Negative experiences of encounters in healthcare

A positive encounter is essential to the provision of qualitative healthcare. Experiences of negative encounters in healthcare may affect the patient’s wellbeing and health, and have a negative effect on the patient’s trust in the healthcare system. The overall aim of this thesis was to gain new knowledge about negative experiences of encounters in Swedish healthcare and, based on this knowledge, suggest potential measures to reduce or prevent such experiences. The thesis consists of four different studies: STUDY 1 Aim: To investigate patients’ experiences of not being treated well in medical healthcare in Stockholm County, Sweden. Methods: Systematic review of complaints of negative encounters to Patientnämnden in Stockholm registered in 2006 and 2007. The complaints were subjected to qualitative content analysis by categorization, and a complementary snapshot review of complaints on medical treatment was conducted. Results: The most common types of complaints were “rude, aggressive or arrogant behaviour”, followed by “being ignored, not listened to, or being taken seriously”. One third of the complaints about “medical treatment” also contained complaints about negative encounters. Women were found to complain on negative encounters more frequently than men. STUDY II Aim: To examine how long-term sick-listed persons perceive healthcare encounters, with special emphasis on negative encounters and feeling wronged. Methods: Postal questionnaire to 10 042 long-term sick-listed persons. Statistical analysis of Attributable Risk (AR) with 95% CI. Results: Response rate 58%. 1 628 of the respondents had experiences of negative encounters in healthcare, and of these 1 036 reported also having felt wronged. Types of negative encounters with highest AR for feeling wronged were “nonchalant behaviour” and “treated me with disrespect”. Men reported higher AR for feeling wronged than women, as did respondents with psychiatric diagnoses compared to other patients. Feeling wronged seems to be an outcome based on accumulated experiences of negative encounters. STUDY III Aim: To gain an improved understanding of experiences of negative healthcare encounters in the general population. Methods: Postal questionnaire to a sample of 1 484 inhabitants of Stockholm County. Conventional content analysis of data from open-ended questions. Results: Response rate 62.1%. 17 different types of complaints about negative encounters were identified and two comprehensive explanatory factors were established: “structure and allocation of healthcare” and “the staff’s attitudes and professional practice”. STUDY IV Aim: To investigate the hypothesis that complaints of adverse events related to encounters with healthcare personnel are underreported, and to identify barriers to filing such complaints. Methods: Postal questionnaire to a sample of 1 484 inhabitants of Stockholm County. Statistical analysis of proportions and OR with CI: 95%, and minor qualitative content analysis by categorization. Results: Response rate 62.1%. Patient complaints about negative encounters were found to be under-reported. The main barriers for filing complaints were “did not have the strength” or “did not know where to turn”, or that “it makes no difference anyway”. Experiences of negative encounters were also found to have a negative impact on people’s trust in healthcare

Variable demand as a means to more sustainable biofuels and biobased materials

Abstract: Expanding the use of biofuels is controversial because of concerns about competition with food. Here we describe how varying the biofuel demand could help address these concerns. Variable biofuel demand can be implemented through market or policy mechanisms that adjust biofuel production according to feedstock availability, expanding or contracting in response to supply surplus or limitations. Based on a survey, an expert workshop, and relevant literature, the effects of a variable biofuel demand approach are evaluated with respect to food security, agricultural productivity, detrimental land-use change, and feedstock competition with biobased chemicals and materials. Here we provide evidence that variable biofuel demand can enhance the synergistic development of agriculture, renewable biomass feedstocks and biofuels, but implementation faces several challenges. Recommendations are provided for governance options to tackle these challenges.</p

European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project : Results from the treatment of mucosal cancers

AIM: Electrochemotherapy is an effective local treatment for cutaneous tumours and metastases. In this prospective trial, six European institutions investigated electrochemotherapy in recurrent, mucosal head and neck tumours. PATIENT AND METHODS: Forty-three patients with recurrent mucosal head and neck tumours and no further curative or reasonably effective palliative treatment options were enrolled and treated with electrochemotherapy. Patients were treated in general anaesthesia using intravenous or local injection of bleomycin followed by delivery of electric pulses to the tumour area. Primary end-point was local tumour response. Secondary end-points were safety and toxicity, overall and progression free survival, and quality-of-life. RESULTS: Thirty-seven patients were evaluable for tumour response, pain score, side-effects and quality of life questionnaires. Six patients were not evaluable due to lost follow-up, disease progression or death before evaluation. Intention to treat analysis revealed an objective response of 56% (complete response 8 (19%), partial response 16 (37%), stable disease 10 (23%), progressive disease 3 (7%), and not evaluable 6 (14%)). Three patients (7%) remained in complete response at 30, 34, and 84 months post-treatment. The treatment procedure was generally well tolerated. Swelling of the mucosa was observed in the first days after treatment. Pain and use of pain medication rose temporarily; fatigue and dysphagia were also noted in the quality of life assessment. CONCLUSION: Electrochemotherapy can be applied to mucosal head and neck recurrent tumours accessible to the procedure with promising objective response, survival and toxicity profile. Attention should be paid to post-treatment swelling and planning of pain medication. These favourable results indicate that electrochemotherapy could play a role in patients with recurrent head and neck cancer

European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project: Results from the treatment of mucosal cancers

Aim Electrochemotherapy is an effective local treatment for cutaneous tumours and metastases. In this prospective trial, six European institutions investigated electrochemotherapy in recurrent, mucosal head and neck tumours. Patient and methods Forty-three patients with recurrent mucosal head and neck tumours and no further curative or reasonably effective palliative treatment options were enrolled and treated with electrochemotherapy. Patients were treated in general anaesthesia using intravenous or local injection of bleomycin followed by delivery of electric pulses to the tumour area. Primary end-point was local tumour response. Secondary end-points were safety and toxicity, overall and progression free survival, and quality-of-life. Results Thirty-seven patients were evaluable for tumour response, pain score, side-effects and quality of life questionnaires. Six patients were not evaluable due to lost follow-up, disease progression or death before evaluation. Intention to treat analysis revealed an objective response of 56% (complete response 8 (19%), partial response 16 (37%), stable disease 10 (23%), progressive disease 3 (7%), and not evaluable 6 (14%)). Three patients (7%) remained in complete response at 30, 34, and 84 months post-treatment. The treatment procedure was generally well tolerated. Swelling of the mucosa was observed in the first days after treatment. Pain and use of pain medication rose temporarily; fatigue and dysphagia were also noted in the quality of life assessment. Conclusion Electrochemotherapy can be applied to mucosal head and neck recurrent tumours accessible to the procedure with promising objective response, survival and toxicity profile. Attention should be paid to post-treatment swelling and planning of pain medication. These favourable results indicate that electrochemotherapy could play a role in patients with recurrent head and neck cancer

European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project: Results of the treatment of skin cancer

AbstractElectrochemotherapy is an effective and safe method for local treatment of cutaneous and subcutaneous tumours, where electric pulses cause increased permeability of cell membranes in the tumour mass, enabling dramatically enhanced effectiveness of bleomycin and other hydrophilic drugs. Here, we report results of a European multi-institutional prospective study of the effectiveness of electrochemotherapy in the treatment of skin cancer of the head and neck (HN) area, where standard treatments had either failed or were not deemed suitable or declined by the patient. A total of 105 patients affected by primary or recurrent skin cancer of the HN area were enrolled; of these, 99 were eligible for evaluation of tumour response. By far, the majority (82%) were treated only once, and 18% of patients had a second treatment. The objective response was highest for basal cell carcinoma (97%) and for other histologies was 74%. Small, primary, and treatment-naive carcinomas responded significantly better (p < 0.05), as investigated by univariate analysis. Electrochemotherapy was well tolerated and led to a significant improvement of quality of life, estimated by the European Organisation for Research and Treatment of Cancer quality of life questionnaires. At 1-year follow-up, the percentages of overall and disease-free survival were 76% and 89%, respectively. Electrochemotherapy is an effective option for skin cancers of the HN area and can be considered a feasible alternative to standard treatments when such an alternative is appropriate. The precise role for electrochemotherapy in the treatment algorithm for non-melanoma skin cancer of the HN region requires data from future randomised controlled studies.(ISRCTN registry N. 30427

FP6-7603 – TONES Thinking ONtologiES WP4

FP6-7603 – TONES Thinking ONtologiES WP4 This report summarizes the reasoning techniques and algorithms developed in the TONES project that realize the reasoning services identified as fundamental for ontology-based access, processing, and usage. In addition to a detailed presentation of the algorithms, we report on their computational properties and investigate solutions for the expressivity and data scalability problems. c○2007/TONES – July, 2007 2/143 TONES-D18 – v.1.