BACKGROUND:

A rapid emergency care intervention can prevent the cardiac arrest from resulting in death. In order for Cardio Pulmonary Resuscitation (CPR) to have any real significance for the survival of the patient, it requires an educational effort educating the large masses of people of whom the youth is an important part. The aim of this study was to investigate the effect of a two-hour education intervention for youth regarding their self-confidence in performing Adult Basic Life Support (BLS).

METHODS:

A quantitative approach where data consist of a pre- and post-rating of seven statements by 50 participants during an intervention by means of BLS theoretical and practical education.

RESULTS:

The two-hour training resulted in a significant improvement in the participants' self-confidence in identifying a cardiac arrest (pre 51, post 90), to perform compressions (pre 65, post 91) and ventilations (pre 64, post 86) and use a defibrillator (pre 61, post 81). In addition, to have the self-confidence to be able to perform, and to actually perform, first aid to a person suffering from a traumatic event was significantly improved (pre 54, post 89).

CONCLUSION:

By providing youth with short education sessions in CPR, their self-confidence can be improved. This can lead to an increased will and ability to identify a cardiac arrest and to begin compressions and ventilations. This also includes having the confidence using a defibrillator. Short education sessions in first aid can also lead to increased self-confidence, resulting in young people considering themselves able to perform first aid to a person suffering from a traumatic event. This, in turn, results in young people perceiveing themselves as willing to commence an intervention during a traumatic event. In summary, when the youth believe in their own knowledge, they will dare to intervene.

Background: Children with cerebral palsy (CP) face particular challenges, e.g. daily pain that threaten their participation in school activities. This study focuses on how teachers, personal assistants, and clinicians in two countries with different cultural prerequisites, Sweden and South Africa, manage the pain of children in school settings.

Method: Participants’ statements collected in focus groups were analysed using a directed qualitative content analysis framed by a Frequency of attendance-Intensity of involvement model, which was modified into a Knowing-Doing model.

Results: Findings indicated that pain management focused more on children’s attendance in the classroom than on their involvement, and a difference between countries in terms of action-versus-reaction approaches. Swedish participants reported action strategies to prevent pain whereas South African participants primarily discussed interventions when observing a child in pain.

Conclusion: Differences might be due to school- and healthcare systems. To provide effective support when children with CP are in pain in school settings, an action-and-reaction approach would be optimal and the use of alternative and augmentative communication strategies would help to communicate children’s pain. As prevention of pain is desired, structured surveillance and treatment programs are recommended along with trustful collaboration with parents and access to “hands-on” pain management when needed.

Background: Effective clinical teaching is crucially important for the future of patient care. Robust clinical training therefore is essential to produce physicians capable of delivering high quality health care. Tools used to evaluate medical faculty teaching qualities should be reliable and valid. This study investigates the psychometric properties of modification of the System for Evaluation of Teaching Qualities (SETQ) instrument in the clinical years of undergraduate medical education.

Methods: This cross-sectional multicenter study was conducted in four teaching hospitals in the Kingdom of Bahrain. Two-hundred ninety-eight medical students were invited to evaluate 105 clinical teachers using the SETQ instrument between January 2015 and March 2015. Questionnaire feasibility was analyzed using average time required to complete the form and the number of raters required to produce reliable results. Instrument reliability (stability) was assessed by calculating the Cronbach’s alpha coefficient for the total scale and for each sub-scale (factor). To provide evidence of construct validity, an exploratory factor analysis was conducted to identify which items on the survey belonged together, which were then grouped as factors.

Results: One-hundred twenty-five medical students completed 1161 evaluations of 105 clinical teachers. The response rates were 42% for student evaluations and 57% for clinical teacher self-evaluations. The factor analysis showed that the questionnaire was composed of six factors, explaining 76.7% of the total variance. Cronbach’s alpha was 0.94 or higher for the six factors in the student survey; for the clinical teacher survey, Cronbach’s alpha was 0.88. In both instruments, the item-total correlation was above 0.40 for all items within their respective scales.

Conclusion: Our modified SETQ questionnaire was found to be both reliable and valid, and was implemented successfully across various departments and specialties in different hospitals in the Kingdom of Bahrain.

Background: Patient safety is a critical issue in healthcare services particularly in surgical units and operation rooms because of the high prevalence and risk of medical errors in such settings. This study was conducted to determine whether a 1-day educational intervention can change the attitude and behavior of surgical residents regarding patient safety.

Methods: A total of 90 surgical residents were recruited from 6 university hospitals located in Tehran and Qazvin, Iran, and were randomized to either the intervention or a control group. Those in the intervention group participated in a 1-day workshop on patient safety, whereas the control group received no intervention. Both groups were followed for 3 months after the intervention was completed. The Safety Attitude Questionnaire and Oxford Non-Technical Skills scale were administered at 3 points in time (baseline, 1 month after the intervention, and 3 month later). The data were analyzed using repeated measures analysis of variance.

Results: Total score on the Safety Attitude Questionnaire improved from 54.5 (SD = 14.4) at baseline to 58.3 (SD = 13.8) 3 months after the intervention in the intervention group; all dimensions, with the exception of working condition, showed significant changes. In addition, the Oxford Non-Technical Skills scale – as assessed by attending surgeons – improved significantly in all domains (p < 0.05). More than 60% of participants in the intervention group scored in the positive range for items assessing safety and teamwork climate.

Conclusions: A 1-day interactive educational workshop may be effective in changing the attitude and practice of surgical residents regarding patient safety. Further assessment of this intervention in other healthcare settings involving health professionals from various specialties and use of an objective measure such as number of reported medical errors are needed to corroborate these findings. 

Syftet med denna kunskapsöversikt är att belysa hur förbättringskunskapen utvecklats i den svenska hälsovård- och välfärdssektorn, och vilka implikationer förbättringskunskap kan ha för projektet ”Barnens Bästa Gäller! i Kronoberg” (BBGiK). Rapporten avslutas med en diskussion om de möjligheter och utmaningar som påverkar projektet. Förbättringskunskap är nära besläktat med kvalitetsutveckling, och är numer vanligt förekommande i hälso- vård- och välfärdsorganisationer. De lagar och regelverk som styr innefattar skyldigheter att bedriva kvalitetsutveckling, och Ledningssystem för systematiskt kvalitetsarbete (SOSFS 2011:9) gäller för både vård- och omsorgsorganisationer.

Rapporten lyfter fram förbättringskunskapens ursprung, dess forskningsanknytning och evidens och utveckling och övergång till vård- och välfärdsorganisationer. När förbättringskunskap fått fäste i den kunskapsintensiva evidensbaserade vårdsektorn och förbättringsarbeten började bli mera vanligt, uppstod frågor om hur förbättringsmetoder fungerar. Flera av de tidiga aktörerna inom förbättringskunskap var läkare och sjuksköterskor, och därför blev det angeläget att även arbetet med förbättringar kunde betraktas utifrån evidenskrav. Runt sekelskiftet 2000 började de första forskningspublikationerna dyka upp. En av förbättringsforskningens stora utmaningar är att utveckla vetenskaplig robust kunskap, och en vanlig kritik har varit att en svag vetenskaplig och teoretisk grund.

I rapporten har befintlig litteratur producerad i Sverige, i form av böcker och bokkapitel, avhandlingar och artiklar, sammanställts och analyserats avseende publikationsfrekvens över tid och innehåll (tema). Sammanställningen lyfter fram studier som har extra relevans för projektet, såsom samverkansprojekt och olika ansatser att överföra och anpassa förbättringskunskap till den sociala sektorn. Mellan åren 2007–2020 utkom 30 böcker, bokkapitel och enklare skrifter. De flesta är läroböcker i form av antologier skrivna för vårdens professioner och handlar ofta om grundläggande förbättringskunskap. 32 avhandlingar från nio svenska lärosäten identifierades, den första från 2003. Flera avhandlingar intar organisationsperspektiv, men även ledarskap, patientsäkerhet och patientinvolvering/delaktighet förekommer. Totalt 210 artiklar identifierades publicerade mellan 1992 och 2020, med flest antal (n=166) efter 2011. Tematiseringen resulterade i sex olika teman: 1) Systematiskt och värdeskapande förbättringsarbete; 2) Samverkan mellan organisationer och vårdgivare; 3) Användning av förbättringsmetoder och (teoretiska) modeller; 4) Ledarskap och lärande; 5) Mätningar, kvalitetsregister och uppföljning; samt 6) Personinvolvering och patientsäkerhet.

Delaktighet och samskapade är en tydligt ökande trend inom vården. Samtidigt har det inom sociala verksamheter länge ansetts viktigt att beakta personers rättigheter och möjligheter till inflytande. Sammanställningen pekar mot en utveckling där samverkan mellan organisationer och samskapande med dem vård och omsorg är till för blir en allt viktigare faktor. Detta är en viktig aspekt för projektet BBGiK, som spänner över flera olika verksamheter och organisationer. Det är alltid en utmaning när olika verksamheter tillsammans ska hitta fungerande lösningar. Denna utmaning blir inte mindre av att de kommer ifrån olika kunskapstraditioner, men i projektet finns förutsättningar för gemensamt lärande runt en gemensam modell. En förutsättning för att lyckas med förbättringsarbete är ett aktivt ledarskap, och strävan mot samma gemensamma mål: ”att skapa en trygg och säker uppväxt för VARJE barn genom främjande, tidiga och samordnade insatser”.

AbstractBackground: Type 1 diabetes is one of the most common chronic diseases in children. The overall goal in treating diabetes is to normalize the blood sugar level, in order to avoid complications in adulthood. Since a child spends a large part of the day at school, the treatment has to work well during the school hours. In 2008, paediatric diabetes team in Sweden reported that about 50% of the children in lower primary school, suffering from diabetes, do not receive sufficient support in their diabetic treatment at school. A function such as diabetes resource nurse has been tested in Jönköping County Council for two years to offer the school staff necessary knowledge about diabetes. Purpose: Describe the diabetes resource nurse possibility to influence the support children with diabetes receive at school. Method: The collection of empirical data was done through interviews, questionnaires and comparison of HbA1c. Results: The diabetes resource nurse feels that she is able to convey the knowledge necessary for the school personnel. Parents whose children have been visited by a diabetes recourse nurse says that they less often fear that their child does not get good support at school, that more of the children have a person in charge in school and that more children have an individual communication plan, compared to parents whose children have not been visited by a diabetes resource nurse. The function of the diabetes resource nurse did not improve the metabolic control during the study period. Discussion: The result of the intervention shows that a diabetes resource nurse can successfully improve the support children with type 1 diabetes receive at school. Further studies are needed to clarify which grades benefits the most from the support of a diabetes resource nurse and inquire the school personnel's experience of the diabetes consultant's work.

Background

This study explored the relationship between intelligence quotient (IQ) and aspects of everyday functioning/participation in individuals (age 16–40) who have a mild/borderline intellectual disability (IQ 55–85).

Method

Correlations were examined between IQ and (i) self-rated (n = 72) ability, participation as performance (how often an activity is performed), important participation restriction (not/seldom performing an activity perceived as important) and general well-being and (ii) proxy-rated (n = 41) ability and participation as performance.

Results

No significant correlations between IQ and any of the explored measures were found. However, the effect sizes of the correlations between IQ and ability were considered as small but not negligible.

Conclusions

The results support the notion that IQ is a poor predictor of general aspects of everyday functioning in persons with mild/borderline intellectual disability. The result indicates that self-ratings partly generate other information than proxy ratings which may be important for assessments of supportive requirements and diagnosis.

Background: Scanners are becoming widespread in Prosthetics and Orthotics, replacing plaster casting in the manufacture of some types of devices. P&O shape capture must be accurate and reliable, so the device is comfortable and reproducible between clinicians/sessions.

Objectives: To map knowledge on measuring accuracy and reliability of spatial data produced from 3D scanners.

Methods: The study design was a scoping review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Studies published in or after 2010 in English with a full-text available that analyse either the accuracy/validity or reliability of human 3D scanning data within a P&O context. Sources were obtained from Pubmed, CINAHL, Scopus, Cochrane Library, Web of Science, and AMed databases on 25th March.

Results: The search identified 115 studies of which 9 were included (7 experimental [4 prosthetic, 3 orthotic], 1 systematic review, 1 literature review). 7 analysed both reliability and accuracy/validity and 2 analysed reliability. High heterogeneity amongst studies’ methods, techniques, and equipment.

Conclusion: Methods, techniques, and equipment used to measure accuracy/validity and reliability varied greatly though more so in the measurement of accuracy/validity. Within the studies, researchers called for more research on standardisation of measurement methods and techniques.

Background: The Futurum Academy for Health and Care is Region Jönköping County's (RJL) activity for research and education. We were there for five weeks to observe the operations and collect data that is the basis for our thesis. 

Purpose: This assignment aims to investigate VFU managers' perceptions and use of the current course evaluation that the students fill in after completing the placement within RJL. 

Method: We have chosen to use a qualitative method in the form of semi-structured interviews. The target group in the study are VFU-managers. 

Conclusion:  Overall, the result shows that Futurum's course valuation requires revision. The data we have collected shows the perceptions that the interviewed VFU managers have regarding the course evaluation. The result shows that the answers to the course evaluation can form the basis of the organization's quality work. Regarding the extent of how the organizations use the compiled results from the course valuation that they receive from Futurum, they differ.

Background: Newly graduated nurses in Region Jönköping are invited to attend a regional introduction and development program - RIU. This program has previously been evaluated with a survey that did not show what the participants gain in new knowledge. A new evaluation model has been needed that shows what the nurses learn and whether the RIU has strengthened them in their professional role. The evaluation model used is Kirkpatrick's model of evaluating learning.

Purpose: The purpose of the study is to evaluate the significance of RIU for the newly graduated nurses in Region Jönköpings län. The evaluation will show the learning and if the new knowledge makes a difference in their work.

Method: The method that has been used is a questionnaire based on all four steps in Kirkpatrick's model. This survey was sent to nurses who completed the RIU. For additional material, previous evaluations and logbooks from nurses currently attending RIU have been analysed. Three groups attending RIU have been observed. The method for compiling the results has been to make text analyses, tables, and diagrams.

Result: RIU has increased the self-confidence and security of the nurses when they carry out their work. They enter care situations more confidently and dare to make their own decisions. What is most appreciated at RIU is team training and scenarios. Having newly graduated nurses undergo RIU increases patient safety and security for Esther.

Conclusion: The study shows that the use of Kirkpatrick’s model is a good way to evaluate the learning. RIU has a great significance to the newly graduated nurses and a difference can be seen in their work after completing RIU.

Background: To write notes takes time, time that could have been set aside for patients. Medical records in health care are an important aspect seeing that it will contribute to safer care. A work improvement to the medical records could be done at Habilitation center for efficiency and time saving. Our survey is a step towards improving this.

Purpose: The aim of the study is to investigate how the search term templates in Cosmic can be improved for occupational therapist and physiotherapist at the Child and Youth and Adult habilitation center in Jönköping County and suggest a new template.

Method: We chose action research as a method because our investigation is a part of an improvement project. The term is about the workplace facing a problem and we used PDSA (PGSA) to create a survey. The survey was sent to the occupational therapist and physiotherapist to collect data.

Conclusion: Our collected data showed that the existing templates worked well at the workplace. But some of the search terms were rarely used or not used at all and could be removed. By researching which search terms were most used and adjusting the template based on that, the search terms template could be improved.

Background & Problem description:

Parents with disabilities affecting their ability to ambulate, like spinal cord injuries, struggle to find knowledge and assistive technology that sufficiently satisfies their needs for support while caring for their children. For parents that use wheelchairs, propelling a stroller to safely and securely transport their child is difficult and currently there are very few products that aim to solve this challenge.

Aim:

The aim of this project is to identify and understand the challenges and needs of parents who require the use of wheelchairs in relation to independent ambulation with a stroller, and in doing so to develop a concept to meet these needs and challenges.

Method:

This project achieves this aim by applying a compilation of the Double Diamond approach and the Bootleg Design thinking design approach. The main modes of the design process followed were Discover, Define, Develop, and Deliver and Testing. During the Discover stage the information regarding the focus of the project is gathered through an in-depth literature study, a market study and semi structured interviews with potential users. The Define stage focuses on using the information gathered during the preceding stage to revaluate the intended aim and research questions, as well as to create a framework of needs that the design must satisfy and eventually creating a mood board. The Develop stage is the stage in which comprehensive design concepts are generated according to the design framework, these concepts are then evaluated, and initial mock-ups are created. The Deliver and Testing, focuses on constructing prototypes of the concepts chosen for development and evaluating the prototypes according to the design framework in order to measure how well the product may satisfy the needs stipulated in the design framework as well as to discern the perceived value of the product from the perspective of potential users.Results &

Conclusion:

This project set out to investigate and understand the needs of parents requiring the use of wheelchairs, specifically within the scope of using a stroller, and using the insight gained to develop a concept that satisfies these needs. After reviewing the available literature covering these individuals’ experiences in the context of childcare, it was found that research into the topic is very limited. Through individual contact in the form of informed semi-structured interviews with the target group valuable feedback was collected and a set of base needs was synthesised. These base needs informed the compilation of a design framework which formed the basis of how the concept should function in order to satisfy the needs of its potential users.

Aim: This review aims to describe the existing evidence base for using elevated vacuum suspension and pin-lock suspension systems in regards to fluctuations of limb volume, balance, effect on gait (spatial and temporal, kinematic, and kinetic data), and in-socket movement (pistoning and transverse forces).

Background: There is a growing population with a TT amputation thus there is an increased demand for TT prosthetic solutions. There are a multitude of different suspension methods with different drawbacks and benefits. This review investigates elevated vacuum suspension (EVS) and pin-lock suspension systems.

Method: A systematic search was conducted in Medline, PubMed, and Scopus, and included or excluded articles per the eligibility criteria. The chosen studies will be carefully read and critically appraised for their quality of evidence.

Results: 13 articles were found that matched the eligibility criteria and aim, 5 articles included pin-lock suspension systems and 9 included EVS systems. 3 looked at limb volume fluctuation, 1 at balance, 4 at in-socket movement (transverse forces and pistoning), and 8 at the quality of gait (temporal and spatial, kinematic, and kinetic).

Conclusion: Several of the articles included in this review indicate that EVS results in better performance on balance tests, higher velocity, and a more stable residual limb volume than other suspension systems. Furthermore, it was shown that prosthetic users with an EVS had more normal values in their ROM during gait and less in-socket movement.

The average life expectancy and the proportion of the elderly in the Western countries are increasing. The care processes used for the elderly are known to differ between the care providers in Sweden. Accordingly, the need to develop a system to support the processes in order to attain a standardized, structured, and systematic approach to improve preventive care processes for the elderly has been called for. The County Council of Jönköping developed a national Web-based quality registry, Senior Alert, with a focus on the following areas: falls, pressure ulcers, malnutrition, and oral health. The patients are evaluated using validated risk assessment instruments, and the care is planned, executed, evaluated. The registry supports the users to work with preventive care systematically and in a standardized way and provides feedback to the care providers on their preventive care processes. The registry helps the caregivers fulfill the preventive care according to the best available clinical knowledge and practice. The registry also provides the government and health care politicians with data for setting aims for elderly care. The registry is used in 90% of the municipalities and county councils throughout the country. The total number of risk assessments completed from 2009 to 2014 exceeded 1 000 000.

Background: Interprofessional teamwork is in many ways a norm in modern health care, and needs to be taught during professional education.

Description: This study is an evaluation of a newly introduced and mandatory learning module where students from different health profession programs used Improvement of Quality and Safety as a way to develop interprofessional competence in a real-life setting. The intention of this learning module was to integrate interprofessional teamwork within the students' basic education, and to give students a basic knowledge about Improvement of Quality and Safety. This report focuses on evaluations from the participating students (n=222), mainly medical and nursing students.

Materials and methods: To evaluate this new learning module, a questionnaire was developed and analyzed using a mixed methods design, integrating both qualitative and quantitative methods. The evaluation addressed learning concepts, learning objectives, and interprofessional and professional development.

Results and conclusion: A majority of students responded positively to the learning module as a whole, but many were negative towards specific parts of the learning module and its implementation. Medical students and male students were less positive towards this learning module. Improvements and alterations were suggested. 

Introduktion: Metodikum är Region Jönköpings läns (RJL) kliniska träningscenter för scenarioträning. Vårt examensarbete bygger på det uppdrag vi fick från Metodikum som är att undersöka verksamhetschefers och vårdenhetschefers uppfattning om Metodikum. Under fem veckors tid befann vi oss på Metodikum för att observera verksamheten och samla in underlag till examensarbetet.

Syfte: Syftet med studien är att undersöka vilken uppfattning verksam-hetschefer och vårdenhetschefer i RJL har om Metodikums funktion, samt behovet av praktisk träning idag och i framtiden.

Metod: En kvalitativ metod i form av semi strukturerade intervjuer och en kvantitativ metod i form av en enkätundersökning med fasta frågor används i studien. Målgruppen för den kvalitativa studien, som även är studiens primära målgrupp, är verksamhetschefer i RJL och målgruppen för den kvantitativa studien är vårdenhetschefer i RJL.

Resultat: Studiens resultat visar att både verksamhetschefer och vårdenhetschefer har en god uppfattning om den funktion Metodikum har och att verksamheten bidrar till en mer säker vård. Behovet av träning är stort och kommer att bli större i framtiden. Det framkommer från primärvårdens verksamhetschefer att de vill nyttja Metodikum mer, men att det råder viss okunskap om vad Metodikum kan erbjuda.

Slutsats: Majoriteten av verksamhetscheferna och vårdenhetscheferna är nöjda med Metodikum och de tycker att det är förmånligt att sjukvårdspersonal i RJL har tillgång till centret, men det framkommer att enheterna tidvis har svårt att frisätta personal till träning eftersom de behövs på de egna klinikerna. Det råder en brist i kommunikation inom enheterna och mellan cheferna och Metodikum.

The purpose of the underlying improvement work was to increase the proportion of calls in which vital parameters are secured, and the case is given correct prioritization through regular interception and reflection. The purpose of the study was to identify success and risk factors from the perspective of the emergency call-taker on the emergency call with a focus on securing vital parameters, correct prioritization and the context of the emergency call.

In the improvement work, 12 emergency call-takers were asked, within a period of four months, to individually reflected on the contents in calls and write down reflections. This was contributing to an increase in secured vital parameters and correct prioritization. A content analysis of the reflections demonstrated that it was a success factor to be professional and limitations in the call methodology was a risk factor. When the set process for the call was followed it was a success factor and a risk factor when it was not followed.

The conclusion is that regular interception and reflection increase securing vital parameters and correct prioritization in emergency calls and that it is a success factor to follow the set process for the call, but that technical support for the purpose is missing.

Although sitting is a large part of everyday life is the influence of the sitting positions and chair design on pressure and load distribution as well as comfort for transfemoral amputees quite unexplored. The aim of this study was therefore to examine this further.

Two transfemorally amputated females (49 and 57 years old) participated in the study. Three positions were examined for each subject; sitting without foot support and sitting with the knee joints flexed 90◦ and 105◦. The pressure inside the socket was measured by two pressure sensors, placed distally and proximally on the posterior wall inside the socket. The lengthwise pressure distribution and the sidewise load distribution between the socket and the underlying material was measured by a pressure mat. In addition to this, the subjects answered a questionnaire regarding the subjective comfort for each position. 

The result showed that the pressure underneath the socket were higher distally than proximally without foot support. The pressure transferred proximally as the knee became more flexed. The most even load distribution sidewise was found when the subjects sat with their knees flexed 105 degrees. Sitting with the knees flexed 90◦ was ranked as the most comfortable position. No conclusion could be made regarding the pressure inside of the socket. Additionally, according to this study the level of comfort does not have any clear relation with the sidewise load distribution or the longitudinal pressure distribution.                  

Background: Systemically work environment enhancing work can prevent illness and accidents among employees at workplaces. Maintaining a good working environment can improve the quality of performed work, become more sustainable and increase patient safety. Aim: To investigate how dental hygienists in private dental sector experience their organizational and social work environment. Method: A cross-sectional study with questionnaire as measuring instrument was performed. The sample consisted of dental hygienists in private dental sector in Sweden. Data were processed in SPSS through Spearman’s Rho correlation analysis. Results: 28 dental hygienists responded to the questionnaire and reported positive experiences regarding organizational and social work environment [OSA] in general. A higher number of employed dental hygienists reported more positive experiences of work development ( = 0,404, p = 0,033) and required to work beyond working hours ( =–0,477, p = 0,010). More professional years as dental hygienist increased positive experiences of meaningful work ( = 0,404, p = 0,033). Conclusion: In addition to the identified salutogenic factors in the results, protentional for development regarding OSA was found in the dimension reorganization. To gain understanding and reasons for experienced OSA, research via qualitative approach would be valuable to identify salutogenic factors that may contribute to improved OSA.

Sammanfattning

Bakgrund Rehabilitering efter ett strokeinsjuknande ska påbörjas tidigt och vara målinriktad. För patienter som drabbats av mild till måttlig stroke rekommenderas i Socialstyrelsens riktlinjer vård på strokeenhet i kombination med tidig understödd utskrivning. Uppsatsen beskriver, analyserar och utvärderar ett förbättringsarbete där tidig understödd utskrivning med stöd av ett stroketeam prövades som arbetsmodell på en strokeenhet.

Syfte Syftet med förbättringsarbetet var att patienterna skulle uppleva ett tryggt omhändertagande i samband med utskrivningen, samtidigt som strokeprocessen effektiviserades genom kortare vårdtid på sjukhus. Syftet med studien var att beskriva erfarenheter hos patienter, närstående och personal vid införandet av tidig understödd utskrivning från sjukhus med stöd av ett stroketeam för patienter med mild till måttlig stroke.

Metod Förbättringsarbetet utvärderades genom mätning av vårdtider och mätning av patienternas upplevelse av trygghet i samband med utskrivningen. I studien av förbättringsarbetet insamlades data genom semistrukturerade intervjuer med patienter och deras närstående, samt i en fokusgruppsintervju med involverad personal. Nio patienter och sex närstående intervjuades. Vid fokusgruppsintervjun deltog två arbetsterapeuter, två sjukgymnaster och en sjuksköterska. Intervjuerna analyserades med kvalitativ innehållsanalys.

Resultat Arbetssättet med tidig understödd utskrivning testades på tio patienter. Vårdtiden var något kortare, men osäkerhet finns i mätningarna och i den kvalitativa analysen framkom tveksamhet om vårdtiderna påverkades. Upplevelsen av trygghet i samband med hemgång var något högre bland deltagarna i projektet jämfört med baslinjemätningen. Vid intervjuerna med patienter framkom värdet av att erhålla rehabilitering i sin hemmiljö. Både patienter och närstående beskrev att teamet bidrog med kunskaper om stroke, rehabilitering och säkerhetsaspekter i hemmet, samt att kontinuiteten med samma personal var värdefull. Närstående beskrev också att de fått stöd av teamet i närståenderollen. Personalen framhöll vid fokusgruppsintervjun förbättrad kvalitet för patienterna, tidsbrist och svårigheter med prioriteringar samt en arbetstillfredställelse i nöjda patienter och att arbeta med förbättringar.

Slutsats Tidig understödd hemgång med stöd av ett stroketeam upplevdes positivt av patienter, närstående och personal. Arbetssättet var engagerande men tidskrävande. Förhoppningen är att lärdomarna från detta projekt kan bidra till fortsatt utveckling av rehabiliteringsprocessen i samband med utskrivning.

BACKGROUND: The International Classification of Functioning, Disability and Health is a classification of human functioning and disability and is based on a biopsychosocial model of health. As such, International Classification of Functioning, Disability and Health seems suitable as a basis for constructing models defining the clinical P&O process. The aim was to use International Classification of Functioning, Disability and Health to facilitate development of such a model. Proposed model: A model, the Prosthetic and Orthotic Process (POP) model, is proposed. The Prosthetic and Orthotic Process model is based on the concepts of the International Classification of Functioning, Disability and Health and comprises four steps in a cycle: (1) Assessment, including the medical history and physical examination of the patient. (2) Goals, specified on four levels including those related to participation, activity, body functions and structures and technical requirements of the device. (3) Intervention, in which the appropriate course of action is determined based on the specified goal and evidence-based practice. (4) Evaluation of outcomes, where the outcomes are assessed and compared to the corresponding goals. After the evaluation of goal fulfilment, the first cycle in the process is complete, and a broad evaluation is now made including overriding questions about the patient's satisfaction with the outcomes and the process. This evaluation will determine if the process should be ended or if another cycle in the process should be initiated.

CONCLUSION: The Prosthetic and Orthotic Process model can provide a common understanding of the P&O process. Concepts of International Classification of Functioning, Disability and Health have been incorporated into the model to facilitate communication with other rehabilitation professionals and encourage a holistic and patient-centred approach in clinical practice. Clinical relevance The Prosthetic and Orthotic Process model can support the implementation of International Classification of Functioning, Disability and Health in P&O practice, thereby providing a common understanding of the P&O process and a common language to facilitate communication with other rehabilitation professionals.

Bakgrund: Magnetresonanstomografi (MRI) har med sin bildkvalitet och detaljrikedom börjat bli ett alternativ till ultraljud som idag är ledande inom fosterdiagnostik. Tidigare forskning har studerat magnetfältets inverkan på fostret, denna inverkan har fortfarande inte kunnat bekräftas. Syfte: Syftet är att svara på evidensfrågan: Vad finns det för evidens för att MR-undersökningar på gravida kvinnor leder till fosterskada? Metod: Arbetet är en systematisk litteraturstudie som innehåller 13 vetenskapliga artiklar, som har sökts fram via olika databaser. Resultat: Ingen evidens för biologiska effekter eller hörselnedsättning kunde ses hos exponerade foster, dock gavs motstridiga resultat gällande gadolinium och värmeökning. Gadolinium kan ge NSF biverkningar och ökad risk för missfall. Värmeökning kan ske hos fostret om normal mode inte används och längre sekvenser körs. Det är osäkert vem av fostret och modern som uppnår högsta helkropps-SAR värdet. Slutsats: Resultatet av denna studie skall bejakas med försiktighet då resultaten visar olika och få studier har gjorts med högsta evidensvärdet. Alla 13 studier i detta arbete påpekar att mer forskning bör göras för att kunna säkerställa riskerna med MR på gravida.

Background: The report explores alternative diagnostic methods for lipedema – a chronic condition affecting the subcutaneous fat tissue. Currently, clinical knowledge about the condition is insufficient and in Sweden there are no diagnostic criteria for the disease.

Objective: To better understand how magnetic resonance imaging and ultrasound can be utilized to diagnose lipedema.

Method: A structured literature review was used to answer the research questions. A methodical search technique using the databases PubMed and Scopus yielded a total of six publications.

Conclusions: MRI and ultrasound can be used to differentiate patients with lipedema from other groups of patients and healthy controls. Lipedema exhibits unique imagery regarding fat and water distribution, skin thickness, the lymphatic system and fluid infiltration.

Prosthetic alignment is the principle of the position and orientation and of the components in a lower limb prosthesis to achieve desirable biomechanical characteristics. Poor alignment of lower limb prostheses is related to decreased balance, knee and hip arthritis, and higher energy expenditure for the user. Clinicians, the prosthetists, have declared they need better tools and increased knowledge in how to perform lower limb prosthetic alignments. Therefore, the aim was to develop a tool concept for clinicians to use in the prosthetic alignment process. This thesis mapped out most of the variables a clinician must consider in the alignment process, identified the clinicians needs of an alignment tool, and screened the market for existing solutions. A systematic approach was applied to develop a conceptual tool from the gathered information. The needs of the customer were based on interviews with clinicians and competing products were benchmarked. Two different conceptual tools were developed, tested with clinicians with promising results, and presented in this thesis. Due to confidentiality agreements with the cooperating company, the designs and functions of the final concepts cannot be shown in the report and are therefore covered in the publication.

Most children with severe cerebral palsy experience daily pain that affects their school performance. School professionals need to assess pain in these children, who may also have communication difficulties, in order to pay attention to the pain and support the children’s continued participation in school. In this study, South African school professionals’ perceptions of how they observed pain in children with cerebral palsy, how they questioned them about it and how the children communicated their pain back to them were investigated. Thirty-eight school professionals participated in five focus groups. Their statements were categorized using qualitative content analysis. From the results it became clear that professionals observed children’s pain communication through their bodily expressions, behavioral changes, and verbal and non-verbal messages. Augmentative and alternative communication (AAC) methods were rarely used. The necessity of considering pain-related vocabulary in a multilingual South African context, and of advocating for the use of AAC strategies to enable children with cerebral palsy to communicate their pain was highlighted in this study.

Background: Dental hygienist profession plays a significant role in Swedish dentistry and works primarily with prevention/health promotion. Dentists and dental hygienist's professions complete each other, which makes co-operation necessary to obtain a safe care for the patient. The aim was to study dental students (semester 10) knowledge regarding dental hygienists competence. Method: A cross-sectional study with questionnaire as measuring instrument was performed. The sample consisted of dentistry students from Malmo- and Gothenburg’s University, with two respective three years of dental hygienist education. Variables were analyzed by descriptive statistics. Comparisons between institutions, through Chi²-test were performed in SPSS. The result was based on 51 (Malmo) respective 26 (Gothenburg) participants. Statistically significant differences occurred regarding questions of diagnosing pericoronitis, behavioral changes, removing sutures, working with temporomandibular disorders, bite-impressions and responsibility of radiographic equipment. Malmo had 39 participants and Gothenburg 18 that reported they had not received enough knowledge. The relationship between the students knowledge and dental hygienists’ length of education cannot be established. Conclusion: There is a knowledge about dental hygienist’s competence, but with some variation. Differences in knowledge exists between the institutions. The majority of participants felt that the education did not give them sufficient knowledge about the dental hygienist's competence.

Sammanfattning

Tillgänglighet och väntetid till såväl undersökningar som vård är två stora utmaningar inom svensk hälso-och sjukvård. Bristande tillgänglighet och onödig väntetid är faktorer som kan innebära lidande för patienter, medföra onödiga kostnader för sjukvården och påverka medarbetarnas upplevelse av sin arbetsmiljö. I såväl diagnostik som behandling inom hälso- och sjukvården har radiologi en central roll.

Detta förbättringsarbete utgår från frågan om ett förbättrat flöde i form av en förberedelseenhet kan minska väntetider för patienter som behöver genomgå en datortomografiundersökning och hur det påverkar medarbetarnas arbetsmiljö.

Förbättringsarbetet visade att en förberedelseenhet kunde startas upp och ta emot fler patienter med samma medarbetarstyrka. Studien av förbättringsarbetet påvisade att arbetsmiljön upplevdes fortsatt positiv från medarbetarnas sida. Medarbetarna förklarade att förberedelseenheten underlättade flödet att de fick en tydligare överblick om flödet vilket gjorde planeringen lättare. Medarbetarna upplevde även att det var positivt att de fick utökade möjligheter till rotation mellan förberedelseenheten och undersökningsrum. De kände att det var tillfredsställande att kunna erbjuda lediga tider till fler patienter samtidigt som de kunde erbjuda lediga tider inom en snar framtid vid eventuella avbokningar.  

Förbättringsarbetets slutsats är att produktiviteten och effektiviteten ökade genom införandet av förberedelseenheten. Studiens slutats är att medarbetarnas arbetsmiljö påverkades positivt genom ökad variation av arbetsuppgifter och att mer tid frigörs för patientens frågor och funderingar.   

Under det senaste decenniet har det blivit allt vanligare med arbetsrelaterade besvär hos uniformerad polis i yttre tjänst, främst är det besvär från nedre delen av ryggen som uppgetts. Hälsohögskolan i Jönköping har fått i uppdrag av Rikspolisstyrelsen att belysa och utreda den uppkomna problematiken. Två tidigare rapporter, Polisens fysiska arbetsmiljö och Polisens psykosociala miljö, har presenterats. I rapporten om polisens fysiska arbetsmiljö framkom en hög förekomst av besvär från muskler och leder, främst nedre delen av ryggen under förhållande med bärande av utrustningsbältet i kombination med mycket stillasittande i tjänstebilar. I den andra rapporten framkom att en stor del av poliserna arbetar treskift och i många fall långa arbetspass, vilket yttrar sig i att de har svårt att psykiskt återhämta sig, inte har tid för familj och vänner samt att de ofta upplever sig trötta. I den tredje och sammanfattande rapporten presenteras vilka bakomliggande variabler som påverkar den fysiska och psykosociala arbetsmiljön.

Syftet med studien var att analysera vilka variabler och vilka kombinationer av variabler som påverkar den fysiska och psykosociala arbetsmiljön för uniformerad polis i yttre tjänst i Sverige. Rapporten baseras på 4244 enkätsvar från poliser i yttre uniformerad tjänst.

Resultatet från föreliggande studie har visat att det finns skillnaden i besvärsfrekvens mellan myndigheterna när det gäller otillräcklig fysisk och psykisk återhämtning samt besvär ifrån nedre delen av ryggen. Orsakerna till skillnaden mellan myndigheterna är inte utredda. Studien har visat att besvärsfrekvensen ökar då det föreligger krav att arbeta på ett rullande treskiftsschema. Utifrån detta föreslår vi att man:

• utför benchmarking av polismyndigheter för att öka förståelsen för de stora skillnader som förekommer

• utvärderar olika modeller av schemaläggning avseende treskift

• fortsätter arbetet med att utreda hur polisens uniform och kroppsburna utrustning, i kombination med bilsätets utformning, påverkar besvär från nedre delen av ryggen.

Background: Previous studies have shown that there is insufficient knowledge regarding orthotics amongst healthcare professionals. This insufficient knowledge can result in low compliance or ill-fitting devices, which in itself can lead to abandonment, redness or even ulcers. None of the previous studies were conducted in Sweden, on the population or under the same conditions as we are interested in. Under these preconditions, this thesis was formulated. 

Aim: Explore the knowledge that healthcare professionals have about orthotic devices.

Method: Qualitative online questionnaire that was analyzed with a thematic approach. The questionnaire was answered by 28 healthcare professionals working as; nurses, vocational nurses, occupational therapists, physical therapists, home-care assistants or home-care workers. Working in retirement homes, special needs housing or rehabilitation centers.

Results: The answers given to our questionnaire varied a great deal. The answers were divided into three different themes; function, don/doff and hygiene. The answers exhibited a variety of knowledge within these themes. 

Conclusion: The knowledge varied among the respondents and the specific areas concerned has a significant impact on the degree of knowledge exhibited. More statistics regarding the population as a whole is needed in order generalize the results to a larger population, although it still has clinical relevance.

Aim: The aim of the study is to compare the result in Cobb angle and quality of life (QoL) for patients with idiopathic scoliosis in adolescence treated with Providence nighttime brace or Boston full-time brace.

Method: The study is a systematic review and the databases used were Medline, CINAHL and Scopus. The appraisal tool used was JBI. Non-matching articles to the inclusion criteria were excluded. Outcome of interest is Cobb angle and QoL.

Result: Six articles were included in which a total of 645 patients participated. Three articles evaluated Cobb angle and three QoL. No statistically significant difference in Cobb angle between Providence nighttime brace and Boston full-time brace was found. QoL questionnaires had statistically significant difference between the two braces in some domains. There were differences regarding validity and reliability of the included studies, although the majority measured outcome in a valid way.

Conclusion: There is no significant difference between Providence nighttime brace and Boston full-time brace in Cobb angle. No conclusion could be drawn from current articles in QoL since the studies evaluated Boston full- time brace had different results. More research must be conducted in both Cobb angle and QoL.

A common reason for unsatisfactory cytological smears is contamination of blood. Blood contaminated gynaecological samples are washed with Cytolyt® solution and acetic acid at the Cytological Laboratory, County Hospital Ryhov to reduce contaminations. The objective of this study was to determine the potential effect of Cytolyt® solution and acetic acid on the morphology of mesothelial cells. In this study 60 samples of pleural effusions and ascites was analysed with conventional cytological method. Cytological smears were prepared without wash (controls) and with wash for different durations. The morphology of mesothelial cells in the samples were then examined. Out of the controls 53% had a wellpreserved cytoplasm while this distribution decreased to 5.8% amongst the washed smears. About 87% of the controls and 46% of the washed smears had a preserved and distinct nucleus. Changes in morphology could be seen in mesothelial cells after wash with Cytolyt® solution and acetic acid. However, the changes could not be associated with disease. Washing exudates with Cytolyt® solution and acetic acid can alter morphological changes in mesothelial cells although the changes seen cannot be mistaken for pathological changes. 

Background

People with mental illness have a greater extent of somatic illness and the mortality rate is two to three time higher than in general population. Life expectancy is 25 years shorter among people with mental illness than in the general population.

Purpose

Global aim: To improve health among people with psychosis.

Specific aim: Health promotion among people with psychosis by developing routines for that work.

Purpose of the study: Identify conditions in a cooperation project that can affect spread and sustainability.

Method

The improvement ramp and structure of a project has been the starting point of this improvement work.

The study is a case study including two focus groups and content analysis is made from this and from documentation. Qualitative content analysis with deductive approach was done from a theory of spread and sustainability.

Results

Routines for health promotion has been developed and tested in community social services and in hospital. Evaluation among six patients showed mixed results and underlined the importance of establishing a plan and follow-up.

Conclusion

The study indicates the importance of doing a cooperation project with focus on person centeredness, aim and timeframe, common approach and understanding. Combining this

with improvement knowledge might increase opportunities for spread and sustainability.

Introduction: Destination Jönköping is a firm whose task is to promote and developJönköping as a destination. The physical tourist offices were staffed byDestination Jönköpings crew until 2018. A concept called “InfoPoint” wereestablished when the tourist offices closed. An InfoPoint is a tourist servicelocation. The InfoPoints are placed in different businesses around themunicipality where the visitor can turn for help. The staff from DestinationJönköping supports the business staff in their hosting performance bycontributing with knowledge and material about the activities the municipalityhas to offer. Businesses who are not InfoPoints are welcome to take part of thesupport Destination Jönköping offer. The support is given in the form ofincluding newsletters, study trips, sightseeing trips, and workshops.

Purpose: The purpose of this study is to investigate how the participants within thehospitality industry experience the support from Destination Jönköping in theirhosting performance.

Methods: A quantitative survey with qualitative features was used based on the purposeof the study and the question formulation. The survey was designed as a websurvey.

Conclusion: The support given is perceived as positive and the majority is satisfied with thecontent and see the benefits of the activities. Two factors can affect theexperience of hospitality support. The first factor is how the business definesthe concept of hospitality. The second factor is the vision the business has aboutDestination Jönköping’s mission.

Background: Motion capture and analyzing systems are essential for understanding locomotion. However, the existing devices are too cumbersome and can be used indoors only. A newly-developed wearable motion capture and measurement system with multiple sensors and ultrasound imaging was introduced in this study. Methods: In ten healthy participants, the changes in muscle area and activity of gastrocnemius, plantarflexion and dorsiflexion of right leg during walking were evaluated by the developed system and the Vicon system. The existence of significant changes in a gait cycle, comparison of the ankle kinetic data captured by the developed system and the Vicon system, and test-retest reliability (evaluated by the intraclass correlation coefficient, ICC) in each channel’s data captured by the developed system were examined. Results: Moderate to good test-retest reliability of various channels of the developed system (0.512 ≤ ICC ≤ 0.988, p < 0.05), significantly high correlation between the developed system and Vicon system in ankle joint angles (0.638R ≤ 0.707, p < 0.05), and significant changes in muscle activity of gastrocnemius during a gait cycle (p < 0.05) were found. Conclusion: A newly developed wearable motion capture and measurement system with ultrasound imaging that can accurately capture the motion of one leg was evaluated in this study, which paves the way towards real-time comprehensive evaluation of muscles and joint motions during different activities in both indoor and outdoor environments.

I detta paper kommer jag att föra ett resonemang kring möjligheten att kombinera ett praktiskt utvecklingsprojekt med ett interaktivt forskningsperspektiv. Jag inleder med att beskriva den praktik jag verkar i och mitt forskningsintresse, inkluderande ett antal aktuella begrepp. Därefter reflekterar jag över den interaktiva forskningen. Utifrån praktikens kontext och det problemområde som skisserats fram resonerar jag kring hur forskningen i samverkan med praktiken (interaktivt) skulle kunna struktureras för att bidra till att kritiskt skildra problemområdet och fördjupa kunskaperna i pågående utvecklingsprojekt. Avslutningsvis kommer jag att beröra forskarens roll med betoning på dikotomin med att både vara forskare och del av den studerade verksamheten. Mitt resonemang tar sin utgångspunkt ett par huvudfrågor:

• Hur kan en interaktiv forskningsansats vara till fördel för att fångade faktorer som stödjer professionaliseringen av chefsrollen i dess kontextuella miljö, socialtjänsten i Jönköpings kommun samt vara till nytta för både praktiken och teorin?
• Hur är det möjligt att hålla behövlig distans för att öka förståelsen för forskningsområdet och samtidigt bibehålla närheten som krävs för ett lyckat utvecklingsarbete?

Background: Multiple sclerosis is a chronic inflammatory auto-immune disease with various symptoms, which requires comprehensive multidisciplinary treatment for distinct and individualized conditions. Reviews on this population address treatment alternatives (i.e., pharmaceutical and rehabilitation). Orthotic interventions are seldom mentioned or mentioned briefly in conjunction with physiotherapy interventions.

Aim: This study aims to critically appraise and summarize current evidence regarding orthotic interventions for multiple sclerosis population with lower limb deficiencies.

Methods: This study uses umbrella review protocol for systematic reviews. 5 databases were used (CINAHL, Cochrane, PubMed, Scopus, Web of Science). From 44 reviews, 6 systematic reviews were obtained using JBI appraisal tool. Methodological quality is appraised using AMSTAR II, data were extracted via JBI data extraction form for umbrella reviews. 2 articles were excluded and the evidence quality of the remaining 4 articles were appraised via GRADE.

Results: 2 out of 4 investigated the effect of foot orthoses, whilst the remaining investigated FES devices. 3 out of 4 articles scored “Critically low” in methodological quality, 1 scored “High”. The evidence quality of the different outcomes ranges from "Very low” to “High”.

Conclusion: Foot orthoses reported an increase RoM in ankle and knee joints. FES intervention found an increase in speed and endurance during gait and increased RoM of ankle and knee. However, more studies with higher quality are needed to establish clinical recommendations.

Background: Evidence-based practice is commonly accepted as a means of improving patient outcomes; however, there is little understanding of the processes required to successfully implement it into prosthetic and orthotic practice.

Objectives: To discuss factors affecting adoption of evidence-based practice and present a theoretical framework for its implementation into prosthetic and orthotic practice.

Discussion: Numerous factors that affect adoption of evidence-based practice are discussed, ranging from individual factors to those that can be attributed to administrative and environmental issues. Specific factors are likely to be context specific and are influenced by the manner in which evidence-based practice is introduced into the working environment. It is argued that successful implementation of evidence-based practice requires consideration of numerous interrelated factors. A formal translating research into practice model is presented as a means of developing a strategic plan that considers all relevant factors and maximizes acceptance of evidence-based practice into prosthetics and orthotics clinical practice.

Conclusions: The use of a theoretical model for implementation of evidence-based practice is likely to improve its adoption by prosthetic and orthotic clinicians.

Ankle-foot orthoses (AFOs) are typically designed to limit the motion of the ankle joint in one or more planes. Given that balance may be compromised when joint range of motion is restricted, an understanding of the relative effects of AFOs on balance performance is clinically relevant. The aim of this systematic review was to evaluate existing evidence related to the effects of AFOs on static and dynamic balance. A search of appropriate medical databases was conducted, and 37 articles were found to satisfy predetermined inclusion criteria. Articles were categorized under two main areas: those investigating the use of AFOs designed for sporting applications (sports orthoses, 18 studies) and those investigating orthoses that are intended to facilitate ambulation in subjects with locomotor disorders (ambulatory orthoses, 19 studies). Combined results suggest that sports orthoses may facilitate certain aspects of balance in subjects with ankle instability and that balance is unlikely to be compromised when able-bodied subjects wear AFOs as a prophylactic measure. No evidence exists to suggest that any one design of sports orthosis is superior to another in terms of performance on balance measures. Results of studies involving ambulatory orthoses indicated that their effects on balance were largely dependent on the design characteristics of the orthosis used. Rigid AFOs seemed to facilitate static balance tasks, although the level of confidence in this outcome was relatively low. Under dynamic conditions, rigid AFOs seemed to compromise balance for the tested populations; confidence in this outcome was rated as moderate. A high level of confidence was ascribed to the statement that leaf spring AFOs, which allow controlled motion in the sagittal plane, seemed to facilitate both static and dynamic balance in the studied cohorts. ( J Prosthet Orthot. 2010;22:P4–P23.)

Height estimations based on security camera footage are often requested by law enforcement authorities. While valid and reliable techniques have been established to determine vertical distances from video frames, there is a discrepancy between a person's true static height and their height as measured when assuming different postures or when in motion (e.g., walking). The aim of the research presented in this report was to accurately record the height of subjects as they performed a variety of activities typically observed in security camera footage and compare results to height recorded using a standard height measuring device. Forty-six able bodied adults participated in this study and were recorded using a 3D motion analysis system while performing eight different tasks. Height measurements captured using the 3D motion analysis system were compared to static height measurements in order to determine relative differences. It is anticipated that results presented in this report can be used by forensic image analysis experts as a basis for correcting height estimations of people captured on surveillance footage.

This case study has been conducted at a private health care center in Sweden. The health care center has been experiencing difficulties with the feedback process regarding test results and X-ray results to patients, which they assume is one of the reasons why listed patients choose to list themselves at other health care centers. The case study aims to map the health care center's feedback process regarding test results and X-ray results to patients. The methods used to conduct data to the case study was cross mark-statistics, surveys and interviews, whichgenerated both quantitative and qualitative results. The respondents in the case study wherelimited to a selected group of patients and to staff members at the health care center. The results of the case study demonstrated that the feedback of test results and X-ray results was variated. The majority of both the patients and the staff members considered that feedback of test resultsor X-ray results should be executed by letter. The results also demonstrated that the staff members agreed in who is responsible for the execution of the feedback. The responding staffmembers also wished for a written routine for the feedback process. The health care center should face minor resistance if they choose to establish a cross-professional routine for the feedback process to patients. By standardized and efficient processes, the health care center should see benefits with their workload and their waste of resources reduced. In addition, the most important benefit, the patient safety should be increased.