Högskolan i Skövde

INTRODUCTION: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28days after admission to hospital. Furthermore, the long-term outcome was assessed.

METHODS: This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records.

RESULTS: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code "fever, infection" more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p<0.0001).

CONCLUSION: This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.

BACKGROUND: This article reports on patient-reported sexual dysfunction and micturition symptoms following a randomized trial of laparoscopic and open surgery for rectal cancer.

METHODS: Patients in the COLOR II randomized trial, comparing laparoscopic and open surgery for rectal cancer, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 questionnaire before surgery, and after 4 weeks, 6, 12 and 24 months. Adjusted mean differences on a 100-point scale were calculated using changes from baseline value at the various time points in the domains of sexual functioning, sexual enjoyment, male and female sexual problems, and micturition symptoms.

RESULTS: Of 617 randomized patients, 385 completed this phase of the trial. Their mean age was 67·1 years. Surgery caused an anticipated reduction in genitourinary function after 4 weeks, with no significant differences between laparoscopic and open approaches. An improvement in sexual dysfunction was seen in the first year, but some male sexual problems persisted. Before operation 64·5 per cent of men in the laparoscopic group and 55·6 per cent in the open group reported some degree of erectile dysfunction. This increased to 81·1 and 80·5 per cent respectively 4 weeks after surgery, and 76·3 versus 75·5 per cent at 12 months, with no significant differences between groups. Micturition symptoms were less affected than sexual function and gradually improved to preoperative levels by 6 months. Adjusting for confounders, including radiotherapy, did not change these results.

CONCLUSION: Sexual dysfunction is common in patients with rectal cancer, and treatment (including surgery) increases the proportion of patients affected. A laparoscopic approach does not change this.

Background: Previous studies comparing laparoscopic and open surgical techniques have reported improved health-related quality of life (HRQL). This analysis compared HRQL 12 months after laparoscopic versus open surgery for rectal cancer in a subset of a randomized trial.

Methods: The setting was a multicentre randomized trial (COLOR II) comparing laparoscopic and open surgery for rectal cancer. Involvement in the HRQL study of COLOR II was optional. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38, and EuroQol – 5D (EQ-5D™) before surgery, and 4 weeks, 6, 12 and 24 months after operation. Analysis was done according to the manual for each instrument.

Results: Of 617 patients in hospitals participating in the HRQL study of COLOR II, 385 were included. The HRQL deteriorated to moderate/severe degrees after surgery, gradually returning to preoperative values over time. Changes in EORTC QLQ-C30 and QLQ-CR38, and EQ-5D™ were not significantly different between the groups regarding global health score or any of the dimensions or symptoms at 4 weeks, 6 or 12 months after surgery.

Conclusion: In contrast to previous studies in patients with colonic cancer, HRQL after rectal cancer surgery was not affected by surgical approach.

Purpose Rectal cancer and its treatment have a negative impact on health-related quality of life (HRQoL). If risk factors for sustained low HRQoL could be identified early, ideally before the start of treatment, individualised interventions could be identified and implemented to maintain or improve HRQoL. The study aimed to develop a multivariable prediction model for global HRQoL 12 months after rectal cancer treatment.

Methods Within COLOR II, a randomised, multicentre, international trial of laparoscopic and open surgery for rectal cancer, a sub-study on HRQoL included 385 patients in 12 hospitals and five countries. The HRQoL study was optional for hospitals in the COLOR II trial. EORTC QLQ-C30 and EORTC QLQ-CR38 were analysed preoperatively and at 1 and 12 months postoperatively. In exploratory analyses, correlations between age, sex, fatigue, pain, ASA classification, complications, and symptoms after surgery to HRQoL were studied. Bivariate initial analyses were followed by multivariate regression models.

Results Patient characteristics and clinical factors explained 4–10% of the variation in global HRQoL. The patient-reported outcomes from EORTC QLQ-C30 explained 55–65% of the variation in global HRQoL. The predominant predictors were fatigue and pain, which significantly impacted global HRQoL at all time points measured.

Conclusion We found that fatigue and pain were two significant factors associated with posttreatment global HRQoL in patients treated for rectal cancer T1-T3 Nx. Interventions to reduce fatigue and pain could enhance global HRQoL after rectal cancer treatment.

This article is a pilot study on the relationship between performance in online classes and behavior in online discussion forums. Measuring student activity on the discussion forum, the collected data is then analyzed and mapped to the performance of the students on the course. The student activity was dividedinto a number of parameters, and during the study these parameters were compared to the performance of the students.The significance of each parameter was also analyzed through a Kruskall-Wallis-test Overall there was a strong tendency thatstudents with more activity and engagement received higher grades. This is in the future useful for developing some kind of monitoring to identify and support students on the verge of failing the course.

This article uses binary logistic regression to create models for predicting course performance. The data used is the data-trail left by students activities on a discussion forum while attending an online course. The purpose of the study is to evalute how well models based on binary logistic regression can be used to predict course completion.Three sets of data was used for this. One set collected at the end of the course, one collected after 75% of the course and one set collected after half the course. The result of the study says that it's possible to design models with an accuracy of between 70% and 80% using these methods, regardless of what time is used.

BACKGROUND: Studies have reported that early physical rehabilitation after surgical procedures is associated with improved outcome measured as shorter hospital stay and enhanced recovery. The aim of this study was to explore the relationship between the preoperative physical activity level and subsequent postoperative complications, sick-leave and hospital stay after radical prostatectomy for prostate cancer in the setting of the LAPPRO trial (LAParoscopic Prostatectomy Robot Open). METHODS: LAPPRO is a prospective controlled trial, comparing robot-assisted laparoscopic and open surgery for localized prostate cancer between 2008 and 2011. 1569 patients aged 64 or less with an occupation were included in this sub-study. The Gleason score was <7 in 52 % of the patients. Demographics and the level of self-assessed preoperative physical activity, length of hospital stay, complications, quality of life, recovery and sick-leave were extracted from clinical record forms and questionnaires. Multivariable logistic regression, with log-link and logit-link functions, was used to adjust for potential confounding variables. RESULTS: The patients were divided into four groups based on their level of activity. As the group with lowest engagement of physical activity was found to be significantly different in base line characteristics from the other groups they were excluded from further analysis. Among patients that were physically active preoperativelly (n = 1467) there was no significant difference between the physical activity-groups regarding hospital stay, recovery or complications. However, in the group with the highest self-assessed level of physical activity, 5-7 times per week, 13 % required no sick leave, compared to 6.3 % in the group with a physical activity level of 1-2 times per week only (p < 0.0001). CONCLUSIONS: In our study of med operated with radical prostatectomy, a high level of physical activity preoperatively was associated with reduced need for sick leave after radical prostatectomy compared to men with lower physical activity. TRIAL REGISTRATION: The trial is registered at the ISCRTN register. ISRCTN06393679 .

Objective: To investigate the incidence and risk factors for small-bowel obstruction (SBO) after certain surgical procedures.

Design: A population-based retrospective register study.

Setting: Small-bowel obstruction causes considerable patient suffering. Risk factors for SBO have been identified, but the effect of surgical technique (open vs laparoscopic) on the incidence of SBO has not been fully elucidated.

Patients: The Inpatient Register held by the Swedish National Board of Health and Welfare was used. The hospital discharge diagnoses and registered performed surgical procedures identified data for cholecystectomy, hysterectomy, salpingo-oophorectomy, bowel resection, anterior resection, abdominoperineal resection, rectopexy, appendectomy, and bariatric surgery performed from January 1, 2002, through December 31, 2004. Data on demographic characteristics, comorbidity, previous abdominal surgery, and death were collected.

Main Outcome Measures: Episodes of hospital stay and surgery for SBO within 5 years after the index surgery.

Results: A total of 108 141 patients were included. The incidence of SBO ranged from 0.4% to 13.9%. Multivariate analysis revealed age, previous surgery, comorbidity, and surgical technique to be risk factors for SBO. Laparoscopy exceeded other risk factors in reduction of the risk of SBO for most of the surgical procedures.

Conclusions: Open surgery seems to increase the risk of SBO at least 4 times compared with laparoscopy for most of the abdominal surgical procedures studied. Other factors such as age, previous abdominal surgery, and comorbidity are also of importance

Purpose There is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter. Basic Procedures All patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey. Main Findings/Results In all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had "true pathogens" in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with "true pathogens" were one hour and 19 minutes versus three hours and 15 minutes (P =.009).

CONCLUSION: Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment. Axelsson C , Herlitz J , Karlsson A , Sjöberg H , Jiménez-Herrera M , Bång A , Jonsson A , Bremer A , Andersson H , Gellerstedt M , Ljungström L . The early chain of care in patients with bacteraemia with the emphasis on the prehospital setting. Prehosp Disaster Med. 2016;31(3):1-6.

The objective of this paper is to study the role of local e-government regarding citizens view of municipality service, information and accessibility to municipality service. The main hypothesis was that municipalities with high degree of pro-activity regarding e-government are municipalities with high degree of satisfied citizens. Satisfaction among citizens was studied by using a national survey which is performed twice ever year. The survey normally includes roughly 130 municipalities out of the 290 municipalities in Sweden. The number of randomly selected individuals per municipality is usually 600 in smaller municipalities and 1200 in larger municipalities. In this study we focus on the following dimensions: Overall satisfaction, Satisfaction with response and accessibility and Satisfaction with influence and confidence.The results implies that e-government and satisfied citizens are correlated. The correlations between the e-variables: e-proactivity, e-strategy, e-information/transparency, e-interaction were all significantly correlated to the satisfaction indices. The correlations were generally of medium strength, i.e. around 0.2-0.4. There were no significant correlations between in real life interactions, strategy for democracy and the satisfaction indices.

Universities need to constantly accommodate new forms of collaboration with society. Interaction with and impacts on society and practice are of crucial importance. University West (UW) in Sweden has a profile area in work-integrated learning (WIL), which generally aims to address issues on integrating theory and practice in a coherent and sustainable way. In this paper we base our arguments on a research education (3rd cycle) in informatics with specialization in work-integrated learning. The aim with the paper is to evaluate UW’s research education and research environment from a WIL perspective. We will adopt an informing science model in order to conduct a current state analysis, in which we identify and visualize collaboration activities within and between the research education/environment and the UWs key stakeholders; society/practices, research community and PhD students. Concrete implications show how collaboration and informing flows are connected and how they can be improved. General reflections are given on the model as a useful means for quality development and assurance beyond learning outcomes, including aspects of collaboration and interaction that can be regarded as paths of societal and practical impacts.

Universities need to constantly accommodate new forms of collaboration with society. Interaction with and impacts on society and practice are of crucial importance. University West (UW) in Sweden has a profile area in work-integrated learning (WIL), which generally aims to address issues on integrating theory and practice in a coherent and sustainable way. In this paper we base our arguments on a research education (third-cycle) in informatics with specialization in work-integrated learning. The aim with the paper is to evaluate UW’s research education and research environment from a WIL perspective. We will adopt an informing science model in order to conduct a current state analysis, in which we identify and visualize collaboration activities within and between the research education/environment and the UWs key stakeholders; society/practices, research community and PhD students. Concrete implications show how collaboration and informing flows are connected and how they can be improved. General reflections are given on the model as a useful means for quality development and assurance beyond learning outcomes, including aspects of collaboration and interaction that can be regarded as paths of societal and practical impacts.

The aim was to investigate whether there is a relationship between degree of e-government in Swedish municipalities and perceived satisfaction among citizens generally. This is a large-scale quantitative study based on validand reliable Swedish national surveys. Based on these surveys, a new comprehensive index for measuring "degree of digitalization" was constructed. Citizen satisfaction was measured using established indices covering three dimensions:satisfaction with living in the municipality, satisfaction with performance of government activities (delivered services), and satisfaction with transparency and influence. The results show that there is a relationship between the degree of digitalization in a municipality and the perceived satisfaction among its citizens. The degree of digitalization is related to all three dimensions of citizen satisfaction. Additionally, this study indicates that the strength of this relationship is in parity with or even stronger than the relationship between citizen satisfaction and other crucial factors such as educational level and median income.

Higher education plays a new role in the society and the highly specialized labor market, and higher education institutes are expected to interact with and contribute to the surrounding society. University West in Sweden is since 2002 commissioned by the government to develop the pedagogical strategy called work-integrated learning (WIL) and WIL is the “trade mark” for the University. This means that pedagogical methods are based on WIL and that the faculty is working on further refinement and development in order to maximize the pedagogical gain offered by using the synergy between theory and practice.

Work-integrated-learning activities are often implemented in a course as methods aligned to the learning outcomes regarding knowledge in the specific subject. However, another perspective is that the capacity to reflect and understand the integration of theory and practice could actually be a learning outcome in itself. From this perspective, it is vital to theoretically frame and formulate stringent learnings outcomes. To have a clear framework for this is important for curriculum design, course delivery and assessment, as well.

In a self-evaluation conducted at the University, including focus groups with, both undergraduate and post graduate students, teachers, researchers and managers, a call for a framework has been expressed.

In this conceptual paper, we propose a framework to support, design, delivery and assessment of work-integrated-learning progression, i.e. understanding of the integration between theory and practice. This framework is inspired by theories regarding constructive alignment [3], the SOLO taxonomy, agentic learning, SAMR-model and the RAT-model. RAT means Replacement, Amplifying and Replacement [4] while SAMR is the acronym for Substitution, Augmentation, Modification and Redefinition [5]. Our WIL-4U has also been inspired by SOLO taxonomy [6]

In short, the framework for progression includes a progression from being descriptive regarding the observed practice, skills for comparing and evaluating practices, to be agentic in how theory and practice could be used in synergy for evolving, new theory and development of practice. Thereby, putting on eye on the “i” in WiL.

Ultimately such a framework could support the progression of “WiL-understanding” through an educational program, and that students after graduation have developed readiness for “life-long-learning” and could be agentic at workplaces in the sense that practice and theory are used in synergy.

The knowledge society of today is characterized by a continuously ongoing technological development and digitalization that steadily calls for new competencies and transforms existing professions. For being able to provide up-to-date competence in a fast-changing labor market there is, perhaps more than ever, a need for extensive cooperation between Universities and surrounding society. A number of different models supporting the civic university has been established, e.g. “entrepreneurial university”, the triple-helix model and the increasingly popular adoption of “work-integrated learning” (WIL). 

Work-integrated learning offer students authentic learning experiences and create synergy between theory and practice, e.g. by cooperative educational programs, internship, sandwich programs and case based teaching. Beyond the pedagogical benefits with experiential learning, WIL also supports the transfer between higher education and work, i.e. increases readiness, employability and also encourage a more agentic engagement. Furthermore, research results show that WIL-students have career benefits regarding salary in early career and job advancement. Even though, WIL and similar strategies for combining theory and practice seems to have promising pedagogical and career advantages, the theoretical underpinning is still underdeveloped. For instance, the methodology for how learning is promoted and which role external partners could play is vague. 

At University West with more than 25 years’ experience of WIL a holistic approach to WIL have been adopted and WIL permeates all the Universities activities: education, research and extensive collaboration with the surrounding society. Over the years our efforts have been formalized and a taxonomy for will-activities have been developed. In sum, we know that WIL have promising potential, and we know what to do. But, in a recently performed study at this University, based on focus groups interviews and consolidation of our experiences we identified that even if the question “what?” is responded to, there is an important sub-question to be addressed, namely: “so what?”. When adopting different WIL activities, both small and large scale activities, e.g. a guest lecture or an internship, it is reasonable to reflect on whether these activities are used in an optimal way? What kind of impact does the WIL-activity imply? What could be achieved by successful integration between theory and practice? Could it be visualized?

Inspired by models used for integrating technique in education (RAT, SAMR and TPCK-models), we have developed a framework for the progression of work-integrated learning in education. The framework is in a sense a model for “Wil-value”. This framework could be used on different levels and in different context: in a single course, educational program, in research projects, cooperation with surrounding society, mentorship and on partner workplaces.

Higher education is facing exceptional challenges due to an increased complexity on the labour market. The work life of today is highly specialized and demands continuous education, i.e. lifelong learning. Higher education must focus on developing competencies for work life, beyond traditional theoretical knowledge [1]. To cater for these demands, higher education must adopt more application-oriented and trans-disciplinary research [2]. Moreover, colleges and universities could more systematically take responsibility for career development and adjust curricula for both traditional and non-traditional students [3]. A crucial question to address is how higher education could foster a student to become a “lifelong learner”? From a pedagogical perspective, it is of course vital to teach a student how to learn [4], aiming at achieving the skill to become a self-directed learner. Interestingly, it is argued that the qualities for being a proactive and agentic learner in higher education are the very same abilities required for effective professional practice [5]. We need to use educational strategies, e.g. work-integrated learning (WiL), as a part of the preparation of becoming an agentic learner, that permit them to successfully negotiate, engage and learn from what they are afforded, for both personal and professional outcomes [6]. Furthermore, we need to adopt important key factors that support fostering agentic learners [7]. 

In parallel to pedagogical strategies and key factors, Information and Communication Technology (ICT) could play an important role for continuous learning [8-10]. Research shows that over the recent years, social media has been pointed out as a tool, not only for external communication, but also for informal learning within organizations [11-14]. 

In this paper we wish to suggest a combination where important pedagogical strategies are combined with ICT-support. Moreover, we wish to suggest a strategy for how this combination could be practiced in higher education, making the transfer to work life smoother. 

We acknowledge that students of today most often have good knowledge of the use of various digital tools such as Facebook, Youtube etc. This is however often constrained to the use of various platforms and tools for entertainment and social contacts. How these tools can be used for learning portfolios, both during their studies and for lifelong learning, is less known and used. We suggest that students during their education choose digital tools based on individual preferences and build a personal learning environment (PLE) [15]. The PLE should include “open tools”, such tools are available outside closed systems within organizations, in order to be useful also after graduation. The student has the possible to develop and re-use knowledge of tools and platforms to work in the new context, working life. However, the use of a PLE will not in itself do the trick. 

Portfolio is one of many tools to assess learning. When the digital development progressed and applications on the Internet has expanded, the portfolio characteristics can be changed to the e-portfolio [16]. We advocate that both teachers and student need support for developing pedagogical strategies that optimize the use of ICT and aims at fostering agentic learners. We suggest that an e-portfolio may constitute such a joint support. 

In this paper we will show that an e-portfolio and PLE can support important factors for fostering agentic learners who in an efficient way take advantage of modern ICT. In sum, we suggest an approach for fostering “digitalized agentic learners”. 

The COVID-19 pandemic, clearly illustrated the magnitude of threat caused by communicable diseases and the importance of public health work. In addition, an aging population, increasing costs of health care, epidemic non-communicable diseases and health issues raised due to climate changes are also present challenges illustrating that the need for a competent public health workforce is greater than ever.

Furthermore, the digitalization that progressively permeates our society also transforms public healthcare profession. For instance, digitalization has the potential to make healthcare systems more efficient; to support a people centered care and increased empowerment, a kind of flipped healthcare is . The digitalization in public health is still in its infancy, and there is a need for how it could be planned, introduced and implemented in an evidence-based manner. Furthermore, digitalization also enables increased cooperation and knowledge sharing and increased access to information, i.e. crucial ingredients in evidence-based work.

The digitalization and the transformation of the public healthcare workers landscape accentuates the need for strong competence in research methodology, theory and how it underpins public health practice i.e. one of the core competencies for public health workers. Public health workers must know how to find information, how to analyze and evaluate evidence from several sources and how this could support evidence-based decisions. Traditionally, public health educational programs include scientific and information literacy as learning outcomes, supported by courses in e.g. research methods, biostatistics and epidemiology. These “methodological courses” are accompanied by “subject courses” with different theoretical aspects of public health. One advantage with separated courses is that students get the chance to fully concentrate on one theory and its complexity, e.g. biostatistics. On the other hand, there is a risk that the relationship to subject courses may be weak. For instance, a course in biostatistics may be focusing on different significance test and how to interpret confidence interval, which are rather complex theory demanding time for reflection and understanding, leaving very little or no time over for putting the analyses in its professional context, discussing how statistical analyses are interpreted and used as support for an evidence based public health decision.

In short, one challenge in an educational program is how to integrate methodological and subject courses in a synergetic way. It is also crucial to consider the progression in scientific method beyond the subject progression in a program. Finally, information literacy, pointed out as one of the 21st century skills in our information society, is also vital for public health workers.

This article describes the method used and findings in a work aiming at developing the progression of scientific literacy, including information literacy, and integration of scientific and subject literacy in a bachelor program in public health. The specific questions addressed in this work was:

- How to increase the integration and synergy between “methodological courses” and “subject courses”

- Evaluate and develop the progression in scientific literary

- Evaluate and develop the progression in information literacy, using library-faculty partnership

PURPOSE: This study was initiated with the purpose of developing and evaluating a system for measuring the magnitude of the variation between a computer-aided design (CAD) object created on the computer screen and a replicated object produced by computer-aided manufacturing (CAM).

MATERIALS AND METHODS: Controlled geometric forms, a square and a cone, were designed in a CAD program, and measuring distances were selected. The CAD data were transmitted to CAM data, and objects were produced. The CAD/CAM process was the Procera system, and the holder system permitted the objects to be ground into cross sections, similar to the visualization in the CAD program. Five objects of each shape were produced and measured by two operators two times. Three operators measured one of the objects 30 times.

RESULTS: Observed values were greater than the true value. For all objects, the systematic error was at most 15.5 microns. Interoperator difference was small. The variation because of measurement error was greater for the square object compared to the cone. However, the variation because of object was higher for the cone object than for the square. The total standard deviation was 7.7 microns. Thus, the total random error caused by object variation and measurement error was in approximately 95% of all measurements less than 15 microns.

CONCLUSION: There are no differences in the measurement data derived from this method and actual measurement data from an object created by the computer-aided dental design program. The method has high validity and reliability, i.e., high accuracy.

Background: The purpose of this survey was to relate completion rate and results on national clinical final examinations to student’s admission background and examination results for nursing and medical courses.

Methods: The research data were based on a quantitative case study, with 286 nursing students, using statistical analysis.

Results: The programme's overall completion rate was 76%, i.e. almost one out of four students did not complete the programme. The higher students' upper secondary/high school grades, the fewer attempts they needed to pass the nursing and medical courses exams (p<0.001). The average examination attempts needed to pass courses in medical science was significantly greater than the number needed to pass courses in nursing science (p<0.001). In a multivariate analysis both upper secondary/high school grades and average examination attempts needed to pass were significant predictors for national clinical final examination score.

Conclusion: In sum, upper secondary/high school grades and examination attempts needed, especially for courses in medical science, may be regarded as important indicators of achieved knowledge and skills which are tested in the national final examination.

The digital era and online education offers new possibilities for distributing higher education to non-traditional students, for instance full-working participants. This article describes experiences based on six years’ experience from an online course designed for non-traditional students. An on-line course in statistics, designed for attracting non-traditional students is used as a case. It is shown that the characteristics of the participants are completely different in comparison to traditional campus students. These differences may be rewarding for teachers and may offer interesting pedagogical opportunities.

 The aim with this thesis was to describe, exemplify and develop theory for reference values and diagnostic tests, especially focusing on the variability between individuals. To facilitate interpretation of medical information it is common to establish some kind of limit. There are several different rationales for the choice of such a limit. Reference values are intended to be solely descriptive, while medical decision limits are used for identification of a present or future disorder. The frequently used bimodal model can be used not only for discrimination between healthy vs diseased but for separation of other conditions as well. Reference values for amplitude of accommodation among school children were suggested based on a bimodal model discriminating between children with vs without symptoms occurring at near work. If the variability between individuals is high compared to the variability found within an individual or if the diagnostic information is subjective, it may be favorable to use the individual as its own reference. The diagnosis of food-hypersensitivity for patients with subjective symptoms was used as an illustration. A pre-defined approach for interpretation of case records gave high inter-observer reliability, and gave different diagnoses than a previously used approach. To harmonize the sensitivity and specificity of reference values across subpopulations, partitioning of reference values is one possibility. Existing criteria are limited to the consideration of only two subpopulations. A computer assisted procedure for considering partitioning of several subpopulations was developed. The potential relationship between diagnostic accuracy of a test and other factors are highlighted in diagnostic theory. However, there is no advice regarding how to adjust for this relationship. Two possibilities have been presented; to use a multivariate model including interactions or to use different thresholds for different subpopulations. Diagnostic information could be individually adjusted by using a prevalence function which estimate probability of target disorder, given patient characteristics. A computer based decision support system including such a prevalence function was shown to have potential benefits for assisting medical decisions.

BACKGROUND: To be able to interpret laboratory values, it is essential to develop population-based reference intervals. A crucial consideration is whether a reference interval should be divided into subpopulations or not, so-called partitioning. There are established methods for deciding whether partitioning should be done or not. However, these methods are only applicable when partitioning into two subpopulations is considered. The primary aim of this study was to suggest a procedure that was also valid for several subpopulations. The method assumes that these subpopulations are Gaussian. Furthermore, a secondary aim was to provide a tailor-made computer program to support calculations. METHODS: The fundamental idea is to partition reference intervals if the proportions of the distributions of the subpopulations outside the combined reference limit deviate from the nominal value of 0.025. This is made possible by finding the combined reference interval using an equation solver algorithm. RESULTS: It was found that an equation solver algorithm could easily identify the combined reference interval when combining two or more subpopulations, even if these subpopulations had unequal prevalences. It was also found that this could be done even if the ratio between samples does not reflect the ratio between prevalences. Using this algorithm, it was possible to study whether the proportion outside the combined reference limits in any of several subpopulations deviated from the nominal 0.025 by such a magnitude that partitioning was recommended. When similar figures to those found in earlier studies with other methods were tested, the procedure showed consistent results with these methods. The procedure was also found to be applicable when several subpopulations were considered. As a practical result of the study, a tailor-made computer program was developed and is now provided over the Internet. CONCLUSIONS: The suggested procedure could serve as an alternative or complement to existing methods. The procedure provides calculations of the combined reference interval, even if sample fractions do not reflect prevalence fractions. The important advantage with the suggested procedure is the generalisation to the situation when several Gaussian subpopulations, possibly with unequal prevalences, are considered. Finally, since a tailor-made computer program is provided, the procedure is simple to use.

The digitalization of health care is really a game changer for developing health care. This article gives an, overview, discuss opportunities and reflects on methodological issues in this new era. Important issues discussed include: Could digitalization offer the right chemistry between evidence based medicine and individualization of health care. Does Big Data imply long tail health care? How could patients be co-creators of health care? And, methodological pros and cons with different sources of "evidence".

Online user generated reviews are transforming business and customer behavior and could have a major impact on sales. The primary aim of this study was to measure the impact of online reviews in comparison with the impact of a good friend's opinion. The question in focus was: to what extent could a single review made by a good friend compensate the opinion of the online majority? Subjects were randomly allocated to different versions of guest reviews of a fictive hotel: either constituting a positive or a negative online majority. After reading the reviews, respondents were asked about their booking intention. The respondents were also asked to re-evaluate booking intention given the additional information that a good friend has given a recommendation or an advice against booking the hotel. The study design was experimental and based on a survey which included 1319 respondents who were randomized to the different versions of guest reviews. The results showed that the overall valence of reviews is crucial for booking intention, also the latest two reviews were important even though the effect was much smaller. If the overall valence was negative the latest two reviews had no importance, no matter if these were positive or negative. But, if the overall valence was positive, then the booking intention could be diluted if the two latest reviews were negative. Concerning the primary aim of the study, it is concluded that a good friend’s word of mouth could outweigh the online majority. This means that a negative online majority could be outweigh by a good friend's recommendation and that a positive online majority could be outweigh by a goods friend's recommendation against booking the hotel. 

The digital era gives many new opportunities for higher education. Especially online education makes it possible to reach new groups of students like, for instance, full time working professionals. This case study investigates an online course in applied statistics constructed to attract “non-traditional students” such as full-time working professionals. The course was constructed using the Work Integrated Learning (WIL) approach as well as guidelines for statistics courses (GAISE) and online courses. The main goal of the article is to investigate if the course attracted the participants that were intended, and to summarize the pedagogical experiences from the course. Among the findings are that the course succeeded in attracting “non-traditional students”, it is also found that the concept of WIL and GAISE helps increase the participant’s interest in, and perceived usability of, statistics. Furthermore, the concept of WIL can be enhanced, both for the traditional and “non-traditional” students, by inviting the “non-traditional students” to share statistical problems from their workplace. This opens up for the pedagogical concept of using the participants in the course as a resource for WIL and hence building a course with the students rather than for the students.

It is important to identify and understand important factors underpinning the integration of information and communication technology (ICT) in schools. And, it is important that ICT is adopted in a sound pedagogical manner. The aim with this study was to suggest a model for the actual use of ICT in schools and how it may be related to important factors such as technological pedagogical expectations. The design of the model was inspired by TAM2 and UTAUT models, but with some modifications. We have developed a model which highlight the pedagogical aspects beyond the technical ones. Furthermore, our suggested model also include the adoption of digital techniques in everyday life as a potential predictor of adoption of ICT at work. The sample consists of 122 teachers and we analyzed the model with a structural equation model. This study contributes with a suggested model including a new construct for measuring expected performance from a technological pedagogical point of view. This new construct was a significant predictor to actual use of ICT in school. Furthermore we also developed a new construct for adoption of ICT in everyday life, which also was a significant predictor to actual use of ICT in school.

The standard of reporting in diagnostic studies has generally been low. Fortunately, this issue has begun to be addressed in recent years through the discussion of important methodological issues in educational series, textbooks, and checklists. Double-blind, placebo-controlled, oral food challenges (DBPCFC) are considered to be the gold standard for diagnosis of food allergy. However, there is no consensus regarding how to interpret the outcome and how to define positive and negative provocations in DBPCFC. Furthermore, since most theories on the diagnosis of food allergy rely on the assumption that the DBPCFC has a high accuracy, this accuracy must be formally statistically evaluated. In this review, we discuss essential methodological issues for diagnostic accuracy studies in general and for oral food challenges in particular and discuss the importance of methodological issues as a guide for forthcoming studies of diagnostic procedures.

In this paper we outline models for conducting work-integrated learning research. Our experiences from two decades of doing research in close collaboration with practitioners are presented and discussed. Our main message is that by engaging practitioners in all steps of the research project there is a potential for research outcomes to have high societal impact, and theoretical contribution

AIM: The aim of this study was to evaluate (a) the differences between men and women in symptom profile, allocated life support level (LSL), and presence of acute myocardial infarction (AMI), life-threatening condition (LTC), or death and (b) whether a computer-based decision support system could improve the allocation of LSL. PATIENTS: All patients in Göteborg, Sweden, who called the dispatch center because of chest pain during 3 months (n = 503) were included in this study. METHODS: Age, sex, and symptom profile were background variables. Based on these, we studied allocation of LSL by the dispatchers and its relationship to AMI, LTC, and death. All evaluations were made from a sex perspective. Finally, we studied the potential benefit of using a statistical model for allocating LSL. RESULTS: The advanced life support level (ALSL) was used equally frequently for men and women. There was no difference in age or symptom profile between men and women in relation to allocation. However, the allocation of ALSL was predictive of AMI and LTC only in men. The sensitivity was far lower for women than for men. When a statistical model was used for allocation, the ALSL was predictive for both men and women. Using a separate model for men and women respectively, sensitivity increased, especially for women, and specificity was kept at the same level. CONCLUSION: This exploratory study indicates that women would benefit most from the allocation of LSL using a statistical model and computer-based decision support among patients who call for an ambulance because of acute chest pain. This needs further evaluation.

The very early handling of patients with suspected acute myocardial infarction (AMI) is crucial for the outcome. In Gothenburg approximately two-third of all patients with AMI dial the emergency number for ambulance transport (reference).

Objectives: To evaluate whether a computer-based decision support system could be useful for the emergency medical system when identifying patients with acute myocardial infarction (AMI) or life-threatening conditions and thereby improve the allocation of life support level.

Methods: Patients in the Municipality of Goteborg who dialled the dispatch centre due to chest pain during a period of 3 months. To analyse the relationship between patient characteristics (according to a case record form used during an interview) and the response variables (AMI or life-threatening condition), multivariate logistic regression was used. For each patient, the probability of AMI/life-threatening condition was estimated by the model. We used these probabilities retrospectively to allocate advanced life support or basic life support. This model allocation was then compared with the true allocation made by the dispatchers.

Results: The sensitivity, that is, the percentage of AMI patients allocated to advanced life support, was 85.7% in relation to the true allocation made by the dispatchers. The corresponding sensitivity regarding allocation made by the model was 92.4% (P=0.17). The specificity was also slightly higher for the model allocation than the dispatcher allocation. Among the 15 patients with AMI who were allocated to basic life support by the dispatchers, nine died (eight during and one after hospitalization). Among the eight patients with AMI allocated to basic life support by the model, only one patient died (in hospital) (P=0.02).

Conclusion: A computer-based decision support system including a prevalence function could be a valuable tool for allocating the level of life support. The case record form, however, used for the interview can be refined and a model based on a larger sample and confirmed in a prospective study is recommended.

The primary aim with this study was to examine the impact of digitalization and the use of ICT for knowledge sharing in an organization. A secondary aim was to further develop knowledge management models to also include collaborative knowledge production and expertise sharing. Based on such a model, we developed a questionnaire answered by 265 respondents. We found that the relationship between using ICT for knowledge sharing was correlated to knowledge sharing also when adjusted for established factors like organisational climate and social norms. We conclude that digitalization, both individually and on an organisational level is an important asset for knowledge management, and that the use of ICT could support knowledge sharing beyond known and established important factors.

There is a demand for increased cooperation between higher education institutes and surrounding society, and different frameworks for such cooperation have been developed. University West in Sweden has a profile calledwork-integrated learning which could be regarded as a systematical approach for combining theory and practice.Actually work-integrated learning has become an ideologyfor the University which permeates all activities, i.e. education, research and cooperation with surrounding society. This article is a review, explaining and exemplifying our approach. We will also discuss strategies and challenges for bringing the relationship between theory and practice into a prospering marriage.

Background: Subjective symptoms after food challenges are difficult to interpret and no standard is available. We discuss a strategy for how to interpret a diary. Furthermore, the interobserver reliability is evaluated.

Methods: Diaries for 32 patients with subjective symptoms were used. The diaries were re-evaluated with a predefined strategy by three independent observers.

Results: The proportion of positives was 21.9% among the old diagnoses, according to the new approach 34.4% (observers I and II) and 37.5% (observer III) were positive. The new approach had high interobserver reliability (97 and 100%).

Conclusions: The proportion of positives depends on how subjective symptoms are interpreted. Interpretations of subjective symptoms in diaries could be made with high interobserver reliability.

The double-blind placebo-controlled food challenge (DBPCFC) is the gold standard for diagnosing food hypersensitivity (1–5). However, DBPCFC needs further standardization regarding essential issues, e.g. quantity of food, vehicles, blinding, dose titration and interpretation of symptoms (2, 3, 6–10). This study highlights the latter problem. For patients with several subjective symptoms that may occur in various degrees both on active and placebo provocations, a standardized strategy for interpretation would be valuable. Bindslev-Jensen et al. have theoretically illustrated that there may be great differences dependent on how placebo symptoms are treated (11, 12) and in a position paper (13) it is suggested that in situations when only subjective symptoms are present, several provocations must be used. The lack of an interpretation standard may be one reason for explaining the doubts regarding the value of subjective variables for making a diagnosis (9, 14). We discuss a strategy for how to interpret the symptom profile found in such a mixed sequence of active and placebo provocations. Furthermore, the interobserver reliability is evaluated.

Objective

One crucial prerequisite for increased patient empowerment is the willingness among patients to take a more active role. The aim of this study was to develop questionnaires for measuring a patient’s willingness to be empowered in general and by using e-health.

Methods

The study was based on a random sample from an online panel. The 800 responders were Swedish citizens and reflected the internet-using population in Sweden regarding age, gender, income, and education. The measurement properties were evaluated according to the Rasch Measurement Theory.

Results

The analyses showed two questionnaires with adequate fit to the basic measurement model and with high reliability (PSI 0.84 and 0.89, respectively).

Conclusion

We conclude that this study generated two questionnaires with an intuitive order of items illustrating an understandable progression of willingness to be empowered in general as well as for e-health.

Practice implications

The suggested questionnaires are valuable tools supporting the effort to tailor empowerment strategies to meet the patient’s willingness. Questionnaires will also be valuable for evaluating strategies for supporting willingness, studying factors related to willingness and potential inequalities due to e.g. varying digital literacy, and for enabling identification of patient stereotypes using cluster analyses.

This paper examines the relation between municipalities' social media performance and citizen satisfaction withthe municipality. An observational study was conducted, based on four different Swedish national public data sources. Thestudy shows that municipalities' Facebook performance is correlated to citizens' satisfaction with living in the municipalityand with satisfaction with municipal service provision. There was however no significant relationship between Facebookperformance and satisfaction with transparency and influence from a citizen perspective. In conclusion, one importantimplication of the study is that citizen perception regarding whether a municipality is a good place to live in or not is related to the use of social media for promoting the municipality. Furthermore, a relation between satisfaction and citizenperception of government service performance implies that social media could be valuable for interaction and co-creation.Finally, an implication is that usage of social media and the potential relationship to trust, influence and transparency mustbe further elaborated and studied. Overall, our recommendation is that municipalities and their citizens may benefit fromwell thought-out strategies of how to use social media for marketing, interaction and co-creating.

The journey from being a new Ph. D.-candidate towards passing the doctorate grade is often a bumpy road with both unexpected and complex challenges that has to be turned in to learning experiences that adds to progression. In this paper we describe the development and use of a tool (the Goalkeeper) designed to support, structure and visualize this journey. It is a tool for supervisors, doctorate students as well as people responsible for quality assurance of a doctorate education. Based on our experiences of having utilised the tool we argue that it is important that the implementation of such a tool is firmly grounded in a quality culture where support of progression and formative assessment dominate over summative assessment and control.

BACKGROUND: A crucial question when developing reference intervals is whether different subpopulations need their own reference interval or if a single joint reference interval can be used. It is reasonable to use partitioned reference intervals in situations where a single interval results in considerable variation in sensitivity between subpopulations. The aim of partitioning is to harmonize the sensitivity of the reference intervals, i.e., to make the sensitivity similar for all patients, regardless of patient characteristics. Statistical criteria to identify when partitioning is adequate have been developed over the last two decades. These criteria are applicable when considering two subpopulations, but recently a procedure for considering several subpopulations has been developed. When several subpopulations are considered, there is a possibility that some subpopulations could form a group or cluster that could share a common reference interval. However, there is no formal systematic approach to indicate how to divide these subpopulations into clusters. The aim of this study was to suggest such a systematic approach for clustering. METHODS: A clustering technique was applied to data including several subpopulations. The technique is based on measuring the distance between separated reference limits and successively pooling subpopulations divided by short distances. A cluster is defined by a group of subpopulations that are close to each other and that differ from subpopulations in another cluster. A cluster recruits new subpopulations as long as the subpopulations can be pooled without violating a partitioning criterion. CONCLUSIONS: We have suggested a procedure for partitioning a number of Gaussian (or Gaussian-transformable) subpopulations into clusters. This is the only formalized procedure indicating how to analyze several subpopulations and identify a suitable number of groups and reference intervals. Using a computer program developed for partitioning issues, the approach was easy to adopt.

Background: To evaluate whether a computer-based decision support system could improve the allocation of patients with acute coronary syndrome (ACS) or a life-threatening condition (LTC). We hypothesised that a system of this kind would improve sensitivity without compromising specificity. Methods: A total of 2285 consecutive patients who dialed 112 due to chest pain were asked 10 specific questions and a prediction model was constructed based on the answers. We compared the sensitivity of the dispatchers' decisions with that of the model-based decision support model. Results: A total of 2048 patients answered all 10 questions. Among the 235 patients with ACS, 194 were allocated the highest prioritisation by dispatchers (sensitivity 82.6%) and 41 patients were given a lower prioritisation (17.4% false negatives). The allocation suggested by the model used the highest prioritisation in 212 of the patients with ACS (sensitivity of 90.2%), while 23 patients were underprioritised (9.8% false negatives). The results were similar when the two systems were compared with regard to LTC and 30-day mortality. This indicates that computer-based decision support could be used either for increasing sensitivity or for saving resources. Three questions proved to be most important in terms of predicting ACS/LTC, [1] the intensity of pain, [2] the localisation of pain and [3] a history of ACS. Conclusion: Among patients with acute chest pain, computer-based decision support with a model based on a few fundamental questions could improve sensitivity and reduce the number of cases with the highest prioritisation without endangering the patients.

This paper reports on the experiences from online courses in applied statistics. The courses were designed with the ambition of making studies in statistics, fun, interesting, useful, not that difficult and directly supported the possibility to combine studies and work. When designing the courses we considered three dimensions: "pedagogies","community" and "structure". Experiences after giving a first-year course three times show that the online course succeeds in attracting new studen ts since 90% of the participants would not be able to follow an on-campus course and 62% worked full time.

The pedagogies were highly appreciated because focusing on the interpretation of results and using computer analyses really changed the prejudices about statistics. Structure and prompt feedback was experienced as important factors. It was possible to combine online studies with employment, and the student completion rate was (84%, 55% and 61%), with a potential for further improvements.

During the last few decades, a great deal of effort has been put into improving statistical education, focusing on how students learn statistics and how we as teachers can find effective ways to help them. At the same time the use of computers, the Internet, and learning management systems has grown rapidly, and offers new educational possibilities. In this chapter, we will discuss how these changes in the pedagogical landscape have affected our introductory course in applied statistics. The course and teaching context are presented in relation to guidelines for assessment and instruction in statistics and to seven principles for effective teaching. Teaching strategies, course content, and examples of course material are included. Furthermore, results from evaluations are discussed, especially focusing on diversity in student characteristics. These results indicate a variation in learning styles both between and within groups. Finally, we present some of our ideas for future development including strategies for individualization and the use of educational mining.

PURPOSE: The number of colorectal cancer patient survivors is increasing. Information and support during and after treatment are requested by patients, but questions remain on what to provide. The aim of this study was to understand what informational needs colorectal cancer patients and survivors have, with a focus on the potential support given by patient peers and the use of blended care.

METHODS: A qualitative study using focus groups was conducted with patients diagnosed at the same hospital at least one year prior to the initiation of the study. The focus group interviews were transcribed verbatim and analyzed using deductive content analysis.

RESULTS: The need for informational support varied over time and depended on individual patient characteristics. Timing was crucial and patients requested options of blended care and informational support after treatment cessation. The patients felt alone after treatment and requested assistance in communication with their next-of-kin. They also identified the value of peer support, especially to contextualize knowledge provided by healthcare.

CONCLUSION: This study showed a need for focus on individualized informational support. Blended care through integrating communication with peers online could be one way to support patients, both to enable shared decision-making as well as to provide person-centered care.

Increased patient engagement and the use of new types of data, such as patient-generated health data (PGHD) is shifting how work is performed in relation to healthcare. This change enables healthcare professionals to delegate parts of work previously conducted by them to patients. There is a consensus regarding the need for nurses and physicians to work seamlessly together to make healthcare flow, but the role and responsibility of patients are less researched. In this paper, we aim to fill that gap by focusing on the shift of work from healthcare professionals to patients from the perspective of i) patients and ii) healthcare professionals. We use infrastructuring as a lens to understand the design of everyday work and actions from both perspectives. The main contribution is an analysis of, and insights into, how the work of patients can support healthcare professionals along with a conceptualization of how infrastructuring processes within and outside of healthcare are interconnected.