Latest publications from LIME - 2020

Current (not all) articles in scientific journals to which LIME researchers have contributed.


Experiences of tobacco cessation including a prescription approach among patients in Swedish primary health care with a focus on socioeconomically disadvantaged areas
Leppänen A, Ekblad S, Tomson T
PLOS ONE, 12 October 2020;15(10):e0240411.doi: 10.1371/journal.pone.0240411. eCollection 2020.

The study was based on inductive content analysis of transcripts from eight semi-structured interviews with patients who had personal experience of Tobacco Cessation on Prescription (TCP) in the given setting.

The study found that a holistic approach may be needed in cessation treatment, combined with interventions outside the health care system, to facilitate tobacco cessation among patients in socioeconomically disadvantaged areas in Swedish primary health care.

The TCP prescription form may be helpful for primary health care providers but counseling and follow-up appear to be the most important components of TCP for patients in this setting.

Patient researchers — the missing link?
Riggare S
Nature Medicine, published online 7 October 2020;


A virtual patient model for students’ interprofessional learning in primary healthcare.
Tran C, Toth-Pal E, Ekblad S, Fors U, Salminen H
PLOS ONE, 23 September 2020;

Objective: to develop and assess a virtual patient model for primary healthcare and to investigate students' perceptions of learning with this interprofessional virtual patient model.

Methods: Ten interprofessional groups with 39 students assessed the virtual patient from four different study programmes: nursing, physiotherapy, medicine, and occupational therapy. The students answered a questionnaire about how they perceived the usability of the virtual patient and participated in group interviews. Qualitative content analysis was used to analyse the data from the semi-structured group interviews.

Results: The students perceived that the mixture of text and multimedia made the virtual patient seem authentic and stimulated their group discussions, which they valued most. The students gave generally high points for usability in the questionnaire, but they also gave input for improvement of the program in their comments.

Conclusions: The interprofessional virtual patient model facilitated interactions and discussions between students and may be a useful complement for interprofessional education in clinical contexts and might be a suitable tool in preparing students for future teamwork.

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.
Ernstsson O, Janssen MF, Heintz E
Journal of Patient-Reported Outcomes, 16 September 2020;4(1):78

The majority of the Swedish NQRs collect patient-reported outcomes, 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.

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.

Twenty-two of the registries reported that EQ-5D data are being used for follow-up, decision-making or quality improvement. However, there is potential for improving the use of EQ-5D data.

Theories, models, and frameworks for de-implementation of low-value care: A scoping review of the literature.
Nilsen P, Ingvarsson S, Hasson H, von Thiele Schwarz U, Augustsson H
Implementation review and practice, first published 18 September 2020, Review Article;

The aim of the scoping review was to identify theories, models, and frameworks for understanding the processes and determinants of de-implementing low-value care (LVC).

In total ten studies were identified, five of these presented theories, models, or frameworks developed specifically for de-implementation of LVC (i.e., conceptual studies) and five studies applied an existing theory, model, or framework concerning implementation of evidence-based practices (i.e., empirical studies).

Most of the theories, models, and frameworks suggest a multi-level understanding of de-implementation of LVC. The role of the patient is inconsistent in these theories, models, and frameworks; patients are accounted for in some but not in others.

The findings point to the need for more research to identify the most important processes and determinants for successful de-implementation of LVC and to explore differences between de-implementation and implementation.

Adaptation of evidence‐based suicide prevention strategies during and after the COVID‐19 pandemic.
Wasserman D, Iosue M, Wuestefeld A, Carli V
World Psychiatry 15 September 2020;19(3)

The COVID-19 pandemic affects risk and protective factors for suicide at each level of the socio-ecological model.

In this paper, the scientific community, health care professionals, politicians and decision-makers will find  a systematic description of the effects of the pandemic on suicide risk at the society, community, family and individual levels, and an overview of how evidence-based suicide preventive interventions should be adapted.

Universal, awareness increasing measures should be directed to workplaces and schools. Selective interventions should continue to target known vulnerable groups who are socio-economically disadvantaged, but also new ones such as first responders and health care staff, and the bereaved by COVID-19 who have been deprived of the final contact with loved ones and funerals.

Indicated preventive strategies targeting individuals who display suicidal behaviour should focus on available pharmacological and psychological treatments of mental disorders, ensuring proper follow-up and chain of care by increased use of telemedicine and other digital means.

How can technology support quality improvement? Lessons learned from the adoption of an analytics tool for advanced performance measurement in a hospital unit.
Tolf S, Mesterton J, Söderberg D, Amer-Wåhlin I, Mazzocato P
BMC Health Services Research, 1 September 2020, 20, 816 (2020).

Background: Technology for timely feedback of data has the potential to support quality improvement (QI) in health care. However, such technology may pose difficulties stemming from the complex interaction with the setting in which it is implemented. To enable professionals to use data in QI there is a need to better understand of how to handle this complexity. This study aims to explore factors that influence the adoption of a technology-supported QI programme in an obstetric unit through a complexity informed framework.

Methods: This qualitative study, based on focus group interviews, was conducted at a Swedish university hospital’s obstetric unit, which used an analytics tool for advanced performance measurement that gave timely and case mix adjusted feedback of performance data to support QI. Data was collected through three focus group interviews conducted with 16 managers and staff. The Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework guided the data collection and analysis.

Results: Staff and managers deemed the technology to effectively support ongoing QI efforts by providing timely access to reliable data. The value of the technology was associated with a clear need to make better use of existing data in QI. The data and the methodology in the analytics tool reflected the complexity of the clinical conditions treated but was presented through an interface that was easy to access and user friendly. However, prior understanding of statistics was helpful to be able to fully grasp the presented data. The tool was adapted to the needs and the organizational conditions of the local setting through a collaborative approach between the technology supplier and the adopters.

Conclusions: Technology has the potential to enable systematic QI through motivating professionals by providing timely and adequate feedback of performance. The adoption of such technology is complex and requires openness for gradual learning and improvement.

Using narrative analysis to explore traditional Sámi knowledge through story telling about end-of-life. (Döbra Research Program)
Kroik L, Stoor K, Edin-Liljegren A, Tishelman C.
Health & Place, September 2020, Vol 65, 102424.

In this narrative study, we investigate salient Sámi-specific aspects of a death system, inspired by Kastenbaum's model.

We explore traditional Sámi knowledge derived through storytelling in go-along group discussions to gravesites at the tree-line with cultural and historical significance for the Indigenous Sámi peoples.

Analysis illustrates how important material and immaterial cultural values are transferred across generations through their connection to people, place, and time − nature-bound as opposed to calendar-bound − symbols, and objects in relation to end-of-life issues.

We found that the environment both shaped storytelling and became part of the stories themselves.


Working with national quality registries in older people care: A qualitative study of perceived impact on assistant nurses’ work situation.
Westerlund A, Sparring V, Hasson H, Weinehall L, Nyström ME.
Nursing Open, 31 August 2020; 00:1–10.

Aim: The aim was to investigate assistant nurses’ perceptions of how working with national quality registries affected their work situation in care of older people. 

Type of study: Qualitative interview study. 

Method: Sixteen semi-structured interviews were conducted at four special housing units in Sweden, and a conventional content analysis, with elements of thematic analysis, was applied. 

Result: The introduction of national quality registries contributed to role clarifications and the development of new formal work procedures in terms of documentation and arenas and routines for communication.

Conclusion: The increased systematics and effectiveness gained from these changes had a perceived positive effect on the work situation, workload, work satisfaction, staff interactions and learning and reflection.

How to … assess the quality of qualitative research
Stenfors T, Kajamaa A, Bennet D
The Clinical Teacher, 13 August 2020,

This is the last part of a series of short introductory papers on “How to do qualitative research”.

The first part was published in 2018 and topics such as “How to write a good research question”, “How to analyse your data”, “How to be reflexive”, “How to use theory” etc are covered.

The series is using examples from medical education but is probably useful for master students or beginner PhD students and others in related fields new to qualitative research.

I believe I can craft! introducing Job Crafting Self-Efficacy Scale 
Roczniewska M, Rogala A, Puchalska-Kaminska M, Cieślak R, Retowski S (JCSES)
PloS one, 10 August 2020, 15(8), e0237250

Job crafting concerns proactive employee behaviors targeted an increasing their person-job fit.

Research has demonstrated that they are beneficial for employees and organizations.

To better predict these behaviors, we introduce the concept of job crafting self-efficacy (JCSE) and define it as an individual’s beliefs about their capability to modify the demands and resources of their job to better fit their needs.

This article describes the development and validation of a scale to measure JCSE. 

Exercise Induces Different Molecular Responses in Trained and Untrained Human Muscle.
Moberg M, Lindholm ME, Reitzner SM, Ekblom B, Sundberg CJ, Psilander N
Medicine and Science in Sports and Exercise, August 2020;52(8):1679-1690


Capturing Life and Its Fluctuations: Experience Sampling and Daily Diary Studies in Studying Within-person Variability.
Roczniewska M, Smoktunowicz E, & Gruszczyńska E
Social Psychological Bulletin, 31 July 2020, 15(2), 1-7.;

This is an editorial to a special issue on intensive longitudinal research methods, which outlines opportunities that these methods offer researchers.

How to design, implement and evaluate organizational interventions for maximum impact: the Sigtuna Principles.
von Thiele Schwarz U, Nielsen K, Edwards K, Hasson H, Ipsen C, Savage C, Simonsen Abildgaard J, Richter A, Lornudd C, Mazzocato P, Reed JE
European Journal of Work and Organizational Psychology, 27 July 2020; 1-13,

This is a discussion paper that offers 10 principles, grounded in knowledge from various disciplines, that can guide researchers in designing, implementing, and evaluating organizational interventions.

The principles were developed through a transdisciplinary, participatory and iterative process where practitioners and academics worked together to develop, refine and validate the principles.

The 10 principles are:

  1. Ensure active engagement and participation among key stakeholders
  2. Understand the situation (starting points and objectives)
  3. Align the intervention with existing organizational objectives
  4. Explicate the program logic
  5. Prioritize intervention activities based on effort-gain balance
  6. Work with existing practices, processes, and mindsets
  7. Iteratively observe, reflect, and adapt
  8. Develop organizational learning capabilities
  9. Evaluate the interaction between intervention, process, and context
  10. Transfer knowledge beyond the specific organization

The principles suggest how the design, implementation, and evaluation of organizational interventions can be researched in a way that maximizes both practical and scientific impact.

How People with Parkinson's Disease and Healthcare Professionals Wish to Partner in Care Using eHealth: A Co-design Study
Wannheden C, Revenäs Å
Journal of Medical Internet Research, 26 July 2020,

Chronic care management requires a different practice of healthcare compared to the management of acute conditions, emphasizing both patients’ and HCP's knowledge and active collaboration for best possible health outcomes, which has been described as 'co-care'.

The aim of this study was to explore how co-care could be operationalized in Parkinson's disease care, supported by eHealth/mHealth.

Through a series of co-design workshops we identified six core eHealth functionalities that were desired by both PwP and HCPs and all of them were rated important or very important in a group of PwP and informal caregivers that did not participate in the co-design.

Co-care implies a shift from episodic routine-driven care to more flexible care management that is driven by patients' needs and enabled by active information exchange between PwP and HCPs and further supported by automated information processing to generate patient-specific advice.

To increase mental health literacy and human rights among new-coming, low-educated mothers with experience of war: a culturally, tailor-made group health promotion intervention with participatory methodology addressing indirectly the children.
Ekblad S
Frontiers in Psychiatry, Community case study. ID 476241, July 8, 2020:11, article 611, 1-6.

'Did I pass the licensing exam?' aspects influencing migrant physicians' results: a mixed methods study.
Sturesson L, Heiding A, Olsson D, Stenfors T
BMJ Open 2020 Jul;10(7):e038670

Migrant physicians (MPs) who wish to practice their profession in a new country often must undergo a recertification process, including a licensing exam. In many cases, this is the same licensing exam used for peers educated within the country; however, the pass rate of MPs is usually lower.

This study aimed to explore MPs exam results, and aspects that may influence these.

We used exam results from 564 physicians and conducted interviews with 14 MPs. Age seems to be an important predictor for failing the first attempt. MPs have had less time to familiarise themselves with the exam type and the language used on the exam.

To improve their results, MPs used studied with nationally trained physicians, used old exams and a web-based study tool consisting of common exam subjects. These strategies and tools are also mediators in the socialisation of MPs into the exam context.

Impact of variable look-back periods on the incidence rates of chronic diseases using real world data.
Rosenlund M, Ekström N, Törnblom M, Wintzell V, Stark JH, Titievsky L
Pharmacoepidemiol Drug Saf., 9 July 2020, DOI: 10.1002/pds.5066

Background/Objective: Estimating disease incidence based on secondary data requires a look-back period to exclude patients with pre-existing disease from the incidence risk set. However, the optimal length of the look-back period and its impact on incidence rates are often unknown. We studied the impact of the length of the look-back period on incidence rates of 24 different chronic diseases.

Methods: Everyone residing in Sweden between January 1, 2005 and December 31, 2013 were identified from national registries and followed up to 2 years (through December 31, 2015). Outcome events were identified from inpatient and outpatient hospital contacts and incidence rates were calculated per 100,000 person-years. The length of the look-back period was varied with 6-month increments, starting at 6 months. The maximum look-back period of nine years was used as reference period.  

Results: There were 7,943,807 individuals with a look-back period of at least 9 years (mean age 46.5 years) and a mean follow-up time of 1.97 years. Incidence rates were higher across all diseases when restricting the look-back to 1 year compared to 9 years, with a magnitude of overestimation of the incidence rates between 13% (temporal arteritis) and 174% (type 1 diabetes). However, for most diseases the effect of extending the look-back period beyond 3-5 years appeared comparably small. 

Conclusions: This study illustrates how short look-back periods cause overestimation of the incidence rates of chronic diseases, suggesting that sensitivity analyses with respect to look-back period are considered, particularly using data sources with limited information on past medical history.

Benefits of Massive Open Online Course Participation: Deductive Thematic Analysis.
Blum E, Stenfors T, Palmgren P,
Journal of Medical Internet Research, 8 July 2020, Vol 22, No 7

To date, studies on participants in Massive Open Online Courses (MOOCs) have focused mainly on learners’ assessment of the course. However, there is little scholarship on what learners themselves gain from participating in MOOCs.

This qualitative synthesis of a set of MOOC evaluation studies aimed to explore outcomes for MOOC learners, that is, how the learners themselves benefit from participating in MOOCs.

We used deductive thematic analysis and structured our inquiry using the Kirkpatrick model, identifying six types of Kirkpatrick outcomes in 17 studies.

Our findings point to some gains from MOOCs. While we can expect MOOCs to persist, how learners benefit from the experience of participating in MOOCs remains unclear.

Constructing Good Nursing Practice for Medical Assistance in Dying in Canada: An Interpretive Descriptive Study.
Pesut B, Thorne S, Schiller C, Grieg M, Roussel J, Tishelman C.
Global Qualitative Nursing Research. 7 July 2020, Vol 7, pp 1-11,


Practice for Medical Assistance in Dying in Canada: An Interpretive Descriptive Study.
Pesut B, Thorne S, Schiller C, Grieg M, Roussel J, Tishelman C. 2020.
Constructing Good Nursing Global Qualitative Nursing Research. 7 July 2020,Vol 7, pp 1-11, https://doi/pdf/10.1177/2333393620938686

Background: Nurses play a central role in Medical Assistance in Dying (MAiD) in Canada. However, we know little about nurses’ experiences with this new end-of-life option.

Purpose: The purpose of this study was to explore how nurses construct good nursing practice in the context of MAiD.

Method: This was a qualitative interview study using Interpretive Description. Fifty-nine nurses participated in semi-structured telephone interviews. Data were analyzed inductively.

Results/findings: The findings illustrated the ways in which nurses constructed artful practice to humanize what was otherwise a medicalized event. Registered nurses and nurse practitioners described creating a person-centered MAiD process that included establishing relationship, planning meticulously, orchestrating the MAiD death, and supporting the family.

Conclusion: Nurses in this study illustrated how a nursing gaze focused on relationality crosses the moral divides that characterize MAiD. These findings provide an in-depth look at what constitutes good nursing practice in MAiD that can support the development of best practices.

Sense-making, Mutual Learning and Cognitive Shifts When Applying Systems Thinking in Public Health – Examples from Sweden; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners' Experiences of a Systems-Focused Research Collaboration in Preventive Health”.
Nyström ME, Tolf S, Strehlenert H
Int Journal of Health Policy and Management, 5 July 2020; doi:

Background: It is widely acknowledged that systems thinking (ST) should be implemented in the area of public health, but how this should be done is less clear.

Methods: In this commentary we focus on sense-making and double-loop learning processes when using ST and soft systems methodology in research collaborations with policy-makers. In their study of policy-makers’ experiences of ST, Haynes et al emphasize the importance of knowledge processes and mutual learning between researchers and policy-makers, processes which can change how policy-makers think and thus have impact on real-world policy concerns.

Results: We provide some additional examples from Sweden on how ST has been applied to create learning and shared mental models among stakeholders and researchers in national and regional healthcare development initiatives.

Conclusions: We conclude that investigating and describing such processes on micro-level can aid the knowledge on how to implement ST in public health.

“Skeletal muscle transcriptomic comparison between long-term trained and untrained men and women”.
Chapman MA, Arif M, Emanuelsson EB, Reitzner SM, Lindholm ME, Mardingoglu A, Sundberg CJ
Cell Reports, online June 23, 2020, doi: 10.1016/j.celrep.2020.107808

Decades-long endurance training alters the activity of genes in human skeletal muscle that are important for metabolic health. This is according to a new study published in the journal Cell Reports by researchers at Karolinska Institutet in Sweden and the University of San Diego in the U.S.

Sex differences found in untrained individuals were also dramatically reduced with long-term training. The results may have implications for metabolic disease prevention.

Read article: Long-term exercise impacts genes involved in metabolic health


Selecting Instruments for Measuring the Clinical Learning Environment of Medical Education: A Four-Domain Framework.
Irby DM, O'Brien BC, Stenfors T, Palmgren PJ
Acad Med. 23 June 2020;10.1097/ACM.0000000000003551

Learning environments shape the experiences of learners and practitioners. However, educators find it challenging to decide whether to measure clinical learning environments with existing instruments or to design their own new instrument and, if using an existing instrument, which to choose.

To assist educators with these decisions, the authors of this article identified and compared 6 clinically oriented learning environment instruments designed for medical education. Key information about each instrument was collected and items from each instrument were coded according to an apriori 4 domain model.

The findings indicated that the instruments varied in number of items, underlying constructs, subscales, definitions of clinical learning environment, and domain coverage. Most instruments focused heavily on the organizational and social domains, and less on the personal and material domain. The variations in these instruments suggest that educators might consider several guiding questions: How will they define the learning environment and which theoretical lens is most applicable? What aspects or domains of the learning environment do they most wish to capture? 

How comprehensive do they want the instrument to be? Whose perspective do they wish to evaluate?

Unravelling the polyphony in clinical reasoning research in medical education.
Koufidis C, Manninen K, Nieminen J, Wohlin, M, Silén C.
Journal of Evaluation in Clinical Practica, 22 June 2020;1–13. DOI: 10.1111/jep.13432

Underlying theoretical assumptions of clinical reasoning are explored aiming to promote a comprehensive conceptual and theoretical understanding of the subject area.

A scoping review of the clinical reasoning literature was undertaken using a “snowball” search strategy. Three main conceptualisations, reflecting different theoretical understandings of clinical reasoning, were identified: “reasoning as cognitive activity,” “reasoning as contextually situated activity,” and “reasoning as socially mediated activity”.

Between a rock and a hard place: RNs’ descriptions of their work situation in cancer care in Swedish acute care hospitals.
Smeds Alenius L, LIndqvist R, Ball J, Sharp L, Lindqvist O, Tishelman C.
European J of Oncology Nursing, 17 June 2020, Vol 47,

Purpose: Hospital organizational features related to registered nurses' (RNs') practice environment are often studied using quantitative measures. These are however unable to capture nuances of experiences of the practice environment from the perspective of individual RNs. The aim of this study is therefore to investigate individual RNs’ experiences of their work situation in cancer care in Swedish acute care hospitals.

Methods: This study is based on a qualitative framework analysis of data derived from an open-ended question by 200 RNs working in specialized or general cancer care hospital units, who responded to the Swedish RN4CAST survey on nurse work environment. Antonovsky's salutogenic concepts “meaningfulness”, “comprehensibility”, and “manageability” were applied post-analysis to support interpretation of results.

Results: RNs describe a tension between expectations to uphold safe, high quality care, and working in an environment where they are unable to influence conditions for care delivery. A lacking sense of agency, on individual and collective levels, points to organizational factors impeding RNs’ use of their competence in clinical decision-making and in governing practice within their professional scope.

Conclusions: RNs in this study appear to experience work situations which, while often described as meaningful, generally appear neither comprehensible nor manageable. The lack of an individual and collective sense of agency found here could potentially erode RNs’ sense of meaningfulness and readiness to invest in their work.

A Piece of the Boardroom Pie-An Interview Study Exploring What Drives Swedish Corporate Boards' Engagement in Occupational Health and Safety.
Lornudd C, Stenfors T, Hasson H, Frykman M, Sundberg CJ, Schwarz UVT
J. Occup. Environ. Med. 2020 Jun;62(6):389-397


Informing children of their parent’s illness: A systematic review of intervention programs with child outcomes in all health care settings globally from inception to 2019
Oja C, Edbom T, Nager A, Månsson J, Ekblad S
Plos One, 26 May 2020, DOI: 10.1371/journal.pone.0233696

This systematic review gives an overview of the current state of research and extracts what children and parents found helpful in the interventions aimed at informing children of their parent’s illness.

We selected and reviewed the studies independently, and any inconsistencies were resolved by discussion in face-to-face meetings and emails.

A descriptive synthesis of evidence-based concepts from quantitative and qualitative studies was conducted.

Content analysis of the results of studies employing qualitative methodology resulted in four concepts important to both children and parents in interventions (increased knowledge, more open communication, new coping strategies and changed feelings) and three additional concepts important to parents (observed changes in their children’s behavior, the parent’s increased understanding of their own child and the relief of respite).

In the literature there is evidence of mild to moderate positive effects on the child’s level of internalized symptoms as well as concepts important to children and parent’s worth noting when trying to bridge the still existing knowledge gaps. In further efforts the challenges of implementation as well as adaptation to differing clinical and personal situations appear key to address.

Occupational therapy and physiotherapy students’ communicative and collaborative learning in an interprofessional virtual setting.
Björklund K, Silén, C,
Scandinavian Journal of Occupational Therapy, 15 May 2020, DOI: 10.1080/11038128.2020.1761448

The aim was to explore occupational therapist and physiotherapist students learning of skills in interprofessional communication. The students worked together with a virtual patient and their communication was studied. A rich reciprocal learning situation was created by the students. Making shared decisions about a patient can facilitate learning how to communicate interprofessionally and improve students’ understanding of their own profession.

Death, loss and community - Perspectives from children, their parents, and older adults on intergenerational community-based arts initiatives in Sweden.
Kleijberg M, Ahlberg BM, Hilton R, Tishelman C
Health and Social Care in the Community, 15 May 2020, DOI: 10.1111/hsc.1301414

This article describes a qualitative study investigating perspectives from children, their parents and older adults participating in Studio DöBra, a community-based initiative in which children (9 y/o) and older adults (mostly 80+) engaged with topics related to dying, death, and loss through shared arts activities.

Findings indicate that participants acted as individuals with agency in connecting across generations and in creating spaces for engaging with EoL‐topics, not only in Studio DöBra but also in their social networks.

Participants reflected on a changing sense of community through new intergenerational connections and social activities, and expressed a desire to maintain these. However, participants indicated sustainability challenges related to lacking agency in maintaining these spaces and sense of intergenerational community, as they rely on support from community organizations.

Grounding judgement in context: A conceptual learning model of clinical reasoning Medical Education.
Koufidis C, Manninen K, Nieminen J, Wohlin M, Silén C.
Medical Education, 13 May 2020, DOI: 10.1111/medu.14222

In this study we explored novice medical students making sense of the patient encounter in the clinical situation.

Interviews and observations were analysed using grounded theory methodology. Students experience disjunctions in the clinical environment when their frames of reference are challenged. These disjunctions carry significant learning potential. 

The first author will be podcast interviewed related to the paper by the editor in chief of Medical education in September.


Experience-Based Swedish TTO and VAS Value Sets for EQ-5D-5L Health States.
Burström K, Teni FS, Gerdtham UG, Leidl R, Helgesson G, Rolfson O, Henriksson M
Pharmaeconomics, 20 April 2020, doi: 10.1007/s40273-020-00905-7 [Epub ahead of print]


Exploring Community-dwelling Older Adults’ Considerations about Values and Preferences for Future End-of-Life Care: A study from Sweden. (Döbra Research Program)
Eneslätt, M., Helgesson G, Tishelman C.
The Gerontologist. 21 March 2020;

Background and Objectives: There is a substantial body of research on advance care planning (ACP), often originating from English-speaking countries and focused on health care settings. However, studies of content of ACP conversations in community settings remain scarce. We therefore explore community-dwelling, older adults’ reasoning about end-of-life (EoL) values and preferences in ACP conversations.

Research Design and Methods: In this participatory action research project, planned and conducted in collaboration with national community-based organizations, we interviewed 65 older adults without known EoL care needs, about their values and preferences for future EoL care. Conversations were stimulated by sorting and ranking statements in a Swedish version of GoWish cards, called the DöBra cards, and verbatim transcripts were analyzed inductively.

Results: While participants shared some common preferences about EoL care, there was great variation among individuals in how they reasoned. Although EoL preferences and prioritizations could be identical, different individuals explained these choices very differently. We exemplify this variation using data from four participants who discussed their respective EoL preferences by focusing on either physical, social, existential, or practical implications.

Discussion and Implications: A previously undocumented benefit of the GoWish/DöBra cards is how the flexibility of the card statements support substantial discussion of an individual’s EoL preferences and underlying values. Such in-depth descriptions of participants’ reasoning and considerations are important for understanding the very individual nature of prioritizing EoL preferences. We suggest future users of the DöBra/GoWish cards consider the underlying reasoning of individuals’ prioritizations to strengthen person-centeredness in EoL conversations and care provision.

You say it, we say it, but how do we use it? Communities of practice: A critical analysis
McGrath C, Liljedahl M, Palmgren P
Medical Education, March 2020, 54(3):188-195


The Informal Curriculum of Family Medicine – what does it entail and how is it taught to residents? A systematic review.
Rothlind E, Fors U, Salminen H, Wändell P, Ekblad S
BMC Family Practice (accepted Feb 28, 2020,    BMC Family Practice - FAMP-D-19-00423R3)

Electroconvulsive Therapy in Depression: Improvement in Quality of Life Depending on Age and Sex.
Güney P, Ekman CJ, Hammar Å, Heintz E, Landén M, Lundberg J, Nordanskog P, Nordenskjöld A
The Journal of ECT, 27 February 2020, doi: 10.1097/YCT.0000000000000671

Effect of acute transcranial magnetic stimulation on intracellular signalling in human skeletal muscle.
von Walden F, Gidlund EK, Liu C, Ramstrand N, Norrbom J, von Wachenfelt N, Kjellgren H, Sundberg CJ, Pontén E, Alkner B.
Journal of Rehabilitation Medicine, 27 February 2020; 52(2):jrm00022. doi: 10.2340/16501977-2643

How can evidence-based interventions give the best value for users in social services? Balance between adherence and adaptations: a study protocol.
Hasson H, Gröndal H, Hedberg Rundgren Å, Avby G, Uvhagen H, von Thiele Schwarz U
Implementation Science Communications 1, 25 February 2020;15 (2020)

What about me? The impact of employee change agents’ person-role fit on their job satisfaction during organisational change.
Nielsen K, Dawson J, Hasson H, von Thiele Schwarz U
Work & Stress, online 24 February 2020, 10.1080/02678373.2020.1730481

Predicting Sustainable Employability in Swedish Healthcare: The Complexity of Social Job Resources.
Roczniewska M, Richter A, Hasson H, von Thiele Schwarz U
International Journal of Environmental Research and Public Health, 13 February 2020, 17(4).

Advancing health services collaborative and partnership research: Comment on Experience of health leadership in partnering with university-based researchers in Canada – a call to ‘re-imagine’ research.
Nyström M E, Strehlenert H
International Journal of Health Policy and Management, 15 February 2020, doi:10.15171/ijhpm.2020.16

Whom should we ask? A systematic literature review of the arguments regarding the most accurate source of information for valuation of health states.
Helgesson G, Erntsson O, Åström M, Burström K
Quality of Life Research, 3 February 2020, doi: 0.1007/s11136-020-02426-4

Nursing and euthanasia: A narrative review of the nursing ethics literature.
Pesut B, Greig M, Thorne S, Storch J, Burgess M, Tishelman C, Chambaere M, Janke R.
Nursing Ethics, February 2020,Vol. 27(1) 152–167.

Background: Medical Assistance in Dying, also known as euthanasia or assisted suicide, is expanding internationally. Canada is the first country to permit Nurse Practitioners to provide euthanasia. These developments highlight the need for nurses to reflect upon the moral and ethical issues that euthanasia presents for nursing practice.

Purpose: The purpose of this article is to provide a narrative review of the ethical arguments surrounding euthanasia in relationship to nursing practice.

Methods: Systematic search and narrative review. Nine electronic databases were searched using vocabulary developed from a stage 1 search of Medline and CINAHL. Articles that analysed a focused ethical question related to euthanasia in the context of nursing practice were included. Articles were synthesized to provide an overview of the literature of nursing ethics and euthanasia.

Ethical Considerations: This review was conducted as per established scientific guidelines. We have tried to be fair and respectful to the authors discussed.

Findings: Forty-three articles were identified and arranged inductively into four themes: arguments from the nature of nursing; arguments from ethical principles, concepts and theories; arguments for moral consistency; and arguments from the nature of the social good. Key considerations included nursing’s moral ontology, the nurse–patient relationship, potential impact on the profession, ethical principles and theories, moral culpability for acts versus omissions, the role of intention and the nature of the society in which euthanasia would be enacted. In many cases, the same assumptions, values, principles and theories were used to argue both for and against euthanasia.

Discussion: The review identified a relative paucity of literature in light of the expansion of euthanasia internationally. However, the literature provided a fulsome range of positions for nurses to consider as they reflect on their own participation in euthanasia. Many of the arguments reviewed were not nursing-specific,but rather are relevant across healthcare disciplines. Arguments explicitly grounded within the nature of nursing and nurse–patient relationships warrant further exploration.


A prospective cohort study of self-reported computerised medical history taking for acute chest pain: protocol of the CLEOS-Chest Pain Danderyd Study (CLEOS-CPDS).
Brandberg H, Kahan T, Spaak J, Sundberg K, Koch S, Adeli A, Sundberg CJ, Zakim D.
BMJ Open, 21 January 2020;10(1):e031871. doi: 10.1136/bmjopen-2019-031871

The past is present: Death systems among the Indigenous Sámi in Northern Scandinavia today.
Kroik L, Lindqvist O, Stoor K, Tishelman C
Mortality, 27 January 2020, doi: 10.1080/13576275.2020.1715359

Authorship order and effects of changing bibliometrics practices.
Helgesson G
Research Ethics, 21 January 2020;

Patient experience of communication consistency amongst staff is related to nurse–physician teamwork in hospitals.
von Knorring M, Griffiths P, Ball J, Runesdotter S, Lindqvist R
Nursing open, 15 January 2020,

The use of complementary medicine in palliative care in France: an observational cross-sectional study.
Filbet M, Schloss J, Maret JB, Diezel H, Palmgren PJ, Steel A
Supportive Care in Cancer, 9 January 2020; 28, pages4405–4412(2020)

A performance comparison of patient pathways in Nordic capital areas - a pilot study for ischaemic stroke patients.
Häkkinen U, Goude F, Hagen TP, Kruse M, Moger T, Peltola M, Rehnberg C.
Scand J Public Health. 9 January 2020;1403494819863523

12-hr shifts in nursing: Do they remove unproductive time and information loss or do they reduce education and discussion opportunities for nurses? A cross-sectional study in 12 European countries.
Dall’Ora C, Griffiths P, Emmanuel T, Rafferty A-M, Ewings S
Journal of Clinical Nursing, January 2020, Volume 29:53–59. (on behalf of the RN4CAST consortium)

Aims and objectives: To examine the association between registered nurses' (referred to as “nurses” for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers.

Background: The introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps.

Design: Cross‐sectional survey of 31,627 nurses within 487 hospitals in 12 European countries.

Methods: The associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist.

Results: When nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant.

Conclusion: Working shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care.
Relevance to clinical practice: Implementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients.