P036 IMPACT OF THE COVID-19 PANDEMIC ON HERNIA SURGERY IN A SWEDISH HEALTH-CARE REGION WITHOUT LOCKDOWN: A RETROSPECTIVE COHORT STUDY

Aim During the COVID-19 pandemic, Swedish health care centers were restructured. This was accompanied by changes in the surgical programme. The aim of this study was to determine the effects of COVID-19 on emergency and elective hernia surgeries in a Swedish health-care region. Material and Methods This was a retrospective, observational cohort study. Data from inguinal and ventral hernia surgeries were retrieved from a medical database using procedure codes from all three hospitals in Region Jönköping County from March 1, 2019 to January 31, 2021. The participants were divided into two groups: COVID-19 group (March 1, 2020 - January 31, 2021) and reference group (March 1, 2019 - January 31, 2020). The incidence rate (IR) and relative risk (RR) of operations over different time frames were analyzed. Results A total 1351 participants met the inclusion criteria. 590 were operated during the COVID-19 period and 761 during the reference period. The IR of elective operations was decreased during the COVID-19 pandemic; 146 operations/100.000 population vs 192 operations/100.000 population during the reference period. RR was 0,76 (95% CI 0.6813-0.8545, p < 0.0001). Moreover, IR of emergency operations decreased insignificantly during the COVID-19 pandemic; 17,5 operations/100.000 population vs 19,4 operations/100.000 population during the reference period. RR was 0,9 (95% CI 0.6404- 1.2649, p 0.5441). No significant variations in the emergency operations have identified when different time frames were compared. Conclusions There is no evidence to support that COVID-19 pandemic has increased emergency hernia operations during the studied period despite the significant reduction of elective operations.

A Discursive Shift - Commissioned Reports in Swedish Health Care Governance

Background: Over the course of several decades, the organization of health care in Sweden, as in many other countries, has changed, from a dominant logic of professional dominance and political control towards managerial control through market mechanisms. A crucial motive was to increase cost efficiency. The Swedish government, as well as regional-level agencies, regularly commissions expert reports that are supposed to form the basis for decisions regarding governance, organization and control models of the health care system.Aim: The aim of this study was a) to perform a descriptive mapping of commissioned reports on Swedish health care governance and b) to perform an in-depth content analysis of a strategic sample of such reports.Method: Initially, 106 reports from both national and regional levels were gathered and analysed. A matrix was constructed, consisting of questions on who had commissioned the report, who had produced it, what problems the report set out to solve and what solutions were suggested. Further, questions were posed on whether the report was research-based and whether ethical assumptions and arguments were presented. Thereafter, a strategic sample of 36 reports was selected for an in-depth analysis, using thematic content analysis. Results: The mapping showed that the aim of the reports varied from giving an overview and to investigating effects and consequences of new steering forms, to more concrete goals, such as suggesting improvement measures. Most of the authors involved were administrators; only in rare cases were they from academic disciplines. Experts with academic degrees were in most cases from economics or business studies. The content analysis resulted in an overarching theme, Dominant discourses, and three categories: Equity as geographical sameness, Knowledge-based management and Management based on trust. Discussion: The analysed reports varied in form and content. They were mostly produced by administrators, but in some cases with input from academic researchers. The contents mirrored dominant discourses of the time but could also express conflicting values and goals. The analysis revealed examples of standardization in care, characterized by requirements to follow national guidelines, but also examples of requests for increased respect for professionals’ competence and experience.Conclusion: The great number of reports implies that the system risks requesting more information than it can handle. Further, it might result in reports where the same message is repeated in different documents, or create conflicts of interest and value tensions between different suggestions. In sum, our analysis showed a discursive shift of two trends or dominant discourses in the analysed reports, from increased standardization to arguments for trust in the system.

Validation of the diagnosis of eosinophilic esophagitis based on histopathology reports in Sweden

Background: Eosinophilic esophagitis (EoE) is a relatively new diagnosis, where until recently a specific international classification of disease code was missing. One way to identify patients with EoE is to use histopathology codes. We validated the clinicopathological EoE diagnosis based on histopathology reports and patient charts to establish these data sources as the basis for a nationwide EoE patient cohort. Methods: Through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study, we randomly selected 165 patients from five Swedish health care regions with a histopathologic diagnosis of EoE. Patients were assigned a histopathology diagnosis of EoE if they had ≥15 eosinophils per high-power field or, in the absence of eosinophil quantification, the pathologist interpreted the biopsy as consistent with EoE. Patient charts were scrutinized to see if the other diagnostic criteria were fulfilled. Of the 131 received patient charts, 111 (85%) had sufficient information to be included in the study. Results: Of the 111 validated patients, 99 had EoE, corresponding to a positive predictive value of 89% (95% confidence interval = 82–94%). Dysphagia was the most common symptom (n = 78, 70%), followed by food impaction (n = 64, 58%) and feeding difficulties (n = 37, 33%). Twelve patients had coexisting asthma (11%) and 16 allergic rhinitis (14%). Seventeen patients underwent esophageal dilatation (15%), of which seven had more than one dilatation. Ninety-seven (87%) patients had a proton-pump inhibitor treatment ≤2 years before or after the diagnosis. Forty-two patients (38%) had been prescribed inhalation steroids and 64 (58%) had undergone esophageal radiology. Conclusion: Histopathology reports from the ESPRESSO cohort with esophageal eosinophilic inflammation are suggestive of EoE.

Leaving early or staying on? Retirement preferences and motives among older health-care professionals

There is a need for improved knowledge about how workplace conditions and organisational factors may obstruct or facilitate work in late life. By means of both quantitative and qualitative data, this study aims to explore retirement preferences among employees (aged 55 and older) in a large Swedish health-care organisation and to identify work-related motives influencing their retirement preferences. The quantitative analysis showed large variation in retirement preferences in the organisation. The qualitative results were summarised into two overarching types of motives for late and early retirement preferences, general and group-specific. The general motives were shared by the early and late preference groups, and included recognition, flexibility, health and work motivation. The group-specific motives were exclusively related to either an early or a late retirement preference. Criticism towards the organisation and strenuous working conditions were specific motives for an early retirement preference, while positive accounts of work and a wish to utilise one's own competencies as well as being financially dependent on work was stated as specific motives for wanting to retire late. The results illustrate the need to improve organisational practices and routines, as well as working conditions, in order to make an extended working life accessible for more than already-privileged groups of employees.

Developing and Evaluating Novel Treatments for Nonsuicidal Self-Injury Within Swedish Health Care

Selvskading er hyppig forekommende og har ofte mange uheldige konsekvenser. Tidlig intervensjon er et viktig selvmordsforebyggende tiltak. Eksisterende behandlingsalternativer er som regel omfattende og tidkrevende og er ikke alltid lett tilgjengelige for dem som har behov for behandling. Emosjonsreguleringsterapi i gruppe (ERGT) og som individualterapi (ERITA) er utviklet for å imøtekomme behovet for effektiv kortvarig og fokusert behandling somer enkel å implementer for voksne og ungdom med selvskadende atferd. Et svensk forskningsprogram bestående av fem psykologiske behandlingsstudier har blitt lansert, blant dem utviklingen av en online versjon av ERITA. Resultater fra de tre første studiene gir lovende informasjon om gjennomførbarhet, akseptabilitet og nytteverdi av ERGT og ERITA. Den fjerde og femte studien vil bruke randomisert kontrollerte design for å undersøke behandlingseffekten av online ERITA. I denne artikkelen gjennomgås og diskuteres metodiske betraktninger, resultater, erfaringer med disse behandlingsprogrammene og implikasjoner for fremtidig forskning.

Designing a Web-Based Psychological Intervention for Patients With Myocardial Infarction With Nonobstructive Coronary Arteries: User-Centered Design Approach

Background The involvement of patient research partners (PRPs) in research aims to safeguard the needs of patient groups and produce new interventions that are developed based on patient input. Myocardial infarction with nonobstructive coronary arteries (MINOCA), unlike acute myocardial infarction (MI) with obstructive coronary arteries, is presented with no significant obstructive coronary artery disease. Patients with this diagnosis are a subset of those diagnosed with traditional MI and often need more psychological support, something that is presently not established in the current treatment scheme in Swedish health care or elsewhere, to our knowledge. An internet-delivered intervention might offer patients with MINOCA the opportunity to access a psychological treatment that is tailored to their specific needs after MINOCA and could therefore supplement the existing medical care in an easily accessible format. Objective This paper aims to describe the development of a therapist-guided, internet-delivered psychological intervention designed specifically for patients with MINOCA. Methods The study used a participatory design that involved 7 PRPs diagnosed with MINOCA who collaborated with a team consisting of researchers, cardiologists, and psychologists. Intervention content was developed iteratively and presented to the PRPs across several prototypes, each continually adjusted and redesigned according to the feedback received. The intervention and experience of it were discussed by PRPs in a final meeting and then presented to a panel of 2 clinical psychologists and a cardiologist for further input. Results The outcome of the collaboration between PRPs and the research group produced a web-based psychological 9-step program focusing on stress, worry, and valued action. The input from PRPs contributed substantially to the therapy content, homework tasks, interactive activities, multimedia, and design presentation. Conclusions Working with PRPs to develop an intervention for people with MINOCA produced a web-based intervention that can be further evaluated with the goal of offering a new psychological treatment option to a patient group currently without one. Direct contribution from PRPs enabled us to obtain relevant, insightful, and valuable feedback that was put towards the overall design and content of the intervention.

Collection and use of EQ-5D for follow-up, decision-making, and quality improvement in health care - the case of the Swedish National Quality Registries

Background The Swedish National Quality Registries (NQRs) contain individual-level health care data for specific patient populations, or patients receiving specific interventions. Approximately 90% of the 105 Swedish NQRs include any patient-reported outcome measure, with EQ-5D being the most common. As there has been no general overview of EQ-5D data within the NQRs, this study fills a knowledge gap by reporting how the data are collected, presented, and used at different levels of the Swedish health care system. Methods All 46 NQRs with a license for the use of EQ-5D were included. Information was retrieved from the registries’ annual reports or from websites, using a template that was subsequently sent to each registry for completion and confirmation. If considered necessary, the contact was followed-up with an interview, either in-person or over the telephone. The uses of EQ-5D were categorised as denoting usage for follow-up, decision-making, or quality improvement in Swedish health care. Results In total, 41 of the 46 licensed registries reported collection of EQ-5D data. EQ-5D is most commonly collected within registries related to the musculoskeletal system, but it has a wide application also in other disease areas. Thirty-six registries provide EQ-5D results to patients, clinicians, or other decision-makers. Twenty-two of the registries reported that EQ-5D data are being used for follow-up, decision-making or quality improvement. The registries most commonly reported use of data for assessing interventions, and in quality indicators to follow-up the quality of care at a national level. Conclusion Collection and use of EQ-5D data vary across the Swedish NQRs, which may partly be accounted for by the different purposes of the registries. The provided examples of use illustrate how EQ-5D data can inform decisions at different levels of the health care system. However, there is potential for improving the use of EQ-5D data.