Developed with the intention to make the patient data storage system in the clinical outpatient area more efficient, this system stores all pertinent and relevant patient data such as lab results, patient history and X-ray images. The system is accessible via the internet as well as operable over a local area network (LAN). The intended audience for this program is essentially the clinical staff (e.g., physicians, nursing staff, secretarial staff). The computer program was developed using Java Server Pages (JSP) and utilizes the Oracle 9i database.

Artefakter försvårar analys av långtids-elektrokardiografi-registrering (LTER) och resulterar i en försämrad diagnostisk säkerhet. Minimering av mängden artefakter spelar således en väsentlig roll för ställandet av rätt diagnos. Syftet med denna studie var att jämföra om mängden artefakter, som uppkom vid 24-timmars LTER på patienter, skiljde sig åt med och utan fixering av elektroderna. Populationen bestod av trettio patienter som var inbokade för 24-timmars LTER vid Länssjukhuset Ryhov i Jönköping. Patienterna delades in i två grupper med femton patienter i varje grupp. På grund av fyra externa bortfall bestod det slutgiltiga urvalet av tretton studiedeltagare i vardera gruppen. I grupp A användes ett tubnät för att hålla kablarna på plats och i grupp B fixerades varje elektrod och kabel med Mefix. Grupperna jämfördes sedan avseende mängden artefakter som uppkom under registreringsperioden.  För att analysera om det förelåg någon signifikant skillnad i artefaktuppkomst mellan grupperna användes Wilcoxons rangsummetest. Rangsummorna för respektive grupp beräknades och jämfördes med ett kritiskt intervallvärde. Rangsummorna låg inom intervallet för det kritiska värdet, varpå nollhypotesen ej kan förkastas. Följaktligen förelåg ingen signifikant skillnad i mängden uppkomna artefakter mellan grupperna. På grund av ett litet urval samt brister i undersökningsförfarandet kunde dock inga grundade statistiska slutsatser konkluderas. / Artefacts complicate the analysis of long-term electrocardiography-registration (LTER) and result in a worsened diagnostic accuracy. Thus, minimization of the amount of artefacts plays a vital role in the making of a correct diagnosis. The aim of this study was to compare if the amount of artefacts that occurred during 24-hour LTER on patients, differed with and without electrode fixation.  Thirty patients who underwent a 24-hour LTER, at Länssjukhuset Ryhov in Jönköping, were included in the study and divided into two groups. In group A; a tubular net bandage was used to keep the electrocardiography (ECG) cables in place. In group B, the electrodes and ECG cables were fixated with Mefix. A comparison was made, between the groups, regarding the amount of artefacts that occurred during the registration period.  To analyze if there was a significant difference between the groups, Wilcoxon rank sum test was applied. The result proved to be within the range limits of the critical value, which implies that the null hypothesis cannot be rejected. Hence, there was no significant difference regarding the amount of artefacts that occurred. However, because of a small sample volume and shortfalls in the study procedure, no founded statistical conclusions could be drawn.

published_or_final_version / Mental Health / Master / Master of Social Sciences

Approximately 65% of all surgeries are conducted in the outpatient surgery setting involving more than 35 million patients. Thirty-five to fifty percent of these outpatients will experience post discharge nausea and vomiting (PDNV), nausea and vomiting that occurs after discharge from the health care facility after surgery. A dearth of literature details the problems associated with nausea and vomiting experienced by patients after discharge home from outpatient surgery. The purposes of this dissertation were to (1) review the current knowledge in the area of post discharge nausea and vomiting; (2) present results of an integrative review of the research literature to determine best evidence for prevention of PDNV in adults or rescue of patients who suffer from post discharge nausea and vomiting (PDNV); (3) present a critical review and analysis of measurement of nausea and vomiting after discharge from outpatient surgery, and (4) present findings of a prospective research study. The purposes of the research study were to: 1) describe the incidence and severity of PDNV over a 7-day period in a sample of adult surgical patients undergoing outpatient surgeries under general anesthesia, 2) describe the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, 3) compare the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and 4) determine outcomes associated with PDNV. This study was part of a multi-site study that had as a primary objective development of a simplified risk model for predicting patients most likely to suffer PDNV. In this research study we described the incidence and severity of PDNV in adult outpatients after ambulatory surgery, described the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, compared the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and determined outcomes associated with PDNV.

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No description available.

Coordination is a vital component in health care provision and teamwork. The need for better coordination is particularly prominent in outpatient setting where patients assume the primary responsibility to follow-up on their own health care, especially when treatment is complex and lengthy in duration. Relational coordination represents a type of informal coordination process reinforced by communication and supportive relationships. This concept has been associated with enhanced interprofessional team performance, including patient care outcomes. This study aimed to examine the theoretical underpinnings of relational coordination in the outpatient setting using social capital theory. It was hypothesized that social capital, resources embedded within network of relationships, would predict relational coordination. Additionally, social capital was hypothesized to be predicted by team tenure; and relational coordination was hypothesized to be predicted by formal coordination mechanisms. A non-experimental, cross-sectional survey design was used to examine the relationship between social capital and relational coordination. Participants (N=342) were physicians and nurses recruited from outpatient clinics in two University affiliated hospitals. Study surveys were sent to 501 nurses and 187 physicians with follow-up reminders sent at three, five and seven weeks after the initial distribution of surveys. The overall response rate was 49.71%. Study variables were measured using previously validated instruments with acceptable levels of reliability and validity. Structural equation modeling (SEM) was used for hypothesis testing. Final analysis revealed good fit of data to the hypothesized model (Chi-square=383.38, df=177, p<0.001; CFI=0.966; RMSEA=0.060; SRMR=0.0316). SEM revealed that social capital predicted both factors of relational coordination [communication (β=0.70, p<0.001); supportive relationship (β=0.81, p<0.001)], and team tenure predicted social capital (β=0.13, p<0.05). In addition, the association between team tenure and relational coordination (β=0.09, p<0.05) was found to be partially mediated by social capital. Findings of this study suggested that characteristics within relational ties are predictive of informal coordination. Administrators may facilitate teamwork through team building initiatives that foster these relational qualities, such as trust and shared language. Future research can further investigate the association between social capital and relational coordination in other health care settings, as well, in larger teams involving health care professionals in addition to physicians and nurses.

Enhancing primary care is key to the Canadian health care reform. Considered as an indicator of primary care access and quality, hospitalisations for ambulatory care sensitive (ACS) conditions are commonly reported by Canadian organisations as sentinel events signaling problems with the delivery of primary care. However, the literature calls for further research to identify what lies behind ACS hospitalisation rates in regions with a predominantly urban population benefiting from universal access to health care. A theoretical model was built and, using an ecological design, multiple regressions were implemented to identify which neighbourhood characteristics explained the socio-economic gradient in ACS hospitalisation rates observed in Ottawa. Among these neighbourhoods, healthy behaviour and - to a certain extent - health status were significantly associated with ACS hospitalisation rates. Evidence of an association with primary care accessibility was also signaled for the more rural neighbourhoods. Smoking prevention and cessation campaigns may be the most relevant health care strategies to push forward by policy makers hoping to prevent ACS hospitalisations in Ottawa. From a health care equity perspective, targeting these campaigns to neighbourhoods of low socio-economic status may contribute to closing the gap in ACS hospitalisations described in this current study. Reducing the socio-economic inequalities of neighbourhoods would also contribute to health equity.

No description available.

Background: In patients with diabetes, high blood pressure is an established risk factor for cardiovascular disease. The aim of this thesis was to explore the associations between blood pressure levels measured with different techniques and during different circumstances, and the degree of cardiovascular organ damage and subsequent prognosis in patients with diabetes. Methods: We analysed baseline data from patients with type 2 diabetes who participated in the observational cohort study CARDIPP (Cardiovascular Risk factors in Patients with Diabetes – a Prospective study in Primary care), and longitudinal data from patients registered in the Swedish national quality registry RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive care Admissions). Patients in CARDIPP underwent nurse-recorded, 24-hour ambulatory and non-invasive central blood pressure measurements. Patients in RIKS-HIA had their systolic blood pressure measured upon hospitalisation for acute chest pain. Results: In CARDIPP, nearly one in three patients with office normotension (&lt;130/80 mmHg) were hypertensive during the night (≥120/70 mmHg). This phenomenon, masked nocturnal hypertension, was significantly associated with increased arterial stiffness and increased central blood pressure. Furthermore, nearly one in five CARDIPP patients with office normotension had high central pulse pressure (≥50 mmHg), and there was a significant association between high central pulse pressure and increased carotid intima-media thickness and increased arterial stiffness. Among CARDIPP patients who used at least one antihypertensive drug, those who used beta blockers had significantly higher central pulse pressure than those who used other antihypertensive drugs, but there were no significant between-group differences concerning office or ambulatory pulse pressures. In CARDIPP patients with or without antihypertensive treatment, ambulatory systolic blood pressure levels were significantly associated with left ventricular mass, independently of central systolic blood pressure levels. When RIKS-HIA patients, admitted to hospital for chest pain, were stratified in quartiles according to admission systolic blood pressure levels, the risk for all-cause one-year mortality was significantly lower in patients with admission systolic blood pressure in the highest quartile (≥163 mmHg) than in patients with admission systolic blood pressure in the reference quartile (128-144 mmHg). This finding remained unaltered when the analysis was restricted to include only patients with previously known diabetes. Conclusions: In patients with type 2 diabetes, ambulatory or central blood pressure measurements identified patients with residual risk factors despite excellent office blood pressure control or despite ongoing antihypertensive treatment. Ambulatory systolic blood pressure predicted left ventricular mass independently of central systolic blood pressure. In patients with previously known diabetes who were hospitalised for acute chest pain, there was an inverse relationship between systolic blood pressure measured at admission and the risk for one-year all-cause mortality.