Self-assessed visual function in cataract surgery using Catquest-9SF

The cataract disease is the leading cause of preventable blindness in high-income countries alone as well as globally despite the groundbreaking technological advancements in recent years and steadily increasing number of cataract operations. Even when the clouded lens of the eye has been successfully removed during cataract surgery and been replaced by a plastic intra-ocular lens (IOL) a significant number of patients experience no benefit from cataract surgery. There is an ongoing quest to find factors that affect the result and to monitor and ensure high-quality cataract surgery. The Swedish National Cataract Register (NCR) collection of data on more than 2 million cataract surgeries is a great aid in this challenge. In 2009 the NCR introduced Catquest- 9SF, recently proven to be a state-of-the-art questionnaire. We used Catquest-9SF to investigate factors that might affect the outcome of cataract surgery using the patient self-assessed visual function perspective. We also studied the reliability of Catquest- 9SF and the minimum important difference (MID) of the results. In Paper I we investigated how other simultaneous diseases of the eye in addition to cataract affect the patient self-assessed outcome of cataract surgery using the Catquest-9SF in a prospective nationwide, multicenter study including more than 10,000 patients. This comorbidity study showed that several other ocular diseases at the time of cataract surgery affect the patient´s self-assessed visual function after cataract surgery despite inclusion of the preoperative corrected distance visual acuity (CDVA) and postoperative CDVA in the analyses. Paper II assessed how challenging characteristics of the eye and difficulties during surgery as well as the feared complication of posterior capsular tear affect the outcome of cataract surgery in a prospective study including almost 11,000 patients from 42 Swedish surgical ophthalmology units. Several of the studied intraoperative difficulties and complications were significantly associated to the patient-reported outcome in cataract surgery. Including the preoperative CDVA and postoperative CDVA in the analyses reduced the impact of the intraoperative difficulties. In Paper III our aim was to estimate the reliability of the Catquest-9SF questionnaire. In patient reported outcome measurement (PROM) it is fundamental that the patients’ answers are repeatable, that they do not depend on chance, that the reliability is high. This test-retest study of the reliability of the Catquest-9SF, including 144 patients, showed an intraclass correlation of 0.93, thus we can conclude that the reliability of the Swedish Catquest-9SF is very high. Together with previous knowledge, our findings support continued use of the Catquest-9SF in assessing the quality and outcome in cataract surgery. Our most recent study was reported in Paper IV in which we assessed the minimum important difference (MID) of Catquest-9SF. The large set of data in the NCR has a statistical power large enough to find even rather small significant associations. Our purpose was to assess how large the change measured in logit has to be to be significant to the patient, that is the MID. The assessment of MID of Catquest-9SF in this study adds detailed knowledge of MID and shows that MID differs depending on the baseline visual function. The findings enable even more precise high-quality evaluation of the outcome and benefit of cataract surgery

"Make it or break it" : En kvalitativ studie med entreprenörer och anställda; Det sociala kapitalet och tillit inom sociala relationer

The aim of this essay is to study social capital among entrepreneurs and employees and see how trust in social relations manifests itself in each working group. This is based on two theoretical concepts: social capital and trust. The essay focuses primarily on the social capital but will also affect trust in social relations. In the essay analysis questions is answered about how entrepreneurs and employees' social capital manifests itself and how trust in social relations is expressed in each working group. The general results of the essay are the following: Social capital for employees and contractors manifests itself in different ways, even if they have not proven to be any different in how much support they have from colleagues or other related parties. It has also been shown that contractors and employees utilize their social capital in various ways. Those surveyed employees and entrepreneurs trust towards social relations have also shown differ. This has been reflected in how they perceive hierarchical systems in the workplace, in the great extent they can be themselves and trust their colleagues. This is basely proved in that they possess different forms of employment, and thus has a different chance to influence who they work with

"We have each other" : - A qualitative interview study on social workers' professional resilience in the form of recuperation and resistance

The aim of this study was to examine professional resilience among social workers. Professional resilience in this study included three dimensions; organizational, relational and emotional resilience. Resilience was described in this study as recuperation and resistance. The aim was to see which resilience factors contribute to social workers staying at their workplaces for more than two years. The study was based on six interviews with social workers at the social services in social child care in Sweden. The theory of emotional wage labor and the concept of SOC, Sense of Coherence, were used as theoretical frameworks. The study concluded that social workers stay longer than two years in their workplaces in social child care, primarily thanks to their colleagues. Other important factors for social workers to thrive were leadership and personal qualities, such as the emotional ability to leave the job at work and not engage too much emotionally

"Make it or break it" : En kvalitativ studie med entreprenörer och anställda; Det sociala kapitalet och tillit inom sociala relationer

The aim of this essay is to study social capital among entrepreneurs and employees and see how trust in social relations manifests itself in each working group. This is based on two theoretical concepts: social capital and trust. The essay focuses primarily on the social capital but will also affect trust in social relations. In the essay analysis questions is answered about how entrepreneurs and employees' social capital manifests itself and how trust in social relations is expressed in each working group. The general results of the essay are the following: Social capital for employees and contractors manifests itself in different ways, even if they have not proven to be any different in how much support they have from colleagues or other related parties. It has also been shown that contractors and employees utilize their social capital in various ways. Those surveyed employees and entrepreneurs trust towards social relations have also shown differ. This has been reflected in how they perceive hierarchical systems in the workplace, in the great extent they can be themselves and trust their colleagues. This is basely proved in that they possess different forms of employment, and thus has a different chance to influence who they work with

"Analys av Lunds kommuns strategi för äldreomsorgen"

Uppsatsens syfte är att analysera om Lunds kommun har en strategi för omsorgen av de äldre och i sådana fall ge den karaktäristik och jämföra den med andra kommuner. För att kunna karaktärisera strategin ska även en modell utvecklas.Arbetet bygger på en kvalitativ fallstudie som varit av semistrukturerad natur. En kvalitativ metod användes för att strategier i offentliga verksamheter ännu är ett relativt outforskat område och för att en kvalitativ metod ansågs kunna ge mer djup åt studien. Även mycket sekundär data har använts. De teorier, som ligger till grund för studien, har använts för att analysera strategin. Dessutom har en modell utvecklats som visar hur strategin kan analyseras på ett enklare sätt. Empirin har hämtats från intervjuer med politiker och anställda inom Lunds kommun samt från dokumentstudier och WebOr (ett elektroniskt, statistiskt jämförelseverktyg för kommuner). Lunds kommun har enligt denna studies resultat en delvis medveten strategi. Enligt denna studies resultat har Lunds Kommun som strategi, för äldreomsorgen, att satsa mycket resurser på en låg andel äldre i relation till jämförbara kommuner. Enligt matrismodellen ligger LK i det spetsiga segmentet. Matrismodellen kan även användas för jämförelser av kommuners effektivitet

Self-assessed visual function outcome in cataract surgery : minimum important difference of the Catquest-9SF questionnaire

Background: The purpose of this study was to study the minimum important difference (MID) of the Catquest-9SF questionnaire in cataract surgery. Methods: A nationwide multi-center prospective randomized study was conducted using the Swedish National Cataract Register and the Catquest-9SF questionnaire. Randomized patients (n = 400) who had completed the Catquest-9SF before surgery and three months after surgery were sent an anchor question on self-assessed change in visual function after cataract surgery 14 days after the postoperative Catquest-9SF. Rasch analysis was performed on the preoperative and postoperative Catquest-9SF questionnaires, and the patients were dichotomized with regard to their preoperative Rasch score. The MID range of the two groups was calculated based on the anchor question, and the anchor question based MID was then estimated in a scatter plot. The MID was also estimated based on distribution by calculating Cohen’s effect size. Results: The analyses included 231 patients who had completed the Catquest-9SF on both occasions as well as the questionnaire with the anchor question. The group with better preoperative visual function had an anchor question based MID of − 0.5 and a Cohen’s effect size based MID of − 1.07. The group with worse preoperative visual function had an anchor question based MID of − 1.80 and a Cohen’s effect size based MID of − 1.46. Conclusion: This article contributes detailed knowledge of the MID of Catquest-9SF, enabling even more accurate high-quality evaluation of the outcome and benefit of cataract surgery worldwide

Turistföretags marknadsföring online : Har sociala nätverk förvandlats till kundsegment?

Uppsatsens syfte är att kartlägga hur nio svenska turistföretag ser på sociala mediers och konsumentens roll inom marknadsföring online. Vidare vill uppsatsförfattarna analysera potentiella effekter av virala marknadsföringskampanjer. Detta utifrån fyra teoretiska ramverk: webb 2.0, word-of-mouth, viral marknadsföring samt social valuta. I uppsatsens analys besvaras tre frågeställningar: hur ser turistföretagen på marknadsföring genom sociala medier, vad har konsumenternas sociala nätverk för betydelse i turistföretagens virala marknadsföring, samt vilka är de upplevda effekterna av virala marknadsföringskampanjer? Uppsatsens empiri baseras på data insamlad via nio semistrukturerade intervjuer. De generella resultaten visar på att konsumentens sociala nätverk online har en stor betydelse för företagens marknadsföring online, konsumenterna äger varumärket genom att de i sina sociala kanaler kan sprida både positiv och negativ word-of-mouth till det sociala nätverket. Sociala medier är en viktig faktor i turistföretagens marknadsföring och företagen måste idag vara närvarande på sociala medier då allt fler konsumenter befinner sig online. Studien har även visat att företagen endast upplever positiva effekter av företagens virala marknadsföringskampanjer. Kampanjerna leder till att konsumenterna integreras i marknadsföringen och sprider företagets varumärke till dess sociala nätverk. I och med detta bildas en positiv relation mellan företag och konsument.The aim of this essay is to identify how nine Swedish tourism companies view the role of social media and the consumer in online marketing. Furthermore, the authors will analyze the potential effects of viral marketing campaigns. This is based on four theoretical frameworks: web 2.0, word-of-mouth, viral marketing and social currency. The analysis answer three questions: how tourism companies looks on marketing through social media, what consumer social networks importance of tourism businesses viral marketing, and what are the perceived effects of viral marketing campaigns? The essays empirics are based on data collected through nine semi-structured interviews. The overall results show that the social networks of consumers have a great significance for the companies’ online marketing. Through their social media channels, consumers can spread both positive and negative word-of-mouth to their social networks, this has the effect that consumers now can be said to own the companies’ brands. Social media is an important element of the tourism companies’ marketing strategies. Consumers increasing usage of social media means that companies today must be present online. Furthermore, the study has shown that tourism companies have only seen positive effects of their viral marketing campaigns. The campaigns have the effect of consumers integrating with the companies’ marketing and spreading the companies’ brands within their social networks. This creates a positive relation between company and consumer

Patient-reported visual function outcome in cataract surgery : test–retest reliability of the Catquest-9SF questionnaire

Purpose: To study the test–retest reliability of the Catquest-9SF questionnaire in cataract surgery. Methods: A single-centre prospective non-randomized test–retest study was conducted using the Swedish National Cataract Register and the Catquest-9SF questionnaire, which is a valid patient-reported outcome measurement tool developed and used for evaluating quality and visual disability outcome in cataract surgery. Consecutive patients (n = 144) scheduled for cataract surgery completed the Catquest-9SF twice before surgery, with a minimum of 7 days and a maximum of 14 days between the two questionnaires. A rating scale model was constructed on the basis of the questionnaires from the first measurement and used to generate scores for both the first and second measurements. The consistency was investigated by calculating intraclass correlation, Pearson correlation and a Bland–Altman plot. Internal consistency was measured using Cronbach’s alpha. Results: Analyses showed an intraclass correlation of 0.93 (95% confidence interval: 0.90–0.95), a Pearson correlation of 0.93 and Cronbach’s alpha of 0.94. The results fit well in a Bland–Altman plot. Conclusion: The test–retest reliability of the Swedish Catquest-9SF is excellent. Along with previous knowledge, this supports continued use of the Catquest-9SF in evaluating quality and outcome in cataract surgery

Ocular comorbidity and self-assessed visual function after cataract surgery.

To study the association between ocular comorbidities and the change in patient-perceived visual function, postoperative patient-perceived visual function, and visual satisfaction after cataract surgery