribing of drugs (88%). Most respondents believed they were able to provide the patients better service by ePrescribing (92%), and regarded ePrescriptions to be time saving (91%) and to be safer (83%), compared to handwritten prescriptions. Some of the most frequently reported weaknesses were: not clearly displayed price of drugs (43%), complicated drug choice (21%), and the perception that it was possible to handle more than one patient at a time when ePrescribing (13%). Moreover, 62% reported a lack of receipt from the pharmacy after successful transmission of an ePrescription. Although a majority (73%) of the physicians reported that they were always or often checking the ePrescription a last time before transmitting, 25% declared that they were seldom or never doing a last check. The respondents suggested a number of improvements, among others, to simplify the drug choice and the cancellation of ePrescriptions.</p> <p>Conclusion</p> <p>The Swedish physicians in the group studied were generally satisfied with their specific EHR-system and with ePrescribing as such. However, identified weaknesses warrant improvements of the EHR-systems as well as of their implementation in the individual health care organisation.</p

Mumbai : den cykelvänliga staden

Mumbai – the city of contrasts, is home for more than 20 million people. It is the financial centre and the most modern city in India. As most cities within developing countries Mumbai is striving to imitate the western model of growth and lifestyle to achieve a “developed” status. Motorization, especially private motorized modes, has become prioritized because they are seen as a big part of this development. This neglecting has also led to a significant prejudice against bicycle riding as a transport mode. Over 300 new cars are registered ever day in the city. Not only is congestion a big problem but pollution from vehicles are posing serious threats to peoples health and to the environment. 88% of the population is using public transport today but with a larger growing middle class, ready to buy private vehicles, traffic related problems are likely to worsen. The gap between rich and poor is increasing, parts of the population can hardly afford to use the public transport system. Even though Mumbai is claimed to have the highest income per capita in India, 40 % of the inhabitants are still living below the poverty line. There are many aspects in society that could have a positive effect if a well working bicycle infrastructure were to be developed in Mumbai. Bicycling is not something new in India, bicycles have been used for a long time both for commuting and transporting goods. India is the second largest producer of bicycles in the world. 3% - 7% of all trips are done by bicycles in Mumbai today but studies shows a sharp decline in bicycle journeys over the past two decades. It is likely that bicycles will disappear from the streets in less than a decade if no actions are taken from the government. Six goals have been chosen to look at in this thesis, they are; Equality, Safety, Mobility, Urban life, Environment and Health. Some facts under each goals are presented and it is explained how a well working bicycle network could improve some aspects under each goal. Design standards of how bicycle facilities should be constructed and an illustration of a bicycle masterplan is proposed based on interviews with the public, literature studies and analyzing of the existing roads. Recommendations on how to work with changing prejudices against bicycling and how the planning of a bicycle network could be implemented are given

Mumbai : den cykelvänliga staden

Mumbai – the city of contrasts, is home for more than 20 million people. It is the financial centre and the most modern city in India. As most cities within developing countries Mumbai is striving to imitate the western model of growth and lifestyle to achieve a “developed” status. Motorization, especially private motorized modes, has become prioritized because they are seen as a big part of this development. This neglecting has also led to a significant prejudice against bicycle riding as a transport mode. Over 300 new cars are registered ever day in the city. Not only is congestion a big problem but pollution from vehicles are posing serious threats to peoples health and to the environment. 88% of the population is using public transport today but with a larger growing middle class, ready to buy private vehicles, traffic related problems are likely to worsen. The gap between rich and poor is increasing, parts of the population can hardly afford to use the public transport system. Even though Mumbai is claimed to have the highest income per capita in India, 40 % of the inhabitants are still living below the poverty line. There are many aspects in society that could have a positive effect if a well working bicycle infrastructure were to be developed in Mumbai. Bicycling is not something new in India, bicycles have been used for a long time both for commuting and transporting goods. India is the second largest producer of bicycles in the world. 3% - 7% of all trips are done by bicycles in Mumbai today but studies shows a sharp decline in bicycle journeys over the past two decades. It is likely that bicycles will disappear from the streets in less than a decade if no actions are taken from the government. Six goals have been chosen to look at in this thesis, they are; Equality, Safety, Mobility, Urban life, Environment and Health. Some facts under each goals are presented and it is explained how a well working bicycle network could improve some aspects under each goal. Design standards of how bicycle facilities should be constructed and an illustration of a bicycle masterplan is proposed based on interviews with the public, literature studies and analyzing of the existing roads. Recommendations on how to work with changing prejudices against bicycling and how the planning of a bicycle network could be implemented are given

Clinical pharmacy services within a multiprofessional healthcare team

Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital. Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate. Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated. Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced.Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modelle

Från Colosseum till Allianz Arena : En explorativ studie om processen att förändra ett företags grafiska profil

The strategy when you change the visual part of the brand identity is often referred to as Corporate rebranding and is seen as a good way to show that a company has undergone a change. Despite high risks and high costs, this strategy has become more common and there are companies today who make the choice to change an already well-known graphic profile. This phenomenon is what underlies this essay’s problem statement: Why does a company with an already well-known graphic profile choose to change it and how does the process behind the change occur? In what way have the company’s customers recognized the change and how has the company’s image changed in this context? The purpose of this essay is therefore to explore the process that occurs when a company in the sport and fashion industry changes its visual identity and to explore how the company’s customers have perceived the change. To fulfil the purpose of the essay a case study was carried out on a company’s Corporate rebranding process. The company that was chosen was the Swedish sports retail chain Stadium Sweden AB who decided to change its graphic profile even though their logo was one of the two most recognized in their field. With the help of existing theories on brands and Corporate rebranding two interviews and a survey was conducted for this study. After this case study we have come to the following conclusions; The reason for the brand change was primarily the need to modernize the graphic profile in context of a larger reorganization of the company. The process can be described in four main phases: Initiation phase, Planning phase, Development phase and Launch and implementation phase. The study also showed that most of the customers had noticed the change and that the company’s image had changed for the better as they managed to maintain the core values of the brand while making it more contemporary and unique. We have also come up with three propositions that can be used in future research on this subject: 1. A reason for a brand change might be that the old graphic profile needs to be modernized to practically suit new media, 2. The choice of the Phase in/Phase out strategy is controlled by the availability of various resources and 3. To distance the brand from its heritage doesn’t need to be a pitfall for a brand change

Lighting design in a complex industrial environment

I Sverige arbetar i dagsläget ca 930 000 personer inom industrin. Inom industribranschen är det ofta fokus på direkta energiekonomiska vinster och inte på de vinster som görs indirekt. Detta gör att komfortaspekter som bra ventilation, ergonomiskt ljus och estetiskt tilltalande miljöutformningar inte prioriteras. Dagens industrier har ofta varierande flexibla layouter för att optimera sina processer. Det vill säga att arbetsstationer, maskiner och lagerhyllor flyttas för att gynna flödet för specifika produkter. Vid variation i layouten kan belysningen påverkas negativt om den om fast monterad. Genom en benchmarkingstudie samt ljusberäkningar undersöktes det i vilken utsträckning en fast belysningsinstallation kan vara lämplig för en industriverksamhet med varierande flöde. Resultatet av en del i studien visar att en fast belysningsinstallation, där armaturerna har bred spridningsvinkel, fungerar bra i industriverksamheter med varierande flöde. En experimentell studie med 17 deltagare genomfördes i en industrilokal för att undersöka i vilken utsträckning trivsel påverkas i en industri med god ljuskvalité, jämfört med en anläggning med sämre ljuskvalité. Undersökningen pågick under fyra veckor genom att två belysningsinstallationer utvärderades med hjälp av en enkät. Anläggningens befintliga belysningsinstallation jämfördes med en belysningsinstallation av bättre teknik och ljuskvalité. I den här delen av undersökningen framkom det att i ljuset med högre kvalité upplevdes naturligare, mer fokuserat, varmare och behagligare än i ljuset med lägre kvalité. Andra aspekter, såsom skuggbildning och reflektion, upplevdes relativt lika under alla undersökningsveckorna. Genom att upprätta LCC-kalkyler samt beräkna LENI-tal kunde det fastslås hur anläggningens energikostnad påverkas med en ny belysningsanläggning bestyckad med LED. En ljusanläggning med den nya tekniken har en lägre energianvändning än den äldre installationen. Detta bidrar till en mer ekonomisk och miljömässig hållbarhet.Today, Sweden employs about 930,000 people in industry. In the industrial sector, there is often a focus on direct energy-economic gains and not on the indirect gains. This means that comfort aspects such as good ventilation, ergonomic light and aesthetically pleasing environmental design are not prioritized. Today's industries often have varied flexible layouts to optimize their processes. That is, workstations, machines and storage shelves are moved to favor the flow of specific products. If the layout is varied, the lighting can be adversely affected if it is permanently mounted. Through a benchmarking study and light calculations, it was investigated to what extent a fixed lighting installation might be suitable for an industry with varying flow. The result of a part of the study shows that a fixed lighting installation, where the luminaires have wide diffusion angle, work well in industrial operations with varying flow rates. A quantitative study of 17 participants was conducted in an industrial room to investigate the extent to which well-being is affected in an industry of good light quality, compared with a poorer light quality facility. The study was conducted for four weeks by evaluating two lighting installations. The system's existing lighting installation was compared with a lighting installation of better technology and light quality. In this part of the survey it was found that the light of the higher light quality perceived more natural, more focused, warmer and more comfortable than in the light with lower light quality. Other aspects, such as shadowing and reflection, were experienced relatively similar throughout the extent of the research. By establishing LCC calculations and calculating LENI numbers, it could be determined how the energy cost of the plant is affected by a new lighting system with LED. A light facility with the new technology has a lower energy consumption than the older installation. This contributes to a more economic and environmental sustainability