Psychosocial consequences of screening-detected abdominal aortic aneurisms: a cross-sectional study.

OBJECTIVE: In Sweden, an abdominal aortic aneurysm (AAA) screening programme was gradually implemented from 2009 to reduce the incidence of rupture and thereby mortality. AAA screening introduces a variety of unintended, but generally unavoidable, harms, e.g. stress and worry. Such psychosocial consequences have previously only been investigated with generic measures. Therefore, the aim of this study was to describe and compare the psychosocial consequences in men with a screening detected AAA to men with a normal screening result after they participated in the Swedish national AAA-screening programme using a validated psychometric instrument. MATERIAL AND METHODS: This study was a cross-sectional survey. Data were originally collected to validate the COS-AAA and has previously been published in details. The Consequences of Screening in Abdominal Aortic Aneurysm (COS-AAA) questionnaire was sent to 250 men with a screening detected AAA and 500 with a normal screening result who were randomly selected from a Swedish population-based screening register. RESULTS: In total, 158 (63%) men with a screening detected AAA and 275 (55%) men with a normal screening result completed the COS-AAA. We found that men with a screening detected AAA reported negative psychosocial consequences to a greater extent in 10 of 13 COS-AAA Part 1 scales, all statistically significant except three (behaviour, sleep and negative experiences from examination). For COS-AAA Part 2, there was a statistically significant difference between groups in four of five scales. CONCLUSIONS: Men diagnosed with a screening detected AAA, reported more negative psychosocial consequences compared to men with a normal result. Screening for abdominal aorta aneurism (AAA) introduces intended benefits and unintended harms. Adequate measures are necessary to determine the balance between them.Key points:This study applied a condition-specific questionnaire with high content validity and adequate psychometric properties to measure psychosocial consequences in men participating in AAA screening.We found that men with a screening detected AAA reported more negative psychosocial consequences than men with a normal aorta size.The risk of negative psychosocial consequences is important to include in the decision making on whether to participate in screening or not.

Normative video head impulse test data in subjects with and without vascular risk factors.

PURPOSE: There is a paucity of age- and vascular risk factor-stratified video head impulse test (vHIT) vestibulo-ocular reflex (VOR) data in the literature. The aim of this study was to investigate the vHIT VOR properties in healthy subjects of different ages and subjects with vascular risk factors. METHODS: This was a prospective observational single-center study at a tertiary referral university hospital in northern Sweden. Healthy participants and subjects with vascular risk factors were investigated with a floor standing external camera vHIT device. Age-stratified mean VOR gain among healthy adults and between group gain and gain asymmetry differences were calculated. RESULTS: We included eighty-eight healthy adults with a mean (range) age of 50 (22-85) years and n = 48 stroke ward patients with vascular risk factors (but without vestibular disease) with a mean (range) age of 74 (42-92) years. The mean VOR gain of horizontal canals decreased at higher ages in healthy subjects (r = - 0.32, p < 0.01, n = 167 canals). The age-stratified mean (SD) VOR gains were < 30 years: 0.98 (0.07), 30-39 years: 0.97 (0.07), 40-49 years: 0.98 (0.06), 50-59 years: 0.99 (0.06), 60-69 years: 0.93 (0.08), ≥ 70 years: 0.89 (0.15). No consistent differences between healthy subjects and subjects with vascular risk factors were seen except for a trend towards more pronounced gain asymmetries in the latter group. CONCLUSIONS: Age, but not vascular risk factors influence VOR gain. Age-adjusted vHIT-measurements may be useful in acute vertigo stroke risk differentiation.

Identification of the dynamics of time-varying phase aberrations from time histories of the point-spread function.

To optimally compensate for time-varying phase aberrations with adaptive optics, a model of the dynamics of the aberrations is required to predict the phase aberration at the next time step. We model the time-varying behavior of a phase aberration, expressed in Zernike modes, by assuming that the temporal dynamics of the Zernike coefficients can be described by a vector-valued autoregressive (VAR) model. We propose an iterative method based on a convex heuristic for a rank-constrained optimization problem, to jointly estimate the parameters of the VAR model and the Zernike coefficients from a time series of measurements of the point-spread function (PSF) of the optical system. By assuming the phase aberration is small, the relation between aberration and PSF measurements can be approximated by a quadratic function. As such, our method is a blind identification method for linear dynamics in a stochastic Wiener system with a quadratic nonlinearity at the output and a phase retrieval method that uses a time-evolution-model constraint and a single image at every time step.

De novo biosynthesis of anthocyanins in Saccharomyces cerevisiae.

Anthocyanins (ACNs) are plant secondary metabolites responsible for most of the red, purple and blue colors of flowers, fruits and vegetables. They are increasingly used in the food and beverage industry as natural alternative to artificial colorants. Production of these compounds by fermentation of microorganisms would provide an attractive alternative. In this study, Saccharomyces cerevisiae was engineered for de novo production of the three basic anthocyanins, as well as the three main trans-flavan-3-ols. Enzymes from different plant sources were screened and efficient variants found for most steps of the biosynthetic pathway. However, the anthocyanidin synthase was identified as a major obstacle to efficient production. In yeast, this enzyme converts the majority of its natural substrates leucoanthocyanidins into the off-pathway flavonols. Nonetheless, de novo biosynthesis of ACNs was shown for the first time in yeast and for the first time in a single microorganism. It provides a framework for optimizing the activity of anthocyanidin synthase and represents an important step towards sustainable industrial production of these highly relevant molecules in yeast.

Flawed communications: Health professionals' experience of collaboration in the care of frail elderly patients.

AIMS: Frail elderly patients who have multiple illnesses do not fare well in modern health care systems, mainly due to a lack of care planning and flawed communication between health professionals in different care organisations. This is especially noticeable when patients are discharged from hospital. The aim of this study was to explore health care professionals' experience of obstacles and opportunities for collaboration. METHODS: Health professionals were invited to participate in three focus groups, each consisting of a hospital physician, a primary care physician, a hospital nurse, a primary care nurse, a municipal home care nurse or an assistant officer, a physical or occupational therapist and a patient or a family member representative. These individual people were then asked to discuss the obstacles and opportunities for communication between themselves and with the patients and their relatives when presented with the case report of a fictitious patient. Content analysis was used to identify categories. RESULTS: Several obstacles were identified for effective communication and care planning: insufficient communication with patients and relatives; delayed collaboration between care-givers; the lack of an adequate responsible person for care planning; and resources not being distributed according to the actual needs of patients. The absence of an overarching responsibility for the patient, beyond organisational borders, was a recurring theme. These obstacles could also be seen as opportunities. CONCLUSIONS: Obstacles for collaboration were found on three levels: societal, organisational and individual. As health care professionals are well aware of the problems and also see solutions, management for health care should support employees' own initiatives for changes that are of benefit in the care of frail elderly patients with multiple illnesses.

High hospital readmission rates for patients aged ≥65 years associated with low socioeconomic status in a Swedish region: a cross-sectional study in primary care.

OBJECTIVE: There is a presumption that hospital readmission rates amongst persons aged ≥65 years are mainly dependent on the quality of care. In this study, our primary aim was to explore the association between 30-day hospital readmission for patients aged ≥65 years and socioeconomic characteristics of the studied population. A secondary aim was to explore the association between self-reported lack of strategies for working with older patients at primary health care centres and early readmission. DESIGN: A cross-sectional ecological study and an online questionnaire sent to the heads of the primary health care centres. We performed correlation and regression analyses. SETTING AND SUBJECTS: Register data of 283,063 patients in 29 primary health care centres in the Region Örebro County (Sweden) in 2014. MAIN OUTCOME MEASURE: Thirty-day hospital readmission rates for patients aged ≥65 years. Covariates were socioeconomic characteristics among patients registered at the primary health care centre and eldercare workload. RESULTS: Early hospital readmission was found to be associated with low socioeconomic status of the studied population: proportion foreign-born (r = 0.74; p < 0.001), proportion unemployed (r = 0.73; p < 0.001), Care Need Index (r = 0.74; p < 0.001), sick leave rate (r = 0.51; p < 0.01) and average income (r = -0.40; p = 0.03). The proportion of unemployed alone could explain up to 71.4% of the variability in hospital readmission (p < 0.001). Primary health care centres reporting lack of strategies to prevent readmissions in older patients did not have higher hospital readmission rates than those reporting they had such strategies. CONCLUSION: Primary health care centres localized in neighbourhoods with low socioeconomic status had higher rates of hospital readmission for patients aged ≥65. Interventions aimed at reducing hospital readmissions for older patients should also consider socioeconomic disparities. Key Points In Sweden, hospital readmission within 30 days among patients aged ≥65 has been used as a measure of quality of primary care for the elderly. However, in our study, elderly 30-day readmission was associated with low neighbourhood socioeconomic status. A simple survey in one Swedish region showed that the primary health care centres that lacked active strategies for working with aged patients did not have higher hospital readmission rates than those that reported having strategies. Interventions aimed at reducing elderly hospital readmissions should therefore also consider the socioeconomic disparities in the elderly.

The dilemma of repeat weak opioid prescriptions - experiences from swedish GPs.

OBJECTIVE: To explore general practitioners' (GP) experiences of dealing with requests for the renewal of weak opioid prescriptions for chronic non-cancer pain conditions. DESIGN: Qualitative focus group interviews. Systematic text condensation analysis. SETTING AND SUBJECTS: 15 GPs, 4 GP residents and 2 interns at two rural and two urban health centres in central Sweden. MAIN OUTCOME MEASURES: Strategies for handling the dilemma of prescribing weak opioids without seeing the patient. RESULTS: After analysing four focus group interviews we found that requests for prescription renewals for weak opioids provoked adverse feelings in the GP regarding the patient, colleagues or the GP's inner self and were experienced as a dilemma. To deal with this, the GP could use passive as well as active strategies. Active strategies, like discussing the dilemma with colleagues and creating common routines regarding the renewal of weak opioids, may improve prescription habits and support physicians who want to do what is medically correct. CONCLUSION: Many GPs feel umcomfortable when prescribing weak opioids without seeing the patient. This qualitative study has identified strategic approaches to deal with that issue. Key points  Opioid prescription for chronic non-cancer pain is known to cause discomfort, feelings of guilt and conflicts for the prescribing doctor. From focus group interviews with GPs we found that to deal with this: • Doctors can use active strategies, such as confronting the patient or creating common routines together with their colleagues, or… • They can use passive coping strategies such as accepting the situation, handing over the responsibility to the patient or choosing not to see that there is a problem. • Opportunities for doctors to discuss prescription routines may be the best way to influence prescription habits.

Unusual electronic properties and transmission in hexagonal SiB monolayers.

After the success of graphene, several two-dimensional (2D) layers have been proposed and investigated both theoretically and experimentally in order to evaluate their structural stability and possible applications of these unusual materials in electronics. Except for graphene, only silicon and germanium were predicted to form semi-metallic honeycomb monolayers, while most of the binary graphene-like compounds are all semiconductors. These predictions have been corroborated for several 2D structures experimentally synthesized. Considering the possibility of finding other candidates in this realm, exhibiting exceptional electron mobility, we have explored low-dimensional silicon-boron compounds containing planar sp(2)-bonding silicon atoms, through first-principles density-functional theory calculations. We have demonstrated that the so-called h-SiB sheet, which is a structural analogue of 2D honeycomb binary compounds, exhibits good structural stability, compared to the structure of silicene, for example, and predicted that this structure is also able to roll up into thermally stable single-walled silicon-boron nanotubes. The h-SiB sheet exhibits a delocalized charge density like in graphene, but the partially filled π band and two highest occupied σ bands are above the Fermi level, leading to the metallic behaviour of this SiB sheet. In this sense, we perform first-principles electron transport calculations, based on the nonequilibrium Green's function formalism, which has demonstrated that h-SiB exhibits higher transmission around the Fermi energy than the transmission in graphene. Our results indicate the unusual conductivity of this new material and open up new possibilities for the realization of metallic graphene-like systems for electronic transport in low dimensions.

Unemployment and dispensed prescribed antidepressants in Stockholm County 1998-09.

The association between unemployment rates and population mental health has been studied with contradictory results. We examine the association between unemployment and antidepressants in Stockholm County. Age- and sex-specific monthly data on unemployment and dispensed prescribed antidepressants from January 1998 to January 2008 in Stockholm County were used. The association was studied with bivariate cointegration analysis with stationarity check of the residuals. We found that dispensing of antidepressants was inversely associated with unemployment. One interpretation is that antidepressants have not followed decreasing unemployment rates.

Beyond the impasse? Systemic consultation and understanding complex cases.

BACKGROUND: Systemic consultation provides an opportunity for clinicians working with complex cases and behaviours of concern to reflect on interpersonal dynamics that may be inhibiting change. This approach to case review is drawn from systemic family therapy, a model that is gaining some acceptance within the field of intellectual disability. METHOD: Thematic analysis was used to explore the experience of eleven clinicians attending systemic consultation. Clinicians were experienced in behaviour support, had no prior experience in family therapy and presented with complex cases described as 'stuck'. RESULTS: Consultations were seen to have many benefits, including a heightened awareness of the interpersonal needs of both clients and carers and the development of a facilitative position and skills to apply to cases. Less experienced clinicians were more likely to feel overwhelmed by this less structured, more relationally oriented focus. CONCLUSIONS: Systemic consultation has the potential to augment behaviour support, enabling clinicians to understand and negotiate problematic interpersonal dynamics when responding to behavioural difficulties. Less experienced clinicians may require additional training and support in the systemic approach.

Evaluation of selected organic fertilizers on conditioning soil health of smallholder households in Karagwe, Northwestern Tanzania.

Soil management is a strategy for improving soil suffering from problems such as low pH, nutrient deficiency, and erosion. The study evaluated the effects of human urine (HU), biogas slurry (BS), standard compost (StC), animal manure (AM), and synthetic fertilizer (SF) in comparison with no soil fertility management (NFM) on soil pH, cation exchange capacity (CEC), soil organic carbon (SOC), soil moisture content, nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg), sodium (Na), copper (Cu), zinc (Zn), manganese (Mn), and iron (Fe) in the Karagwe district, a Northwestern Tanzania. Four household farms representing each soil amendment type were selected for soil sampling. A total of 192 soil samples were collected and air-dried. After laboratory analysis, BS-enriched soil had the highest pH (6.558), CEC (23.945 cmol+/kg), SOC (5.573%), soil moisture (5.573%), N (0.497%), P (247.130 mg/kg), K (3.036 cmol+/kg), Ca (18.983 cmol+/kg), Mg (4.076 cmol+/kg), Na (2.960 cmol+/kg), and Cu (12.548 mg/kg). Similar soil properties were lower in NFM than in the other soils. The soil properties on the chosen farms did not differ significantly depending on the sampling zone for each organic fertilizer. Therefore, the result indicates that all evaluated organic fertilizers improved soil health compared to NFM, but BS and HU fertilizers led to relatively better soil health improvements than StC, AM, and SF.

Pathways from research to sustainable development: Insights from ten research projects in sustainability and resilience.

Drawing on collective experience from ten collaborative research projects focused on the Global South, we identify three major challenges that impede the translation of research on sustainability and resilience into better-informed choices by individuals and policy-makers that in turn can support transformation to a sustainable future. The three challenges comprise: (i) converting knowledge produced during research projects into successful knowledge application; (ii) scaling up knowledge in time when research projects are short-term and potential impacts are long-term; and (iii) scaling up knowledge across space, from local research sites to larger-scale or even global impact. Some potential pathways for funding agencies to overcome these challenges include providing targeted prolonged funding for dissemination and outreach, and facilitating collaboration and coordination across different sites, research teams, and partner organizations. By systematically documenting these challenges, we hope to pave the way for further innovations in the research cycle.

Climate change in the Baltic sea region: a cross-country analysis of institutional stakeholder perceptions.

Before climate change is considered in long-term coastal management, it is necessary to investigate how institutional stakeholders in coastal management conceptualize climate change, as their awareness will ultimately affect their actions. Using questionnaires in eight Baltic Sea riparian countries, this study examines environmental managers' awareness of climate change. Our results indicate that problems related to global warming are deemed secondary to short-term social and economic issues. Respondents agree that problems caused by global warming will become increasingly important, but pay little attention to adaptation and mitigation strategies. Current environmental problems are expected to continue to be urgent in the future. We conclude that an apparent gap exists between decision making, public concerns, and scientific consensus, resulting in a situation in which the latest evidence rarely influences commonly held opinions.

Low health literacy and multiple medications in community-dwelling older adults: a population-based cohort study.

OBJECTIVES: Adequate health literacy is important for patients to manage chronic diseases and medications. We examined the association between health literacy and multiple medications in community-dwelling adults aged 50 years and older in England. DESIGN, SETTINGS AND PARTICIPANTS: We included 6368 community-dwelling people of median age 66 years from the English Longitudinal Study of Ageing. Health literacy was assessed at wave 5 (2010/11) with 4 questions concerning a medication label. Four correct answers were categorised as adequate health literacy, otherwise low. Data on medications were collected at wave 6 (2012/13). To examine the difference in the number of medications between low and adequate health literacy, we used zero-inflated negative binomial regression, estimating odds ratio (OR) for zero medication and incidence rate ratios (IRR) for the number of medications, with 95% CIs. Associations were adjusted for demographic, socioeconomic and health characteristics, smoking and cognitive function. We also stratified the analysis by sex, and age (50-64 and ≥65 years). To be comparable with preceding studies, multinomial regression was fitted using commonly used thresholds of polypharmacy (0 vs 1-4, 5-9, ≥10 medications). RESULTS: Although low health literacy was associated with a lower likelihood of being medication-free (OR=0.64, 95% CI: 0.45 to 0.91), health literacy was not associated with the number of medications among those at risk for medication (IRR=1.01, 95% CI: 0.96 to 1.05), and this finding did not differ among younger and older age groups or women. Among men, low health literacy showed a weak association (IRR=1.06, 95% CI: 0.99 to 1.14). Multinomial regression models showed graded risks of polypharmacy for low health literacy. CONCLUSIONS: Although there was no overall association between health literacy and the number of medications, this study does not support the assertion that low health literacy is associated with a notably higher number of medications in men.

Ethnopharmacological inventory of plants used in Coronel Portillo Province of Ucayali Department, Peru.

CONTEXT: Despite a rich tradition of folk medicinal usage of plants in the Peruvian Amazon, no studies documenting ethnobotanical information of Coronel Portillo Province of Ucayali Department have been published at an international level. OBJECTIVE: This field research documented traditional ethnobotanical knowledge related to the local use of medicinal plants. MATERIALS AND METHODS: Ethnobotanical data were collected in native communities around Pucallpa city (Coronel Portillo Province of Ucayali Department, Peru) and in the city itself during the period June-October 2007. The data were collected through direct interviews with 23 people. RESULTS: Uses of 30 plant species belonging to 18 families in traditional medicine are described in this article. Botanical and vernacular names, plant part used, popular medicinal use, forms of preparation and applications of the herbal remedies for each species are reported. DISCUSSION AND CONCLUSION: Among investigated species, Brunfelsia grandiflora D. Don (Solanaceae), Calycophyllum spruceanum (Benth.) K. Schum. (Rubiaceae), Naucleopsis glabra Spruce (Moraceae), Phthirusa pyrifolia Eichler (Loranthaceae) were identified to be widely used in the studied area. However their beneficial health properties have not been well studied.

Working together--primary care doctors' and nurses' attitudes to collaboration.

BACKGROUND: Multidisciplinary teamwork is recommended for various disorders and it has been suggested that it is a way to meet the new challenges and demands facing general practitioners (GPs) in modern society. Attempts to introduce the method in primary care have failed partly due to GPs' unwillingness to participate. The aim of this study was to measure attitudes towards collaboration among GPs and district nurses (DN) and to investigate whether there is a correlation between a positive attitude toward collaboration and high self-esteem in the professional role. METHODS: The Jefferson Scale of Attitudes toward Physician Nurse Collaboration and the Professional Self-Description Form (PSDF) was used to study a cohort of 600 GPs and DNs in Västra Götaland region. The purpose was to map differences and correlations of attitude between DNs and GPs, between male and female GPs, and between older and younger DNs and GPs. RESULTS: Four hundred and one answers were received. DNs (mean 51.7) were significantly more positive about collaboration than GPs (mean 49.4). There was no difference between younger and older, male and female GPs. DNs scored higher on the PSDF-scale than GPs. CONCLUSIONS: DNs were slightly more positive about collaboration than GPs. A positive attitude towards collaboration did not seem to be a part of the GPs' professional role to the same extent as it is for DNs. Professional norms seem to have more influence on attitudes than do gender roles. DNs seem more confident in their profession than GPs.

Medical students' attitudes toward collaboration between doctors and nurses - a comparison between two Swedish universities.

The aim of this study was to investigate differences in attitudes towards collaboration between doctors and nurses among medical students in two medical schools: Gothenburg University (GU), which did not offer interprofessional education, and Linköping University (LiU), with a curriculum containing an interprofessional education programme; between male and female students; and between those with previous working experience in medical care and those without. A questionnaire, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, was distributed to 314 first year and final year students at GU and LiU: 261 (82%) answers were received. There was no significant difference in attitudes toward collaboration, between first students at GU and LiU, between final year students at the two universities; and between those who had or did not have earlier experience of working in health care. There was a significant difference between male and female students (p = 0.0017) implying a more positive attitude among female students. Females were in majority among final year students (females 80 and males 46) final year, yet, students at both universities did not show a more positive attitude towards collaboration, than did first year students. It was concluded that students who had an interprofessional thread within their medical curriculum did not show different attitudes towards collaboration. The impact of the interprofessional teaching and training programme is discussed and further, especially longitudinal, studies are advocated.

Digitalization and Physician Learning: Individual Practice, Organizational Context, and Social Norm.

INTRODUCTION: The emerging context of online platforms and digitally engaged patients demands new competencies of health care professionals. Although information and communication technologies (ICTs) can strengthen continuous professional development (CPD) and learning at work, more research is needed on ICT for experiential and collegial learning. METHODS: The study builds on prior qualitative research to identify issues and comprises a quantitative assessment of ICT usage for learning in health care. A survey was administered to Swedish physicians participating in a CPD program as part of specialist medical training. Conclusions focused specifically on learning dimensions are drawn from correlation analyses complemented with multiple regression. RESULTS: The findings show that physicians' actual use of ICT is related to perceived performance, social influence, and organizational context. Social norm was the most important variable for measured general usage, whereas performance expectancy (perceived usefulness of ICT) was important for ICT usage for learning. The degree of individual digitalization affects performance and, in turn, actual use. DISCUSSION: The study highlights the need to incorporate ICT effectively into CPD and clinical work. Besides formal training and support for specific systems, there is a need to understand the usefulness of digitalization integrated into practice. Moving beyond instrumentalist views of technology, the model in this study includes contextualized dimensions of ICT and learning in health care. Findings confirm that medical communities are influencers of use, which suggests that an emphasis on collegial expectations for digital collaboration will enhance practitioner adaptation.

Yeast artificial chromosomes employed for random assembly of biosynthetic pathways and production of diverse compounds in Saccharomyces cerevisiae.

BACKGROUND: Natural products are an important source of drugs and other commercially interesting compounds, however their isolation and production is often difficult. Metabolic engineering, mainly in bacteria and yeast, has sought to circumvent some of the associated problems but also this approach is impeded by technical limitations. Here we describe a novel strategy for production of diverse natural products, comprising the expression of an unprecedented large number of biosynthetic genes in a heterologous host. RESULTS: As an example, genes from different sources, representing enzymes of a seven step flavonoid pathway, were individually cloned into yeast expression cassettes, which were then randomly combined on Yeast Artificial Chromosomes and used, in a single transformation of yeast, to create a variety of flavonoid producing pathways. Randomly picked clones were analysed, and approximately half of them showed production of the flavanone naringenin, and a third of them produced the flavonol kaempferol in various amounts. This reflected the assembly of 5-7 step multi-species pathways converting the yeast metabolites phenylalanine and/or tyrosine into flavonoids, normally only produced by plants. Other flavonoids were also produced that were either direct intermediates or derivatives thereof. Feeding natural and unnatural, halogenated precursors to these recombinant clones demonstrated the potential to further diversify the type of molecules that can be produced with this technology. CONCLUSION: The technology has many potential uses but is particularly suited for generating high numbers of structurally diverse compounds, some of which may not be amenable to chemical synthesis, thus greatly facilitating access to a huge chemical space in the search for new commercially interesting compounds.

Flipped healthcare for better or worse.

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.