När ett barn föds sjukt eller för tidigt och är i behov av neonatalvård är det en omtumlande och traumatisk tid för föräldrarna. För att underlätta för föräldrarna i deras svåra situation utgör sjuksköterskan ett stort stöd som kan främja välbefinnandet och hälsan. Syftet var att belysa föräldrarnas upplevelse av sjuksköterskans stöd på neonatalvårds avdelning. Litteraturöversikten utgår ifrån 12 olika artiklar varav 7 kvantitativa och 5 kvalitativa som har granskats och analyserat. Artiklarna är tagna från olika länder (Sverige, Australien, Nederländerna, USA, Sydkorea, England, Iran, Nya Zeeland och Spanien). Resultatet delades upp i 3 teman med 5 tillhörande subteman. Sammanfattningsvis uppgav föräldrar i samtliga artiklar att sjuksköterskornas stöd var en stor faktor för en bättre tid på neonatalvårdsavdelningen. Genom att känna sig sedda, delaktiga i sitt barns vård, vara väl informerade och väl bemötta av personalen. Majoriteten av föräldrarna uppgav att de var tillfreds med sjuksköterskans stöd, de uppskattade regelbunden information och närhet från sjuksköterskan. Brist på kommunikation och information från sjuksköterskan uppgav en del föräldrar som bristande i stödet. Det kan tyda på att det finns utvecklingspotential inom området på neonatalvården. / When a child is born sick or prematurely and requires neonatal care, it is a tumultuous and traumatic time for the parents. To ease the parents' difficult situation, the nurse provides significant support that can promote well-being and health. The purpose was to highlight the parents' experiences of the nurse's support in the neonatal care unit. The literature review is based on 12 different articles, of which 7 are quantitative and 5 are qualitative, that have been reviewed and analyzed. The articles are from various countries (Sweden, Australia, the Netherlands, the USA, South Korea, England, Iran, New Zealand, and Spain). The results were divided into 3 themes with 5 corresponding subthemes. In summary, parents in all the articles reported that the nurses' support was a major factor for a better experience in the neonatal care unit. They felt seen, involved in their child's care, well-informed, and well-treated by the staff. The majority of parents were satisfied with the nurse's support, appreciating regular information and proximity from the nurse. Some parents reported a lack of communication and information from the nurse as a shortcoming in the support. This suggests that there is potential for improvement in the neonatal care area.

Arbetsgivare väljer ofta att rekrytera internt för att tillsätta vissa tjänster. Dessa typer av rekryteringar går inte alltid smärtfritt då de som befordras sällan får fullständig introduktion till arbetet och känner rädslor inför sin nya roll. Tidigare forskning är inriktad på hur chefen och organisationen hanterar en sådan förändring även om relationen mellan medarbetare och chef är av stor vikt för att verksamheten ska fungera. Syftet med denna uppsats är att belysa de utmaningar som personer ställs inför när de går från att vara en kollega till att bli chef för samma personalgrupp. Studien ämnar även att belysa om förändring sker i personalgruppen i och med att en person går från att vara kollega till att bli chef. Tre chefer och fem medarbetare intervjuades med hjälp av semistrukturerade intervjuer. Transkriptionerna av intervjuerna lästes och analyserades med deduktiv ansats. Till hjälp användes Tuckmansgrupp utvecklingsteori och FIRO. Dessa användes även för att stärka resultaten i diskussionen. Resultatet visade på både fördelar och nackdelar med internrekryterade chefer. Medarbetarna kände en trygghet i att få en chef som kände dem och som visste hur verksamheten fungerade. Cheferna upplevde att de inte fick den introduktion de behövde och de förlitade sig på kollegor för att lära sig vad som skulle göras. Mycket tyder på att gruppen backar i sin grupputveckling under en sådan transition. Med tanke på att antalet deltagare i studien är litet är resultaten svåra att överföra på populationen även om den överensstämmer till stor del med tidigare forskning. / Employers often choose to recruit internally to fill certain positions. These types of recruitment do not always go smoothly as those promoted rarely receive a full induction to the job and feel apprehensive about their new role. Previous research focuses on how the manager and the organization deal with such a change, although the relationship between the employee and the manager is of great importance for the organization to function. The purpose of this paper is to shed light on the challenges that people face when they go from being a colleague to becoming a manager of the same staff group. The study also aims to shed light on whether change occurs in the staff group when a person goes from being a colleague to becoming a manager. Three managers and five employees were interviewe dusing semi-structured interviews. The transcripts of the interviews were read and analyzed using a deductive approach. Tuckman's group development theory and FIRO were used to assist in the analysis. These were also used to strengthen the results in the discussion. The results showed both advantages and disadvantages of internally recruited managers. Employees felt secure in having a manager who knew them and who knew how the organization worked. Managers felt that they did not receive the induction they needed and relied on colleagues to learn what to do. There are strong indications that the group regresses in its group development during such a transition. Given the small number of participants in the study, the results are difficult to generalize to the population, although they are largely consistent with previous research.

Första linjens chefer inom vård- och omsorgssektorn har ett omfattande ansvar, de ansvarar för personal, ekonomi samt utvecklingsansvar. Att undersöka vad som ger dem arbetstillfredsställelse kan ge svar på vad inom organisationen som fungerar och skapar en god arbetsmiljö för första linjens chefer. Karasek och Theorells (1990) teorimodell understryker hur balansen mellan arbetskrav och kontroll på arbetsplatsen påverkar chefernas välmående och deras förmåga att hantera arbetsmiljön. En välbalanserad arbetsmiljö kan främja positiva resultat och skapa förutsättningar för långsiktig arbetstillfredsställelse och produktivitet hos första linjens chefer. Detta arbete presenterar en integrativ litteraturstudie som sammanfattar och analyserar ett brett spektrum av forskning inom området. Databaserna Cinahl Complete och Scopus har använts vid artikelsökning. Tio artiklar mellan åren 2014–2020 ingår, varav sju artiklar med kvalitativ metod och tre artiklar med kvantitativ metod. I resultatet presenteras tre huvudkategorier med tio subkategorier. Huvudkategorierna är följande: Arbetstillfredsställelse - faktorer som respekt, rättvisa och lön hade en positiv påverkan på arbetstillfredsställelse. Även att uppleva samstämmighet mellan privata värderingar och organisationens värderingar var betydande. Organisatoriska förutsättningar för arbetstillfredsställelse - behandlar vikten av administrativt stöd vilket kan generera ett effektivare arbete, minska arbetsbelastningen samt bidra till ett ökat välbefinnande hos första linjens chefer. Faktorer som påverkar arbetstillfredsställelse – ett flertal faktorer framkom ur artiklarna, som kompetensutveckling och erfarenhet, att uppleva arbetet som meningsfullt och känna stolthet i uppdraget samt att finna en balans mellan arbete och privatliv. Slutsatsen är att första linjens chefer inom vård och omsorg behöver administrativt stöd, socialt nätverk och utbildning för att förbättra arbetsmiljön och ledarskapskompetens, vilket resulterar i arbetstillfredsställelse. / First-line managers in the health and care sector bear extensive responsibilities. They are accountable for personnel, finances, and development. Investigating what provides them with job satisfaction can reveal what aspects of the organization function well and create a good work environment for first-line managers. The theoretical model by Karasek and Theorell (1990) emphasizes how the balance between job demands and control at the workplace affects managers' well-being and their ability to handle the work environment. A well-balanced work environment can promote positive outcomes and create conditions for longterm job satisfaction and productivity among first-line managers. This work presents an integrative literature review that summarizes and analyzes a broad spectrum of research in the field. The databases Cinahl Complete and Scopus were used for article searches. Ten articles from the years 2014–2020 are included, of which seven use qualitative methods and three use quantitative methods. The results are presented in three main categories with ten subcategories. The main categories are as follows: Job satisfaction - factors such as respect, fairness, and salary had a positive impact on job satisfaction. Also, experiencing alignment between personal values and the organization's values was significant. Organizational conditions for job satisfaction - this addresses the importance of administrative support, which can lead to more efficient work, reduced workload, and increased well-being among first-line managers. Factors affecting job satisfaction - several factors emerged from the articles, such as professional development and experience, perceiving the work as meaningful and feeling pride in the task, and finding a balance between work and private life. The conclusion is that first-line managers in health and care need administrative support, a social network, and education to improve the work environment and leadership skills, resulting in job satisfaction.

Abstrakt Bakgrund: Flertalet av patienterna vilka söker akuten är inte i behov av akutsjukvård. Sjuksköterskor på akutmottagningarna kan idag hänvisa patienter till annan vårdnivå så som primärvård eller till hemmet med egenvårdsråd.   Syfte: Syftet var att belysa triagesjuksköterskans erfarenhet av hänvisning till annan vårdnivå än akutmottagning.   Metod: Studien var en kvalitativ intervjustudie genomförd med semistrukturerade intervjuer. I studien ingick intervjuer med 12 sjuksköterskor, både med och utan specialistutbildning, vilka arbetar på akutmottagning samt har erfarenhet av hänvisning av patienter till annan vårdnivå. Kvalitativ innehållsanalys har använts för att bearbeta insamlad data.   Resultat: Triagesjuksköterskans erfarenhet av att hänvisa patienter till annan vårdnivå tolkades utifrån följande teman för att belysa olika faktorer som påverkar sjuksköterskans handling på en akutmottagning; faktorer som påverkar hänvisning, professionella stöd och handläggningsstrategier vid hänvisning. Resultatet visade att respondenterna upplever hänvisning som komplext och stundtals svårt där sjuksköterskan känner sig osäker, samtliga respondenter uppgav att de hade erfarenhet av patienter som uppträder agiterat samt hotfullt vid hänvisning, flertalet uttryckte därför att de kände sig otrygga på sin arbetsplats, de uttryckte även att erfarenhet samt klinisk blick var av stor betydelse vid hänvisning av patienter.   Slutsats: Författarnas kliniska slutsats är att respondenterna anser att möjligheten till att kunna hänvisa patienterna till en annan vårdnivå är av stor patientnytta. Detta då patienten får adekvat och rätt vård från början relaterat till deras sjukdomstillstånd vilket även kan leda till att väntetiden på akutmottagningen minskar. Mer utbildning liksom beslutstöd behövs för att göra sjuk sjuksköterskor tryggare med sin hänvisning. Författarna anser även att studien ger viktiga infallsvinklar inom problemområdet som kan vara användbara i en kommande yrkesroll. / Abstract Background: The majority of patients who seek emergency care, are not in need of it. Nurses at emergency departments can refer patients to other type of care, such as primary care or to the home with self-care advices. Referral are often carried out independent and therefore the nurses requires a high level of expertise as well as good communication skills.   Purpose: The aim of the study is to highlight the triage nurse's experience of referral of patients from the emergency department to other care givers such as primary healthcare and self-care.   Method: The study was a qualitative interview study, conducted with semi-structured interviews. The study included interviews with 12 nurses, both with and without specialisteducation, who works in the emergency department and has experience of referring patients to other level of care. Content analysis has been used to process the collected data   Result: The triagenurse experience of referring patients to other care was interpreted based on the following themes to highlight the various factors affecting the nurse's action in an emergency; factors affecting reference, professional support and management strategies by reference. The results showed that respondents perceive reference as complex and sometimes difficult where the nurse feels insecure, all respondents stated that they had the experience of patients who appear agitated and threatening at time of referral, the majority of the respondents therefore expressed they felt insecure in their workplace, they also expressed that the experience and clinical gaze was of great importance in referring patients.   Conclusion: The authors' clinical conclusion is that the respondents believe that the ability to be able to refer patients to other level of care is of significant patient benefit. This resulting in the patient receiving adequate care from the start related to their disease severity which also can lead to that the waiting time at the emergency room is reduced. More education and decision support is needed to make nurses more secure whilst performing referrals. The authors also believe that the study provides important insights in the problem area that may be useful in a future profession.

Large resources are invested in healthcare research, but despite this there is a wide gap between research knowledge and healthcare practice. Implementation researchers have addressed this gap, focusing mostly on the role of healthcare practitioners. However, a narrow focus on implementation does not take into consideration the preceding stages and the roles of different actors during the whole innovation process, which starts from research and ends with implementation. The aim of this thesis is to examine the behaviors of three key actors during an innovation process and to explore the influence of selected contextual factors on their behavior. Study I (n=10 funders) identifies several facilitative roles for funders and suggests that implementation risks becoming no one’s responsibility as the funders identify six different actors responsible for implementation, the majority of whom embody a collective or an organization. Study II finds that the implementation knowledge of Swedish funding managers (n=18) is mostly based on experience-based knowledge. The majority of the funding managers define implementation as a process and express limited knowledge of implementation. The findings of Study III (n=4 innovation cases) show that the roles and involvement of academic inventors and ISAs (innovation-supporting actors) are more connected to intellectual property (IP) nature than to intellectual property rights (IPR) ownership. Study IV (n=4 innovation cases) identifies three different logics that influence the behavior of academic inventors: market, academic and care logics. A pattern emerges where the behavior of academic inventors is guided by a unique logic and there is no interaction between logics, despite the existence of multiple logics. The individual strategies to handle multiple logics coincide with the influence of logics. In addition, IP nature, distinguishing between high-tech and low-tech innovations, is connected to the influence of institutional logics: low-tech connected to the care logic and high-tech connected to the market logic. This thesis has three main theoretical and practical implications relevant for practitioners, policymakers and researchers. First, implementation responsibility is an important issue to study and discuss, because without clearly defined responsibilities and management of responsibilities, responsibility might become no one’s responsibility. Second, the finding that experience-based implementation knowledge contributes heavily to policymakers’ knowledge encourages further studies and discussions regarding this relatively neglected issue. Third, the importance of IP nature in shaping innovation processes should be considered and further examined, not only as a factor influencing inventors and ISAs’ roles and involvement, but also as influencing the prevalence of different institutional logics. Further, the relevance of a distinction between low-tech and high-tech IP should be reflected on.

A large number of emerging infectious diseases (including influenza epidemics) has been identified during the last century. The emergence and re-emergence of infectious diseases have a negative impact on global health. Influenza epidemics alone cause between 3 and 5 million cases of severe illness annually, and between 250,000 and 500,000 deaths. In addition to the human suffering, influenza epidemics also impose heavy demands on the health care system. For example, hospitals and intensive care units have limited excess capacity during infectious diseases epidemics. Therefore, it is important that increased influenza activity is noticed early at local levels to allow time to adjust primary care and hospital resources that are already under pressure. Algorithms for the detection and prediction of influenza epidemics are essential components to achieve this. Although a large number of studies have reported algorithms for detection or prediction of influenza epidemics, outputs that fulfil standard criteria for operational readiness are seldom produced. Furthermore, in the light of the rapidly growing availability of “Big Data” from both diagnostic and prediagnostic (syndromic) data sources in health care and public health settings, a new generation of epidemiologic and statistical methods, using several data sources, is desired for reliable analyses and modeling. The rationale for this thesis was to inform the planning of local response measures and adjustments to health care capacity during influenza epidemics. The overall aim was to develop a method for detection and prediction of influenza epidemics. Before developing the method, three preparatory studies were performed. In the first of these studies, the associations (in terms of correlation) between diagnostic and pre-diagnostic data sources were examined, with the aim of investigating the potential of these sources for use in influenza surveillance systems. In the second study, a literature study of detection and prediction algorithms used in the field of influenza surveillance was performed. In the third study, the algorithms found in the previous study were compared in a prospective evaluation study. In the fourth study, a method for nowcasting of influenza activity was developed using electronically available data for real-time surveillance in local settings followed by retrospective application on the same data. This method includes three functions: detection of the start of the epidemic at the local level and predictions of the peak timing and the peak intensity. In the fifth and final study, the nowcasting method was evaluated by prospective application on authentic data from Östergötland County, Sweden. In the first study, correlations with large effect sizes between diagnostic and pre-diagnostic data were found, indicating that pre-diagnostic data sources have potential for use in influenza surveillance systems. However, it was concluded that further longitudinal research incorporating prospective evaluations is required before these sources can be used for this purpose. In the second study, a meta-narrative review approach was used in which two narratives for reporting prospective evaluation of influenza detection and prediction algorithms were identified: the biodefence informatics narrative and the health policy research narrative. As a result of the promising performances of one detection algorithm and one prediction algorithm in the third study, it was concluded that both further evaluation research and research on methods for nowcasting of influenza activity were warranted. In the fourth study, the performance of the nowcasting method was promising when applied on retrospective data but it was concluded that thorough prospective evaluations are necessary before recommending the method for broader use. In the fifth study, the performance of the nowcasting method was promising when prospectively applied on authentic data, implying that the method has potential for routine use. In future studies, the validity of the nowcasting method must be investigated by application and further evaluation in multiple local settings, including large urbanizations.

The rarity of a disease can give rise to challenges that differ from conventional diseases. For example, rarity hampers research and development of new drugs, and patients with severe, rare diseases have limited access to qualified treatments. When drugs are available, clinical evidence has higher uncertainty and the drugs can be very expensive. When setting priorities in the healthcare sector, treatments aimed at patients with rare diseases, so called orphan drugs, have become a source of concern. Orphan drugs seldom show solid evidence of effectiveness or cost-effectiveness. Still, treatments for rare disease patients, available on the European market, has increased rapidly since the adoption of a regulation offering incentives for research and development of orphan drugs. The question arises as to whether the publicly funded health care system should provide such expensive treatments, and if so, to what extent. This doctoral thesis aims to investigate healthcare priority setting and rare diseases in the context of orphan drug reimbursement. Priority setting for orphan drugs is located at the intersection of economic, ethical and psychological perspectives. This intersection is explored by studying the public’s view on the relevance of rarity when setting priorities for orphan drugs, and by examining how orphan drugs are managed when making reimbursement decisions in practice. Papers I and II in this thesis employ quantitative, experimental methods in order to investigate preferences for prioritising rare diseases, and the extent to which psychological factors influence such preferences. Papers III and IV employ qualitative methods to further explore what factors (apart from rarity) influence priority-setting decisions for orphan drugs, as well as how decisions regarding orphan drugs are made in practice in England, France, the Netherlands, Norway and Sweden. Combining quantitative and qualitative methods has provided a more comprehensive understanding of the topic explored in the thesis, and the methods have complemented each other. Paper I shows that there is no general preference for giving higher priority to rare disease patients when allocating resources between rare and common disease patients. However, results show that preferences for treating the rare patients are malleable to a set of psychological factors, in particular “proportion dominance”. Paper II shows that the identifiability of an individual has no, or a negative, influence on the share of respondents choosing to allocate resources to him/her (compared to a nonidentified individual). Paper III confirms that rarity per se is not seen as a factor that should influence priority-setting decisions (i.e. accept a greater willingness to pay for orphan drugs), however, other factors such as disease severity, treatment effect and whether there are treatment alternatives were seen as relevant for consideration. Paper IV explores the challenges with and solutions for orphan drug reimbursement, as perceived by different actors in five European countries. Perceived challenges are related to the components involved when making reimbursement decisions, to the reimbursement system, and to the acceptance of the final decision. Solutions are either specific for orphan drugs, or general measures that can be used for orphan drugs as well as for other drugs. In conclusion, priority setting for orphan drugs is complex and requires particular attention from decision makers. There are many factors to consider when making reimbursement decisions for orphan drugs. The consequences of a decision are potentially severe (both for rare disease patients and for common disease patients, depending on the decision) and psychological factors can potentially influence decisions.

Bakgrund: Ljumskbråck är den vanligaste operationen inom allmänkirurgin, varje år utförs nästan 20 000 operationer i Sverige. I Östergötland utförs ljumskbråcksoperationer på tre ställen inom ramen för dagkirurgi; vid Aleris Specialistvård i Motala (ASM), Närsjukvården i Finspång (NiF) samt Medicinskt Centrum i Linköping (MCL). Det finns en teori om att privata vårdgivare är mer tidseffektiva än offentliga vårdgivare. De privata anses kunna utföra fler operationer under en given tid, men ingen studie har gjorts på tidseffektiviteten kring operationerna hos respektive vårdgivare. Denna studie har genomförts för att detektera om det finns en skillnad i hur lång tid olika moment tar att utföra och vad denna skillnad i sådana fall beror på, samt om patientunderlaget skiljer sig mellan klinikerna. Metod: Studien omfattade 70 patienter fördelade på tre kliniker; ASM, MCL och NiF. Ljumskbråcksoperationerna delades upp i flertalet moment som mättes med digital klocka. Dessutom samlades uppgifter in om patientens ålder, ASA-klass, BMI samt information om vilka som närvarade i operationssalen. Statistisk analys gjordes enligt Kruskal-Wallis. Programvaran som användes var SPSS version 22. Resultat: Studien fann ingen signifikant skillnad i BMI, ASA-klass eller ålder mellan klinikernas patienter (p > 0,05 för samtliga). Däremot fanns stora skillnader vad gäller hur lång tid ett flertal av momenten under ljumskbråcksoperationen tog. Slutsats: Studien påvisar att det finns stora skillnader i olika moment vid ljumskbråcksoperationer. De privata klinikerna var alltid snabbare än den offentliga kliniken. Då det saknas studier inom området vore det intressant att se om det finns liknande skillnader vid andra ingrepp som utförs av olika aktörer. / Background: Inguinal hernia surgery is one of the most common surgeries within general surgery, with approximately 20 000 surgeries per year in Sweden. There are three places in Östergötland County where inguinal hernias are executed within outpatient surgery; at Aleris Specialistvård in Motala (ASM), Närsjukvården in Finspång (NiF) and at Medicinskt Centrum in Linköping (MCL). There is a theory that private health care providers are more time-efficient than public health care providers. The private health care providers are considered to perform more operations over a given time though no studies has been done on time efficiency. This study was performed to detect if there is a difference in time in the various steps during the surgery between the clinics, what causes these differences and if the patients differ. Methods: The study includes 70 patients distributed on three outpatient surgery clinics; ASM, MCL and NiF. The inguinal hernia operations were divided into shorter steps measured with a digital watch.  Furthermore, data were noted about the patients’ age, ASA-score, BMI and who were present in the operating room. Statistical analyses were performed with the Kruskal-Wallis one-way analysis of variance. The software used was SPSS version 22. Results: The study found no significant difference in BMI, ASA-score and age between the health care providers (p > 0,05). However, regarding the time efficiency, there were significant differences between the clinics. Conclusions: The study concludes that there are big differences in time, within the various steps in the inguinal hernia surgeries, between the clinics. The private health care providers were always faster than the public health care provider. Since no earlier studies have been made in this area, it would be interesting to see if there are similar differences in other types of surgeries.

<p>Colorectal cancer is one of the most common malignancies in Sweden, with more than 5000 new cases annually. Median age at time of diagnosis is approximately 75 years. Owing to the ageing population, the incidence of colorectal cancer is increasing. The improvement in surgical technique and the introduction of adjuvant radio- and chemotherapy increased the 5-year survival rate from approximately 30-40% in the early 1960s to almost 60% in the late 1990s. The cost of public health care has risen considerably, and case-costing systems are increasingly demanded. Linked to clinical guidelines and quality registers, such control systems form a proper basis for quality assurance projects and improvement. The aim of this thesis is to describe the efficiency and cost effectiveness of colorectal cancer treatment in a defined Swedish population. Emergency surgery for colon cancer, constituting 25% of the cases, increased both mortality and cost. Among emergency cases there was not only an increase in postoperative mortality but also a stage specific decrease in long-term survival rate. Correct staging is decisive for further treatment of patients after colon cancer surgery and influences long-term survival. The number of lymph nodes examined varied between different pathology departments and could be used as a quality measurement. The proportion of tumour stage III increased the more nodes examined. A prognostic estimation of stage III cases that is less sensitive to the number of nodes examined is proposed. A case-control study aimed at identifying risk factors for anastomotic leakage after rectal cancer surgery confirmed previously known risk factors but failed to identify further steps during the perioperative course that were amenable to improvement. This research has confirmed that population-based quality and case-costing registers, linked to clinical guidelines, constitute a proper source for projects of quality improvement and decisions about distribution of resources in health care.</p>

Colorectal cancer is one of the most common malignancies in Sweden, with more than 5000 new cases annually. Median age at time of diagnosis is approximately 75 years. Owing to the ageing population, the incidence of colorectal cancer is increasing. The improvement in surgical technique and the introduction of adjuvant radio- and chemotherapy increased the 5-year survival rate from approximately 30-40% in the early 1960s to almost 60% in the late 1990s. The cost of public health care has risen considerably, and case-costing systems are increasingly demanded. Linked to clinical guidelines and quality registers, such control systems form a proper basis for quality assurance projects and improvement. The aim of this thesis is to describe the efficiency and cost effectiveness of colorectal cancer treatment in a defined Swedish population. Emergency surgery for colon cancer, constituting 25% of the cases, increased both mortality and cost. Among emergency cases there was not only an increase in postoperative mortality but also a stage specific decrease in long-term survival rate. Correct staging is decisive for further treatment of patients after colon cancer surgery and influences long-term survival. The number of lymph nodes examined varied between different pathology departments and could be used as a quality measurement. The proportion of tumour stage III increased the more nodes examined. A prognostic estimation of stage III cases that is less sensitive to the number of nodes examined is proposed. A case-control study aimed at identifying risk factors for anastomotic leakage after rectal cancer surgery confirmed previously known risk factors but failed to identify further steps during the perioperative course that were amenable to improvement. This research has confirmed that population-based quality and case-costing registers, linked to clinical guidelines, constitute a proper source for projects of quality improvement and decisions about distribution of resources in health care.