| 1. |
- Browall, Maria, 1963, et al.
(författare)
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Health care staff's opinions about existential issues among patients with cancer.
- 2010
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Ingår i: Palliative & supportive care. - : Cambridge University Press. - 1478-9523 .- 1478-9515. ; 8:1, s. 59-68
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective of this study was to explore health care staff's opinions about what existential issues are important to patients with cancer and staff's responsibility when existential issues are raised by patients. METHOD: Four focus group interviews were conducted with health care staff (N = 23) at an in-patient hospice, on an oncology ward, on a surgical ward, and with a palliative home health care team. The focus group interviews focused on two questions, first, about health care staff's opinions about patients' important existential questions and, second, about health care staff's responsibility when existential issues are raised by the patient. The interviews were tape-recorded, transcribed verbatim, and analyzed by qualitative content analysis into subcategories and categories. RESULTS: Four categories and 11 subcategories emerged from the first question. The first category, "life and death," was based on joy of living and thoughts of dying. The second category "meaning," consisted of acceptance, reevaluation, hope, and faith. The third category, "freedom of choice," consisted of responsibility and integrity, and the fourth and last category, "relationships and solitude," consisted of alleviation, dependency, and loss. One category emerged from the second question about the health care staff's responsibility, "to achieve an encounter," which was based on the subcategories time and space, attitudes, and invitation and confirmation. SIGNIFICANCE OF RESULTS: The strength of this study was that the findings were fairly congruent in different settings and in different geographical areas. Health care staff were aware of the importance of existential issues to patients. The existential issues, mentioned by health care staff, are similar to findings from studies conducted among patients, which is another strength of the present study. Health care staff are also confident about how to act when these issues are raised by the patients. The challenge for the future is to implement the findings from this study among health care staff in different settings.
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| 2. |
- Gellerstedt, Martin, 1966-, et al.
(författare)
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Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?
- 2006
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Ingår i: Eur J Emerg Med. - London, UK : Lippincott Williams & Wilkins, Ltd.. - 0969-9546 .- 1473-5695. ; 13:5, s. 290-4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate whether a computer-based decision support system could be useful for the emergency medical system when identifying patients with acute myocardial infarction (AMI) or life-threatening conditions and thereby improve the allocation of life support level. METHODS: Patients in the Municipality of Goteborg who dialled the dispatch centre due to chest pain during a period of 3 months. To analyse the relationship between patient characteristics (according to a case record form used during an interview) and the response variables (AMI or life-threatening condition), multivariate logistic regression was used. For each patient, the probability of AMI/life-threatening condition was estimated by the model. We used these probabilities retrospectively to allocate advanced life support or basic life support. This model allocation was then compared with the true allocation made by the dispatchers. RESULTS: The sensitivity, that is, the percentage of AMI patients allocated to advanced life support, was 85.7% in relation to the true allocation made by the dispatchers. The corresponding sensitivity regarding allocation made by the model was 92.4% (P=0.17). The specificity was also slightly higher for the model allocation than the dispatcher allocation. Among the 15 patients with AMI who were allocated to basic life support by the dispatchers, nine died (eight during and one after hospitalization). Among the eight patients with AMI allocated to basic life support by the model, only one patient died (in hospital) (P=0.02). CONCLUSION: A computer-based decision support system including a prevalence function could be a valuable tool for allocating the level of life support. The case record form, however, used for the interview can be refined and a model based on a larger sample and confirmed in a prospective study is recommended.
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| 3. |
- Henoch, Ingela, 1956, et al.
(författare)
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Patients’, family members’ and healthcare staffs’ opinions about existential issues as a base for an educational intervention
- 2011
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Ingår i: BMJ Supportive & Palliative Care. - : BMJ. - 2045-4368 .- 2045-435X. ; 1:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective To explore patients', family members' and healthcare staff's opinions about existential issues important to patients with cancer and their relatives. Methods Two integrative literature reviews were conducted about existential issues among cancer patients and relatives, and interventions to meet these issues. Four focus groups were conducted with healthcare staff working with cancer patients at different stages about patients' existential issues, and staff's responsibility when existential issues are raised. Results In the patient review, existential issues were divided into two themes: struggle to maintain self-identity and threats to self-identity. Relatives' existential issues concerned living both in and beyond the presence of death, with reminders of death, compelling them to respond to life close to death and seek support. Few interventions directed to patients or relatives applicable to everyday healthcare practice were found. Focus groups with staff revealed four categories of patients' existential issues, life and death, meaning, freedom of choice, relationships and solitude. According to staff, their responsibility concerned achieving an encounter with the patient. Conclusion Results from three studies are congruent in that, patients, relatives and staff agree, although in different ways, about the importance of existential issues to patients and relatives. Healthcare staff was aware of the importance of existential issues and are to some extent confident about how to act when these issues are raised by the patients. Ongoing studies The project group now continues implementing findings from these studies in an educational intervention to healthcare staff in different settings, and planning interventions to patients and relatives.
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| 4. |
- Gellerstedt, Martin, 1966-, et al.
(författare)
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Interpretation of subjective symptoms in double-blind placebo-controlled food challenges - interobserver reliability
- 2004
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Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : Wiley. - 0105-4538 .- 1398-9995. ; 59, s. 354-356
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Subjective symptoms after food challenges are difficult to interpret and no standard is available. We discuss a strategy for how to interpret a diary. Furthermore, the interobserver reliability is evaluated. METHODS: Diaries for 32 patients with subjective symptoms were used. The diaries were re-evaluated with a predefined strategy by three independent observers. RESULTS: The proportion of positives was 21.9% among the old diagnoses, according to the new approach 34.4% (observers I and II) and 37.5% (observer III) were positive. The new approach had high interobserver reliability (97 and 100%). CONCLUSIONS: The proportion of positives depends on how subjective symptoms are interpreted. Interpretations of subjective symptoms in diaries could be made with high interobserver reliability.
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| 5. |
- Magnusson, J, et al.
(författare)
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A kinetic study in adults with food hypersensitivity assessed as eosinophil activation in fecal samples
- 2003
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Ingår i: Clinical and Experimental Allergy. - : Wiley. - 0954-7894 .- 1365-2222. ; 33:8, s. 1052-1059.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Immune-mediated food hypersensitivity affecting the gut is difficult to evaluate, and objective tools to diagnose local gastrointestinal (GI) inflammatory reactions are lacking. OBJECTIVES: To determine whether allergic manifestations in adults with a history of food-related GI symptoms could be assessed in feces during symptomatic and non-symptomatic periods, using the surrogate markers, eosinophil cationic protein (ECP), eosinophil protein X (EPX) and myeloperoxidase (MPO). METHODS: Thirteen subjects with food hypersensitivity-related GI symptoms, confirmed by a positive double-blind placebo-controlled food challenge (DBPCFC), were subjected to an open kinetic food challenge design for 6 weeks. Symptoms were recorded and scored during the 3-week study period and stool samples were obtained every day. The surrogate markers ECP, EPX and MPO were measured in the supernatants from feces samples. RESULTS: A significant increase in abdominal pain, distension and flatulence was observed during challenge, with a gradual decrease during elimination diet. Both between days and subjects, EPX levels were more frequently increased compared to ECP and MPO. Individuals with a history of a short duration of symptoms had significantly higher mean levels of EPX and MPO than those with a longer duration of symptoms. CONCLUSIONS: An overall increase in levels of eosinophil markers, in particular EPX, was observed in feces from patients with food-related GI symptoms. However, rather than being a tool to differentiate symptomatic from non-symptomatic periods, EPX might be used for detecting an ongoing clinical or subclinical chronic inflammation, that may have an impact on the patient's clinical course of GI symptoms.
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| 6. |
- Schytt, Erica, et al.
(författare)
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Incompleteness of Swedish local clinical guidelines for acupuncture treatment during childbirth
- 2011
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 90:1, s. 77-82
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the presence and content of local clinical guidelines for acupuncture treatment in Swedish labor and postnatal wards. Design. A Swedish national survey. Main Outcome Measures. Presence and content of clinical guidelines for acupuncture. Setting. All Swedish labor and postnatal wards at the time of data collection (April 2007–March 2008). Material and Methods. Enquiry was made on local clinical guidelines for acupuncture treatment at 50 labor and 50 postnatal wards. The standards for reporting interventions in controlled trials of acupuncture document was used to identify core aspects of acupuncture treatment and the proportion of wards with guidelines on these aspects was evaluated. Results. Guidelines were obtained from 27 labor wards and 22 postnatal wards. Descriptions of the core aspects of acupuncture treatment, such as acupuncture rationale, needling details and treatment regimens, were limited in most. All local guidelines included indications for treatment, but these were not based on scientific evidence of effect, and only two mentioned the importance of achieving de-qi – a feeling of soreness reflecting an effective treatment. Few clinical guidelines required that the practitioners’ acupuncture education should be on an academic level and relevant references based on clinical trials were lacking in all guidelines. Conclusion. Swedish local clinical guidelines on acupuncture for childbirth-related symptoms lack sufficient information to support midwives and obstetricians in administering acupuncture treatment. The content of the guidelines was unclear, inconclusive and, in some cases, irrelevant, and a majority lacked important information on indications and technique.
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| 7. |
- Löfström, Tuve, et al.
(författare)
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Ensemble member selection using multi-objective optimization
- 2009
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Ingår i: IEEE Symposium on Computational Intelligence and Data Mining. - : IEEE conference proceedings. - 9781424427659 ; , s. 245-251
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Konferensbidrag (refereegranskat)abstract
- Both theory and a wealth of empirical studies have established that ensembles are more accurate than single predictive models. Unfortunately, the problem of how to maximize ensemble accuracy is, especially for classification, far from solved. In essence, the key problem is to find a suitable criterion, typically based on training or selection set performance, highly correlated with ensemble accuracy on novel data. Several studies have, however, shown that it is difficult to come up with a single measure, such as ensemble or base classifier selection set accuracy, or some measure based on diversity, that is a good general predictor for ensemble test accuracy. This paper presents a novel technique that for each learning task searches for the most effective combination of given atomic measures, by means of a genetic algorithm. Ensembles built from either neural networks or random forests were empirically evaluated on 30 UCI datasets. The experimental results show that when using the generated combined optimization criteria to rank candidate ensembles, a higher test set accuracy for the top ranked ensemble was achieved, compared to using ensemble accuracy on selection data alone. Furthermore, when creating ensembles from a pool of neural networks, the use of the generated combined criteria was shown to generally outperform the use of estimated ensemble accuracy as the single optimization criterion.
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| 8. |
- Löfström, Tuve, et al.
(författare)
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On the Use of Accuracy and Diversity Measures for Evaluating and Selecting Ensembles of Classifiers
- 2008
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Ingår i: 2008 Seventh International Conference on Machine Learning and Applications. - : IEEE. - 9780769534954 ; , s. 127-132
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Konferensbidrag (refereegranskat)abstract
- The test set accuracy for ensembles of classifiers selected based on single measures of accuracy and diversity as well as combinations of such measures is investigated. It is found that by combining measures, a higher test set accuracy may be obtained than by using any single accuracy or diversity measure. It is further investigated whether a multi-criteria search for an ensemble that maximizes both accuracy and diversity leads to more accurate ensembles than by optimizing a single criterion. The results indicate that it might be more beneficial to search for ensembles that are both accurate and diverse. Furthermore, the results show that diversity measures could compete with accuracy measures as selection criterion.
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| 9. |
- Johansson Sundler, Annelie, et al.
(författare)
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The Meaning of Close Relationships and Sexuality : Women's Well-Being Following a Myocardial Infarction
- 2009
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Ingår i: Qualitative Health Research. - : Sage Publications. - 1049-7323 .- 1552-7557. ; 19:3, s. 375-387
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Tidskriftsartikel (refereegranskat)abstract
- Relationships and sexuality following heart attack (MI) have been studied; nevertheless, little is known about the meaning of social support and relationships to health and well-being after an MI. To our knowledge, no qualitative studies have further investigated the phenomenon. In this study we explore the meaning of close relationships and sexuality to women's health and well-being following MI. Ten women were interviewed using a reflective lifeworld approach and phenomenological epistemology. The meaning of women's close relationships following an MI appears to be closely intertwined with their long-term health process; both health processes and the relationships are affected. Suffering after an MI can be compared to taking a fall in that close relationships can become a safety net. Close relationships and sexuality are integrated into their lived bodies, and in that way have profound influence in their lifeworld experiences. Not all close relationships are intimate; however, all close and meaningful relationships can provide power and strength to the women's health processes. At the same time, these relationships also appear to drain energy and cause suffering.
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| 10. |
- Sandmark, Hélène, 1951-, et al.
(författare)
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Understanding work ability : Experiences of female assistant nurses in elderly care
- 2009
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Ingår i: Work. - Amsterdam : IOS Press. - 1051-9815 .- 1875-9270. ; 34:3, s. 373-383
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Tidskriftsartikel (refereegranskat)abstract
- Few studies to date have investigated retained work ability. The aim of this explorative study was to describe female assistant nurses’ experiences of high work attendance over the years. The setting is a municipality in mid-Sweden that employs 466 female assistant nurses permanently within municipal elderly care. A qualitative methodology was chosen and thematic, open-ended, interviews were carried out with 12 female assistant nurses. The interviewees were selected from the 117 women who had taken the least amount of sick leave over the past five years, which meant no sick leave at all or no more than 5 days. The interviews were transcribed verbatim, and thereafter a content analysis was carried out. Three main themes connected with the aim of the study emerged from the interviews: “a desirable job, despite low status”, “supportive social networks”, and “coping ability”. In order to strengthen work ability among female employees in elderly care, the findings indicate that it is crucial to support mobility in working life, and to promote social support and networks at the workplace and in private life, as well as a coping-oriented approach to health issues and social life.
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