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- Hommel, Ami, et al.
(författare)
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Öka satsningarna på forskning i omvårdnad
- 2017
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Ingår i: Dagens Medicin. - 1104-7488. ; :19 januari
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Långsiktiga satsningar för välfärdsforskning är bra, men för att nå ända fram och minimera hälsoklyftorna är det nödvändigt att även forskning inom omvårdnad prioriteras, skriver tio debattörer.
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| 4. |
- Hommel, Ami, et al.
(författare)
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Öka satsningarna på forskning i omvårdnad
- 2017
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Ingår i: Dagens medicin. - 1104-7488. ; :19 januari
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Långsiktiga satsningar för välfärdsforskning är bra, men för att nå ända fram och minimera hälsoklyftorna är det nödvändigt att även forskning inom omvårdnad prioriteras, skriver tio debattörer.
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| 5. |
- Afua Quaye, Angela, et al.
(författare)
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Children's active participation in decision‐making processesduring hospitalisation : An observational study
- 2019
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Ingår i: Journal of cilinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 28:23¨24, s. 4525-4537
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: The aim was to explore and describe the child's active participationin daily healthcare practice at children's hospital units in Sweden.Objectives: (a) Identify everyday situations in medical and nursing care that illustratechildren's active participation in decision‐making, (b) identify various ways of activeparticipation, actual and optimal in situations involving decision‐making and (c) explorefactors in nursing and medical care that influence children's active participation indecision‐making.Background: Despite active participation being a fundamental right for children, theyare not always involved in decision‐making processes during their health care. Therestill remains uncertainty on how to support children to actively participate in decisionsconcerning their health care.Design: A qualitative study with overt, nonparticipant observations fulfilling theCOREQ checklist criteria.Methods: Observations of interactions between children aged 2 and 17 years withboth acute and chronic conditions, their parents, and healthcare professionals wereconducted at three paediatric hospitals in Sweden. The Scale of Degrees of SelfDetermination was used to grade identified situations. The scale describes five levelsof active participation, with level one being the least and level five being the mostactive level of participation. Normative judgements were also made.Results: Children's active participation was assessed as being generally at levels fourand five. Children demonstrated both verbal and nonverbal ways of communicationduring decision‐making. Findings indicated that children's, parents' and healthcareprofessional's actions influenced children's active participation in decision‐makingprocesses involving healthcare.Conclusions: Healthcare professionals specialised in paediatrics need to embrace botha child perspective and a child's perspective, plan care incorporating key elements of achild‐centred care approach, to ensure children's active participation at a level of theirchoosing.
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| 6. |
- Afua Quaye, Angela, et al.
(författare)
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How are children’s best interests expressed during their hospital visit? : An observational study
- 2021
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 30:23-24, s. 3644-3656
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: To describe ways in which children's best interests were observed to be expressed in paediatric settings during their hospital visit. Background: The best interests of the child are embodied in national and international legal systems, although the definition remains problematic. The child's limited autonomy mandates duty bearers to have both a child perspective and the child's perspective when considering what the best interest of the child entails in care situations. Design: A qualitative descriptive study with overt, non-participant observations fulfilling the COREQ criteria. Methods: Thirty-two observations of interactions between children aged 2 to 17 years with both acute and chronic conditions, their parents and healthcare professionals were conducted at three paediatric hospitals in Sweden. Inductive and abductive reasoning were used in the content analysis of data, which followed the identification, coding, categorising and abstraction of observed patterns of the best interest of the child. Results: Findings reveal facilitating and obstructing factors for the child's best interests to be safeguarded in healthcare situations. Children were guided in or hindered from exercising their competence. The observations showed a variation in actions taken by both parents and healthcare professionals to safeguard the best interests of the child. Conclusions: Determining the best interest of the child requires a case-by-case basis, as it is context-dependent, situational, flexible and dependent on all actors involved and actual decisions made. Relevance to clinical practice: Healthcare professionals’ actions can facilitate or obstruct observed expressions of the child's best interest. It is essential to enhance healthcare professionals’ communication skills, knowledge awareness and continuing education about the rights of children receiving healthcare services. Reflections and discussions on how to protect the best interests of children may help healthcare professionals to uphold children's best interest in daily clinical practice.
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| 7. |
- Aldridge, Jonathan, et al.
(författare)
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Blood PD-1+TFh and CTLA-4+CD4+ T cells predict remission after CTLA-4Ig treatment in early rheumatoid arthritis.
- 2022
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Ingår i: Rheumatology (Oxford, England). - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 61:3, s. 1233-1242
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Tidskriftsartikel (refereegranskat)abstract
- Treatment with CTLA-4Ig blocks T cell activation and is clinically effective in rheumatoid arthritis (RA). However, it is unknown if specific CD4+ T cell subsets in blood at baseline predict remission after CTLA-4Ig, or other biological treatments with different modes of action, and how treatment affects CD4+ T cells in patients with untreated early RA (eRA).This study included 60 patients with untreated eRA from a larger randomised trial. They were treated with methotrexate combined with CTLA-4Ig (abatacept, n=17), anti-IL6 receptor (tocilizumab, n=21) or anti-TNF (certolizumab-pegol, n=22). Disease activity was assessed by clinical disease activity index (CDAI), DAS28, swollen joint counts, tender joint counts, CRP and ESR. The primary outcome was CDAI remission (CDAI≤2.8) at week 24. Proportions of 12 CD4+ T cell subsets were measured by flow cytometry at baseline and after 4, 12 and 24weeks of treatment.In patients treated with CTLA-4Ig, the proportions of PD-1+TFh and CTLA-4+ conventional CD4+ T cells at baseline predicted CDAI remission at week 24. CD4+ T cell subset proportions could not predict remission after treatment with anti-IL6R or anti-TNF. The percentage of regulatory T cells (Tregs) expressing CTLA-4 decreased in all treatment arms by 24weeks, but only CTLA-4Ig treatment significantly reduced the proportions of Tregs and PD-1+T follicular helper (TFh) cells.These findings indicate that circulating proportions PD-1+TFh and CTLA-4+ conventional CD4+ T cells at baseline may serve as predictive biomarkers for remission in early RA after CTLA-4Ig treatment.
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| 8. |
- Almblad, Ann-Charlotte, 1965-
(författare)
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Early Detection and Treatment for Children : Experiences and outcome of implementation at a pediatric hospital
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Early recognition of severely ill children is necessary to prevent serious adverse events and unexpected death. To promote patient safety the Early Detection and Treatment Program for Children (EDT-C) was developed at a University Children’s Hospital in Sweden. This program consists of validated tools for communication and teamwork combined with the Pediatric Early Warning Score (PEWS) and guidelines for recommended actions. Ward specific guidelines were developed and EDT-C instructors were trained. The aims were to describe healthcare professionals’ experience of caring for acutely, severely ill children (Study I) and to evaluate the implementation of EDT-C (Study II, III, IV). The Promoting Action on Research Implementation in Health Services (PARiHS) framework guided both implementation and the research study.Before introducing the EDT-C, focus group interviews were performed to explore healthcare professionals’ experience of caring for acutely, severely ill children. A context assessment, using the Alberta Context Tool (ACT) was also conducted. After implementation, a retrospective review of the electronic patient records (EPR) to assess adherence to guidelines were carried out. Instructors’ and healthcare professionals’ experiences from the implementation of EDT-C were gathered through individual interviews. To evaluate the introduction of EDT-C in relation to admission and stay at intensive care a retrospective before-after study using EPR data was performed. Interviews were analyzed using qualitative content analysis and descriptive statistical methods were utilized for quantitative data.The caring for acutely severely ill children was described as being in a multifaceted area of tension with paradoxical elements where contradictory emotions emerged. According to documentation, children at a very high risk of clinical deterioration according to PEWS were identified. Adherence to actions prescribed in guidelines varied. Healthcare professionals and instructors described EDT-C as suitable for clinical practice and that it created a more structured way of working. It was furthermore described that PEWS measurement had become routine practice at the hospital.EDT-C can lead to increased knowledge about early detection of deterioration, strengthen the healthcare in their profession, optimize treatment and teamwork and thereby has potential to increase patient safety for children treated in hospitals.
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| 9. |
- Andersson, Ann-Christin, et al.
(författare)
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Föräldrars upplevda erfarenheter av att tillfrågas om medverkan i forskning för sitt prematura barns räkning
- 2005
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Ingår i: Vård i Norden. - 0107-4083. ; 25:77, s. 29-32
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Tidskriftsartikel (refereegranskat)abstract
- Clinical research, when children involved, may cause difficult ethical problems for both caregivers and parents. Informed consent has to be obtained from the parents and from the child depending on age and maturity. The concept of informed consent is complicated and depending on the ability of communication between the professionals and the parents. The aim of the study was to illuminate parents lived experiences when being asked to volunteer their new-born premature child to a clinical research study. Parents of fifteen children were interviewed concerning their experiences and a phenomenological based analysis was carried out. Three themes were found: experience of exposure, experience of insufficiency and experience of possibilities. The parents expired themselves being in a state of shock and their statements were characterised by the existing chaos. Despite this, the parents experienced that they could do something good for others in the future. Researchers have to be aware of the parents’ exposure, and attentive to their individual needs.
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| 10. |
- Astermark, Cathrine, et al.
(författare)
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Health-related quality of life in children with Type 1 diabetes : an RCT of hospital-based care and hospital-based home care at diagnosis
- 2017
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Ingår i: International Diabetes Nursing. - : Taylor & Francis. - 2057-3316 .- 2057-3324. ; 14:2-3, s. 90-95
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Tidskriftsartikel (refereegranskat)abstract
- Introduktion: När ett barn får diagnosen typ 1 diabetes betyder det omfattande ändringar i livsstilen för hela familjen. Det finns begränsad kunskap avseende den påverkan som den initiala vården har för barn och föräldrar. Syftet var att jämföra barns diabetesspecifika hälsorelaterade livskvalitet (HRQOL) i sjukhusbaserad vård och sjukhusbaserad hemsjukvård (HBHC), 12 respektive 24 månader efter debuten av typ 1 diabetes. Syftet var också att jämföra barnens och föräldrarnas beskrivning av barnens diabetesspecifika HRQOL efter 12 och 24 månader oavsett vårdform. Metod: Undersökningen genomfördes vid ett universitetssjukhus i Sverige och hade en randomiserad kontrollerad design för att utvärdera sjukhusbaserad vård och HBHC, med hänvisning till specialist vård i en hemmiljö. Barn i åldern 5-16 år och deras föräldrar besvarade enkäten PedsQLTM 3.0 Diabetes Module, 12 månader och 24 månader efter debuten av sjukdomen. Resultat: Resultatet visade ingen skillnad avseende barnens diabetes-specifika HRQOL. Däremot, 12 månader efter diagnos, upplevde barnen och deras föräldrar som fått HBHC mer oro jämfört med de som hade fått sjukhusbaserad vård vid diagnosen (p=0,012). Oaktat vilken vårdform som erbjudits rapporterade barnen mer obehag av sjukdomen jämfört med vad deras föräldrar upplevde att barnen kände (p=0.017). Konklusion: Sammanfattningsvis så indikerar resultatet att både sjukhusbaserad vård och HBHC erbjuder jämförbara resultat gällande barnens diabetes-specifika HRQOL. Dock verkar en vårdmodell mer lik vård i hemmet innebära större påfrestning för vissa familjer. Dessa familjer behöver bli identifierade och rutinerna behöver vara mer flexibla för att kunna möta dessa familjers behov.
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