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  • 51.
    Norström, Livia
    et al.
    University West, School of Business, Economics and IT, Division of Media and Design.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics.
    Topics and Approaches: A Framework for Municipality Social Media Engagement2018Conference paper (Other academic)
  • 52.
    Olofsson, Pia
    et al.
    University West, Department of Nursing, Health and Culture, Division of Nursing.
    Gellerstedt, Martin
    University West, Department of Economics and IT, Division of Computer Science and Informatics.
    Carlström, Eric
    University West, Department of Nursing, Health and Culture, Division of Health and Culture.
    Triage på akutmottagning: en utvärdering av triage i Västra Götalandsregionen2008Report (Other academic)
    Abstract [sv]

    Triage är en systematiserad form av prioritering som utförs på de flesta akutmottagningar i Sverige och internationellt. Syftet med triage är att uppnå en medicinskt säkerställd turordning för patienter som söker vård. I Västra Götalandsregionen har akutmottagningarna de senaste två åren implementerat Manchester Triage (MTS). Modellen består av ett medicinskt beslutsstöd i form av ett flödesschema, samt fem triagekategorier, som var och en anger maximal väntetid. Patienterna som bedöms tillhöra kategori 1 behöver omedelbar läkarkontakt. De övriga fyra kategorierna bedöms kunna vänta mellan 10 minuter och upptill 240 minuter. Den här studien utvärderar överensstämmelsen i form av mellanbedömarreliabilitet, samt träffsäkerhet i triagebedömningar hos sjuksköterskor som arbetar med MTS. De 79 sjuksköterskor som deltog i studien var verksamma på sju olika akutmottagningar i Västra Götalandsregionen. Sjuksköterskorna bedömde 13 fiktiva patientfall vardera. Dessa patientfall hade tilldelats en förväntad triagekategori utifrån en expertgrupps samlade bedömning. Mellanbedömar-reliabiliteten för akutmottagningarna totalt var 0,61 i oviktat k-värde vilket innebär god överensstämmelse. Mellan akutmottagningarna varierade k-värdet från 0,56-0,65. Träffsäkerheten gentemot expertgruppens förväntade triagekategori var 73 % totalt. 14 % av patienterna tilldelades en högre triagekategori än den förväntade (övertriage) och 13 % en lägre (undertriage). Träffsäkerheten för MTS var hög i kategori 1 (92 %) och kategori 2 (91 %), men lägre i kategori 3 (66 %) och 4 (63 %). Slutsatsen är att mellanbedömar-reliabiliteten var god och träffsäkerheten hög. Triagekategori 1 och 2 redovisade högst värden, vilket tyder på att denna grupp av patienter bereds vård utan riskfyllda väntetider. De patienter som ges en lägre prioritet visar sig emellertid vara svåra att bedöma. Trots att dessa patienter är mest frekventa på akutmottagningarna var de svåra att särskilja. Detta pekar på ett behov av att ytterligare utveckla bedömningar av kategori 3 och 4 i triagemodellen MTS.

  • 53.
    Olofsson, Pia
    et al.
    Nu-sjukvården, Trollhättan, Department of Emergency Medicin.
    Gellerstedt, Martin
    University West, Department of Economics and IT, Division of Computer Science and Informatics.
    Carlström, Eric. D.
    University West, Department of Nursing, Health and Culture, Division of Nursing.
    Manchester Triage in Sweden: Interrater reliability and accuracy2009In: International Emergency Nursing, Vol. 17, no 3, p. 143-148Article in journal (Refereed)
    Abstract [en]

    This study investigates the interrater reliability and the accuracy of Manchester Triage (MTS) at emergency departments in Western Sweden. Methods: A group of 79 nurses from seven emergency departments assessed simulated patient cases and assigned triage categories using the same principles as in their daily work. K statistics, accuracy, over-triage and under-triage were then analyzed. The nurses performed 1027 triage assessments. Results: The result showed an unweighted κ value of 0.61, a linear weighted κ value of 0.71, and a quadratic weighted κ value of 0.81. The determined accuracy was 92% and 91% for the two most urgent categories, but significantly lower for the less urgent categories. Conclusions: Patients in need of urgent care were identified in more than nine out of 10 cases. The high level of over-triage and under-triage in the less urgent categories resulted in low agreement and accuracy. This may suggest that the resources of emergency departments can be overused for non-urgent patients.

  • 54.
    Olsson, Anna Karin
    et al.
    University West, Department of Economics and IT, Division of Business Administration.
    Gellerstedt, Martin
    University West, Department of Economics and IT, Division of Computer Science and Informatics.
    Doing Good: an Exploration of Members' Motivations and Behaviours in Tourism SettingsManuscript (preprint) (Other academic)
  • 55.
    Olsson, Anna Karin
    et al.
    University West, Department of Economics and IT, Division of Business Administration.
    Gellerstedt, Martin
    University West, Department of Economics and IT, Division of Computer Science and Informatics.
    Doing good at a nonprofit tourist attraction2014In: International Journal of Culture, Tourism and Hospitality, ISSN 1750-6182, E-ISSN 1750-6190, Vol. 8, no 1, p. 74-91Article in journal (Refereed)
    Abstract [en]

    PurposeThe purpose of this paper is to contribute to the growing field of membership research by applying a relationship marketing perspective on members in tourism settings. Focus is on exploring why consumers are members (motivational dimensions) and how motivations are related to member behaviours (retention, participation and co-creation), and to member demographics (gender, age, distance between the member’s home and the supported organization).

     

    Design/methodology/approach -   A survey was conducted among members of a nonprofit tourist attraction (N=755). Classical chi-square tests, t-tests and multivariate analysis using logistic regression were used to analyze data and to test eight hypotheses on member demographics, member motivations and member behaviours.

     

    Findings - Findings show that among the three motivational dimensions, altruism, i.e., doing good for others, was the strongest motive, followed by self-interest, i.e., doing good for yourself, and then the social motive, i.e., doing good with others, which scored lowest. Furthermore, findings show that gender, age and distance were significantly related to member motivations and member behaviours.  Member behaviours were significantly related to motivations.

     

    Research limitations/implications – This study was conducted at a single nonprofit tourist attraction. However, it provides insights into different motivational dimensions for why people pay to become members and what kind of member behaviour they demonstrate. This topic calls for further research to explore the complex membership phenomenon such as extending this study by identifying member motives and behaviour in other contexts.

     

    Practical implications – This explorative study of members of a nonprofit tourist attraction contributes insights into why consumers are members (motivational dimensions), how motivations are related to member behaviours in a membership relationship context, and how member demographics are related to motivations and behaviours. Findings have implications for membership managers and the development of memberships in terms of giving a deeper insight into members as consumers in order to develop memberships as strategic resources and hence use the full potential of memberships especially vital to non-profit organizations. Several aspects of memberships are discussed that may inspire the development of member offerings. The present study contributes to the developing field of membership research as it is a response to the calls for more empirical studies of members to develop an integrated understanding of motivations of memberships. Furthermore it contributes with research of co-creation in customer relationships linking the co-creation concept to research of members in tourism settings.

     

     

    Originality/value –   This study contributes to the developing field of membership research and furthermore gives insights into consumer motivations and behaviours that may inspire development of innovative and competitive membership offerings building membership relationships in tourism settings.

     

  • 56.
    Olsson, Anna Karin
    et al.
    University West, School of Business, Economics and IT, Division of Business Administration.
    Lindh, Kristina
    University West, School of Business, Economics and IT, Division of Business Administration.
    Berndtsson, Leif
    University West, School of Business, Economics and IT, Division of Business Administration.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Division of Computer Science and Informatics.
    Nehls, Eddy
    University West, Department of Nursing, Health and Culture, Division of Health and Culture.
    Driving forces for sustainable destination development: A Nordic study based on maritime culture and inland sea-regions2012In: Developing Tourism - Sustaining Regions: Book of Abstracts The 21st Nordic Symposium in Tourism and Hospitality Research / [ed] Ednarsson, M., Hoppstadius, F., Lundmark, L., Marjavaara, R., Müller, D., Pitkänen, K., Åkerlund, U., Umeå: Umeå universitet , 2012, p. 110-110Conference paper (Refereed)
    Abstract [en]

    This study focuses on sustainable destination development in a Nordic context. At most destinations stakeholders from private, public and voluntary sectors interact and there is a need for coordination and cooperation. An escalating competition among destinations has raised calls for innovative offerings that are well-coordinated. Studies of tourism destinations show that networks are crucial since successful destinations are based on interrelated stakeholders that understand the concept of the destination and are committed to cooperate in offering a holistic experience to visitors. 

     

    The aim of this paper is to discuss the driving forces of sustainable destination development. In particular the study focuses on stakeholder cooperation and sharing of knowledge and experiences among two Nordic regions based on maritime culture and inland sea-regions.

    The data collection includes a combination of different methods: interviews with main stakeholders, collection of existing documents related to the regions, observation of stakeholder meetings, and participant observations of attractions and events. 

    The project is ongoing but so far we have interviewed a few stakeholders in each destination and gained their insights into how to cooperate in order to develop tourism sustainable regions.

     

  • 57.
    Onerup, Aron
    et al.
    University of Gothenburg, Sahlgrenska Academy, Department of Surgery, Institute of Clinical Sciences,.
    Angerås, Ulf
    University of Gothenburg, Sahlgrenska Academy, Department of Surgery, Institute of Clinical Sciences,.
    Bock, David
    University of Gothenburg, Sahlgrenska Academy, Department of Surgery, Institute of Clinical Sciences,.
    Börjesson, Mats
    Karolinska University Hospital, Swedish School of Sport and Health Sciences and Karolinska University Hospital,.
    Fagevik Olsén, Monika
    Sahlgrenska Academy at Gothenburg University, Department of Gastrosurgical Research and Education.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics. University of Gothenburg, Sahlgrenska Academy, Department of Surgery, Institute of Clinical Sciences,.
    Haglind, Eva
    University of Gothenburg, Sahlgrenska Academy, Department of Surgery, Institute of Clinical Sciences,.
    Nilsson, Hanna
    University of Gothenburg, Sahlgrenska Academy, Department of Surgery, Institute of Clinical Sciences,.
    Angenete, Eva
    University of Gothenburg, Sahlgrenska Academy, Department of Surgery, Institute of Clinical Sciences,.
    The preoperative level of physical activity is associated to the postoperative recovery after elective cholecystectomy: A cohort study2015In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, Vol. 19, no July, p. 35-41Article in journal (Refereed)
    Abstract [en]

    Introduction There is an increasing interest in the role of preoperative physical activity for postoperative recovery. The effect of preoperative physical activity and recovery after cholecystectomy is unknown. The aim of this study was to evaluate the association of self-reported leisure-time preoperative physical activity with postoperative recovery and complications after elective cholecystectomy due to gallstone disease. Methods Prospective observational cohort study with 200 patients scheduled to undergo elective cholecystectomy. Level of self-assessed leisure-time physical activity was compared with recovery. Results Regular physical activity was associated with a higher degree of return to work within three weeks post-operatively (relative chance (RC) 1.26, p = 0.040); with a higher chance of leaving hospital within one day post-op (RC 1.23, p = 0.001), as well as with better mental recovery (RC 1.18, p = 0.049), compared to physically inactive. No statistically significant association was seen with return to work within one week or with self-assessed physical recovery. Discussion In clinical practice, evaluating the patients’ level of physical activity is feasible, and may potentially be used to identify patients being more suitable for same-day surgery. Given the study design, the results from this study cannot prove causality. Conclusion The present study shows that the preoperative leisure-time physical activity-level, is positively associated with less sick leave, a shorter hospital stay and with better mental recovery, three weeks post-elective cholecystectomy. We recommend assessing the physical activity-level preoperatively for prognostic reasons. If preoperative/postoperative physical training will increase recovery remains to be shown in a randomized controlled study.

  • 58.
    Onerup, Aron
    et al.
    University of Gothenburg, Department of Surgery, SSORG—Scandinavian Surgical Outcomes Research GroupInstitute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Gothenburg Sweden.
    Bock, David
    University of Gothenburg, Department of Surgery, SSORG—Scandinavian Surgical Outcomes Research GroupInstitute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Gothenburg Sweden.
    Börjesson, Mats
    Göteborg University and Sahlgrenska University Hospital/Östra, Institute of Neuroscience and Physiology, Institute of Food, Nutrition and Sport Science, Sahlgrenska Academy, Gothenburg Sweden.
    Fagevik Olsén, Monica
    Sahlgrenska Academy at Gothenburg University, Department of Physical Therapy and Department of Surgery, Gothenburg, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics. University of Gothenburg, Department of Surgery, SSORG—Scandinavian Surgical Outcomes Research GroupInstitute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Gothenburg Sweden.
    Haglind, Eva
    University of Gothenburg, Department of Surgery, SSORG—Scandinavian Surgical Outcomes Research GroupInstitute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Gothenburg Sweden.
    Nilsson, Hanna
    University of Gothenburg, Department of Surgery, SSORG—Scandinavian Surgical Outcomes Research GroupInstitute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Gothenburg Sweden.
    Angenete, Eva
    University of Gothenburg, Department of Surgery, SSORG—Scandinavian Surgical Outcomes Research GroupInstitute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Gothenburg Sweden.
    Is preoperative physical activity related to post-surgery recovery?: A cohort study of colorectal cancer patients2016In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 31, no 6, p. 1131-1140Article in journal (Refereed)
    Abstract [en]

    Introduction: An increasing interest is seen in the role of preoperative physical activity (PA) in enhancing postoperative recovery. The short-term effect of preoperative PA on recovery after colorectal cancer is unknown. The aim of this study was to evaluate the association of the preoperative level of PA with postoperative recovery after surgery due to colorectal cancer disease. Methods: This is a prospective observational cohort study, with 115 patients scheduled to undergo elective colorectal surgery. The self-reported level of preoperative PA was compared to measures of recovery. Results: Regular self-reported preoperative PA was associated with a higher chance of feeling highly physically recovered 3 weeks after surgery (relative chance 3.3, p = 0.038), compared to physical inactivity. No statistically significant associations were seen with length of hospital stay, self-assessed mental recovery, re-admittances or with re-operations. Discussion: In clinical practice, evaluating the patients’ level of PA is feasible and may potentially be used as a prognostic tool for patients undergoing colorectal cancer surgery. Given the study design, the results from this study cannot prove causality. Conclusion: The present study found that the preoperative level of PA was associated with a faster self-assessed physical recovery after colorectal cancer surgery. PA did not show any associations with the primary outcome measure length of hospital stay or any of the other secondary outcome measures. Assessment of PA level preoperatively could be used for prognostic reasons. If systematic preoperative/postoperative physical training will enhance recovery, this remains to be studied in a randomized controlled study. Highlights: We examined preoperative physical activity and the recovery after colorectal cancer surgery.Physically active individuals had faster self-assessed physical recovery.Assessment of preoperative physical activity may provide prognostic clinical information. © 2016, Springer-Verlag Berlin Heidelberg.

  • 59.
    Rawshani, Araz
    et al.
    University of Gothenburg, Department of Medicine, Sahlgrenska Academy.
    Larsson, Anna
    University College of Borås,The Pre-hospital Research Centre of Western Sweden, Prehospen.
    Gelang, Carita
    University College of Borås,The Pre-hospital Research Centre of Western Sweden, Prehospen.
    Lindqvist, Jonny
    University of Gothenburg, Department of Medicine, Sahlgrenska Academy.
    Gellerstedt, Martin
    University West, Department of Economics and IT, Divison of Informatics.
    Bång, Angela
    University College of Borås,The Pre-hospital Research Centre of Western Sweden, Prehospen.
    Herlitz, Johan
    University of Gothenburg, Department of Medicine, Sahlgrenska Academy.
    Characteristics and outcome among patients who dial for the EMS due to chest pain2014In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, no 3, p. 859-865Article in journal (Refereed)
    Abstract [en]

    Objectives: This study aims to describe patients who called for the emergency medical service (EMS) due to chest discomfort, in relation to gender and age. Methods: All patients who called the emergency dispatch centre of western Sweden due to chest discomfort, between May 2009 and February 2010, were included. Initial evaluation, aetiology and outcome are described as recorded in the databases at the dispatch centre, the EMS systems and hospitals. Patients were divided into the following age groups: ≀ 50, 51-64 and ≥ 65 years. Results: In all, 14,454 cases were enrolled. Equal proportions of men (64%) and women (63%) were given dispatch priority 1. The EMS clinicians gave priority 1 more frequently to men (16% versus 12%) and older individuals (10%, 15% and 14%, respective of age group). Men had a significantly higher frequency of central chest pain (83% versus 81%); circulatory compromise (34% versus 31%); ECG signs of ischaemia (17% versus 11%); a preliminary diagnosis of acute coronary syndrome (40% versus 34%); a final diagnosis of acute myocardial infarction (14% versus 9%) and any potentially life-threatening condition (18% versus 12%). Individuals aged ≥ 65 years were given a lower priority than individuals aged 51-64 years, despite poorer characteristics and outcome. In all, 78% of cases with a potentially life-threatening condition and 67% of cases that died within 30 days of enrolment received dispatch priority 1. Mortality at one year was 1%, 4% and 18% in each individual age group. Conclusion: Men and the elderly were given a disproportionately low priority by the EMS. 

  • 60.
    Rawshani, Araz
    et al.
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Rawshani, Nina
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Gelang, Carita
    The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andersson, Jan-Otto
    The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Larsson, Anna
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Bång, Angela
    University College of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Herlitz, Johan
    University College of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics. University West, School of Business, Economics and IT, Divison of Informatics.
    Emergency medical dispatch priority in chest pain patients due to life threatening conditions: A cohort study examining circadian variations and impact of the education2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 236, no I June, p. 43-48Article in journal (Refereed)
    Abstract [en]

    Background and aims: We examined the accuracy in assessments of emergency dispatchers according to their education and time of the day. We examined this in chest pain patients who were diagnosed with a potentially life-threatening condition (LTC) or died within 30 days. Methods: Among 2205 persons, 482 died, 1631 experienced an acute coronary syndrome (ACS), 1914 had a LTC.Multivariable logistic regression was used to study how time of the call and the dispatcher's education were associated with the risk of missing to give priority 1 (the highest). Results: Among patients who died, a 7-fold increase in odds of missing to give priority 1 was noted at 1.00 pm, as compared with midnight. Compared with assistant nurses, odds ratio for dispatchers with no (medical) training was 0.34 (95% CI 0.14 to 0.77). Among patients with an ACS, odds ratio for calls arriving before lunch was 2.02 (95% CI 1.22 to 3.43), compared with midnight. Compared with assistant nurses, odds ratio for operators with no training was 0.23 (95% CI 0.13 to 0.40). Similar associations were noted for those with any LTC. Dispatcher's education was not associated with the patient's survival. Conclusions: In this group of patients, which experience substantial mortality and morbidity, the risk of not obtaining highest dispatch priority was increased up to 7-fold during lunchtime. Dispatch operators without medical education had the lowest risk, compared with nurses and assistant nurses, of missing to give priority 1, at the expense of lower positive predictive value. Key messages: What is already known about this subject? Use of the emergency medical service (EMS) increases survival among patients with acute coronary syndromes. It is unknown whether the efficiency – as judged by the ability to identify life-threatening cases among patients with chest pain – varies according to the dispatcher's educational level and the time of day.What does this study add? We provide evidence that the dispatcher's education does not influence survival among patients calling the EMS due to chest discomfort. However, medically educated dispatchers are at greatest risk of missing to identify life threatening cases, which is explained by more parsimonious use of the highest dispatch priority. We also show that the risk of missing life-threatening cases is at highest around lunch time.How might this impact on clinical practice? Dispatch centers are operated differently all over the world and chest discomfort is one of the most frequent symptoms encountered; we provide evidence that it is safe to operate a dispatch center without medically trained personnel, who actually miss fewer cases of acute coronary syndromes. However, non-medically trained dispatchers consume more pre-hospital resources.

  • 61.
    Rawshani, Nina
    et al.
    Sahlgrenska University Hospital, Östra Sjukhuset, Department of Emergency Medicine, Göteborg, Sweden.
    Rawshani, Araz
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Gelang, Carita
    University of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Herlitz, Johan
    University of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Bång, Angela
    University of Borås, School of Health Science, Borås, Sweden.
    Andersson, Jan-Otto
    Department of Ambulance and Prehospital Emergency Care, Skaraborg, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Informatics.
    Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 248, no 1 December, p. 77-81Article in journal (Refereed)
    Abstract [en]

    Background

    In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality).

    Methods

    The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n = 13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG.

    Results

    In the overall cohort, 21% (n = 2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n = 1159) did not undergo a pre-hospital ECG while 32% (n = 1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; p < 0.001). In the matched cohort, the OR was 0.65 (95% CI 0.49-0.85; p < 0.001). Using the propensity score, in the overall cohort, the corresponding HR was 0.65 (95% CI 0.58-0.74).

    Conclusion

    Using propensity score methods, we provide real-world data demonstrating that the adjusted risk of death was considerably lower among the cases in whoma pre-hospital ECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality.

  • 62.
    Rawshani, Nina
    et al.
    Varberg Hospital, Varberg, Halland County, Sweden.
    Rawshani, Araz
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Gelang, Carita
    University College of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Herlitz, Johan
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Bång, Angela
    University of Borås, School of Health Science, Borås, Sweden.
    Andersson, Jan-Otto
    Ambulance Service, Skaraborg, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics.
    Could ten questions asked by the dispatch center predict the outcome for patients with chest discomfort?2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 209, no April, p. 223-225Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: From 2009 to 2010, approximately 14,000 consecutive persons who called for the EMS due to chest discomfort were registered. From the seventh month, dispatchers ask 2285 patient ten pre-specified questions. We evaluate which of these questions was independently able to predict an acute coronary syndrome (ACS), life-threatening condition (LTC) and death.

    METHODS: The questions asked mainly dealt with previous history and type of symptoms, each with yes/no answers. The dispatcher took a decision on priority; 1) immediately with sirens/blue light; 2) EMS on the scene within 30min; 3) normal waiting time.We examined the relationship between the answers to these questions and subsequent dispatch priority, as well as outcome, in terms of ACS, LTC and all-cause mortality.

    RESULTS: 2285 patients (mean age 67years, 49% women) took part, of which 12% had a final diagnosis of ACS and 15% had a LTC. There was a significant relationship between all the ten questions and the priority given by dispatchers. Localisation of the discomfort to the center of the chest, more intensive pain, history of angina or myocardial infarction as well as experience of cold sweat were the most important predictors when evaluating the probability of ACS and LTC. Not breathing normally and having diabetes were related to 30-day mortality.

    CONCLUSIONS: Among individuals, who call for the EMS due to chest discomfort, the intensity and the localisation of the pain, as well as a history of ischemic heart disease, appeared to be the most strongly associated with outcome.

  • 63.
    Rönnberg, Katarina
    et al.
    Göteborg University, Department of Orthopaedics, Sahlgrenska University Hospital.
    Lind, B.
    Göteborg University, Department of Orthopaedics, Sahlgrenska University Hospital.
    Zoega, B.
    Department of Orthopaedics, Landspitali University Hospital, Reykjavik, Iceland.
    Gadeholt-Göthlin, G.
    Göteborg University, Sahlgrenska University Hospital, Department of Radiology .
    Halldin, K.
    Göteborg University, Department of Orthopaedics, Sahlgrenska University Hospital.
    Gellerstedt, Martin
    University West, Department of Economics and IT, Division of Computer Science and Informatics.
    Brisby, H.
    Göteborg University, Department of Orthopaedics, Sahlgrenska University Hospital.
    Peridural scar and its relation to clinical outcome: A randomised study on surgically treated lumbar disc herniation patients2008In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 17, no 12, p. 1714-1720Article in journal (Refereed)
    Abstract [en]

    A prospective randomised 2-year follow-up study on patients undergoing lumbar disc herniation surgery. The objective was to investigate the relationship between peridural scarring and clinical outcome, the scar development 6 and 24 months postoperatively by using MRI, and if ADCON-L (a bioresorbable carbohydrate polymer gel) has an effect on scar size and/or improve patients' outcome after lumbar disc herniation surgery. The association between peridural scarring and recurrent pain after lumbar disc herniation surgery is debated. Numerous materials have been used in attempts to prevent or reduce postoperative peridural scarring; however, there are conflicting data regarding the clinical effects. The study included 119 patients whose mean age was 39 years (18-66); 51 (47%) were women. Sixty patients (56%) were perioperatively randomised to receive ADCON-L, and 48 (44%) served as controls. All patients underwent MRI at 6 and 24 months postoperatively, and an independent radiologist graded the size, location and development of the scar, by using a previously described scoring system. Pre- and 2-year postoperatively patients graded their leg pain on a visual analogue scale (VAS). At the 2-year follow-up patients rated their satisfaction with treatment (subjective outcome) and were evaluated by an independent neurologist (objective outcome), using MacNab score. There was no relationship between size or localisation of the scar and any of the clinical outcomes (VAS, subjective and objective outcome). The scar size decreased between 6 and 24 months in 49%, was unchanged in 42% and increased in 9% of the patients. Patients treated with ADCON-L did not demonstrate any adverse effects, nor did they demonstrate less scarring or better clinical outcome than control patients. No significant association between the presence of extensive peridural scar or localisation of scar formation and clinical outcome could be detected in the present study. Further, no positive or negative effects of ADCON-L used in disc herniation surgery could be seen. 

  • 64.
    Rönnberg, Katarina
    et al.
    Sahlgrenska University Hospital, Department of Orthopaedics.
    Lind, Bengt
    Sahlgrenska University Hospital, Department of Orthopaedics.
    Zoëga, Björn
    Landspitali University Hospital, Reykjavik, Department of Orthopaedics.
    Halldin, Klas
    Sahlgrenska University Hospital, Department of Orthopaedics.
    Gellerstedt, Martin
    University West, Department of Economics and IT, Division of Computer Science and Informatics.
    Brisby, Helena
    Sahlgrenska University Hospital, Department of Orthopaedics.
    Patients' satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery2007In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 32, no 2, p. 256-261Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN. A prospective study of patients undergoing lumbar disc herniation surgery. OBJECTIVES. To assess patients' satisfaction with care/preoperative information, if expectations on surgical results and ability to return to work are related to baseline characteristics, and/or can predict self-reported outcome. Self-reported outcome was compared with objective outcome. SUMMARY OF BACKGROUND DATA. Patients' expectations on treatment results have been discussed as a predictive factor for postoperative outcome and satisfaction demonstrated to be directly related to patient expectations. METHODS. The study includes 148 patients, 46% women, mean age 40 (range 18-66). Before and 2 years after surgery, questionnaires about given information/care, expected/present work ability, and expectations on/obtained improvement of physical functions/symptoms (leg and back pain, sensibility, and muscle function) were filled in. The visual analog scale leg pain, Zung Depression Scale, and Oswestry Disability Index were used as baseline characteristics. At 2-year follow-up, self-reported and objective outcome was assessed. RESULTS. Satisfaction with given information/care were reported by 46% and 82%, respectively. Zung Depression Scale related to expectations on leg pain recovery (P = 0.022), work ability (P = 0.046), and satisfaction with given information (P = 0.031). Patients who expected to return (76%) and not return (24%) to work, returned in 78% and 26%, respectively (P = 0.021). A high agreement between self-reported outcome and objective outcome were found (P < 0.001). CONCLUSIONS. Patients undergoing lumbar disc herniation surgery are mostly satisfied with provided care before and after surgery, however, less satisfied with information provided. Further, patients with preoperative positive expectations on work return and realistic expectations on pain and physical recovery have a greater chance to be satisfied with the surgical results. © 2007 Lippincott Williams & Wilkins, Inc.

  • 65. Silverplats, Katarina
    et al.
    Lind, B
    Zoëga, B
    Halldin, K
    Gellerstedt, Martin
    University West, Department of Economics and IT, Division of Law, Politics and Economics.
    Brisby, H
    Rutberg, L
    Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up.2010In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 19, no 9, p. 1459-67Article in journal (Refereed)
    Abstract [en]

    Factors as age, sex, smoking, duration of leg pain, working status, type/level of disc herniation and psychosocial factors have been demonstrated to be of importance for short-term results after lumbar discectomy. There are few studies with long-term follow-up. In this prospective study of lumbar disc herniation patients undergoing surgery, the result was evaluated at 2 and 5-10 (mean 7.3) years after surgery. Predictive factors for satisfaction with treatment and objective outcome were investigated. Out of the included 171 patients undergoing lumbar discectomy, 154 (90%) patients completed the 2-year follow-up and 140 (81%) completed the long-term follow-up. Baseline data and questionnaires about leg- and back pain intensity (VAS), duration of leg pain, disability (Oswestry Disability Index), depression (Zung Depression Scale), sick leave and employment status were obtained preoperatively, at 2-year- and long-term follow-up. Primary outcome included patient satisfaction with treatment (at both time points) and assessment of an independent observer at the 2-year follow-up. Secondary outcomes at 2-year follow-up were improvement of leg and back pain, working capacity and the need for analgesics or sleeping pills. In about 70% of the patients excellent or good overall result was reported at both follow-ups, with subjective outcome measurements. The objective evaluation after 2 years was in agreement with this result. Time on sick leave was found to be a clinically important predictor of the primary outcomes, with a potential of changing the probability of a satisfactory outcome (both objective and subjective) from around 50% (sick leave >3 months) to 80% (sick leave <2 months). Time on sick leave was also an important predictor for several of the secondary outcomes; e.g. working capacity and the need for analgesics.

  • 66.
    Silverplats, Katarina
    et al.
    University of Gothenburg, Sahlgrenska University Hospital, Department of Orthopaedics.
    Lind, Bengt
    Gothenburg Spine Center.
    Zoega, Bjöörn
    Landspitali University Hospital, Reykjavik.
    Halldin, Klas
    University of Gothenburg, Sahlgrenska University Hospital, Department of Orthopaedics.
    Gellerstedt, Martin
    University West, Department of Economics and IT, Division of Computer Science and Informatics.
    Rutberg, Lena
    University of Gothenburg, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation.
    Brisby, Helena
    University of Gothenburg, Sahlgrenska University Hospital, Department of Orthopaedics.
    Health-related quality of life in patients with surgically treated lumbar disc herniation: 2- and 7-year follow-up of 117 patients2011In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 82, no 2, p. 198-203Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Health-related quality of life (HRQoL) instruments have been of increasing interest for evaluation of medical treatments over the past 10-15 years. In this prospective, long-term follow-up study we investigated the influence of preoperative factors and the change in HRQoL over time after lumbar disc herniation surgery. Methods: 117 patients surgically treated for lumbar disc herniation (L4-L5 or L5-S1) were evaluated with a self-completion HRQoL instrument (EQ-5D) preoperatively, after 2 years (96 patients) and after 7 years (89 patients). Baseline data (age, sex, duration of leg pain, surgical level) and degree of leg and back pain (VAS) were obtained preoperatively. The mean age was 39 (18-66) years, 54% were men, and the surgical level was L5-S1 in 58% of the patients. The change in EQ-5D score at the 2-year follow-up was analyzed by testing for correlation and by using a multiple regression model including all baseline factors (age, sex, duration of pain, degree of leg and back pain, and baseline EQ-5D score) as potential predictors. Results: 85% of the patients reported improvement in EQ-5D two years after surgery and this result remained at the long-term follow-up. The mean difference (change) between the preoperative EQ-5D score and the 2-year and 7-year scores was 0.59 (p < 0.001) and 0.62 (p < 0.001), respectively. However, the HRQoL for this patient group did not reach the mean level of previously reported values for a normal population of the same age range at any of the follow-ups. The changes in EQ-5D score between the 2- and 7-year follow-ups were not statistically significant (mean change 0.03, p = 0.2). There was a correlation between baseline leg pain and the change in EQ-5D at the 2-year (r = 0.33, p = 0.002) and 7-year follow-up (r = 0.23, p = 0.04). However, when using regression analysis the only statistically significant predictor for change in EQ-5D was baseline EQ-5D score. Interpretation: Our findings suggest that HRQoL (as measured by EQ-5D) improved 2 years after lumbar disc herniation surgery, but there was no further improvement after 5 more years. Low quality of life and severe leg pain at baseline are important predictors of improvement in quality of life after lumbar disc herniation surgery. © Nordic Orthopaedic Federation.

  • 67.
    Vallo Hult, Helena
    et al.
    University West, School of Business, Economics and IT, Divison of Informatics. University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics.
    Byström, Katriina
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics. University West, School of Business, Economics and IT, Divison of Informatics.
    ICT and Learning Usability at Work: Challenges and Opportunitiesfor Physicians in Everyday Practice2016In: Nordic Contributions in IS Research: 7th Scandinavian Conference on Information Systems, SCIS 2016 and IFIP8.6 2016, Ljungskile, Sweden, August 7-10, 2016, Proceedings / [ed] Ulrika Lundh Snis, Springer International Publishing , 2016, p. 176-190Conference paper (Refereed)
  • 68.
    Vallo Hult, Helena
    et al.
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics.
    Hansson, A
    University Health Care Research Center (UFC), Region Örebro län (SWEDEN).
    Svensson, Lars
    University West, School of Business, Economics and IT, Divison of Informatics.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics.
    ICT as support for learning: demanding new competence among phycians2017In: INTED2017 Proceedings, 2017, p. 4629-4636Conference paper (Refereed)
    Abstract [en]

    The subject of this paper is on emerging challenges and opportunities related to digitalization of work and learning in healthcare. Physicians are a typical specialized profession with a lot of formal education and demands for training and lifelong learning. Due to patient-centric care and advances in medicine and technology (e.g. apps for self-care) patients are now becoming active participants in healthcare, challenging the profession and patient-physician relationship. Another key challenge relate to evidence based medicine (EBM) that demand of physicians to keep updated and follow guidelines, while also balance this with own knowledge and best practice. Although the medical profession is based on communication, and social media have such major impact today, digital literacy is lacking in medical curriculum. While previous research suggest that social media have potential to support learning the impact of eHealth in relation to workplace learning has not yet been extensively studied. The research question is: How do physicians view their role in relation to informed patients and patient participation, and what are the implications for workplace learning and medical education in the information society of today?The methodology is a qualitative follow-up study. Thematic analysis was conducted on empirical data from 15 initial semi-structured interviews, and follow-up focus group (6 participants) based on patient scenarios. Our findings indicate that despite quite unionist call for change in the past decade medical education and training still seems to be based on traditional learning, formal lectures and learning by heart. We argue that this may be a key reason behind why the physicians find it hard to navigate the vast amount of medical information and digital tools available. Due to an underlying assumption that being a doctor is about treating patients, focus is placed on how to build up medical knowledge in terms of diagnoses, symptoms and treatments. While when they start to work are facing a much more complex situation, with informed, participating patients, increasingly digitalized workplace and extended networks of collegial and professional expertise. Findings from this study further support recent initiatives to increase health related ICT skills in the healthcare workforce but also highlights that what is needed is primarily related to literacy, as opposed to prior focuses on digital technology, computer skills and specific systems or databases. Thus, in addition to medical knowledge, this study indicate that a key skill is to have design knowledge, that is the ability to understand how the design of one's digital environment can make everyday life and work more effective. The physicians also addressed ethical concerns on the future digital healthcare in relation to patient participation, such as issues of equal care and responsibility. In conclusion, our findings call for a change in education and practice, further stressing a need for new educational models that emphasize on analytic and critical thinking skills (cf. the Bologna declaration) to meet the needs of modern medical learners along with meeting the demand for digital competence for lifelong learning in general.

  • 69.
    Vallo Hult, Helena
    et al.
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics. NU Hospital Group, Sweden.
    Hansson, Anders
    Örebro University, University Health Care Research Center, Faculty of Medicin and Health, Sweden.
    Svensson, Lars
    University West, School of Business, Economics and IT, Divison of Informatics.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Informatics.
    Flipped healthcare for better or worse2019In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811Article in journal (Refereed)
    Abstract [en]

    The medical profession is highly specialized, demanding continuous learning, while also undergoing rapid development in the rise of data-driven healthcare. Based on clinical scenarios, this study explores how resident physicians view their roles and practices in relation to informed patients and patient-centric digital technologies. The paper illustrates how the new role of patients alters physicians’ work and use of data to learn and update their professional practice. It suggests new possibilities for developing collegial competence and using patient experiences more systematically. Drawing on the notion of flipped healthcare, we argue that there is a need for new professional competencies in everyday data work, along with a change in attitudes, newly defined roles, and better ways to identify and develop reliable online sources. Finally, the role of patients, not only as consumers but also producers of healthcare, is a rather formidable and complex cultural change to be addressed. © The Author(s) 2019.

  • 70.
    Vallo Hult, Helena
    et al.
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics.
    Holmgren, Daniel
    Skaraborg’s Hospital, Skövde. University of Gothenburg, Sweden..
    Wekell, Per
    NU Hospital Group, Sweden. University of Gothenburg, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Informatics.
    Co-designing a Digital Platform: Towards e-Health andContinuous Learning in General Paediatrics2017In: International Forum on Quality & Safety in Healthcare: 26-28 April 2017 ExCel London Conference Proceedings Igniting Collective Excellence, 2017Conference paper (Other academic)
    Abstract [en]

    Background

    The study is part of a paediatric CPD program in Western Sweden, involving researchers and practitioners with expertise in medicine, informatics, and pedagogy. Based on previous experiences, the program provides a strong learning environment with extensive collaboration and networking among participants, while it is hard to maintain the collegial network and continue to share knowledge and experiences. Research has shown that new information technologies have potential to create learning opportunities and support reflection, collaboration and workplace learning. However, due to a history of IT-related problems in healthcare, where (despite documented benefits) many eHealth initiatives have failed in practice, health professionals are often less supportive towards such technologies. The research question is: How can IT be used for continuous learning and what are the implications of participatory design for the introduction of eHealth for workplace learning and use in clinical context?

    Method

    Inspired by participatory action research (PAR), the program is designed to offer a learning environment in which participants develop their paediatric and educational practices, as well as improve IT skills and digital competence needed as per today and in the future. In this new program a digital learning platform is introduced with the intention to contribute to formal course objectives but also to function as support for informal learning, networking and knowledge sharing during and after the CPD program, thus promoting long-term continuity of the educational outcomes. During the two-year course, the participants will develop a digital platform together with a Ph.D. student, for paediatric practice, present, and future learning as well as a web-based learning environment.

    Outcome

    The benefits of this project, where the focus is on eHealth as support for continuous learning, is for healthcare providers and physicians to be able to meet the demands and challenges for the future medical profession. The originality is that the digital platform in use is developed by the participants, integrated into the course and daily work and that the primary focus of the platform is to support continuous learning. This research is still in an initial stage (2016-2018), and findings are tentative. The project is linked to patient benefit, health professionals’ workplace learning, and continuous training. Children, carers or family members are not directly involved in this project, but the CPD program is built up around patient cases and focus on patient outcomes, in terms of improved safety and quality of care of the child.

    Conclusion

    There are potential difficulties recruiting paediatric educators to the program. This is addressed by supporting the participants in their role as educators and experts in outpatient paediatrics as well as regarding how IT could support not only learning a new subject or training skills but also learning how to learn. In summary, this project highlights the importance of interdisciplinary and practice-based research for continuous improvement and quality in healthcare, especially due to new demands following the patient-centric care and new role of patients, and sheds light on both benefits and challenges of integrating IT and learning in daily clinical work

  • 71.
    Walladbegi, Java
    et al.
    University of Gothenburg, Department of Oral Medicine & Pathology, Institute of Odontology, The Sahlgrenska Academy, Box 450, 405 30, Gothenburg, Swede.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics. University West, School of Business, Economics and IT, Divison of Informatics.
    Svanberg, Anncarin
    Uppsala University, Department of Hematology, Institute for Medical Sciences, Faculty of Medicine, Uppsala University Hospital, U751 85, Uppsala, Sweden.
    Jontell, Mats
    University of Gothenburg,Department of Oral Medicine & Pathology, Institute of Odontology, The Sahlgrenska Academy, Box 450, 405 30, Gothenburg, Sweden.
    Correction to Innovative intraoral cooling device better tolerated and equally effective as ice cooling2018In: Cancer Chemotherapy and Pharmacology, ISSN 0344-5704, E-ISSN 1432-0843, Vol. 81, no 1, p. 225-225Article in journal (Refereed)
    Abstract [en]

    Unfortunately, the online published article has error in Table 1. The correct Table 1 is given in the following page.

  • 72.
    Walladbegi, Java
    et al.
    University of Gothenburg, Department of Oral Medicine & Pathology, Institute of Odontology, The Sahlgrenska Academy, Box 450, 405 30, Gothenburg, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics. University West, School of Business, Economics and IT, Divison of Informatics.
    Svanberg, Anncarin
    Uppsala University,Department of Hematology, Institute for Medical Sciences, Faculty of Medicine, Uppsala University Hospital, 751 85, Uppsala, Sweden.
    Jontell, Mats
    University of Gothenburg, Department of Oral Medicine & Pathology, Institute of Odontology, The Sahlgrenska Academy, Box 450, 405 30, Gothenburg, Sweden..
    Innovative intraoral cooling device better tolerated and equally effective as ice cooling.2017In: Cancer Chemotherapy and Pharmacology, ISSN 0344-5704, E-ISSN 1432-0843, Vol. 80, no 5, p. 965-972Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Most of the patients who receive myeloablative therapy prior to stem cell transplantation develop oral mucositis (OM). This adverse reaction manifests as oral mucosal erythema and ulcerations and may require high doses of morphine for pain alleviation. OM may also interfere with food intake and result in weight loss, a need for parenteral nutrition, and impaired quality of life. To date, there have been very few studies of evidence-based interventions for the prevention of OM. Cryotherapy, using ice chips, has been shown to reduce in an efficient manner the severity and extent of OM, although clinical applications are still limited due to several shortcomings, such as adverse tooth sensations, problems with infectious organisms in the water, nausea, and uneven cooling of the oral mucosa. The present proof-of-concept study was conducted to compare the tolerability, temperature reduction, and cooling distribution profiles of an intra-oral cooling device and ice chips in healthy volunteers who did not receive myeloablative treatment, and therefore, did not experience the symptoms of OM.

    METHODS: Twenty healthy volunteers used the cooling device and ice chips for a maximum of 60 min each, using a cross-over design. The baseline and final temperatures were measured at eight intra-oral locations using an infra-red thermographic camera. The thermographic images were analysed using two digital software packages. A questionnaire was used to assess the tolerability levels of the two interventions.

    RESULTS: The intra-oral cooling device was significantly better tolerated than the ice-chips (p = 0.0118). The two interventions were equally effective regarding temperature reduction and cooling distribution.

    CONCLUSIONS: The intra-oral cooling device shows superior tolerability in healthy volunteers. Furthermore, this study shows that temperature reduction and cooling distribution are achieved equally well using either method.

  • 73.
    Walladbegi, Java
    et al.
    University of Gothenburg, Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, Gothenburg, Sweden..
    Svanberg, Anncarin
    Uppsala University Hospital, Department of Hematology, Faculty of Medicine, Institute for Medical Sciences, Uppsala, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Informatics.
    Protocol for a randomised controlled trial to study cryoprevention of chemotherapy-induced oral mucositis after autologous stem cell transplantation.2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 10, article id e021993Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: A majority of patients who receive myeloablative therapy prior to hematopoetic stem cell transplantation develop oral mucositis (OM). This adverse cytotoxic effect manifests as oral mucosal erythema and ulcerations and frequently necessitates high doses of morphine for pain alleviation. OM may also interfere with food intake and result in parenteral nutrition, weight loss and impaired quality of life. To date, there have been a few studies of evidence-based interventions for prevention of OM. Cooling the oral mucosa using ice chips in conjunction with chemotherapy is known to reduce the severity of OM although clinical application is still limited due to several disadvantages. The primary endpoint of this study is therefore to evaluate the efficacy of an innovative intraoral cooling device (Cooral) compared with ice cooling in reducing the degree of OM, in patients with myeloma or lymphoma.

    METHOD AND ANALYSIS: A total of 180 patients from four different university hospitals in Sweden will be randomised to ice or Cooral in a proportion of 1:1. The degree of OM will be assessed at eight intraoral locations, in accordance with the Oral Mucositis Assessment Scale and WHO scale. Patients will be registered beginning at admission and will continue until discharge or until day +28. The primary variable is analysed in a multiple linear regression model. The significance level used is 5%.

    ETHICS AND DISSEMINATION: The study protocol, questionnaire, diaries and letter of invitation to participants have been reviewed by the local ethical board in Göteborg. The trial results will be published in a peer-reviewed journal and disseminated to participants.

    TRIAL REGISTRATION NUMBER: NCT03203733; Pre-results.

    PROTOCOL VERSION: Version 4, 2017-06-05.

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