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- Alm, Fredrik, 1983-, et al.
(författare)
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Establishment of resilience in a challenging recovery at home after pediatric tonsil surgery : Children’s and caregivers’ perspectives
- 2021
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Ingår i: Paediatric and Neonatal Pain. - : John Wiley & Sons. - 2379-5824 .- 2637-3807. ; 3:2, s. 75-86
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to explore children's and caregivers' experiences and management of postoperative recovery at home after tonsil surgery. The study had an explorative qualitative design with an inductive approach. Twenty children (5-12 years of age) undergoing tonsillectomy or tonsillotomy with or without adenoidectomy participated along with their caregivers in semi-structured interviews at a mean time of 28 days after surgery. The interviews were analyzed with content analysis. One main category emerged from the interviews: children and caregivers struggle to establish resilience in a challenging recovery. The families' resilience relied on their situational awareness and capacity to act, which in turn formed a basis for the ability to return to normal daily life. Children and caregivers described the recovery as an evident interruption of daily life which had an impact on the children's physical and psychological well-being. Both children and caregivers described the pain as a central concern. The families used different pharmacological and complementary strategies to manage the pain, which in some cases were complex. Some families said that the analgesics were insufficient in preventing breakthrough pain, and spoke about a lack of support as well as inadequate and contradictory information from healthcare staff. Caregivers also expressed uncertainty, ambivalence, or anxiety about the responsibility associated with their child's recovery. To optimize and support the recovery after tonsil surgery, it is crucial to obtain knowledge of children's and caregivers' perspectives of postoperative recovery at home. The results indicate that the postoperative period included several troublesome experiences for which neither the children nor the caregivers were informed or prepared. The experience of pain was significant, and often complex to manage. To increase families' resilience, the information provided by healthcare professionals needs to be broadened. Multidisciplinary teamwork is necessary to achieve this goal.
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| 2. |
- Alm, Fredrik, 1983-
(författare)
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Postoperative recovery in children after tonsil surgery : with a focus on pain and pain management from the child's, caregivers', and professionals' perspectives
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Tonsil surgery is one of the most common surgical procedures in children. Although there are several health benefits associated with this surgery, the recovery can be challenging. The overall aim of this thesis was to explore varied perspectives of the recovery process following pediatric tonsil surgery, with a focus on postoperative pain and pain management at home. Study I used data from the National Tonsil Surgery Register in Sweden (n=32,225) to investigate factors affecting pain after pediatric tonsil surgery. Age, surgical method, and indication for surgery influenced the outcome of the patient-reported pain-related outcome measures. In Study II, children (n=299) and their caregiver(s) filled in a diary containing age-appropriate instruments, up to 12 days postoperatively. Data were then analyzed to explore the severity and duration of postoperative pain, the management of analgesics, and postoperative recovery. Children and caregivers reported significant pain for several days, along with a range of physical symptoms and impact on daily activities and emotional state. There was a lack of regular administration of analgesics in the home, particularly during late evening and night. In Study III, interviews with children (n=20) and their caregivers were performed to explore experiences and management of postoperative recovery at home. The results showed that the families struggled to establish resilience during the challenging recovery. The families used both pharmacological and complementary strategies to manage this period. Some families reported insufficient analgesia in preventing breakthrough pain, a lack of preparedness, inadequate information, and insufficient support from the healthcare. In Study IV, nurses and physicians (n=139) from Swedish ear, nose, and throat departments (n=48) responded to a questionnaire covering their opinions of and adherence to the Swedish guidelines for the treatment of pain in pediatric tonsil surgery. In accordance with the guidelines, the departments provided instructions for a multimodal analgesic regimen to manage pain in the home after tonsil surgery. Still, differences were noted between the departments regarding doses and routines around rescue analgesics. Overall, the experience of pain was significant, and often complex to manage. Besides pain, the postoperative period included several troublesome experiences for which neither the children nor the caregivers were informed or prepared. These findings offer knowledge to multidisciplinary teams which can help them improve the support they give to families and increase the child’s participation during the recovery process after tonsil surgery.
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| 3. |
- Janson, Christer, et al.
(författare)
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Difference in resistance to humidity between commonly used dry powder inhalers : an in vitro study
- 2016
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Ingår i: npj Primary Care Respiratory Medicine. - : Springer Science and Business Media LLC. - 2055-1010. ; 26
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Tidskriftsartikel (refereegranskat)abstract
- Multi-dose dry powder inhalers (DPIs) are commonly used in asthma and chronic obstructive lung disease (COPD) treatment. A disadvantage is their sensitivity to humidity. In real life, DPIs are periodically exposed to humid conditions, which may affect aerosol characteristics and lung deposition. This study compared DPI aerosol performance after exposure to humidity. Budesonide (BUD) inhalers (Turbuhaler; Novolizer; Easyhaler) and budesonide/formoterol (BUD/FORM) inhalers (Turbuhaler; Spiromax; Easyhaler) were stored in 75% relative humidity (RH) at both ambient temperature and at-0 degrees C. Delivered dose (DD) and fine-particle dose (FPD) were tested in vitro before and after storage. BUD inhalers: Turbuhaler and Novolizer showed only small decreases (<15%) in FPD in 40 degrees C/75% RH, whereas FPD for Easyhaler decreased by >60% (P = 0.01) after 1.5 months of storage. Easyhaler also decreased significantly after 6 months of storage in ambient/75% RH by 25% and 54% for DD and FPD, respectively, whereas only small decreases were seen for Turbuhaler and Novolizer (<15%). BUD/FORM inhalers: Turbuhaler and Spiromax DD were unchanged in 40 degrees C/75% RH, whereas Easyhaler showed a small decrease. FPD (budesonide) decreased for Turbuhaler, Spiromax and Easyhaler by 18%, 10% and 68% (all significant), respectively, at 40 degrees C/75% RH. In ambient/75% RH, DD was unchanged for all inhalers, whereas FPD (budesonide) decreased for Spiromax (7%, P = 0.02) and Easyhaler (34%, (P<0.01)). There are significant differences in device performance after exposure to humid conditions. A clinically relevant decrease of more than half FPD was seen for one of the inhalers, a decrease that may affect patients' clinical outcomes. Prescriber and patient knowledge on device attributes are essential to ensure optimal drug delivery to the lungs.
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| 4. |
- Lööf, Gunilla
(författare)
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Web-based learning design in paediatric perioperative care : the importance of including an educational framework and children’s own perspectives
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The perioperative period is a significant and unforgettable life event for children with both short-term and long-term effects. Despite evidence highlighting the importance of including children’s perspectives, their right to and need for preparation, children’s views of the perioperative period are rarely sought and many are still arriving in the operating room unprepared and with preoperative anxiety. Today, there is an increasing availability of web-based preparation programs for children in paediatric care. The overall aim of the thesis is to provide understanding of how web-based technology can support children to learn about and be prepared for perioperative care. The thesis adopted a pragmatic stance and employed different research approaches. All studies were grounded in children’s perspectives and based on the Anaesthesia-Web (www.anaesthesiaweb.org), a widely used, comprehensive web-based preparation program. In Study 1 children’s level of knowledge about perioperative care after receiving either interactive web-based information or conventional brochure material preoperatively was investigated in a prospective randomised controlled trial. In Study 2 key educational principles in the development and design of websites for children in paediatric care were identified with directed content analysis based on a defined theoretical educational framework. In Study 3 children’s perspectives, experiences and perceptions facing anaesthesia and surgery were explored using inductive interpretative manifest and latent content analysis. In Study 4 children’s use and experiences of a web-based perioperative preparation program were investigated with a directed content analysis based on the theoretical themes identified in study 2 that described children’s learning on a website. The results revealed that web-based technology can function as a significant resource for preparation and learning in paediatric perioperative care. Such programs have to change from simply providing information to incorporate the child’s need to process the information in order to learn and understand. An interactive web-based design was shown to support children to obtain higher levels of knowledge about perioperative care compared with conventional brochure material. Analysis of children’s use of and experiences with a web-based preparation program displayed how the inclusion of children’s perspectives and an educational framework of children’s learning can improve the development and design of websites in paediatric care. Important characteristics supporting children’s learning on a website were found to let the child be; In charge of own learning, to Discover and play, to Recognise events and situations and to identify with others, to Get feedback in the learning process and to facilitate Interaction with other children. Children’s perceptions and interpretations of the perioperative period were found to differ from those of adults and health care providers. Understanding children’s perspectives, and awareness of their need to process the information provided to understand and be prepared, are significant factors in establishing trust and confidence in the highly technological perioperative environment. Web-based technology constitutes an important part of children’s preparation but helping children to become confident also require awareness of communication strategies and preparation as a continuous process, signified by perceptiveness and individualised adjustments during all perioperative phases. It is time to improve existing perioperative structures by taking account of children’s perspectives.
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