Umeå University's logo

Purpose: Providing perioperative care for children who express anxiety or react with negative anxiety-associated consequences can be a challenge. The use of premedication is established as an important intervention for young children before surgery, yet research into care providers’ experiences of premedication is limited. The aim of this study was to explore perioperative staff’s experiences of premedication for preschool-age children.

Design: A descriptive inductive qualitative study was performed based on focus group discussions.

Methods: A purposive sample of a team from the operating department with experience in anesthetizing and caring for children in the perioperative period was interviewed in small focus groups: five preoperative and postoperative care nurses, five nurse anesthetists, and five anesthesiologists. The transcribed text was categorized using qualitative content analysis.

Findings: The content analysis revealed three themes: a matter of time, do not wake the sleeping bear, and on responsive tiptoes.

Conclusions: Care providers must adapt their work to the child’s emotional state of mind and needs, allowing time for the child to trust and accept the premedication and for the premedication to reach its peak effect. Premedication provides light sleep preoperatively, which requires careful treatment of the child to avoid emotional reactions, and the postoperative path is most peaceful when the premedication supports a long duration of sedation. Our findings highlight the need for safety precautions and a permissive and flexible organization with the goal of achieving a smooth and safe journey for the child in the perioperative path.

Objective: Measuring the effectiveness of mass casualty incident (MCI) scenario training is challenging due to simultaneously assessing individual skills, team dynamics, decision-making under pressure and adaptability. Existing instruments often focus too narrowly on individual skills, overlooking the comprehensive range of skills needed for effective prehospital disaster response. This study aims to develop and validate a comprehensive self-Assessment tool for prehospital disaster response skills during initial MCI scenario training.

Design: The instrument was developed and validated using a comprehensive methodology. This included literature reviews to identify the construct, ensuring content validity through expert evaluation and conducting field trials in MCI scenario training to evaluate the instrument under simulated conditions that approximated real-life incidents. The instrument's psychometric properties were assessed using exploratory factor analysis (EFA) and Horn's parallel analysis, as well as Cronbach's α and item-Total correlation analysis.

Setting: Two field trials conducted with participants in Sweden during 2023 and 2024. Participants 75 students from a bachelor's programme at a Swedish university were recruited to participate in the field trials. The programme featured one semester of comprehensive theoretical and practical training in disaster medicine, including MCI response and management. 88 instruments were collected during the field trials.

Results: Overall Cronbach's α score was 0.86, indicating high internal consistency for the instrument. EFA and Horn's parallel analysis revealed a five-factor model accounting for 52.3% of the total variance: incident control and management; systematic examination procedures; risk assessment and management; stress response and impact; and triage procedures. Cronbach's α for all factors indicated good internal consistency (range: 0.74-0.85).

Conclusions: The instrument addresses a critical gap by offering a comprehensive self-evaluation tool for disaster response skills. The robust psychometric properties indicate its potential for practical implication. Future studies should explore its application in diverse training settings and populations to enhance its utility and generalisability. A comprehensive development and validation methodology ensured the high content validity of the instrument.

• För att få svensk läkarlegitimation ska läkaren kunna utöva läkaryrket på ett patientsäkert sätt.
• Låga krav på dokumentation av tidigare utbildning för tillträde till kunskapsprovsvägen till svensk legitimation nödvändiggör ett brett kunskaps- och färdighetsprov.
• Kunskapsprovet har samma målbild för säkerställande av kunskaper och färdigheter som svensk legitimationsgrundande läkarutbildning.
• Vägen via kompletterande utbildning till svensk legitimation kommer att förändras för att bli direkt legitimationsgrundande.
• Målbilden för säkerställande av kunskaper och färdigheter vid kompletterande utbildning bör vara densamma som vid svensk legitimationsgrundande läkarutbildning.

There are four paths to a Swedish medical license. A shared agreement exists for those converting from a European license to recognize qualifications granted in the respective countries mutually. Swedish medical graduates and International Medical Graduates (IMGs) trained outside the EU/EES/Schweiz are assessed against the professional qualifications specified in the Higher Education Ordinance (1993:100). This paper discusses the different pathways to a Swedish Medical License, how they are interrelated and changing, and the number of licenses granted via the specific pathways in 2023 and the previous 7 years. In 2023, 2,318 Swedish medical licenses were awarded. The largest group (1,407/2,318) were graduates from a Swedish medical school (with a minimum of 18 months of internship (AT)). The second largest group (704/2,318) were licensed physicians from a country within the EU/EEA. The smallest group (207/2,318) were international medical graduates (IMGs) who had passed the proficiency test (with a 6-month internship) or a complementary medical education (KUL) at one of the Swedish universities (with a minimum of 18 months of internship (AT)). During 2016–2023, 826 IMGs passed the proficiency test, and 533 IMGs completed KUL. During the same period, 10,958 students graduated from Swedish medical programmes, and 6,844 medical licenses were approved based on education in the EU/EEC. The pathway for IMGs starts with applying to the National Board of Health and Welfare to be approved for the tests. The theoretical test is a 180-item exam with single-best answers covering the medical field with basic and clinical sciences. After passing the theoretical test, the practical skills are tested with an Objective Structured Clinical Examination (OSCE) with fourteen 6-minute and four 14-minute stations. After passing the practical test, the IMG is assessed during a 6-month internship and must take an online Swedish law course. When successfully passing these steps, the IMG applies for a Swedish medical license with a certificate of passing a language test in Swedish at the C1 level. The educational pathway consists of a 1- to 2-year-long complementary programme for international medical graduates (KUL) offered at five Swedish universities. The regular Swedish medical programmes are in transition from preparing for an internship to preparing to qualify directly for a medical license without an intermediate internship. Consequently, KUL also needs to develop new curricula, preparing for direct qualification for a medical license, from which the first students will most likely graduate in spring 2027. 

Excessive daytime sleepiness (EDS) is a common complaint in the general population and is associated with cardiovascular disease and increased mortality. We aimed to investigate whether sleep duration is related to excessive daytime sleepiness in the general population, both in itself and in combination with other factors. We performed a cross-sectional analysis in the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort (n = 27,976; 14,436 females; aged 50–64 years) to assess how sleep-related factors along with anthropometric, lifestyle, socioeconomic factors as well as somatic disease and psychological distress, were related with EDS assessed by the Epworth sleepiness scale (ESS). Analyses were performed using logistic regression modelling with EDS defined by an ESS score of ≥11 as the main outcome. Both short and long sleep duration were related to EDS with increasing ORs for decreasing sleep duration (7 h vs. reference (8 h): OR 1.2, 95% CI 1.02–1.3 to ≤4 h: 1.9; 1.4–2.5). In addition to sleep-related factors such as insomnia (1.3; 1.2–1.4), poor sleep quality (1.2; 1.04–1.4), snoring (1.5; 1.4–1.6), and nocturnal gastro-oesophageal reflux (1.5; 1.21–1.8), psychological distress showed a strong association with EDS. This included sadness/depression (1.2; 1.1–1.3), stress (some stress: 1.4; 1.1–1.7 to constant stress over 5 years: 1.7; 1.3–2.2), and self-rated "control in life" (lowest quartile: 1.7; 1.6–2.0). Daytime sleepiness is multifactorial and associated with both sleep duration and sleep quality. Strong associations were also established with factors related to psychological distress. Further research may investigate interventions targeting both sleep and psychological health to reduce daytime sleepiness at the societal level.

Denna workshop fokuserar på hur man bäst stöttar att personer med en utländsk professionsutbildning och som har svenska som andra språk att integreras med svenska studenter då de går en kompletterande utbildning.

Problemet – integration i svenskt utbildningssystem och svensk sjukvård av studenter som behöver komplettera sin utländska utbildning och dessutom behöver det ske på ett nytt språk (svenska). 

En person som har en utländsk akademisk utbildning och examen kan gå en kompletterande utbildning för att få behörighet att utöva yrket i Sverige. Det gäller exempelvis lärare, socionomer, jurister och olika professioner inom hälso- och sjukvård som läkare, sjuksköterskor, tandläkare.

Studenterna som går en kompletterande utbildning har vanligtvis erfarenheter från utbildningssystem som skiljer sig mycket från det svenska. De har också redan en examen från annat land, många har även lång yrkeserfarenhet. 

Vi tror att heterogenitet och mångfald bidrar till undervisningen på flera sätt, både teoretisk undervisning och verksamhetsförlagd utbildning, men hur gör vi på bästa sätt för att undanröja eventuella problem som kan uppstå?

Under denna workshop fokuserar vi på utlandsutbildade läkare som behöver komplettera för att få arbeta som läkare i Sverige.

Frågeställningar som kommer att beröras:

• Hur kan vi underlätta integrationen med svenska studenter under en kompletterande utbildning?
• Hur påverkas undervisningen när dessa studenter möter svenska studenter i klassrummen?Hur möter vi studenterna i dessa olikheter?
• Hur påverkas lärarna av heterogeniteten i klassrummen med äldre erfarna studenter och studenter utan yrkeserfarenhet som kommer direkt från gymnasiet?
• Hur hanterar handledare under verksamhetsförlagd utbildning att handleda dessa olika studenter?Hur handleder man en kollega?

Hur kan vi dra nytta av heterogeniteten och mångfalden så att den bidrar till positiva värden för alla studenter som läser tillsammans?Under denna workshop kommer man gruppvis och helgrupp att diskutera:

• Inledande språktermin för att utveckla de utlandsutbildade kompletteringsutbildningsstudenternas svenska
• Integrerad undervisning och handledning av studenter som är skolade i vitt skilda system och som därmed har olika erfarenheter med sig i bagage
• Stöd till studenter på kompletteringsutbildningar som läser kurser integrerat med svenska studenter och genomför praktikperioder

Resultatet av denna workshop kommer att kunna användas som underlag för att utveckla Kompletteringsutbildningar som baseras på Förordning (2008:1101) om högskoleutbildning som kompletterar avslutad utländsk utbildning.  

Introduction: Increased globalisation and technological advancements have led to the emergence of distributed teams in various sectors, including healthcare. However, our understanding of how leadership, communication and collaboration influence distributed healthcare teams remains limited.

Objectives: This study aimed to map knowledge on leadership, communication and collaboration in short-term distributed teams across various fields to gain insights that could benefit healthcare.

Design: Scoping review.

Data source: A database search of PubMed, CINAHL, Scopus and PsycINFO was conducted in May 2021 and updated in February 2023 and May 2024.

Eligibility criteria: Articles were eligible if they involved leadership, communication or collaboration in distributed short-term teams supported by synchronised audio-visual communication technology. Two researchers independently screened titles, abstracts and full texts for inclusion.

Data extraction and synthesis: Extracted data on leadership, communication and collaboration were synthesised narratively and reported in terms of patterns, advances, gaps, evidence for practice and research recommendations.

Results: Among 6591 articles, 55 met the eligibility criteria, spanning military, engineering, business, industrial and healthcare contexts. The research focus has shifted over time from adverse effects to solutions for overcoming challenges in distributed teams. Inclusive leadership is vital for engaging all team members. 'Team opacity', the absence of non-verbal cues and reduced awareness of team members' actions, can occur in distributed teams relying on technology. Clear communication is crucial for avoiding misunderstandings and fostering collaboration and adaptability. Developing shared mental models and trust is more challenging, leading to uncertainty and reduced information sharing. There is a lack of studies examining how to apply this knowledge to health professionals' education.

Conclusion: Our findings highlight the importance of implementing strategies in healthcare to enhance inclusive leadership and improve communication in distributed healthcare settings. More empirical research is needed to understand the intricacy of distributed healthcare settings and identify effective ways to train distributed healthcare teams.

There is a lack in understanding the reasons for different lengths of sick leave in patients who sustain ankle fractures. The aim of this study is to examine variations in the length of sick leave in ankle fracture patients and how treatment, type of ankle fracture and the patient-reported outcome are associated with the length of sick leave. In this study were data from the Swedish Social Insurance Agency (SSIA) and the Swedish Fracture Register (SFR), combined. Patients who sustained an ankle fracture were identified and the length of the sick leave calculated. Variables associated to the length of the sick leave were analysed. Fifty-three percent of the patients were on sick leave for an average of 88 days. Factors that were associated with the length of sick leave were an open fracture, operative treatment, multiple treatments, AO/OTA classification, and previous sick leave. Patients on sick leave for 22 weeks or more scored 15 points (CI 95% 12-18) worse on the dysfunction index of the Short Musculoskeletal Function Assessment in the 1-year follow-up compared to the pre- injury survey. This can be compared to 3 points (CI 95% 2-5) lower in patients with the shortest sick leave. There is an association between the severity of the injury and the length of sick leave following an ankle fracture, as well as between the patient-reported outcome after one year and the length of the sick leave.

Background: Without evidence, positive expiratory pressure therapy is a part of rehabilitation worldwide to prevent postoperative hypoxia. Reading aloud could be used as an alternative therapy as lung volumes increases while speaking. We aimed to investigate whether reading aloud is superior to positive expiratory pressure therapy for improving oxygen saturation after abdominal surgery.

Material and Methods: This crossover randomized controlled trial compared reading a text aloud with positive expiratory pressure therapy in patients on postoperative day 1 or 2 after upper gastrointestinal, colorectal, urological, or gynecological abdominal surgery at Umeå University Hospital, Sweden. The primary outcome was the change in peripheral oxygen saturation compared with baseline at 7 min after the intervention. The secondary outcome was transcutaneous carbon dioxide partial pressure change.

Results: This study included 50 patients of which 48 patients were analyzed. Peripheral oxygen saturation rapidly decreased to minimum values below baseline immediately after both interventions and then increased to values above baseline after reading aloud (1%, 95% confidence interval 0.2% to 1%, P = 0.004), but not after positive expiratory pressure therapy (−0.2%, 95% confidence interval −1% to 0.4%, P = 0.436). The difference in oxygen saturation was 1% (95% confidence interval 0.1% to 2%, P = 0.039) at 7 min after termination of the interventions. The interventions reduced transcutaneous carbon dioxide partial pressure by similar amounts.

Conclusions: This trial adds to the evidence against the use of positive expiratory pressure therapy after abdominal surgery. It is even slightly better to read aloud.

Introduction: Despite the increasing use of distributed healthcare teams, performance evaluation is largely lacking. This study examined rural emergency health care in Sweden to determine the effect of teams being either co-located or distributed with remote physicians accessible via telemedicine.

Method: In this crossover study, 17 three-person teams were video recorded during co-located and distributed simulated scenarios. Team performance in the video recordings was evaluated using the TEAM instrument.

Results: Co-located scenarios had significantly higher Total ratings for the instrument (items 1–11), in the teamwork domain (items 3–9), and in overall performance (item 12) compared with distributed scenarios (P < 0.005). Item-level analysis revealed that co-located teams were better at completing tasks on time (item 4) and showed greater adaptability to changing situations (item 7).

Conclusions: The higher rating of the performance of co-located teams underscores the challenges facing distributed teams. Given that distributed healthcare teams are a reality in rural areas in northern Sweden, education and training must be adapted to address these challenges. This adaptation is crucial for ensuring high-quality patient care by distributed teams.