Introduktion: Stroke drabbar över 30000 människor per år i Sverige. Vanliga symptom efter en stroke involverar motoriska problem, spasticitet och mer eller mindre uttalad halvsidesförlamning. Konsensus för rehabilitering är att så tidigt som möjligt utföra rehabilitering med tidig mobilisering och påbörja rörelse- och gångträning. Detta utförs enligt beprövad erfarenhet enligt ett systematiskt konsensusförfarande men det vetenskapliga underlaget bedöms som otillräckligt. Detta skapar frågan hur tidig kan rehabiliteringen påbörjas efter stroke och vilka effekter det medför. Syfte: Syftet med denna studie var att sammanställa konsekvenserna av ökad intensitet och tidigt initierad strokerehabilitering jämfört med ordinär behandling. Metod: Sökning utfördes i databaserna SportDiscuss, PubMed och CINAHL vilket gav sammanlagt 7 relevanta artiklar som inkluderades i studien. Resultat: Riskfaktorer i form av maladaptiva förändringar och ökad dödlighet kunde härledas till en tidigare och intensivare rehabilitering. Detta kunde kopplas mot en neurologisk teorier om hjärnans plasticitet. Konklusion: Denna litteraturstudie har visat på att det finns en indikation på att en tidig intensiv mobilisering och rehabilitering efter stroke kan innebära risker för patientens hälsa. En viloperiod efter stroke försämrar ej möjligheten till att återfå lika god fysisk förmåga som vid tidig rehabilitering. Mer forskning behövs för att hitta en optimal balans mellan vila och fysioterapeutiska behandlingsmetoder för att uppnå en bättre rehabilitering för strokedrabbade patienter.

Syfte – Syftet med denna studie är att kartlägga hur digitala tidsbokningar i sjukvården används i nuläget, identifiera brister och ta fram förbättringsförslag för att skapa en effektivare tidsbokningsprocess. För att uppfylla syftet har tre frågeställningar formulerats: 1. Hur används digitala tidsbokningar i nuläget? 2. Vilka brister finns det i den digitala tidsbokningsprocessen som påverkar effektiviteten? 3. Hur kan den nuvarande digitala tidsbokningsprocessen effektiviseras? Metod – För att kunna uppnå studiens syfte har en fallstudie genomförts på kvinnohälsovården i Jönköping. Fallstudien bestod utav deltagande observationer och dokumentstudier. Även en litteraturstudie har genomförts vilket har legat till grund för det teoretiska ramverket som använts för analys av empiriska data. Resultat – I studien framkom det att kvinnohälsovården till viss del använder sig av digitala tidsbokningar. Fyra brister identifieras i tidsbokningsprocessen som påverkade effektiviteten. Dessa var schemaläggning, begränsat utbud på 1177, bristande användning av prognoser samt samordning. Efter att dessa brister identifierats kunde tre förbättringsförslag formuleras med syfte till att effektivisera tidsbokningsprocessen. Det första förbättringsförslaget gäller ett utökat utbud av tillgängliga tider på 1177. Det andra förbättringsförslaget handlar om hur prognoser kan användas i större utsträckning vid schemaläggning och planering av tillgängliga tider på 1177. Slutligen handlar det tredje förbättringsförslaget om hur en större samordning kan bidra till minskad tid för administration för barnmorskorna. Implikationer – I studien har brister identifierats och förbättringsförslag har tagits fram gällande hur tidsbokningsprocessen ska effektiviseras. Genom användning av förbättringsförslagen kan verksamheten bli mer samordnad och med hjälp av prognoser kunna tillgodose den efterfrågan som finns. Förbättringsförslagen skulle innebära nya arbetsrutiner för kvinnohälsovården. Ingen ny teori har skapats utifrån studien då den är baserad på redan existerande teori. Begränsningar – Studien utfördes endast på ett fallföretag vilket kan påverka studiens generaliserbarhet. Förbättringsförslagen gällande hur tidsbokningsprocessen kan effektiviseras har enbart beskrivits på ett teoretiskt plan och inte testats i praktiken. Studien har även främst varit av kvalitativ karaktär vilket medför att inga mätningar har gjorts gällande hur förbättringsförslagen har bidragit till en effektivare tidsbokningsprocess. / Purpose – The purpose with this study is to chart the using of digital appointment bookings in the health care, identify deficits and to generate suggestions for improvements for a more efficient process regarding appointment bookings. To fulfil the purpose three research questions have been formulated: 1. How are digital appointment bookings currently being used? 2. What deficits are there in the digital appointment booking process that affects the efficiency? 3. In what way can the current digital appointment booking process be more efficient? Method – To be able to fulfil the purpose a case study was conducted at women’s health care in Jönköping. The case study consisted of participatory observations and document studies. A literature review was also conducted to establish the theoretical framework that was used to analyze the empirical data. Findings – The study showed that digital appointment bookings are partly being used in the women’s health care. Four deficits that affected the appointment booking process were identified. The deficits were scheduling, a limited supply of appointments at 1177, limited using of forecasts in the scheduling and planning of appointments and lack of coordination. Once these deficits were identified, three suggestions for improvements to a more efficient appointment booking process were formulated. The first suggestion was to extend the supply of appointments at 1177. The second suggestion was regarding how forecasts can be used for scheduling and planning of appointments at 1177 in a greater extent. Lastly, the third suggestion mentioned how a greater use of coordination can contribute to reduced administration for the midwives. Implications – The study identified deficits and suggestions for improvements regarding how the appointment booking process can become more efficient. By using the suggestions, the organization can become more coordinated and by using forecasts be able to meet the demand. The suggestions for improvements would lead to new work procedures for the women´s health care. No additional research has been developed through this study as it was based on already existing theories. Limitations – the study was only executed at one case company which can affect how generalized the results are. The suggestions for improvement regarding how the appointment booking process can become more efficient are only described in the theory and have not been tested in the reality. The study has mainly been a qualitative research which means that no measurements has been performed regarding on how the suggestions for improvements would lead to a more efficient appointment booking process.

Recent advances in information and communication technologies have made the development and operation of complex disease surveillance systems technically feasible, and many systems have been proposed to interpret diverse data sources for health-related signals. Implementing these systems for daily use and efficiently interpreting their output, however, remains a technical challenge. This thesis presents a method for understanding disease surveillance systems structurally, examines four existing systems, and discusses the implications of developing such systems. The discussion is followed by two papers. The first paper describes the design of a national outbreak detection system for daily disease surveillance. It is currently in use at the Swedish Institute for Communicable Disease Control. The source code has been licenced under GNU v3 and is freely available. The second paper discusses methodological issues in computational epidemiology, and presents the lessons learned from a software development project in which a spatially explicit micro-meso-macro model for the entire Swedish population was built based on registry data. / QC 20110520

We need to employ modern-day technologies in our daily lives to make our life easier. In this thesis, we analyze the user’s oral hygiene habits and core body temperature to help people to track the state of their health. We designed a system in which the data are directly extracted from the mouth, then stored and presented in the application. By means of the system, the people can keep track oftheir core temperature without any extra function apart from their daily chores.The system can also help to keep track of the health of people with symptoms ofdementia and Alzheimer. We used an LM35 temperature sensor to measure temperature. The sensor is mounted on a powered toothbrush head. When the user starts to brush, the sensor records the temperature data for seven times in two minutes of an average brush time and sends it to the mobile application using WiFi. We used a NodeMCUboard, ThingSpeak server and MIT inventor app to transfer the data and designthe mobile application.

Healthcare is a very important and intimate service virtually all people use at least at some occasion in a lifetime. It is also highly complex and variable with heterogeneous patients requiring individualised attention in order to be effectively treated. This requires large resources in terms of labour, knowledge, skill, and time which is why in the past, improving productivity has been difficult. Information and communications technology, ICT, has been seen to have potential to improve productivity in e.g. diagnosing, devising treatment plans, communicating with patients and clinical staff, and record-keeping if applied correctly. During mainly the 1990s, the banking sector changed its distribution channel strategy to focus increasingly on Internet banking rather than local branches. If parallels are drawn between the two, such as comparing local branches to clinics, what can a rheumatology department learn? A case study was conducted at Karolinska University Hospital's Department of Rheumatology. Existing communication pathways associated with the clinic-patient communication were identified, theory and knowledge of the banking sector change was compiled and some current efforts of ICT integration in healthcare were briefly reviewed. Finally, the project sought to provide a future vision for communications in rheumatology. Examples of risks and difficulties considered were legal issues, patient safety and the current compensation for the clinics, which today represent a major limitation for strategy formulation. The study identified several key issue areas to consider when implementing ICT in healthcare and the importance of aligning ICT with workflow. Parts of the banks strategic choices are also applicable in healthcare, e.g. using a multi-channel strategy where different customer segments are targeted with different channels. Further, a unified customer management system containing input from patient as well as provider is highly recommended, together with an online portal increasing accessibility for patients. Most importantly, all distribution channels and ICT systems considered for use should be thoroughly integrated with day-to-day workflow.

Providing high-quality health care to everyone who needs it is a central objective for theSwedish health care system. One way in which this goal is broadly pursued is by allocatingresources that maximize the geographical coverage of ambulances, aiming at reducingambulance response times as much as possible, for as many as possible. However, in reality,emergencies tend to be concentrated in space and time. They are more likely to occur atparticular places and times, following people’s routine activities. Likewise, some groups aremore likely to require acute health care, implying that supply needs to be tailored to patientdemand. This thesis investigates the nature of emergency health care (EHC) services byassessing the temporal and the geographical distribution of ambulance services from a supplyand demand perspective using southern Sweden as a study area. Geographical informationsystem (GIS), spatial analysis and regression models underpin the methodology of the study.Findings indicate that there currently exist disparities in access to EHC services in Sweden,both between urban and rural areas and between sociodemographic groups. Depending on howaccessibility is measured, different spatial patterns emerge, suggesting that the current practiceof measuring response times should be complemented by alternative measures of accessibilityin an attempt to reduce inequities in access to ambulances between groups and places. Resultsalso indicate that the demand for EHC services varies both spatially and temporally, and thatdemographic and land use differences can be helpful in explaining such variations. The thesishighlights that currently employed EHC policy goals may entail unexpected inequities in theaccess to and supply of ambulances and, consequently, of EHC. As such, the study opens upfor a discussion on how useful quantitative measures can be in revealing group inequities inaccess to EHC. / Att erbjuda god tillgång till vård för hela befolkningen är ett centralt mål för det svenskavårdsystemet. Detta eftersträvas genom att resurser fördelas på ett sätt som maximerar dengeografiska täckningen av ambulanser, där målet är att minska ambulansers responstider såmycket som möjligt, för så många som möjligt. I verkligheten är akuta situationerkoncentrerade i både tid och rum. De uppstår på specifika platser, vid specifika tidpunkter ochreflekterar till viss del människors rutinmässiga rörelsemönster. Samtidigt löper vissa grupperstörre risk att drabbas av akuta sjukdomar eller skador, vilket insinuerar att tillhandahållandetav resurser behöver skräddarsys efter behov, snarare än populationsmängd. Den härlicentiatavhandlingen undersöker akutvården genom att analysera temporala och geografiskafördelningen av ambulansresurser utifrån ett tillgång- och efterfrågan-perspektiv i södraSverige. Metoderna som studierna baserades på innefattade användandet av geografiskainformationssystem (GIS), rumslig analys och regressionsmodeller. Resultaten indikerar attdet finns skillnader i tillgång till akutvård i Sverige, både mellan stad och landsbygd ochmellan sociodemografiska grupper. Beroende på hur tillgång mäts uppstår olika rumsligamönster av skillnader i tillgång, vilket pekar på att nuvarande sätt att mäta responstid bordekompletteras med alternativa mått. Detta skulle kunna bidra till att minska ojämlikheter itillgång till ambulansvård. Resultaten indikerar också att behov för akutvård varierar över tidoch rum, och att både demografiska variabler och olika typer av markanvändning kan bidratill att förklara sådana variationer. Den här avhandlingen visar på att nuvarande policymålinom akutvård kan leda till oväntad ojämlikhet vad gäller tillgång och efterfrågan tillambulans och, som en konsekvens, till akutvård generellt. Studierna öppnar således upp fören diskussion om hur användbara kvantitativa mått kan vara vad gäller att belysa ojämlikheteri tillgång till akutvård. / <p>QC220420</p>

I dagens samhälle vill människor bli delaktiga och få medbestämmande. Personcentrerad vård medför att sjukvårdens strävar efter att patienten involveras och vården anpassas efter dennes behov och förutsättningar. På så sätt blir vården mer jämlik och kan utföras på ett kostnadseffektivt sätt. Vid utgångsläget på studerat sjukhus utfördes mindre gynekologiska interventioner på operationsavdelningen. Processen var resurskrävande och hade låg patientdelaktighet. Patientkontrollerad sedering (PCS) betyder att patienten styr sederingen själv. På så sätt kan både patientens delaktighet och värdet i mikrosystemet öka. Förbättringsarbetet innebar att utbilda sjuksköterskor från kvinnoklinikens mottagning att erbjuda PCS självständigt utan att anestesisjuksköterskan deltar. Då skapas möjlighet att utföra vissa interventioner på mottagningen istället för på operation. Syftet med förbättringsarbetet var att öka patientens delaktighet genom att införa patientkontrollerad sedering vid gynekologiska interventioner på kvinnoklinikens mottagning, Värnamo sjukhus. Eftersom detta arbetssätt inte är vedertaget var studiens syfte var att undersöka medarbetarnas erfarenheter av att erbjuda patientkontrollerad sedering. Förbättringsarbetet utgick från Nolans förbättringsmodell och strukturen i förbättringsrampen. Värdekompassens perspektiv och mätetal användes för att belysa effekten av förändringen, både för patienten, medarbetarna och verksamheten. Studien genomfördes med kvalitativ metod med hjälp av semistrukturerad fokusgruppintervju av medarbetare på kvinnoklinikens mottagning, Värnamo Sjukhus. Förbättringsarbetet resulterade i en funktionell sederingsmetod och ett förändrat mikrosystem för kvinnor som ska genomgå gynekologiska interventioner. Förbättringsarbetet stärkte patientens delaktighet och ökade möjligheten att bli en aktiv medspelare i sin egen vård. Samtliga värdekompassens balanserade mått påvisade att arbetssättet var välfungerande, patientsäkert och uppskattat både av patienter och medarbetare. Ytterligare effekt var att medarbetarnas kompetens ökade och att samverkan mellan klinikerna förbättrades. Studien påvisade att medarbetarna upplevde att det nya arbetssättet stärkte den personcentrerade vården. Införandet av PCS upplevdes både relationsskapande, engagerande och resurskrävande. / In modern society people prefer participation and co-determination. Person-centred care leads health care to involve the patient and the care adapts to the patient´s needs and conditions. This way the care will be more equal and can be performed in a more cost-effective way. Originally gynaecological interventions were costly performed in the operating room (OR) with lack of participation. Patient- controlled sedation (PCS) means that the patient controls the sedation itself. With this the patient's participation grows and increases value in the microsystem. The Quality improvement (QI) involved to teach nurses at the out-patient clinic (OPC) to handle PCS by themselves, without an anaesthetic nurse attending. In this way some interventions could be performed in the OPC instead of in the OR. The purpose of QI was to increase patient-participation by introducing PCS during interventions at the gynaecological OPC at Värnamo hospital. The study aimed at determining the co-worker's experiences when introducing PCS. The QI started from Nolans improvement model and the structure in the improvement ramp. The value-compass and measurements were used to evaluate the effects of the changes. The study was performed in a qualitative method with inductive approach using focus-group interview with co-workers at the gynaecological OPC. By introducing PCS in the QI women became participants in the gynaecological OPC. The QI resulted in that more interventions could safely be performed in the OPC. The new procedure makes the patient an active co-player, the competence of the co-workers rises, the collaboration between the clinics grows and the care is performed at the right level of care.  The study showed that the co-workers experienced increased patient-centered care. The QI built relationships, was engaging and demanding resources.

Statistik visar att ransomware har ökat lavinartat de senaste åren, inte minst under den rådande Covid-19-pandemin. Cyberkriminella har kommit att utnyttja sjukhus runt om i världen som redan är överbelastade med att ta hand om patienter svårt sjuka i Covid-19. I denna uppsats undersöks det hur de svenska sjukhusen upplever och hanterar det ökade hotet av ransomware. Den utgörs av en litteraturstudie och några djupintervjuer. Litteraturstudien görs för att utforska fenomenet ransomware och ta reda på varför ransomware är en framgångsrik metod för kriminella att använda vid utpressning. Syftet är även att undersöka hur svenska sjukhus förhåller sig till att hälso- och sjukvårdssektorn har blivit attraktiva mål för cyberangrepp. I intervjustudien undersöks sjukhusens IT-säkerhet för att kartlägga om de är tillräckligt motståndskraftiga mot ransomware-angrepp. Intervjusvaren diskuteras och analyseras mot bakgrund av litteraturen. Slutsatsen av denna analys ligger till grund för åtgärdsförslag. Resultatet visar att sjukhusen/regionerna som tillfrågats har en bra IT-säkerhet. De mest centrala säkerhetsmekanismerna för verksamheterna är deras backup- och återställningsrutiner i kampen mot ransomware. Diskussionen i arbetet sammanfogar resultatet från både litteraturstudien och intervjustudien som genomförts. Utifrån diskussionen dras sedan slutsatsen att regionerna som tillfrågats har bra säkerhet och uppfyller de flesta av rekommendationer som publicerats av svenska myndigheter. Inte desto mindre resulterar studien i några uppslag till förbättringar i säkerhetsrutiner. / Statistics show an increase in ransomware activity in recent years. The increase is mainly due to the ongoing Covid-19 pandemic. Cybercriminals take advantage of the fact that hospitals worldwide are overloaded with caring for seriously ill patients in Covid-19 and perform ransomware attacks. This thesis examines how Swedish hospitals experience and handle the increased threat of ransomware. The bachelor’s thesis consists of a literature study and some in-depth interviews. The literature study is investigating ransomware as a phenomenon and finding out why it is a successful method for cybercriminals to use in digital extortion. The purpose is also to investigate how Swedish hospitals relate to the fact that the healthcare sector has become an attractive target for cyber-attacks. The interview study examines the hospitals' IT security to determine whether they are sufficiently resistant to ransomware attacks. The interview results are discussed and analyzed against the background of the literature. The conclusion of this analysis is the basis for the proposed countermeasure. The results show that the hospitals surveyed have suitable IT security. The most central security mechanisms for the hospitals are their backup and recovery routines in the fight against ransomware. The discussion in this work combines the results from the literature and interview studies carried out. Based on the discussion, the conclusion is that the hospitals surveyed have good security and meet most of the recommendations published by Swedish authorities. Still, there is room for some improvement which is indicated.

INTRODUCTION: The study focuses on finding a methodology for evaluating the effectiveness of the nonpharmaceutical intervention in the face of a new pathogen entering the population. Different interventions can have different effectiveness levels in different populations; thus, studying possible correlations and effectiveness among different groups is essential. With better knowledge of the topic, the outbreak management could be done more cost-effectively, reducing the need for antibiotics, vaccines, and possible reduction of infectious diseases caused burden in developing regions. Furthermore, the study aims to determine the ways of using excess mortality as an evaluation technique for nonpharmaceutical interventions used in the Covid-19 pandemic.  METHOD: The variables in time-series format were used to calculate a cross-correlation score alongside other correlation coefficient tests. With the cross-correlation, the lag will be established to estimate how the variables correlate in the timeline. In addition, the study will attempt to establish the connections between different nonpharmaceutical interventions and their strengths and different age groups. RESULTS: The most frequent lag scores identified were 1 with 16 observations and 2 with 9 observations. The highest lag score was 4, which was observed once for the dataset of Hungary. The correlation between excess mortality and different harshness of NPI's was calculated. The correlation coefficient ranges from -0.3 to -0.39, indicating an overall low to medium correlation. The highest correlation was detected with stay-at-home requirements (-0.36), workplace closing (-0.37), and gathering restrictions (-0.39). In the final step, age-based correlations were established. The correlation ranged from 0.26 – 0.36, indicating an overall medium correlation. The lowest correlation can be seen in the youngest age group, 15-64 (correlation coefficient of 0.26), while the highest correlation of 0.36 can be seen in the 75-84 age group. Surprisingly the age group 85+ had a little lower correlation than the 75-84 age group. DISCUSSION AND CONCLUSIONS: A stronger correlation between excess mortality and stringency index was detected in the countries with a higher death per capita. The two groups of intervention effectiveness were established: more effective (school closing, workplace closing, public event limitation, gathering restriction, and stay at home requirement) and less effective (public transport limitation, restriction on internal movement, international travel control, public information campaigns, protection of elderly campaigns). This suggests that NPI effectiveness depends on population size. In the age-group-based analysis, the correlation became stronger with the age increase, indicating nonpharmaceutical intervention effectiveness against high mortality in older adults.

One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient. Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs. The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care. The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions. Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways. This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway. Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation. This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.