Ed, Bragging

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Lean, agile, and lean and agile hospital management : responses to introducing choice and competition in public health care

Introduction: The marketization of public health care, with its focus on choice and competition, challenges hospital managers to take a market-oriented perspective and position. A combination of lean and agile management strategies has been suggested as a way to achieve efficiency and control costs (lean) and to respond flexibly (agile). Aim: To increase our understanding of how hospital managers can combine lean and agile management strategies as they face the challenges of choice and competition in public health care. Method: The thesis consists of four studies: an integrative literature review and three case studies conducted at two Swedish hospitals. Study I reviews the empirical and theoretical literature on the use of agile strategies in relationship to lean strategies. The specific focus is how these strategies can be combined in hospital management. Study II is a case study of a hospital that followed “operational plans” as it tried to decrease patient waiting times. Study III is a case study of a hospital management team’s drivers and conceptualizations of lean and agile strategies related to expected outcomes. Study IV, which is a case study of the same hospital investigated in Study III, examines the mechanisms that enabled the hospital’s management team to use the lean and agile strategies in practice. Findings: Study I shows that agile was portrayed as a new paradigm following lean, as a development of lean, or as a strategy that can be used in combination with lean. Unlike lean strategies, agile strategies focus on the management of the external environment using proactive, reactive, or embracive coping strategies. The study also examines various organizational capabilities that hospitals require in order to make optimal use of agile strategies. Study II finds that “operational plans” at various organizational levels were needed in order to operationalize the goal of decreasing patient waiting times. The study also finds that an aligned internal strategy can improve processes that span organizational boundaries although with a narrow production focus. Study III finds that sudden and unexpected political public health care policies and market pressure motivated a hospital management, already lean in operations, to look for ways to increase their agility. Agility in the study is conceptualised as the long-term capability for adapting to the environment and for managing budget reductions. Lean was understood as the ability of the hospital to perform its functions efficiently. Enablers were defined as the management’s ability to continuously react to changes, to alter work assignments to accommodate changes in the influx of patients, and to recruit employees with flexible work skills. Study IV finds that the mechanisms that help a hospital to become lean and agile in practice are management’s market-orientation, the use of established production processes, an organization-wide readiness for change, a rapid transition capability, and the flexible use of physical and human resources. Discussion: Hospitals in uncertain and dynamic environments (as is typically the case for hospitals) needs to be both lean and agile. In combination, these two strategies help hospital management to use existing resources efficiently and effectively while at the same time it allows discovery of other assets. Conclusion: Lean management may be viewed as a precondition for agile management. This means that the use of efficient and structured (lean) resources can improve market orientation and positioning (agile). To successfully combine lean and agile activities, hospital managers need to exhibit certain ambidextrous and dynamic effective management capabilitie

Pitch perception and production in children diagnosed with childhood apraxia of speech and typically developing controls

Childhood Apraxia of Speech (CAS) is a pediatric neurodevelopmental speech sound disorder that presents with deficits in articulation and prosody. There have been multiple studies that have investigated aspects of prosody in children with CAS and have found that this population presents with a deficit in production. A major drawback of these studies is they have not considered investigating the mechanisms of perception of prosody in this population. If children with CAS present with perceptual deficits with regard to prosody, it is likely that they will have problems associated with production too. It is imperative to systematically investigate the perceptual deficit of prosody in this population. Considering this limitation, the current study aimed to investigate the perception of prosody in CAS. Participants in this group included 20 children (10 with CAS and 10 typically developing) ages 5-12. This study had two parts: perception and production. In the perception experiment, participants were asked to listen to CVC words and choose the emphatically stressed one. In the production experiment, participants were asked to listen to and produce emphatically stressed CVC words. Outcome measures included percent accuracy for the perception portion and vowel length for the production portion. We found that production as well as perception of prosody was impaired in children with CAS in comparison to their typically developing peers

Oberoende äldres upplevelser av subjektiv hälsa

De äldre äldre, dvs. personer över åttio år, blir allt fler i vårt samhälle. Studier har visat att insatser för att nå en god hälsa har som störst betydelse om de sätts in i förebyggande syfte. För att få reda på vilka faktorer de hälsofrämjande och förebyggande arbetet ska fokusera på behövs kunskap om hur de äldre äldre definierar god hälsa. Syftet med studien var därför att undersöka oberoende äldres (80+) upplevelser av subjektiv hälsa. Metoden som användes var en semistrukturerad intervjustudie där femton personer över åttio år, boendes i en mellanstor kommun (15 000 invånare), intervjuades. Materialet analyserades med innehållsanalys. Resultatet visade att hälsa uppfattades att som äldre få vara en del av samhället och känna sig behövd och medräknad

Humor - ett sätt att kommunicera inom vården

Oavsett var i vårdkedjan man befinner sig är god kommunikation en viktig utgångspunkt för goda möten. Rätt använd humor i dessa möten kan främja den fortsatta kommunikationen och skapa en god grund för ömsesidig respekt och förståelse. Metoden som användes var en litteraturstudie där 11 vetenskapliga artiklar har granskats och analyserats. Syftet var att undersöka på vilket sätt humor som kommunikation förekommer i vården. Resultatet visade att humor spelar stor roll både i kommunikationen mellan vårdpersonal och patient samt personal emellan. Ibland kan det vara svårt att förstå den egentliga innebörden av det som sägs. Det som låter som ett ytligt eller överlägset skämt kan dölja helt andra känslor som oro eller ilska. Vad som upplevs som underhållande och skämtsamt i ett sammanhang kan vara stötande i ett annat. Slutsatsen är att humor är ett viktigt och tacksamt verktyg som måste anpassas efter den aktuella situationen. Vårdpersonal bör vara lyhörd för även de outtalade orden och vara uppmärksam på sitt eget sätt att uttrycka sig

Detection of Intraepithelial and Stromal Langerin and CCR5 Positive Cells in the Human Endometrium: Potential Targets for HIV Infection

Both the upper (endocervix and uterus) and lower (ectocervix and vagina) female genital tract mucosa are considered to be target sites for sexual transmission of HIV. There are a few reports on the T cell and antigen-presenting cell distribution in human endometrial tissue however, there is little known about the expression of the HIV co-receptor CCR5 and HIV-binding C-type lectin receptors on endometrial cell subsets. We therefore assessed endometrial tissue sections from HIV seronegative women undergoing hysterectomy of a benign and non-inflammatory cause for phenotypic characterization of potential HIV target cells and receptors by immunohistochemistry. Langerin was expressed on intraepithelial CD1a+CD4+ and CD11c+CD4+ Langerhans cells. Furthermore, CCR5+CD4+CD3+ T cells, DC-SIGN+MR+CD11c+ myeloid dendritic cells and MR+CD68+ macrophages were found within or adjacent to the epithelium of the uterine lumen. In addition, occasional CD123+ BDCA-2+ plasmacytoid dendritic cells were detected deep in the endometrial stroma. Both T cells and several antigen-presenting cells were detected in lymphoid aggregate formations in close proximity to the epithelial lining. The finding of intraepithelial and stromal Langerin+ cells as well as CCR5+ CD4+ T cells is novel for human endometrium

Image-derived input functions from dynamic O-15-water PET scans using penalised reconstruction

BACKGROUND: Quantitative positron emission tomography (PET) scans of the brain typically require arterial blood sampling but this is complicated and logistically challenging. One solution to remove the need for arterial blood sampling is the use of image-derived input functions (IDIFs). Obtaining accurate IDIFs, however, has proved to be challenging, mainly due to the limited resolution of PET. Here, we employ penalised reconstruction alongside iterative thresholding methods and simple partial volume correction methods to produce IDIFs from a single PET scan, and subsequently, compare these to blood-sampled input curves (BSIFs) as ground truth. Retrospectively we used data from sixteen subjects with two dynamic 15O-labelled water PET scans and continuous arterial blood sampling: one baseline scan and another post-administration of acetazolamide. RESULTS: IDIFs and BSIFs agreed well in terms of the area under the curve of input curves when comparing peaks, tails and peak-to-tail ratios with R2 values of 0.95, 0.70 and 0.76, respectively. Grey matter cerebral blood flow (CBF) values showed good agreement with an average difference between the BSIF and IDIF CBF values of 2% ± and a coefficient of variation (CoV) of 7.3%. CONCLUSION: Our results show promising results that a robust IDIF can be produced for dynamic 15O–water PET scans using only the dynamic PET scan images with no need for a corresponding MRI or complex analytical techniques and thereby making routine clinical use of quantitative CBF measurements with 15O–water feasible

A Model System for In Vitro Studies of Bank Vole Borne Viruses

The bank vole (Myodes glareolus) is a common small mammal in Europe and a natural host for several important emerging zoonotic viruses, e.g. Puumala hantavirus (PUUV) that causes hemorrhagic fever with renal syndrome (HFRS). Hantaviruses are known to interfere with several signaling pathways in infected human cells, and HFRS is considered an immune-mediated disease. There is no in vitro-model available for infectious experiments in bank vole cells, nor tools for analyses of bank vole immune activation and responses. Consequently, it is not known if there are any differences in the regulation of virus induced responses in humans compared to natural hosts during infection. We here present an in vitro-model for studies of bank vole borne viruses and their interactions with natural host cell innate immune responses. Bank vole embryonic fibroblasts (VEFs) were isolated and shown to be susceptible for PUUV-infection, including a wild-type PUUV strain (only passaged in bank voles). The significance of VEFs as a model system for bank vole associated viruses was further established by infection studies showing that these cells are also susceptible to tick borne encephalitis, cowpox and Ljungan virus. The genes encoding bank vole IFN-β and Mx2 were partially sequenced and protocols for semi-quantitative RT-PCR were developed. Interestingly, PUUV did not induce an increased IFN-β or Mx2 mRNA expression. Corresponding infections with CPXV and LV induced IFN-β but not Mx2, while TBEV induced both IFN-β and Mx2

Impact of previous disease-modifying treatment on safety and efficacy in patients with MS treated with AHSCT

Background Autologous haematopoietic stem cell transplantation (AHSCT) is a highly effective treatment for multiple sclerosis (MS). The impact of previous long-lasting disease-modifying treatments (DMT) for safety and efficacy of AHSCT is unknown. Objective To explore whether previous DMTs with long-lasting effects on the immune system (anti-CD20 therapy, alemtuzumab and cladribine) affect treatment-related complications, long-term outcome and risk of new MS disease activity in patients treated with AHSCT. Methods Retrospective observational study of 104 relapsing remitting patients with MS treated by AHSCT in Sweden and Norway from 2011 to 2021, grouped according to the last DMT used ≤6 months prior to AHSCT. The primary outcomes were early AHSCT-related complications (mortality, neutropenic fever and hospitalisation length), long-term complications (secondary autoimmunity) and proportion of patients with No Evidence of Disease Activity (NEDA-3 status): no new relapses, no MRI activity and no disease progression during the follow-up. Results The mean follow-up time was 39.5 months (range 1–95). Neutropenic fever was a common AHSCT-related complication affecting 69 (66%) patients. There was no treatment-related mortality. During the follow-up period, 20 patients (19%) were diagnosed with autoimmunity. Occurrence of neutropenic fever, hospitalisation length or secondary autoimmunity did not vary dependent on the last DMT used prior to AHSCT. A total of 84 patients (81%) achieved NEDA-3 status, including all patients (100%) using rituximab, alemtuzumab or cladribine before AHSCT. Conclusion This study provides level 4 evidence that AHSCT in patients previously treated with alemtuzumab, cladribine or rituximab is safe and efficacious.publishedVersio