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High LDL cholesterol and statin use were independently associated with lower eight-year mortality in a cohort free from terminal illness, cardiovascular disease, and diabetes at baseline.

https://arctichealth.org/en/permalink/ahliterature258310
Source
Scand J Prim Health Care. 2014 Mar;32(1):1-2
Publication Type
Article
Date
Mar-2014
Author
Hans Thulesius
Author Affiliation
MD, GP, Associate Professor, Department of Clinical Sciences Malmö, Family Medicine Lund University, Kronoberg County Research Council Växjö, Sweden . E-mail: hansthulesius@gmail.com.
Source
Scand J Prim Health Care. 2014 Mar;32(1):1-2
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Aged
Cholesterol, LDL - blood
Denmark - epidemiology
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Mortality
Notes
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PubMed ID
24533848 View in PubMed
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Integrating care for neurodevelopmental disorders by unpacking control: A grounded theory study.

https://arctichealth.org/en/permalink/ahliterature282090
Source
Int J Qual Stud Health Well-being. 2016;11:31987
Publication Type
Article
Date
2016
Author
Gustaf Waxegård
Hans Thulesius
Source
Int J Qual Stud Health Well-being. 2016;11:31987
Date
2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Attention Deficit Disorder with Hyperactivity - therapy
Autism Spectrum Disorder - therapy
Child
Delivery of Health Care
Female
Grounded Theory
Health Personnel
Health services
Humans
Male
Middle Aged
Neurodevelopmental Disorders - therapy
Patient Care Planning
Patient care team
Power (Psychology)
Quality of Life
Sweden
Work
Workplace
Young Adult
Abstract
To establish integrated healthcare pathways for patients with neurodevelopmental disorders (ND) such as autism spectrum disorder and attention-deficit hyperactivity disorder is challenging. This study sets out to investigate the main concerns for healthcare professionals when integrating ND care pathways and how they resolve these concerns.
Using classic grounded theory (Glaser), we analysed efforts to improve and integrate an ND care pathway for children and youth in a Swedish region over a period of 6 years. Data from 42 individual interviews with a range of ND professionals, nine group interviews with healthcare teams, participant observation, a 2-day dialogue conference, focus group meetings, regional media coverage, and reports from other Swedish regional ND projects were analysed.
The main concern for participants was to deal with overwhelming ND complexity by unpacking control, which is control over strategies to define patients' status and needs. Unpacking control is key to the professionals' strivings to expand constructive life space for patients, to squeeze health care to reach available care goals, to promote professional ideologies, and to uphold workplace integrity. Control-seeking behaviour in relation to ND unpacking is ubiquitous and complicates integration of ND care pathways.
The Unpacking control theory expands central aspects of professions theory and may help to improve ND care development.
Notes
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PubMed ID
27609793 View in PubMed
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Balancing: a basic process in end-of-life cancer care.

https://arctichealth.org/en/permalink/ahliterature18052
Source
Qual Health Res. 2003 Dec;13(10):1353-77
Publication Type
Article
Date
Dec-2003
Author
Hans Thulesius
Anders Håkansson
Kerstin Petersson
Source
Qual Health Res. 2003 Dec;13(10):1353-77
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Caregivers - psychology
Female
Humans
Interviews
Male
Neoplasms - nursing
Palliative Care - psychology
Patient Care Planning
Problem Solving
Qualitative Research
Research Support, Non-U.S. Gov't
Sweden
Terminal Care - psychology
Terminally Ill - psychology
Abstract
In this grounded theory study, the authors interviewed caregivers and patients in end-of-life cancer care and found Balancing to be a fundamental process explaining the problem-solving strategies of most participants and offering a comprehensive perspective on both health care in general and end-of-life cancer care in particular. Balancing stages were Weighing--sensing needs and wishes signaled by patients, gauging them against caregiver resources in diagnosing and care planning; Shifting--breaking bad news, changing care places, and treatments; and Compensating--controlling symptoms, educating and team-working, prioritizing and "stretching" time, innovating care methods, improvising, and maintaining the homeostasis of hope. The Balancing outcome is characterized by Compromising, or "Walking a fine line," at best an optimized situation, at worst a deceit.
PubMed ID
14658351 View in PubMed
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Striving for emotional survival in palliative cancer nursing.

https://arctichealth.org/en/permalink/ahliterature16620
Source
Qual Health Res. 2006 Jan;16(1):79-96
Publication Type
Article
Date
Jan-2006
Author
Anna Sandgren
Hans Thulesius
Bengt Fridlund
Kerstin Petersson
Author Affiliation
Department of Primary Health Care, University of Gothenburg, Sweden.
Source
Qual Health Res. 2006 Jan;16(1):79-96
Date
Jan-2006
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Emotions
Humans
Neoplasms - nursing
Nursing Staff, Hospital - psychology
Palliative Care
Research Support, Non-U.S. Gov't
Sweden
Abstract
In this grounded theory study, the authors analyze interviews and participant observation data related to palliative cancer nursing in hospitals. Striving for Emotional Survival emerged as the pattern of behavior through which nurses deal with their main concern, the risk of being emotionally overloaded by their work. It involved three main strategies: Emotional Shielding through Professional Shielding or Cold Shielding; Emotional Processing through Chatting, Confirmation Seeking, Self-Reflecting, or Ruminating; and Emotional Postponing through Storing or Stashing. Emotional Competence is a property of Striving for Emotional Survival that explains more or less adequate ways of dealing with emotional overload. The theory Striving for Emotional Survival can be useful in the nurses' daily work and provides a comprehensive framework for understanding how nurses deal with emotional difficulties. The authors suggest that health care organizations encourage self-care, prioritize time to talk, and offer counseling to nursing staff with emotionally difficult working conditions.
PubMed ID
16317178 View in PubMed
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The 2015 National Cancer Program in Sweden: Introducing standardized care pathways in a decentralized system.

https://arctichealth.org/en/permalink/ahliterature284148
Source
Health Policy. 2016 Dec;120(12):1378-1382
Publication Type
Article
Date
Dec-2016
Author
Jens Wilkens
Hans Thulesius
Ingrid Schmidt
Christina Carlsson
Source
Health Policy. 2016 Dec;120(12):1378-1382
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Antineoplastic Protocols - standards
Continuity of Patient Care
Health Care Reform - methods
Health Policy
Humans
National Health Programs
Patient satisfaction
Politics
Sweden
Waiting Lists
Abstract
Starting in 2015, the Swedish government has initiated a national reform to standardize cancer patient pathways and thereby eventually speed up treatment of cancer. Cancer care in Sweden is characterized by high survival rates and a generally high quality albeit long waiting times. The objective with the new national program to standardize cancer care pathways is to reduce these waiting times, increase patient satisfaction with cancer care and reduce regional inequalities. A new time-point for measuring the start of a care process is introduced called well-founded suspicion, which is individually designed for each cancer diagnosis. While medical guidelines are well established earlier, the standardisation is achieved by defining time boundaries for each step in the process. The cancer reform program is a collaborative effort initiated and incentivized by the central government while multi-professional groups develop the time-bound standardized care pathways, which the regional authorities are responsible for implementing. The broad stakeholder engagement and time-bound guidelines are interesting approaches to study for other countries that need to streamline care processes.
PubMed ID
27823827 View in PubMed
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Exploring health navigating design: momentary contentment in a cancer context.

https://arctichealth.org/en/permalink/ahliterature285607
Source
Int J Qual Stud Health Well-being. 2017;12(sup2):1374809
Publication Type
Article
Date
2017
Author
Ulrika Sandén
Lars Harrysson
Hans Thulesius
Fredrik Nilsson
Source
Int J Qual Stud Health Well-being. 2017;12(sup2):1374809
Date
2017
Language
English
Publication Type
Article
Abstract
The technocratic and medicalized model of healthcare is rarely optimal for patients. By connecting two different studies we explore the possibilities of increasing quality of life in cancer care.
The first study captures survival strategies in a historically isolated Arctic village in Norway resulting in Momentary contentment theory, which emerged from analysing four years of participant observation and interview data. The second study conceptualizes everyday life of cancer patients based on in-depth interviews with 19 cancer patients; this was conceptualized as Navigating a new life situation. Both studies used classic grounded theory methodology. The connection between the studies is based on a health design approach.
We found a fit between cancer patients challenging life conditions and harsh everyday life in an Arctic village. Death, treatments and dependence have become natural parts of life where the importance of creating spaces-of-moments and a Sense of Safety is imminent to well-being. While the cancer patients are in a new life situation, the Arctic people show a natural ability to handle uncertainties.
By innovation theories connected to design thinking, Momentary contentment theory modified to fit cancer care would eventually be a way to improve cancer patients' quality of life.
PubMed ID
28911272 View in PubMed
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Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire-family version.

https://arctichealth.org/en/permalink/ahliterature280487
Source
Scand J Caring Sci. 2015 Dec;29(4):859-64
Publication Type
Article
Date
Dec-2015
Author
Jeanette Lindahl
Carina Elmqvist
Hans Thulesius
David Edvardsson
Source
Scand J Caring Sci. 2015 Dec;29(4):859-64
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Emergency Medical Services - organization & administration
Family - psychology
Female
Humans
Male
Middle Aged
Organizational Culture
Patient Safety - statistics & numerical data
Patient-Centered Care - organization & administration
Psychometrics
Quality of Health Care - statistics & numerical data
Reproducibility of Results
Surveys and Questionnaires
Sweden
Abstract
In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed.
Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden.
The Person-centred Climate Questionnaire-Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, everydayness and hospitality--three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P.
The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context.
The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbach's Alpha was >0.7 and item-total correlations were >0.3 and
PubMed ID
25648407 View in PubMed
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Learner-centred education in end-of-life care improved well being in home care staff: a prospective controlled study.

https://arctichealth.org/en/permalink/ahliterature45984
Source
Palliat Med. 2002 Jul;16(4):347-54
Publication Type
Article
Date
Jul-2002
Author
Hans Thulesius
Christer Petersson
Kerstin Petersson
Anders Håkansson
Author Affiliation
Kronoberg County Research Centre and Department of Community Medicine, Malmö, Sweden. hans.thulesius@ltkronoberg.se
Source
Palliat Med. 2002 Jul;16(4):347-54
Date
Jul-2002
Language
English
Publication Type
Article
Keywords
Adult
Anxiety - etiology
Attitude of Health Personnel
Depression - etiology
Education, Medical - methods
Group Processes
Health Personnel - education
Health status
Home Care Services
Humans
Mental health
Middle Aged
Problem-Based Learning
Prospective Studies
Questionnaires
Research Support, Non-U.S. Gov't
Rural Health
Staff Development
Sweden
Teaching - methods
Terminal Care - psychology
Abstract
The aim of this controlled study was to evaluate a 1-year learner-centred educational project in end-of-life care for home care staff in a rural district of Sweden. Another rural district in the same region served as a control area. A 20-item questionnaire measuring attitudes towards end-of-life care was designed, and the Hospital Anxiety and Depression (HAD) scale was used to measure mental well being. Increased agreement to 18 of 20 attitude statements was seen in the education group, while 2 of 20 items showed a decreased agreement in the control group. Test-retest reliability of the 20-item questionnaire was good (r=0.92). The total HAD score decreased from 8.3 pretest to 5.3 post-test in the education group (95% CI = 2.1 -3.7; P
PubMed ID
12132548 View in PubMed
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Encouraging primary care research: evaluation of a one-year, doctoral clinical epidemiology research course.

https://arctichealth.org/en/permalink/ahliterature278120
Source
Scand J Prim Health Care. 2016;34(1):89-96
Publication Type
Article
Date
2016
Author
Helena Liira
Tuomas Koskela
Hans Thulesius
Kaisu Pitkälä
Source
Scand J Prim Health Care. 2016;34(1):89-96
Date
2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Epidemiologic Studies
Female
Finland
Health Personnel
Humans
Male
Middle Aged
Primary Health Care
Research - education
Surveys and Questionnaires
Abstract
Research and PhDs are relatively rare in family medicine and primary care. To promote research, regular one-year research courses for primary care professionals with a focus on clinical epidemiology were started. This study explores the academic outcomes of the first four cohorts of research courses and surveys the participants' perspectives on the research course.
An electronic survey was sent to the research course participants. All peer-reviewed scientific papers published by these students were retrieved by literature searches in PubMed.
Primary care in Finland.
A total of 46 research course participants who had finished the research courses between 2007 and 2012.
Of the 46 participants 29 were physicians, eight nurses, three dentists, four physiotherapists, and two nutritionists. By the end of 2014, 28 of the 46 participants (61%) had published 79 papers indexed in PubMed and seven students (15%) had completed a PhD. The participants stated that the course taught them critical thinking, and provided basic research knowledge, inspiration, and fruitful networks for research.
A one-year, multi-professional, clinical epidemiology based research course appeared to be successful in encouraging primary care research as measured by research publications and networking. Activating teaching methods, encouraging focus on own research planning, and support from peers and tutors helped the participants to embark on research projects that resulted in PhDs for 15% of the participants.
Clinical research and PhDs are rare in primary care in Finland, which has consequences for the development of the discipline and for the availability of clinical lecturers at the universities. A clinical epidemiology oriented, one-year research course increased the activity in primary care research. Focus on own research planning and learning the challenges of research with peers appeared to enhance the success of a doctoral research course. A doctoral research course encouraged networking, and the course collaboration sometimes led to paper co-authoring. In the Nordic countries, the primary care health professionals are used to working in multi-professional teams. A multi-professional strategy also seems fruitful in doctoral research education.
PubMed ID
26854523 View in PubMed
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Waiting management at the emergency department - a grounded theory study.

https://arctichealth.org/en/permalink/ahliterature115550
Source
BMC Health Serv Res. 2013;13:95
Publication Type
Article
Date
2013
Author
Lena Burström
Bengt Starrin
Marie-Louise Engström
Hans Thulesius
Author Affiliation
Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden.
Source
BMC Health Serv Res. 2013;13:95
Date
2013
Language
English
Publication Type
Article
Keywords
Efficiency, Organizational
Emergency Service, Hospital - organization & administration
Female
Focus Groups
Humans
Male
Medical Staff, Hospital - psychology
Models, Theoretical
Patient satisfaction
Qualitative Research
Sweden
Time Factors
Abstract
An emergency department (ED) should offer timely care for acutely ill or injured persons that require the attention of specialized nurses and physicians. This study was aimed at exploring what is actually going on at an ED.
Qualitative data was collected 2009 to 2011 at one Swedish ED (ED1) with 53.000 yearly visits serving a population of 251.000. Constant comparative analysis according to classic grounded theory was applied to both focus group interviews with ED1 staff, participant observation data, and literature data. Quantitative data from ED1 and two other Swedish EDs were later analyzed and compared with the qualitative data.
The main driver of the ED staff in this study was to reduce non-acceptable waiting. Signs of non-acceptable waiting are physical densification, contact seeking, and the emergence of critical situations. The staff reacts with frustration, shame, and eventually resignation when they cannot reduce non-acceptable waiting. Waiting management resolves the problems and is done either by reducing actual waiting time by increasing throughput of patient flow through structure pushing and shuffling around patients, or by changing the experience of waiting by calming patients and feinting maneuvers to cover up.
To manage non-acceptable waiting is a driving force behind much of the staff behavior at an ED. Waiting management is done either by increasing throughput of patient flow or by changing the waiting experience.
Notes
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PubMed ID
23496853 View in PubMed
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14 records – page 1 of 2.