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Sökning: WFRF:(Berterö Carina 1959 )

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21.
  • Drott, Jenny, 1976- (författare)
  • Neurotoxic side effects and impact on daily life in patients with colorectal cancer with adjuvant oxaliplatin-based chemotherapy
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Introduction: Colorectal cancer (CRC) is one of the most common cancers globally. Chemotherapeutic drugs are frequently used in postoperative treatment. The platinum compound oxaliplatin (OXA) is an option for adjuvant treatment of patients with resected CRC, and has been shown to improve survival. OXA-induced neurotoxic side effects are common (e.g. sensitivity to cold, numbness). Neurotoxicity can interfere with the patient’s daily living and affect ability to carry out activities. Because there is no evidence for effective treatment in terms of eliminating neurotoxic side effects, the most successful approaches include early identification, reduction of dose and interruption of treatment. Current research has identified a need for patient-oriented evidence in terms of long-term follow-up of neurotoxicity.Aim: The overall aim of this thesis was to explore OXA-induced neurotoxic side effects in patients with colorectal cancer, and the influence on patients’ daily lives during and post OXA treatment.Methods: The thesis is based on four studies, and includes an analysis of medical records, as well as prospective quantitative and qualitative approaches with longitudinal data collection through a mobile phone-based system. The studies were performed at oncology departments in four hospitals in Sweden. Inclusion criteria were that patients should be at least 18 years of age, and should have been treated with chemotherapy, including OXA (FOLFOX, XELOX), in an adjuvant setting for CRC stages II-III. Study I had a retrospective design, and data involved (n=61) medical records. A structured protocol was used to evaluate the documentation of patients’ neurotoxic side effects. In studies II and III, ten patients were recruited using a strategy of purposeful and consecutive selection according to the inclusion criteria, where OXA-related neurotoxic side effects were assessed. A total of 10 interviews were carried out when neurotoxic side effects appeared (II), and after completed OXA treatment (3, 6 and 12 month’s follow-up) 25 repeated interviews were conducted (III). The prospective longitudinal study IV aimed to identify and assess patient-reported outcomes in terms of neurotoxic side effects, and their impact on patients’ daily activities (n=46). An Oxaliplatin-associated Neurotoxicity Questionnaire (OANQ) was administered in real time to indicate patientreported outcomes. In total, 370 questionnaire responses were available for analysis.Results: The results from the retrospective study (I) showed that a free description of the degree of neurotoxic side effects was given in the patients’ medical records. No formal assessment had been used in the documentation. The findings of the two qualitative studies contribute knowledge about how patients endure neurotoxic side effects early in the treatment phase, and how they learn to live with neurotoxicity in the long-term perspective. Patients coped with their side effects by developing different self-care strategies to restore normality in their daily lives (II-III). Neurotoxic side effects interferes with the patient’s daily activities in a variety of ways. These side effects change in terms of their character and their location in the body over time. The most frequent side effects during treatment were cold-precipitated tingling in the upper extremities and in the mouth/throat. At the end of treatment, neurotoxicity in the lower extremities was considered high and interfered with the patients’ daily activities. The results show significant differences between baseline data, and nine of the patients had not returned to baseline after one year (IV).Conclusion: Neurotoxic side effects affect patients’ daily activities in different ways, with an impact on their physical, psychological, emotional and social life. Patients endured and coped with their side effects in different ways involving self-care strategies to restore normality. The patients’ daily lives were affected by numbness and tingling in the legs and tingling in upper extremity, and they had learned to live with these side effects. The neurotoxic side effects changed character and localisation over time. These results should be taken into account when patients are informed about treatment, and in the dialogue about the benefits and risks.
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22.
  • Drott, Jenny, 1976-, et al. (författare)
  • Neurotoxic Side Effects Early in the Oxaliplatin Treatment Period in Patients With Colorectal Cancer
  • 2018
  • Ingår i: Oncology Nursing Forum. - Pittsburgh, PA, United States : Oncology Nursing Society. - 0190-535X .- 1538-0688. ; 45:6, s. 690-697
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To identify and describe experiences of patients with colorectal cancer (CRC) who have neurotoxic side effects early in the oxaliplatin treatment period, and how neurotoxicity affects their daily lives.PARTICIPANTS & SETTING: 10 patients with stage II-III CRC were included. All were treated with adjuvant oxaliplatin postoperatively and assessed neurotoxicity via a platform-independent mobile phone-based system. Patients were recruited from two hospitals in southern Sweden from November 2013 to August 2014.METHODOLOGIC APPROACH: Qualitative interview study conducted through open-ended, face-to-face, qualitative interviews. Thematic analysis was used.FINDINGS: A main theme was identified.IMPLICATIONS FOR NURSING: Nurses have an obligation to communicate the importance of early detection of neurotoxicity. Mobile phone technology seems to be a valuable tool for monitoring patient-reported neurotoxicity to improve communication and supportive care.
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23.
  • Drott, Jenny, 1976-, et al. (författare)
  • Oxaliplatin-Induced Neurotoxic Side Effects and Their Impact on Daily Activities
  • 2019
  • Ingår i: Cancer Nursing. - : Lippincott Williams & Wilkins. - 0162-220X .- 1538-9804. ; 42:6, s. E40-E48
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Oxaliplatin (OXA) is frequently used in the treatment of patients with colorectal cancer, and OXA-induced neurotoxic side effects are common. Reports on real-time patient-reported neurotoxic side effects and impact on the patient's daily activities are sparse in existing studies. Objective: The aim of this study was to identify and assess patient-reported OXA-induced neurotoxic side effects and their impact on the patient's daily activities, during and after chemotherapy. Methods: In a multicenter prospective longitudinal study, 46 chemo-naïve patients with colorectal cancer treated with postoperative adjuvant OXA-based chemotherapy were monitored during treatment and at 3-, 6-, 9-, and 12-month follow-ups. Patients were recruited from September 2013 to June 2016. In total, 370 Oxaliplatin-Associated Neurotoxicity Questionnaire responses were available for analysis. A mobile phone-based system was used to receive real-time assessments. Results: All patients reported neurotoxic side effects and impact on daily activities during treatment. The side effects changed in character and body location over time and had an impact on the daily activities. Conclusions: The high prevalence of OXA-induced neurotoxic side effects significantly interfered with the patients' daily activities. We found significant differences between baseline data and follow-up time points for neurotoxicity, and the patients had not returned to baseline after 1 year. Implications for Practice: The real-time assessment using mobile phone technology seems to be a valuable tool for monitoring patient-reported neurotoxicity and interventions for tailored care. Effectively identifying neurotoxicity and its impact on the patient's daily activities is important in supportive cancer care.
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24.
  • Grundström, Hanna, 1982- (författare)
  • Disclosing the invisible : experiences, outcomes and quality of endometriosis healthcare
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Introduction: Many women with endometriosis report that their symptoms are normalized and trivialized when they seek medical care and they often experience diagnostic delays, ineffective treatments and physiological, psychological and social consequences. However, there is a knowledge gap when it comes to women’s experiences of different aspects of endometriosis healthcare, and the quality of that care. Aim: The aim of this thesis was to identify, describe and analyse the experiences, encounters and outcomes of endometriosis healthcare from different perspectives. Design and Method: This thesis is a summary of four studies with different methods and designs. Study I and II were qualitative interview studies in which nine women with a laparoscopy-verified endometriosis diagnosis (study I) and 25 healthcare professionals (HCPs) (study II) described their experiences of healthcare encounters related to endometriosis symptoms. The interviews were analysed using interpretive phenomenology (study I) and conventional content analysis (study II). Study III was a cross-sectional observational comparative study measuring pain thresholds, health-related quality of life (HRQoL) and symptoms of anxiety and depression using quantitative sensory testing (QST) and questionnaires in order to determine pain thresholds in healthy women (n=55) and women with persistent pelvic pain (PPP), with (n=14) and without (n=23) a confirmed diagnosis of endometriosis. The correlations between pain thresholds and duration of PPP, HRQoL and symptoms of anxiety and depression were also analysed. Study IV was a quantitative observational study using register data from the National Quality Register for Gynaecological Surgery. Patient-reported experience measures (PREM) and patient-reported outcome measures (PROM) after benign hysterectomy were analysed and compared in women with and without PPP and endometriosis (study IV). Results: The results of the thesis are summarized in three themes: The struggle to visualize the pain, The endometriosis diagnosis as a key to understanding and enduring persistent pelvic pain and Healthcare encounters as potentially life changing. In the first theme, women and HCPs described the healthcare encounters concerning endometriosis symptoms as troublesome (study I, II). The women struggled with disclosing, visualizing and communicating their hidden pain to the HCPs (study I), and HCPs expressed insecurity and limited knowledge when caring for these women (study II). Study III showed widespread reduced pain thresholds among women with PPP compared with healthy controls, and a significant positive correlation between duration of PPP and reduced pain thresholds . Study III also showed a reduced HRQoL and higher prevalence of anxiety and depressive symptoms among women with PPP, which were also described by the women (study I).The importance of getting a diagnosis was described in the second theme by both women and HCPs (study I, II), but women with PPP with and without endometriosis diagnosis did not differ significantly in their pain thresholds or psychosocial outcomes in study III. Likewise, women with PPP with and without endometriosis gave more equal PREM and PROM answers than women in the pain-free comparison group. Overall, women undergoing hysterectomy on benign indications were satisfied with the experience and outcomes of the surgery (study IV).As described in the last theme, healthcare encounters could be constructive or destructive. Positive experiences could make the symptoms easier to endure. The constructive encounters were often characterized by a holistic approach and a care structured in multidisciplinary teams. Conclusion and clinical implications: The results suggest that PPP should be taken seriously and treated actively in order to minimize the risk of physiological and psychological consequences, such as reduced pain thresholds, lower HRQoL and symptoms of anxiety and depression. Unrelieved PPP could also be an explanatory factor for long-term physiological consequences, such as lower PREM and PROM after hysterectomy.High-quality endometriosis healthcare should provide an interaction of physical, psychological and social factors. If women experience that HCPs acknowledge their pain and the effect of pain on HRQoL and mental health, and are offered proper pain-relieving treatment, healthcare encounters could change their lives.
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25.
  • Grundström, Hanna, 1982-, et al. (författare)
  • Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis
  • 2019
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 98:3, s. 327-336
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Endometriosis is a gynecological disorder that may cause considerable pelvic pain in women of fertile age. Determining pain mechanisms is necessary in order to optimize the treatment of the disease. The objective of the study was to evaluate pain thresholds in women with persistent pelvic pain with and without confirmed endometriosis, and healthy, unaffected controls, and analyze how pain thresholds in these cohorts related to duration of pelvic pain, quality of life, and symptoms of anxiety and depression.MATERIAL AND METHODS: Pain thresholds for heat, cold and pressure were assessed with quantitative sensory testing on six locations on a reference group of 55 healthy women and on 37 women with persistent pelvic pain who had been admitted for diagnostic laparoscopy on the suspicion of endometriosis. Validated instruments were applied to assess quality of life and symptoms of anxiety and depression. Data were analyzed by means of uni- and multivariate analysis of variance and Spearman's rank-order correlation.RESULTS: The women with persistent pelvic pain had significantly lower pain thresholds compared with the reference women. In the women with pain, no differences were observed in pain thresholds between women with (n = 13) and women without (n = 24) biopsy-proven endometriosis. The duration of pelvic pain correlated significantly positively with reduced pain thresholds, ie, the longer the duration, the more sensitization. In the persistent pelvic pain group, pain thresholds for heat correlated significantly with the Short Form Health Survey 36 dimension of bodily pain, and thresholds for cold correlated with Short Form Health Survey 36 bodily pain and with symptoms of depression.CONCLUSIONS: Our results showed widespread alterations in pain thresholds in women with persistent pelvic pain that are indicative of central sensitization and a time-dependent correlation. Women with pelvic pain and suspicion of endometriosis should probably be treated more thoroughly to prevent or at least minimize the concomitant development of central sensitization.
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26.
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27.
  • Hjelm, Katarina, 1958-, et al. (författare)
  • Social support as described by Swedish people diagnosed with type 2 diabetes mellitus.
  • 2009
  • Ingår i: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 10:1, s. 26-37
  • Tidskriftsartikel (refereegranskat)abstract
    • Social support can buffer the level and effects of stress. Diabetes mellitus (DM) requires self-care that is demanding and might cause stress. No previous studies focusing perceptions of persons with DM from their own perspective on the content, need and desire they might have for social support. Aim: To identify and describe the meaning of support and its impact on the life-situation of people diagnosed with Tye 2 DM in relation to gender, age, and duration of DM. Methods: Mixed Methods design combining Qualitative data collected by semi-structured interviews and quantitative data collected by Norbeck Social Support Questionnaire (NSSQ). Purposive sample – explore a complex concept 40 Swedish persons diagnosed Type 2 DM Aged 32-80 years (Md 59 yrs),24 men and 16 women. Duration of DM 0.5-39 yrs. Findings:  Heterogenous sample according to age, employment, duration of DM   but Homogenous picture of findings.  Meaning of the concept of support/social support: focus mainly on informative and emotional support. Non-supportive situations were described concerning the relationship and communication with the physician. Physicians not listening to the patient and whom informants perceived lacked competence in diabetes care were often described.  Support experienced while being diagnosed with DM was expressed by ♀, irrespective of duration of DM and yr diagnosed, as limited or non-existent negatively affecting their entire life- situation. Many claimed lack of support when diabetes was detected. Often diagnosed at health care centres in primary health care. Lack of informative support expressed as lack of competence and limited knowledge about DM in health care staff. When being managed at diabetes clinics adequate support was experienced. Need for support w as perceived as individual, varying and differing with regard to gender. Men were perceived to need more support than women, as women were considered having better networks. Young were stated to need more than older, as they have less experience and are going to live longer. Men scored higher on emotional support (p=0.021), aid (p=0.045) and network (p=0.026) than women More women were married but no differences in emotional support, social status and aid. Differences for those with grandchildren in emotional support (p=0.039) and in functional network properties (p=0.047) but not in aid. 20% of informants had lost an important relationship previous year. Mean number of people in network 6.5, r 1-20. In conclusion, DM demands knowledge about managing the disease and self-care, why informative and emotional support is important to gain control over the situation. Informants had perceived lack of support, particularly during the process of diagnosis of DM, in their contact with physicians and with primary health care.    
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28.
  • Hollman, Gunilla, 1953-, et al. (författare)
  • The meaning of quality of life among patients with familial hypercholesterolemia
  • 2004
  • Ingår i: Journal of Cardiovascular Nursing. - 0889-4655 .- 1550-5049. ; 19:4, s. 243-250
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Living with a genetic predisposition to disease may influence quality of life. The presence of premature disease can lead to an increased focus on family history and genetic predisposition.Objective: The purpose of this study was to describe quality of life in patients with the genetic disease, familial hypercholesterolemia, who are at an increased risk of premature coronary heart disease.Methods: Interviews from 12 adult patients with FH were analyzed using constant comparative analysis. The findings of this qualitative study revealed that for patients, quality of life was equated with harmony in life, the core category. Attaining harmony in life presumes satisfaction and togetherness. Cognizance of the threat of coronary heart disease and impending mortality is balanced by the support of togetherness and satisfaction that builds harmony in life.Conclusion: When caring for patients with familial hypercholesterolemia, it is important to meet each patient on his or her own level, and to support balance and their choices for maintaining or regaining harmony in life.
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29.
  • Johansson, Helena, et al. (författare)
  • To live a life with COPD - the consequences of symptom burden
  • 2019
  • Ingår i: International Journal of COPD. - 1176-9106 .- 1178-2005. ; 14, s. 905-909-
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Chronic obstructive pulmonary disease (COPD) is a prevalent disease as with its symptom and treatment gives a burden for the affected person, family, health care and finances. Today the knowledge and understanding are sparse regarding COPD affected person´s own lived experiences about the symptom burden and its effect on their daily life.  Due to this knowledge gap the aim of this study was to identify and describe the symptom burden and its effect on daily life in people with COPD based on their own lived experiences.Subject and Method: Eleven males and fourteen females in GOLD stage III and IV within an age of 58-82 years were interviewed. An interview guide guided the face-to-face interviews. Data was analyzed with Thematic Analysis following the six steps according to Braun and Clarke.Results: The result show one theme; An altered everyday life. The altered everyday life lead to a need of support to handle the everyday life and  different strategies to live as desired. Persons with COPD need to take the day as it comes dependent on the status of the day. The life is not easy to plan, and the day must be taken as it comes. The life is handled with strategies in breathing techniques, take care of the home and garden as well as the emotions. Support from the next of kin, society and the health care is important.Conclusion: This study provides insight in that persons with COPD in stage III and IV have an altered life caused by the symptom burden. They must struggle with strategies to handle everyday life. There is a need of support from next of kin and society to facilitate life, but this support needs to be well-balanced.
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30.
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