Olga Golburean

• Golburean, Olga; Uncuta, Diana; Manrikyan, Gayane; Shakavets, Natalia; Vardanyan, Izabella & Markaryan, Marina [Show all 9 contributors for this article] (2025). Exploring dental students' knowledge on oral cancer prevention: a cross-sectional study in Moldova, Armenia, and Belarus. BMC Oral Health. 25. doi: 10.1186/s12903-025-05459-8. Full text in Research Archive Show summary

  Background: Survival rate of patients with oral cancer (OC) remains to be very low despite advancements in therapy and surgical techniques. This is attributed to the fact that most OC cases are discovered at a late stage. Dentists play a vital role in early detection of OC through oral mucosal examination, and in informing the patients about avoidable risk factors of the disease, such as tobacco and excessive alcohol use. This study aimed at evaluating knowledge about OC among dental students in Moldova, Armenia and Belarus; three former soviet countries with high rates of tobacco use. Methods: This was a cross-sectional, multi-country study based on self-administered questionnaire. Dental students in their clinical years at three dental faculties in Moldova, Armenia and Belarus were invited to participate in the study. Data collection took place during the period May to September 2019. Association between different categorical variables was investigated using Chi-squared test. A knowledge score ranging from 0–14 was constructed from the obtained data. Differences in the knowledge score between different groups of students was investigated using either student`s t-test whenever comparing two groups, or One-way ANOVA with Bonferroni`s correction for three or more groups. The level of significance was set to 0.05 for all statistical tests. Results: A total of 642 dental students participated in the study. The mean knowledge score was found to be 6.62 ± 2.61, with 45% of the students scoring below the mean. Students from Belarus had the highest score (7.3 ± 2.14) in comparison to Armenia (6.66 ± 2.64) and Moldova (5.66 ± 2.81), as revealed by ANOVA test. However, we observed a significant increase (p-value < 0.001, ANOVA) in the students` knowledge score as they proceed through study years from third (6.07 ± 2.61) to fifth year (7.49 ± 2.48). In addition, we found that Students with current or previous cigarette smoking habits had significantly (p-value < 0.001, student`s t-test) lower mean knowledge score (5.96 ± 2.82) when compared to students who have never been smokers (6.98 ± 2.42). Conclusions: The present study reveals notable gaps in OC knowledge and concerning tobacco use behaviors among dental students in Moldova, Belarus, and Armenia. By providing comprehensive education on risk factors and addressing personal habits, dental schools can better prepare future professionals to play a critical role in OC prevention and management.

• Golburean, Olga; Pedersen, Rune; Melby, Line Kari & Faxvaag, Arild (2025). Exploring Physicians’ Dual Perspectives on the Transition From Free Text to Structured and Standardized Documentation Practices: Interview and Participant Observational Study. JMIR Formative Research. 9. doi: 10.2196/63902. Full text in Research Archive Show summary

  Background: Clinical documentation plays a crucial role in providing and coordinating care. Despite the widespread adoption of electronic health record (EHR) systems, many end users still document clinical data in a manner similar to traditional paper-based records. To fully leverage the benefits of EHR systems, it is necessary to adopt new documentation approaches that facilitate easy access to information at the point of care and seamless exchange of information across health care facilities. Objective: We aimed to evaluate how the transition from an older EHR system to a cross-institutional EHR system impacts physicians’ documentation practices and gain a deeper understanding of the factors influencing their choice between free text and structured and standardized documentation methods. Methods: A qualitative study was conducted between September 2023 and January 2024. It involved participant observations and individual semistructured interviews with physicians at a university hospital in Norway. Data were analyzed using reflexive thematic analysis. Results: The analysis revealed 3 main themes. First, physicians encountered challenges during the implementation phase of the new EHR system due to its complexity and their unfamiliarity with its use. However, with time, physicians gradually adopted new documentation processes. This integration or adoption primarily occurred by learning through practical experience and collaborative knowledge exchange with their peers. Second, although the implementation of the new EHR system had increased structured and standardized clinical documentation, free text remained the preferred method, with some exceptions. In addition, the fact that many physicians still relied on free-text documentation created a sense of distrust among them toward some of the standardized clinical data. Finally, the informants had mixed perceptions of Systematized Nomenclature of Medicine–Clinical Terms. Some viewed it as a more nuanced terminology system, while others found it more complex. Most informants found using templates for routine procedures beneficial as it saved time in the documentation process and ensured that all necessary parameters and documentation requirements were met. Conclusions: The study findings revealed that physicians’ acceptance of new documentation processes is influenced by various social and technological factors. These factors include previous documentation experiences, perceived benefits, familiarity with the EHR system, time constraints, and user-friendliness of the system. While physicians generally have a positive attitude toward using templates for routine procedures, they often create their own templates, and data within these templates are documented in a free-text format. To address this, health care organizations should consider implementing common standardized or semistandardized templates to reduce disparities in documentation, enhance data recording, and ensure adherence to guidelines. Furthermore, to facilitate the transition to the new documentation processes, we recommend providing physicians with customized training programs and platforms for tacit knowledge exchange.

• Golburean, Olga; Nordheim, Espen Solbakken; Faxvaag, Arild; Pedersen, Rune; Lintvedt, Ove Kumetz Bomhoff & Ruiz, Luis Marco (2024). A systematic review and proposed framework for sustainable learning healthcare systems. International Journal of Medical Informatics. ISSN 1386-5056. 192. doi: 10.1016/j.ijmedinf.2024.105652. Full text in Research Archive
• Golburean, Olga; Lintvedt, Ove; Nordheim, Espen Solbakken; Pedersen, Rune; Ruiz, Luis Marco & Faxvaag, Arild (2022). Does your EHR support a Learning Healthcare System? An exploration of possible indicators. Linköping Electronic Conference Proceedings. ISSN 1650-3686. doi: 10.3384/ecp187002. Full text in Research Archive Show summary

  Background: The Learning Health System is a concept born from the Institute of Medicine roundtable in 2006 which aims for overcoming the limitations of evidence-based medicine. Since its conception several nations and organizations have actively proposed health policies, research plans, and innovation strategies for its implementation. The effective realization of practices enabling a Learning health system hinge on the availability of Information system functionality and tools. Objective: To describe the EHR functionality that is needed and corresponding indicators for use in evaluation. Methods: Analysis of the content of influential scientific publications on the topic. Results and discussion: The key enabling practices are linked to the life-cycle of biomedical knowledge as well as to knowledge on how to implement evidence-based care.

• Golburean, Olga; Hagen, Maria Helene; Uncuta, Diana; Tighineanu, Marcela; Manrikyan, Gayane & Vardanian, Izabella [Show all 17 contributors for this article] (2021). Knowledge, opinions, and practices related to oral cancer prevention and oral mucosal examination among dentists in Moldova, Belarus and Armenia: a multi-country cross-sectional study. BMC Oral Health. 21. doi: 10.1186/s12903-021-02011-2. Full text in Research Archive Show summary

  Introduction Moldova, Belarus, and Armenia are post-Soviet countries with a high rate of heavy smokers and a relatively high age-standardized incidence of oral cancer. However, to our knowledge, there is lack of available information on dentists’ knowledge on prevention of oral cancer in the countries in question. Accordingly, this study aimed to assess the knowledge, opinions, and practices related to oral cancer prevention and oral mucosal examination among dentists in Moldova, Belarus, and Armenia. Methods This was a multi-country, cross-sectional study based on a self-administered questionnaire. A structured questionnaire was distributed to 3534 dentists (797 in Chisinau, Moldova, 1349 in Minsk, Belarus, and 1388 in Yerevan, Armenia). Dentists' knowledge about risk factors for oral cancer development and its clinical picture, current practices and opinions with regard to oral mucosal screening and oral cancer prevention, and their consistency to perform oral mucosal examination were assessed. A knowledge score ranging from 0 to 14 points was generated based on each dentist’s answer to the questionnaire. Results A total of 1316 dentists responded, achieving an overall response rate of 37.2% (34.5% in Moldova; 52.3% in Belarus; 24.2% in Armenia). Most dentists in the three countries correctly identified tobacco (83.8–98.2%) and prior oral cancer lesions (84.0–96.3%) as risk factors for oral cancer. Most dentists correctly identified leukoplakia as a lesion with malignant potential (68.7% in Moldova; 88.5% in Belarus; 69.9% in Armenia), while erythroplakia was identified by much fewer in all three countries. Less than 52% of dentists identified the tongue, rim of tongue, and floor of mouth as the most common sites for oral cancer. The mean knowledge score for all countries combined was 7.5 ± 2.7. The most commonly reported barriers to perform oral mucosal examination were lack of training, knowledge, and experience. Conclusions This study highlights the need for improved oral cancer-related education and training on oral mucosal examination for dentists in Moldova, Belarus, and Armenia. Such skills are essential to enhance oral cancer prevention and to improve the prognostic outcome by early detection.

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• Golburean, Olga; Faxvaag, Arild; Pedersen, Rune & Melby, Line (2024). Old Habits Die Hard – Doctors’ Experiences with Laying Off Free-Text Documentation in the Face of a New, Structured Documentation Regime. Full text in Research Archive
• Golburean, Olga (2024). Helsepersonells dokumentasjonspraksis: Effekten av overgang til ny strukturert journal og standardisert språk. Full text in Research Archive
• Lohmann-Lafrenz, Signe & Golburean, Olga (2024). Do Hospital workers in Central Norway enjoy “Easy and secure access to health information”? Full text in Research Archive
• Golburean, Olga (2023). EHR functionality to support a learning health system. Full text in Research Archive
• Isaksen, Amanda; Henriksen, André; Bradway, Meghan; Jøsendal, Anette Vik; Golburean, Olga & Lintvedt, Ove (2022). Forskere fra Skandinavia samlet i Tromsø for kunnskapsdeling. Full text in Research Archive
• Golburean, Olga & Hagen, Maria Helene (2019). Perceived barriers to performing oral mucosal examination and oral cancer prevention among Moldovian dentists. Full text in Research Archive
• Golburean, Olga (2026). Health Systems That Learn: From Documentation to Data Reuse in a Cross- Institutional EHR. NTNU Faculty of Medicine and Health Sciences . ISSN 9788232697731. Full text in Research Archive Show summary

  Til tross for fremskritt innen digitalisering i helsesektoren, inkludert utbredt bruk av Elektronisk Pasientjournal (EPJ) systemer, opplever helsepersonell fortsatt utfordringer når det kommer til å få tilgang til nødvendige pasient data på behandlingsstedet. I tillegg kvaliteten på EPJ-data hindres ofte av unøyaktig dokumentasjon og av registrering i formater som vanskeliggjør videre analyse og gjenbruk. Dette hemmer fremgangen mot evidensbasert medisin og bremser utviklingen av et lærende helsesystem (LHS). Målet med dette doktorgradsprosjektet var å bidra med kunnskap om implementering av LHS, samt å vurdere hvordan overgangen til et nytt tverrinstitusjonelt EPJ-system påvirker legenes dokumentasjonspraksis og støtter dem i deres beslutningstaking. Målet ble utvidet til å utforske de oppfattede implikasjonene av denne overgangen på kvalitet og tilgjengelighet av EPJ-data for kvalitetsforbedring og forskning. Denne doktorgradsavhandlingen omfatter totalt fire studier. Studie I presenterer en systematisk litteraturgjennomgang med mål om å identifisere implementeringer av LHS for å gi anbefalinger om implementeringsstrategier, suksessfaktorer, barrierer og rapporterte resultater. Gjennomgangen fulgte PRISMA-retningslinjene og inkluderte totalt 37 artikler i den endelige analysen. Flere barrierer for implementering av LHS ble identifisert, inkludert problemer knyttet til interoperabilitet, utfordringer relatert til EPJ-systemer, og lederskap, blant annet. Funnene understreker også at selv om teknologisk infrastruktur var avgjørende for implementeringen av LHS, var andre faktorer, som engasjement av tverrfaglige team i beslutningsprosesser, også nødvendig. Studie II benyttet en deskriptiv kvalitativ forskningsdesign og omfattet deltakende observasjoner og individuelle semi-strukturerte intervjuer med leger ved et Universitetssykehus i Midt-Norge, som har gått over til et nytt tverrinstitusjonelt EPJ-system. Målet var å vurdere virkningen av denne overgangen på legers dokumentasjonspraksis og identifisere faktorer som påvirker deres preferanser mellom fritekst og strukturert og standardisert dokumentasjonsmetoder. Totalt ble 12 leger observert i omtrent 44 timer til sammen, og 10 leger ble intervjuet. Av de som ble intervjuet, hadde 8 også deltatt i tidligere observasjoner. Funnene indikerer at den nye EPJ-systemet har ført til en øking i strukturert og standardisert dokumentasjon sammenlignet med forrige systemet. Imidlertid forblir fritekst den foretrukne dokumentasjonsmetoden. Resultatene avdekker også en mistillit blant legene ovenfor noe av de strukturerte og standardiserte dataene. Denne mistilliten var knyttet til bevisstheten om at mange kolleger foretrekker fritekst dokumentasjon og/eller ikke oppdaterer standardiserte data i EPJ-systemet. Legers valg av dokumentasjonsmetoder påvirkes av en rekke sosiale og teknologiske faktorer. Studie III benyttet en mixed-methods forskningsmetode, som kombinerte både kvalitative og kvantitative datainnsamlingsmetoder. Den kvalitative komponenten av denne studien samsvarer med den i Studie II, som beskrevet tidligere. Den kvantitative delen baserte seg på spørsmål hentet fra et validerte Finske spørreskjema (NuHISS). Spørreskjemaene ble distribuert via e-post til alle leger ansatt ved sykehuset, hvor de kvalitative dataene for studiene II og III ble samlet inn. Målet med denne studien var å vurdere legers oppfatninger av det nye EPJ systemet med hensyn til 1) kvaliteten, tilgangen og presentasjonen av pasientdata, samt 2) EPJ-systemets effektivitet i å støtte samarbeid og kommunikasjon med pasientene. Totalt deltok 354 leger av 1 476 i undersøkelsen, noe som ga en svarprosent på 24 %. Funnene fra både de kvalitative og kvantitative dataene avdekket bekymringer knyttet til presentasjonen av pasientdata innenfor det nye EPJ-systemet, samt blandede meninger om dets rolle i å støtte samarbeid og kommunikasjon med pasientene. De kvalitative dataene fremhevet videre problemer relatert til informasjons-overflod og defragmentering. Imidlertid pekte informantene også på fordeler med det nye systemet, som forbedret tilgang til pasientdata ved behandling og enklere oppfølging av innlagte pasienter. I tillegg avdekket de kvalitative dataene at legene ikke var kjent med visse funksjoner i det nye systemet. Studie IV benyttet et utforskende kvalitativt forskningsdesign som inkluderte individuelle semi-strukturerte intervjuer med 11 deltakere. Deltakerne bestod av forskere og dataanalytikere fra Universitetssykehuset, hvor dataene til studiene II og III ble samlet, samt dataanalytikere fra selskapet ansvarlig for implementeringen av det nye EPJ-systemet. Hensikten med studien var å undersøke den opplevde kvaliteten og tilgjengeligheten av pasientdata i det nye EPJ-systemet, med særlig fokus på kvalitetsforbedring og forskning, samt å identifisere potensielle fordeler, barrierer og utfordringer. Funnene indikerte at flere av kvalitetsforbedringstiltakene som ble etablert ved sykehuset før implementeringen av det nye EPJ-systemet, ble forstyrret etter innføringen. Flere informanter påpekte også at det eksisterte en hierarkisk struktur i prioriteringen av data mottakere, for eksempel kvalitetsforbedringsformål, og at det var begrensede personalresurser tilgjengelig for kvalitetssikring og validering av data, noe som vanskeliggjorde rettidig levering av data til slike formål. Til tross for dette uttrykte informantene en optimisme om at den tverrinstitusjonelt EPJ-system, vil kunne forbedre mulighetene for kvalitetsforbedringsarbeid og forskning på sikt. De bemerket imidlertid at systemet krever en lengre driftsperiode for å realisere sitt fulle potensial på dette området. Samlet sett viser dette doktorgradsavhandlingen både fremtidige muligheter og utfordringer forbundet med implementeringen av det nye EPJ-systemet, og hvordan dette kan støtte overgangen til et lærende helsesystem.

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