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- Carli, Cheryl
(författare)
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Exploring a national practice-based register for the management of rheumatoid arthritis
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Rheumatoid arthritis (RA) is a chronic, inflammatory, auto-immune disease with an unpredictable and debilitating course. From diagnosis and onward, RA patients who need treatment with anti-rheumatic drugs will require on-going contact with health care professionals to ensure adequate management of their disease. A national quality register for RA, established in Sweden in 1995, aims to support efforts by both rheumatologists and patients to optimise patients future health. The large amounts of data in the register enable investigation of the utility of the register to further the development of the management of RA. The aim of this thesis was to increase our knowledge about aspects of the clinical management of RA as determined by the rheumatologist. Data from the Swedish Rheumatology Quality Register (SRQ) were used to analyse factors influencing prescription in incident RA and to study the relationship between clinical rheumatologists assessments of disease activity and standardised outcome measures, in particular the disease activity score based on 28 joints counts (DAS28). The decision to prescribe a disease modifying anti-rheumatic drug (DMARD) in incident RA was associated with the patient's age, disease activity as measured by DAS28, and the calendar year of the patient's first consultation (year), with some variation by hospital type. On the whole, DMARD prescription increased over the five year period with DMARDs being prescribed more frequently in university and county hospitals compared with district hospitals. Although increasing disease activity would more likely elicit a DMARD prescription in all hospital types, this influence was greater in district hospitals than in either university or county hospitals. When the association of year with increasing DMARD prescription was analysed using Statistical Process Control, the increase was accounted for by a single upward step in July 1998, which could well be related to the promulgation of treatment recommendations that same year. The relationship between the physician's assessment of disease activity and the DAS28 showed that when the rheumatologist deems disease activity to be none in patients treated with biologics, this is not far removed from the DAS28-based definition of remission but is most closely concordant with the recently proposed definition of minimal disease activity. It is likely that DAS28 will remain useful for monitoring quality on a group level but it cannot replace the rheumatologist's global assessment to justify treatment decisions at the individual patient level. In a cross-section of unselected RA patients, both the standard DAS28 based on the erythrocyte sedimentation rate and DAS28 using high sensitive C-reactive protein (DAS28-CRP) were benchmarked against the rheumatologists global assessment of disease activity. Both DAS28 and DAS28-CRP tend to overestimate disease activity compared with the physician's global assessment of disease activity. New cut-offs for DAS28-CRP disease activity states are proposed. In summary, the existence of a national practice-based register for RA has enabled the identification of factors driving prescription of DMARDs in the treatment of incident RA during a period of change in rheumatological practice. The study has also generated knowledge about the utility of the different versions of DAS28 in populations typical for Swedish clinical practice.
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- Gunningberg, Lena, 1954-, et al.
(författare)
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Facilitating student nurses' learning by real time feedback of positioning to avoid pressure ulcers--Evaluation of clinical simulation
- 2016
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Ingår i: Journal of Nursing Education and Practice. - : Sciedu Press. - 1925-4040 .- 1925-4059. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reduction of pressure and shear is recognised as the single most important intervention in order to prevent pressure ulcers (PU). Recently, an objective way to measure and receive feedback about the amount of pressure at the body-mattress interface has become available. Using such feedback in a simulated scenario in which there is a hypothetical risk for pressure ulcer development may prepare students in a safe and controlled environment for clinical placements. The aim of the study was to assess whether student nurses’ learning about optimal repositioning could be facilitated by real-time feedback in a simulated PU prevention scenario.Methods: A quantitative study was performed in the Clinical Training Center using a descriptive, comparative design. Student nurses from the second (n = 24) and last (n = 32) semesters worked in pairs. Their task was to place two volunteers (69 and 70 years) in the best pressure-reducing position (lateral and supine), initially without access to the pressure mapping monitor and then again after feedback. In total 232 positionings were conducted.Results: Despite the controlled environment, there was considerable variation in peak-pressure readings between student pairs Mean peak pressures were consistently higher in the lateral position compared with the supine, both before and after feedback. After feedback from the pressure mapping monitor, most peak pressure readings were significantly reduced and the number of preventive interventions and patients’ comfort had increased.Conclusions: Including simulation of PU prevention in the nursing curriculum provides the possibility for students to train repositioning in a safe environment. The immediate feedback from the pressure monitoring system may strengthen students’ confidence and competence on clinical placements.
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- Gunningberg, Lena, 1954-, et al.
(författare)
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Reduced pressure for fewer pressure ulcers : can real-time feedback of interface pressure optimise repositioning in bed?
- 2016
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Ingår i: International Wound Journal. - : Wiley. - 1742-4801 .- 1742-481X. ; 13:5, s. 774-779
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to (i) describe registered nurses' and assistant nurses' repositioning skills with regard to their existing attitudes to and theoretical knowledge of pressure ulcer (PU) prevention, and (ii) evaluate if the continuous bedside pressure mapping (CBPM) system provides staff with a pedagogic tool to optimise repositioning. A quantitative study was performed using a descriptive, comparative design. Registered nurses (n = 19) and assistant nurses (n = 33) worked in pairs, and were instructed to place two volunteers (aged over 70 years) in the best pressure-reducing position (lateral and supine), first without viewing the CBPM monitor and then again after feedback. In total, 240 positionings were conducted. The results show that for the same person with the same available pressure-reducing equipment, the peak pressure varied considerably between nursing pairs. Reducing pressure in the lateral position appeared to be the most challenging. Peak pressures were significantly reduced, based on visual feedback from the CBPM monitor. The number of preventive interventions also increased, as well as patients' comfort. For the nurses as a group, the knowledge score was 59·7% and the attitude score was 88·8%. Real-time visual feedback of pressure points appears to provide another dimension to complement decision making with respect to PU prevention.
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- Hultin, Lisa, et al.
(författare)
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Pressure Mapping in Elderly Care : A Tool to Increase Pressure Injury Knowledge and Awareness Among Staff
- 2017
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Ingår i: Journal of Wound, Ostomy and Continence Nursing (WOCN). - 1071-5754 .- 1528-3976. ; 44:2
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this study was to evaluate the use of a pressure mapping system with real-time feedback of pressure points in elderly care, with specific focus on pressure injury (PI) knowledge/attitudes (staff), interface pressure, and PI prevention activities (residents). DESIGN: Descriptive, 1-group pretest/posttest study. SUBJECTS AND SETTING: A convenience sample of 40 assistant nurses and aides participated in the study; staff members were recruited at daytime, and 1 nighttime meeting was held at the facility. A convenience sample of 12 residents with risk for PI were recruited, 4 from each ward. Inclusion criteria were participants older than 65 years, Modified Norton Scale score 20 or less, and in need of help with turning in order to prevent PI. The study setting was a care facility for the elderly in Uppsala, Sweden. METHODS: A descriptive, comparative pretest/posttest study design was used. The intervention consisted of the use of a pressure mapping system, combined with theoretical and practical teaching. Theoretical and practical information related to PI prevention and the pressure mapping system was presented to the staff. The staff (n = 40) completed the Pressure Ulcer Knowledge and Assessment Tool (PUKAT) and Attitudes towards Pressure Ulcer (APuP) before and following study intervention. Residents' beds were equipped with a pressure mapping system during 7 consecutive days. Peak pressures and preventive interventions were registered 3 times a day by trained study nurses, assistant nurses, and aides. RESULTS: Staff members' PUKAT scores increased significantly (P = .002), while their attitude scores, which were high pretest, remained unchanged. Peak interface pressures were significantly reduced (P = .016), and more preventive interventions (n = 0.012) were implemented when the staff repositioned residents after feedback from the pressure mapping system. CONCLUSIONS: A limited educational intervention, combined with the use of a pressure mapping system, was successful as it improved staff members' knowledge about PI prevention, reduced interface pressure, and increased PI prevention activities. As many of the staff members lacked formal education in PI prevention and management, opportunities for teaching sessions and reflection upon PI prevention should be incorporated into the workplace. More research is needed to evaluate the effect of continuous pressure mapping on the incidence of PI.
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