| 1. |
- Borglin, Gunilla, et al.
(författare)
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Older people in Sweden with various degrees of present quality of life : their health, social support, everyday activities and sense of coherence.
- 2006
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Ingår i: Health & Social Care in the Community. - : Blackwell Publishing. - 0966-0410 .- 1365-2524. ; 14:2, s. 136-146
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Tidskriftsartikel (refereegranskat)abstract
- Public health policies in most European countries are concerned with how to keep older people living independently with a qualitatively good life in the community as long as possible. However, knowledge about what may characterise those seemingly 'healthy' older people is sparse. The aim of the study was to investigate the characteristics of a sample of people (75+) reporting various degrees of Quality of Life (QoL) with respect to QoL in different areas, as well as self-rated health, health problems, social support, everyday activities and sense of coherence. A postal questionnaire was sent out in spring 2001 to a randomly selected population-based sample (n= 600) in the southern parts of Sweden. A two-step cluster analysis was performed (n= 385, mean age 84.6, SD = 5.7) with 'present QoL' as clustering attribute. Three groups were disclosed, classified as high, intermediate and low present QoL, of which 33.8% could be regarded being at risk of low QoL. Those with low present QoL (18.4%) were the oldest and most vulnerable, a majority were women with 'poor or bad' self-rated health, high frequencies of health problems, low total QoL, low social support and sense of coherence and less physically active. Those with high present QoL (47.8%) reported more 'excellent or good' self-rated health, physical activity, satisfactory social support and higher sense of coherence and total QoL than the other two groups. Those with intermediate present QoL (33.8%) had more of 'poor or bad' self-rated health, more health problems were less physically active, had lower total QoL and sense of coherence, and less social support than those with high present QoL. The sample seemed to reflect the ageing process in that the respondents were at different stages of ageing. However, the fact that the level of social support, sense of coherence and self-rated health followed the same curve as QoL may indicate that some are more vulnerable to low present QoL given the same health and these should be targeted in preventive programmes since they report low QoL.
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| 2. |
- Eckerblad, Jeanette, et al.
(författare)
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To adjust and endure : a qualitative study of symptom burden in older people with multimorbidity
- 2015
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Ingår i: Applied Nursing Research. - : Elsevier. - 0897-1897 .- 1532-8201. ; 28:4, s. 322-327
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Tidskriftsartikel (refereegranskat)abstract
- Context Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life. Objectives The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.Method A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-€“89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.Results The experience of living with a high symptom burden revealed the overall theme, “To adjust and endure†and three sub-themes. The first sub-theme was "To feel inadequate and limited". Participants reported that they no longer had the capacity or the ability to manage, and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience; the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone; the only thing left to do was to sit or lie down and wait for it all to pass.Conclusion This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that are possible to treat or improve.
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| 3. |
- Ahlzen, Rolf
(författare)
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Illness as unhomelike being-in-the-world? : Phenomenology and medical practice
- 2011
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Ingår i: Medicine, Health care and Philosophy. - : Springer. - 1386-7423 .- 1572-8633. ; 14:3, s. 323-331
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Tidskriftsartikel (refereegranskat)abstract
- Scientific medicine has been successful by ways of an ever more detailed understanding and mastering of bodily functions and dysfunctions. Biomedical research promises new triumphs, but discontent with medical practice is all around. Since several decades this has been acknowledged and discussed. The philosophical traditions of phenomenology and hermeneutics have been proposed as promising ways to approach medical practice, by ways of a richer understanding of the meaning structures of health and illness. In 2000, Swedish philosopher Fredrik Svenaeus published a book where he proposes that the phenomenological hermeneutics of Martin Heidegger and also the reflections on health and illness of Hans-Georg Gadamer offer important ways to approach the nature of medicine. In particular, Svenaeus argues that the goal of medicine is to promote and restore health, and that health ought to be seen as "homelike being-in-the-world". Unhealth, illness, consequently should be understood as a situation where a person's "being-in-the-world" in characterized by that lack of the rhythm, balance and "tune" of everyday living that characterizes not "being at home". In this article, Svenaeus' position is briefly outlined. Questions are raised whether "unhomelikeness" is to be seen as a metaphor, and, if so, if it is a fruitful such. Furthermore, I discuss whether or not a discourse on health and illness in these terms may be misleading in a situation where the ontological presuppositions of Heidegger are lost out of sight and the popular understanding of health psychology predominates. I also approach the question whether Svenaeus' assumptions may inadvertently lead us to an unjustifiably broad understanding of the tasks of medicine. It is finally concluded that Svenaeus phenomenological and hermeneutical approach is both interesting and promising. There are, however, several questions that ought to be pursued further, and the step from philosophical analysis to everyday clinical discourse may be unexpectedly long and risky.
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| 4. |
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| 5. |
- Ahlzén, Rolf, 1950-
(författare)
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Why should physicians read? : Understanding clinical judgement and its relation to literary experience
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Is literary experience of any practical relevance to the clinician? This is the overall question addressed by this investigation, which starts by tracing the historical roots of scientific medicine. These are found to be intimately linked to a form of rationality associated with the scientific revolution of the 17th century and with “modernity”. Medical practice, however, is dependent also on another form of rationality associated with what Stephen Toulmin calls “the epistemology of the biographical”. The very core of clinical medicine is shown to be the clinical encounter, an interpretive meeting where the illness experience is at the centre of attention. The physician can reach the goals of medicine only by developing clinical judgement. Clinical judgement is subjected to close analysis and is assumed to be intimately connected to the form of knowledge Aristotle called phronesis. In order to explore how literature – drama, novels, poetry – may be related to clinical judgement, a view of literature is presented that emphasizes literature as an invitation to the reader, to be met responsibly and responsively. Literature carries a potential for a widened experience, for a more nuanced perception of reality – and this potential is suggested to be ethically relevant to the practice of medicine. The “narrative rationality” of a literary text constitutes a complement to the rationality pervading scientific medicine. The final step in my analysis is a closer exploration of the potential of the literary text to contribute to the growth of clinical judgement, in relation to the challenges of everyday clinical work. Some of the conditions that may facilitate such growth are outlined, but it is also shown that full empirical evidence for the beneficial effects of reading on the clinician reader is beyond reach.
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| 6. |
- Bergman, David, et al.
(författare)
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The effects of dialogue groups on physicians' work environment : A matter of gender?
- 2015
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Ingår i: Work. - : IOS Press. - 1051-9815 .- 1875-9270. ; 52:2, s. 407-417
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Over the past decades, the work environment of physicians has been deteriorating, particularly for female physicians. OBJECTIVE: In this study, we evaluated the effects of dialogue groups on the work environment of physicians in relation to gender. METHODS: Sixty physicians (38 women) at Sachs' Children's Hospital in Stockholm, Sweden, participated in dialogue groups once a month during a period of one year. Assessments of their psychosocial work environment were performed before and after the intervention. RESULTS: At baseline, female physicians experienced their work environment as less satisfactory compared to male physicians. After the intervention, the female physicians perceived improvements in more areas than their male colleagues. CONCLUSIONS: Our study shows that female physicians at this clinic were disadvantaged in relation to the work environment, but, more importantly, the findings suggest that several of the disadvantages can be reduced. Dialogue groups appear to improve the physicians' work environment and promote gender equality.
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| 7. |
- Cronin, Séan, et al.
(författare)
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A Qualitative Analysis of the Needs and Experiences of Hospital-based Clinicians when Accessing Medical Imaging
- 2021
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Ingår i: Journal of digital imaging. - : Springer Nature. - 0897-1889 .- 1618-727X. ; :34, s. 385-396
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Tidskriftsartikel (refereegranskat)abstract
- As digital imaging is now a common and essential tool in the clinical workflow, it is important to understand the experiences of clinicians with medical imaging systems in order to guide future development. The objective of this paper was to explore health professionals’ experiences, practices and preferences when using Picture Archiving and Communications Systems (PACS), to identify shortcomings in the existing technology and inform future developments. Semi-structured interviews are reported with 35 hospital-based healthcare professionals (3 interns, 11 senior health officers, 6 specialist registrars, 6 con- sultants, 2 clinical specialists, 5 radiographers, 1 sonographer, 1 radiation safety officer). Data collection took place between February 2019 and December 2020 and all data are analyzed thematically. A majority of clinicians report using PACS fre- quently (6+ times per day), both through dedicated PACS workstations, and through general-purpose desktop computers. Most clinicians report using basic features of PACS to view imaging and reports, and also to compare current with previous imaging, noting that they rarely use more advanced features, such as measuring. Usability is seen as a problem, including issues related to data privacy. More sustained training would help clinicians gain more value from PACS, particularly less experienced users. While the majority of clinicians report being unconcerned about sterility when accessing digital imaging, clinicians were open to the possibility of touchless operation using voice, and the ability to execute multiple commands with a single voice command would be welcomed.
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| 8. |
- Edebol, Hanna, 1984-
(författare)
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Global Assessment of Attention Deficit Hyperactivity Disorder : Examining Objective Measures of Hyperactivity, Impulsivity and Inattention in Adults
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to examine objective laboratory measures of Attention Deficit Hyperactivity Disorder (ADHD) in adult persons and to develop measures for diagnosis and treatment using a psychometric instrument called the Quantified Behavior Test Plus. The instrument objectively quantifies cardinal symptom manifestations in adult ADHD using motion tracking devices and continuous performance testing. Paper I-IV suggest that ADHD predisposes adult persons to perform poorer on continuous performance tasks and to have higher levels of motor activity while performing these tasks as compared to other clinical as well as non-clinical groups. Performance by adults with ADHD is normalized following stimulant treatment which implicates therapeutic effects and measures of response to treatment and remission for ADHD is suggested.Paper I concludes that the psychometric instrument needs to be calibrated with regard to adult ADHD and emphasizes the importance of a composite measure for the disorder. Paper II generates two new measures, the Weighed Core Symptom scale (WCS) - a composite measure of adult ADHD ranging from 0 to 100, and Prediction of ADHD (PADHD) - a categorical variable of the diagnostic status with good predictive power. A majority of participants with ADHD has low points on WCS (indicating high levels of symptoms) and a majority of non-ADHD normative participants has high points on WCS (indicating low levels of symptoms). Paper III examines WCS and PADHD among complex clinical groups with shared symptoms vis-à-vis ADHD. Here, findings from Paper II are replicated since participants with ADHD present the highest level of global symptoms, followed by participants with bipolar II disorder and borderline personality disorder, participant with diconfirmed ADHD and finally, non-clinical participants has the lowest level of global symptoms. In Paper IV, the measures are proposed as indications of response to treatment and remission after titration with stimulant treatment and WCS indicates response to small changes in dose level.The major findings of the present thesis may be summarized as the construction of two new objective measures for ADHD in adult persons with practical implications for diagnosis and treatment. Hyperactivity is the most specific marker of ADHD in both men and women, followed by the cognitive markers of inattention and impulsivity. The composite measure, WCS, quantifies the global amount of ADHD symptoms and provides the most sensitive measure for the disorder. PADHD and WCS may not replace a thorough neuropsychiatric assessment and further studies promoting diagnostic subtype stratification is suggested. Future studies may want to consider these measures in outcome-based investigations of treatment efficacy as well as in the study of neuropsychological endophenotypes. Practical implications include clinical strategies to enhance objectivity during assessment as well as optimizing beneficial effects of treatment and attaining remission.
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| 9. |
- Grim, Katarina, et al.
(författare)
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Development- and usability testing of a web-based decision support for users and health professionals in psychiatric services
- 2017
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Ingår i: Psychiatric rehabilitation journal. - Washington, DC : American Psychological Association (APA). - 1095-158X .- 1559-3126. ; 40:3, s. 293-302
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Shared decision making (SMD) related to treatment and rehabilitation is considered a central component in recovery-oriented practice. Although decision aids are regarded as an essential component for successfully implementing SDM, these aids are often lacking within psychiatric services. The aim of this study was to use a participatory design to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the development and usability processes are reported. Method: The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were used with potential end users participating as informants in focus group and individual interviews and as usability and pilot testers. Results: Interviewing and testing identified usability problems that then led to refinements and making the subsequent prototypes increasingly user-friendly and relevant. In each phase of the process, feedback from potential end-users provided guidance in developing the formation of the web-based decision aid that strengthens the position of users by integrating access to information regarding alternative supports, interactivity between staff and users, and user preferences as a continual focus in the tool. Conclusions and Implications for Practice: This web-based decision aid has the potential to strengthen service users’ experience of self-efficacy and control as well as provide staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to the development and implementation of tools that reflect user perspectives.
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| 10. |
- Henoch, Ingela, 1956, et al.
(författare)
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Perception of quality of care : Comparison of the views of patients' with lung cancer and their family members
- 2012
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Ingår i: Journal of Clinical Nursing. - Oxford : Wiley. - 0962-1067 .- 1365-2702. ; 21:3-4, s. 585-594
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. To explore potential differences within dyads of patients with lung cancer and family members judgment of different aspects of quality of care and relationships between quality of care and personal and health-related characteristics. Background. High quality of care is important for acceptable quality of life in patients in palliative care. If patients are unable to participate in quality of care assessments or decision-making, family members might often act as proxies, despite the complicated nature of their own situation. Design. Cross-sectional survey design. Method. A patient and family member version of the abbreviated questionnaire Quality from Patients' Perspective, with additional items about perceived health and opinions about care, was mailed to members of the Swedish lung cancer Patient Organisation. Wilcoxon's signed rank test was used to identify potential differences within 51 patient-family member dyads' quality of care ratings. Relationships between Quality from Patients' Perspective dimensions and demographic and healthrelated variables were examined with Spearman's correlations. Results. Patient-family member dyads had high levels of agreement in ratings of perceived reality of quality of care. Family members generally rated the subjective importance of individual items higher than did the patient in the dyad, with significant difference in the dimension ` socio-cultural approach'. Older patients were found to rate the physical-technical conditions higher than younger patients, in relation to perceived reality but not subjective importance. Women family members were found to rate the subjective importance of medical-technical competence, identity-oriented approach and socio-cultural approach significantly higher than men did. Conclusions. Patients with lung cancer and their family members agree in ratings of the perceived reality, but they differ more in ratings of the subjective importance of quality of care. When patients are unable to communicate their preferences, family members' opinions could be used as proxies concerning concrete aspects of quality of care. Concerning more subjective aspects, family members' ratings should be interpreted with precaution, as it could diverge from patients' own opinion. Relevance to clinical practice. The perceptions of the importance of different aspects of quality of care were less related to health status than were judgments of quality of care received. This might suggest that the care patients received fulfilled neither the patients' nor family members' expectations, which is an important message to healthcare professionals and which would demand further exploration.
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