<p><p><strong>Bakgrund: </strong>Smärtor i ben är vanligt förekommande och neuropati (nervskada) är en orsak som troligen är underdiagnostiserad. Bimanuell (tvåhändig/tvåsidig) nervpalpation och känseltest med sporre har visat sig vara ganska tillförlitliga och enkla test för att hitta nervskada men har inte testats på friska individer.</p><p><strong>Syfte: </strong>Syftet var att undersöka om bimanuell nervpalpation i fossa poplitea framkallar smärta/obehag och om det finns skillnad mellan vänster och höger sida vid bimanuell undersökning med sporre på underben hos friska försökspersoner.</p><p><strong>Metod: </strong>Ett bimanuellt palpationstest av nervi tibialis och peroneus i fossa poplitea och även ett bimanuellt känseltest med sporre över dermatomen L4, L5 och S1 på underben genomfördes. Urvalet var ändamålsenligt och totalt deltog 37 försökspersoner. Åldersspannet var 20 till 57 och medianålder 23.</p><p><strong>Resultat: </strong>Vid palpationstestet hade intensiteten av smärta/obehag en median på 1 (variationsvidd 3) på den 11 gradiga skalan. En stor del skattade olika mellan sidorna i både palpationstestet (11 av 37) och känseltestet med sporre (25 av 37). Det var inte någon större skillnad mellan könen.</p><p><strong>Slutsats: </strong>När man utför dessa nervtester måste man ta hänsyn till att även friska individer ofta anger en liten sidoskillnad och inte alltid skattar noll vad gäller smärta/obehag. Det behövs dock fler studier för att bekräfta dessa resultat.</p></p> / <p><strong>Background: </strong>Leg pain is common and neuropathy (nerve disease) is one reason which probably is under diagnosed. Bimanual (bilateral) nerve palpation and sensory test with spurs has been shown to be quite reliable. Furthermore, the tests are straight forward detecting nerve disease but have not been tested on a healthy population.</p><p><strong>Purpose: </strong>The purpose was to investigate whether peripheral nerve palpation in fossa poplitea induces pain/discomfort, and if side difference exists in a sensibility test with spurs on the lower leg in healthy subjects.</p><p><strong>Method: </strong>A bimanual palpation test of the tibial and peroneal nerve in fossa poplitea and also a bimanual sensibility test with spurs of dermatome L4, L5 and S1 on the lower leg were carried out. In order to find healthy subjects a purposive sampling was made. A total of 37 subjects between 20 and 57 years with a median age of 23 participated in the study.</p><p><strong>Results: </strong>At the palpation test the intensity of pain/discomfort had a median of 1 (range 3) in the 11 degrees of pain scale. A large part estimated differences between the sides in both the palpation test (11 of 37) and the sensibility test with spur (25 of 37). There was no significant difference between the sexes.</p><p><strong>Conclusion: </strong>When performing these nerve tests it is important to keep in mind that even healthy individuals might perceive some pain/discomfort as well as side difference. However, we need more studies to confirm these results.</p>

<p>In the essay, the view of mistakes and disciplinary sanctions within the military aviation and health and medical service, are compared. The comparison shows that military aviation and health and medical service could have several points in common on how mistakes may occur, but that the present view of mistakes is different betwen the sectors. The view of mistakes and disciplinary sanctions is explicit within military aviation, and is based on a clear ideology on how mistakes occur, which is characterised of a systematic approach. Within health and medical service, an explicit and unequivocal ideology on how mistakes occur is missing, but, however, there are implicit ideas about infallibility and perfection. The comparison indicates that the view of mistakes is also, possibly directed by a bureaucratic model (instead of an ideology on mistakes), which aims to legitimacy, but that this may happen on the expense of not taking surrounding circumstances into consideration. In that way there may be a certain contrast in the health and medical service’s present system between rule of law and medical service safety.</p>

<p>Motion är viktigt för vår hälsa, men många som börjar motionera slutar inom en snar framtid (Fallon, Hausenblas, & Nigg, 2005). Det är därför viktigt att utveckla strategier som motiverar människor till träning. Visualisering är en teknik som visats ha en motivationshöjande effekt hos motionärer. Kim och Giacobbi (2009) menar dock att det finns ett behov av att skilja på innehåll, syfte och effekter inom motionsvisualiseringen och att ett nytt mätinstrument därför behövs. Syftena med studien var därför att: (1) utveckla och testa mätinstrumentet the Individual Profile of Imagery Experiences in Exercise (IPIEE; Weibull & Johnsson 2010), samt att (2) studera motionärers frivilliga och spontana visualiseringsupplevelser. De teoretiska referensramarna som användes var Den Analytiska Referensramen för Visualiseringsupplevelser (Weibull, 2009) samt An Applied Model of Imagery Use in Exercise (Munroe-Chandler & Gammage, 2005). Resultat visar att IPIEE fungerade väl, att motionärerna använde flest frivilliga visualiseringsmönster för syftet motivation och att flest spontana visualiseringsmönster hade effekt på motivationen. De vanligaste innehållen i visualiseringsmönstren var Träningssituationer följt av Icke träningsrelaterade händelser/situationer. Resultaten diskuteras i relation till teoretiska referensramar samt tidigare forskning.</p> / <p>Exercise is important for our health, but many who start exercise drop out in the near future (Fallon, Hausenblas, & Nigg, 2005). It is therefore important to develop strategies that motivate people to exercise. Imagery has been shown to have a motivating effect on exercisers. Kim and Giacobbi (2009) argue that there is a need to distinguish between content, functions and effects in exercise imagery and that a new instrument therefore is needed. The objectives of this study were therefore to: (1) develop and test the instrument Individual Profile of Imagery Experiences in Exercise (IPIEE; Weibull & Johnsson 2010) and (2) study exercisers’ voluntary and spontaneous imagery experiences. The theoretical frameworks that were used were the Analytic Framework of Imagery Experiences (Weibull, 2009) and An Applied Model of Imagery Use in Exercise (Munroe-Chandler & Gammage, 2005). The result shows that IPIEE worked well, that voluntary imagery was mostly used to increase motivation and the most spontaneous imagery patterns had an effect on motivation. The most common contents were Exercise situations followed by Non-exercise related events/situations. The results are discussed in relation to theoretical frameworks and previous research.</p>

<p><strong>Introduction </strong>In order to foster innovation of medical devices within the healthcare sector, a collaboration project, PUSH, has been initiated including the hospitals managed by the Stockholm County Council. The collaboration aims to capture ideas from employees and turn them into so called “high-practice” products as well as facilitate the possibilities for medical device companies to try out their products in the settings of healthcare. Collaborations for innovation, comparable to the PUSH project, can be found in both Swedish and foreign regions, but some of them fail to survive due to obstacles affecting the progress of each collaboration. Avoiding the same destiny will be a challenge to the PUSH project.</p><p><strong>Purpose </strong>The purpose is to search for factors affecting organizational collaboration concerning innovation systems for medical device development. The study is focusing on ”high-practice” products within the PUSH project.</p><p><strong>Theoretical approach </strong>In order to emphasize factors affecting innovation, theories regarding innovation systems, clusters and networks has been studied hence they  all concern organizational collaboration.</p><p><strong>Method </strong>The study’s qualitative approach is based on a semi deductive method. The analysis derives from a deductive outlook consistent with chosen theories, whereas collected data is used inductively to stress and enlarge part of the theoretical framework. Semi structured interviews, earlier research and evaluations constitutes most of the collected data.</p><p><strong>Results and analysis </strong>Experience from collaborations for innovation shows that some affecting factors can’t be influenced by collaborators, as political decisions and medical device directives. Collaborators can however affect circumstances such as connections and networking, which is significant to manage the innovation process; from idea to commercialization. An explicit focus on commercialization is important to the collaboration project’s surviving opportunities. A central cause why innovation projects don’t last is lack of funding, both for commercializing certain products as well as for retaining and developing existing innovation structures.</p><p><strong>Conclusion </strong>Collaborating projects should utilize existing structures and complement their networks to involve extensive competency. Decision makers need to decide whether innovation ventures shall be part of the County Council’s assignment. To fulfil the visions of the collaboration project, a policy common to all participants in the forthcoming innovation project needs to be stated, regarding ownership relations, risk sharing, funding and sharing of profits.</p> / <p><strong>Bakgrund </strong>För att främja medicinteknisk innovation inom vården har ett utvecklingsprojekt för samverkan mellan Stockholms landstingsstyrda sjukhus påbörjats, under namnet PUSH (Produktutveckling inom Stockholms hälso- och sjukvård). Syftet med samverkan är att ta vara på landstingspersonalens idéer och utveckla s.k. high-practice-produkter samt att underlätta för medicintekniska företag att testa produkter i vårdmiljö. Liknande innovationssatsningar finns på olika håll i Sverige och utomlands, men det har varit problematiskt att få flera av dessa att överleva, då olika omständigheter påverkar utvecklingen av satsningarna. Samverkansprojektet mellan sjukhusen står således inför en rad utmaningar om de inte ska gå samma öde till mötes.</p><p><strong>Syfte </strong>Syftet är att undersöka omständigheter som är centrala för organisatorisk samverkan inom innovationssystem för utveckling av medicinteknik. Utgångspunkten är utveckling av ”high-practice-produkter” inom projektet PUSH.</p><p><strong>Teoretisk ansats </strong>För att belysa innovationspåverkande omständigheter i studien, har teorier om innovationssystem, kluster och nätverk studerats, utifrån att de behandlar organisatorisk samverkan.</p><p><strong>Metod </strong>Studiens kvalitativa upplägg bygger på ett semideduktivt tillvägagångssätt. Utifrån ett deduktivt synsätt utgår analysen från befintliga teorier medan empirin på ett induktivt sätt ligger till grund för att framhålla och vidga delar av teorierna. Insamlad data utgörs till stor del av semistrukturerade intervjuer och tidigare undersökningar och utvärderingar.</p><p><strong>Resultat och analys </strong>Erfarenheter från samverkansprojekt för innovationer visar att projekten påverkas delvis av omständigheter som ligger utanför projektens kontroll, som innovationspolitiska beslut och medicintekniskt regelverk. Påverkningsbara omständigheter är exempelvis att innovationsprojekt är beroende av ett välutvecklat kontaktnät som sträcker sig över hela innovationsprocessen, från utveckling av idén till kommersialisering. För långsiktig överlevnad är ett uttalat kommersialiseringsfokus av största vikt för projekten. En central orsak till att innovationsprojekt inte överlever på lång sikt är att det saknas finansiering, dels för kommersialisering av enskilda produkter och dels för att behålla och utveckla befintliga innovationsstrukturer.</p><p><strong>Slutdiskussion </strong>För samverkansprojekt bör befintliga strukturer utnyttjas och kompletteras med en utvidgning av nätverket för att involvera en bredare kompetens. Beslutsfattare måste ta ställning till om huruvida innovationssatsningar ingår i landstingets uppdrag. En gemensam policy för ägarförhållanden och risktagande, finansiering och fördelning av eventuella vinster måste utarbetas om samverkansprojektets visioner ska kunna uppnås.</p>

<p>Background: Because of the high unhealthy rates among women in the com-mune a project to reduce it have begun. For this reason we have been given the mission from the commune of Sotenäs to study the character of these women's health. Objective: To study the health among permanent employed women in the commune of Sotenäs. Method: Quantitative method. The data have been collected through question-naire survey. The purpose of choosing this method was to be able to see connec-tions between various variables. Result: A large number of women who do not have time to carry out their duties during ordinary working hours have experienced that they are tense and anxious, which means that this mental demand may have affected women's health. The study reveals that many of the women who have not received enough informa-tion from their employer to perform their duties have experienced that they are worn out. The majority of women who lacked in development opportunities at work felt tense. These results imply that small decision latitudes could be one of the explanations of a lower level of health among women. The study identified a number of potential explanations for the sick leave in the commune, as the women felt tense and anxious. Adequate emotional support from friends and family, and a satisfactory everyday social life was related to a low degree of anxiety. A good distribution of practical domestic duties at home was a factor related to a low degree of tension among the permanent employed women in the commune of Sotenäs.</p> / <p>Bakgrund: På grund av det höga ohälsotalet bland kvinnorna i Sotenäs kom-mun har ett arbete med att reducera detta påbörjats. Vi fick därför i uppdrag av Sotenäs kommun att undersöka karaktären på dessa kvinnors hälsa.</p><p>Syfte: Att kartlägga hälsan bland tillsvidareanställda kvinnor i Sotenäs kommun och hur den påverkas av psykosociala faktorer i arbets- och privatliv.</p><p>Metod: Kvantitativ metod. Datainsamlingstekniken som tillämpades var enkät. Denna valdes för att kunna genomföra sambandsanalyser mellan olika faktorer.</p><p>Resultat: Ett stort antal kvinnor som inte hinner utföra sina arbetsuppgifter un-der ordinarie arbetstid uppgav att de är spända och utslitna, vilket innebär att detta psykiska krav kan ha påverkat kvinnornas hälsa. I undersökningen fram-kom vidare att många av kvinnorna som inte mottagit tillräckligt med informa-tion från sin arbetsgivare för att utföra sina arbetsuppgifter att de kände sig ut-slitna. Majoriteten av kvinnorna med bristande utvecklingsmöjligheter i arbetet kände sig spända. Dessa resultat antyder att ett litet beslutsutrymme kan vara en av förklaringarna till en lägre grad av hälsa bland kvinnorna. I undersökningen framkom några möjliga förklaringar till sjukskrivningarna i kommunen, såsom att kvinnorna kände sig spända och utslitna. Ett tillfredsställande emotionellt stöd från vänner och familj, samt ett tillfredsställande vardagligt socialt liv kun-de relateras till en låg grad av oro. En god fördelning av praktiska vardagssyss-lor i hemmet var faktorer, vilka kunde relateras till en låg grad anspänning bland de tillsvidareanställda kvinnorna i Sotenäs kommun.</p>

<p>This study proposes that poor understanding of the structures, processes and outcomes of organisations seriously hampers collaboration between professional groups in care organisations. Three care settings were investigated: follow-up of patients with heart disease, an intensive care unit and care services for older people.</p><p>The overall aim was to investigate how people understand structures, processes and outcomes in care organisations. The participants were patients, patient representatives, healthcare professionals, managers and politicians.</p><p>A qualitative approach was used. Thematic analysis and grounded theory were employed in analysing the data.</p><p>Despite considerable efforts, no major changes took place over a 7-year period as to how cardiac follow-up services were understood. The system of cardiac follow-up services was found fragmented in its organisation and in the way individuals understood it. The results indicate that care professionals, patients and leaders have dissimilar understandings. The data suggest that care is organised from a professional-centred perspective rather than from a holistic worldview of the patients’ total context. Leaders in intensive care perceive their organisation as a learning organisation. However, in daily work healthcare tends to function to what can be described as a mass production approach to care. This state of conflict caused confusion and chaos among the leaders. The municipal elderly care services and the county council’s geriatric organisation had difficulties in co-ordination. Older people were perceived as passive recipients of healthcare, rather than as consumers whose well being and outcome were a reflection to the quality of the service.</p><p>The study concludes that despite the major changes that have taken place in the Swedish health and elderly care organisations over the past years, healthcare professionals’ understanding of their work has gone largely unchanged. Their understanding of care structures and processes did not change despite outside pressures. Lack of understanding of what others understand hampers development with the result that care organisations risk stagnation.</p>

<p>The present thesis follows an intensive care unit during four year of hard work and demanding organisational changes (1998-2001). The changes were mainly initiated by diminishing resources and a legislative claim to pay regard to the quality aspect of health care service. The process of implementing a quality system was the main focus for the thesis. Triangulation was used aiming at explore the process from different views. Two interviews studies were conducted one with the staff and another with the leadership. Both interviews were analysed thematically combined with a phenomenographic technique (e.g. using the how, and what aspect). A longitudinal quasi experimental time-series study was also accomplished. The correlation between staff variables and workload were measured once a year. The result show a 20 % increase in workload per staff and year. The staff judged the organisational climate for innovativeness stable over the period. Sick leave increased, and more so, than the general trend in the society. In spite of this increase the prevalence of stress related symptoms was the same. Two different systems emerged, a complex adaptive system and a mechanical system. The two systems exist and functions intertwined. Because of the construction of the patient register it is possible to see that the situation around a patients being admitted ≥ 5 days functions according to the complex systems character while the situation around the acute patients functions according to a mechanical system. Sick leave correlated with number of patient admitted ≥ 5 days (P=,000). It seemed the problem found had its root in the unawareness of the existing of a complex system. The result has implications for a need of increased awareness about how to manage the situation when the ICU is functioning according to the complex adaptive system.</p>

<p><strong>Sammanfattning</strong></p><p>Syftet med denna studie är att undersöka förekomst, styrning och tillämpning av fysisk aktivitet för äldre på äldreboenden i Stockholms län. Syftet utmynnar i följande frågeställningar:</p><p>·        Hur ofta och i vilken form utövas fysisk aktivitet på äldreboenden?</p><p>·        Hur motiveras vikten av fysisk aktivitet på äldreboenden?</p><p>·        Vilka argument finns för att fysisk aktivitet inte används i större utsträckning på äldreboenden?</p><p>·        Hur iscensätts fysisk aktivitet på följande tre nivåer: lagar, kommunala styrdokument samt tillämpning på äldreboenden?</p><p> </p><p><strong>Metod:</strong> Studien har utförts på äldreboenden i fyra kommuner i Stockholms län. Materialet har samlats in med hjälp av enkäter som skickats ut till enhetschef eller motsvarande på 45 äldreboenden. Av dessa svarade 71 procent på enkäten. I relevanta lagar och styrdokument har även riktlinjer för fysisk aktivitet för äldre på äldreboenden undersökts för att sedan med hjälp av enkätsvaren iscensättas på formulerings-, transformerings- och realiseringsarenan.</p><p> </p><p><strong>Resultat:</strong> Den aktivitet som används främst på äldreboenden är promenad/stavgång och de flesta erbjuder det en eller fler gånger i veckan. Rörelse- och balansträning samt motionsgymnastik erbjuds även de i en större utsträckning. Hos många äldreboenden pågår aktiviteter i cirka 30 minuter. De största faktorerna till varför äldre ska utöva fysisk aktivitet på äldreboenden är för att bibehålla moment i vardagen, minska skaderisken samt öka fysisk- och mental hälsa. Två stora faktorer till att äldreboenden inte använder sig mer av fysisk aktivitet beror på tidsbrist hos personalen samt att de äldre är oengagerade till att utöva fysisk aktivitet. Resultatet visar även att det går att tillämpa Göran Lindes läroplansteori angående formulerings-, transformerings- och realiseringsarenan vad det gäller lagar, kommunala styrdokument och tillämpning på äldreboenden.</p><p><strong> </strong></p><p><strong>Avslutande reflektion:</strong> Fysisk aktivitet är en mycket viktig del för att bidra till en bättre livskvalitet hos de äldre. Fysisk aktivitet erbjuds mer eller mindre på alla äldreboenden i studien men förekommer dock inte på den nivå som är behövlig. Om detta beror på att det är otydliga direktiv i lagar och styrdokument eller brist på kunskap etc., är något att beakta.</p>

This study proposes that poor understanding of the structures, processes and outcomes of organisations seriously hampers collaboration between professional groups in care organisations. Three care settings were investigated: follow-up of patients with heart disease, an intensive care unit and care services for older people. The overall aim was to investigate how people understand structures, processes and outcomes in care organisations. The participants were patients, patient representatives, healthcare professionals, managers and politicians. A qualitative approach was used. Thematic analysis and grounded theory were employed in analysing the data. Despite considerable efforts, no major changes took place over a 7-year period as to how cardiac follow-up services were understood. The system of cardiac follow-up services was found fragmented in its organisation and in the way individuals understood it. The results indicate that care professionals, patients and leaders have dissimilar understandings. The data suggest that care is organised from a professional-centred perspective rather than from a holistic worldview of the patients’ total context. Leaders in intensive care perceive their organisation as a learning organisation. However, in daily work healthcare tends to function to what can be described as a mass production approach to care. This state of conflict caused confusion and chaos among the leaders. The municipal elderly care services and the county council’s geriatric organisation had difficulties in co-ordination. Older people were perceived as passive recipients of healthcare, rather than as consumers whose well being and outcome were a reflection to the quality of the service. The study concludes that despite the major changes that have taken place in the Swedish health and elderly care organisations over the past years, healthcare professionals’ understanding of their work has gone largely unchanged. Their understanding of care structures and processes did not change despite outside pressures. Lack of understanding of what others understand hampers development with the result that care organisations risk stagnation.

The present thesis follows an intensive care unit during four year of hard work and demanding organisational changes (1998-2001). The changes were mainly initiated by diminishing resources and a legislative claim to pay regard to the quality aspect of health care service. The process of implementing a quality system was the main focus for the thesis. Triangulation was used aiming at explore the process from different views. Two interviews studies were conducted one with the staff and another with the leadership. Both interviews were analysed thematically combined with a phenomenographic technique (e.g. using the how, and what aspect). A longitudinal quasi experimental time-series study was also accomplished. The correlation between staff variables and workload were measured once a year. The result show a 20 % increase in workload per staff and year. The staff judged the organisational climate for innovativeness stable over the period. Sick leave increased, and more so, than the general trend in the society. In spite of this increase the prevalence of stress related symptoms was the same. Two different systems emerged, a complex adaptive system and a mechanical system. The two systems exist and functions intertwined. Because of the construction of the patient register it is possible to see that the situation around a patients being admitted ≥ 5 days functions according to the complex systems character while the situation around the acute patients functions according to a mechanical system. Sick leave correlated with number of patient admitted ≥ 5 days (P=,000). It seemed the problem found had its root in the unawareness of the existing of a complex system. The result has implications for a need of increased awareness about how to manage the situation when the ICU is functioning according to the complex adaptive system.