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| 2. |
- Franks, P. W., et al.
(författare)
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Technological readiness and implementation of genomic-driven precision medicine for complex diseases
- 2021
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 290:3, s. 602-620
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Forskningsöversikt (refereegranskat)abstract
- The fields of human genetics and genomics have generated considerable knowledge about the mechanistic basis of many diseases. Genomic approaches to diagnosis, prognostication, prevention and treatment - genomic-driven precision medicine (GDPM) - may help optimize medical practice. Here, we provide a comprehensive review of GDPM of complex diseases across major medical specialties. We focus on technological readiness: how rapidly a test can be implemented into health care. Although these areas of medicine are diverse, key similarities exist across almost all areas. Many medical areas have, within their standards of care, at least one GDPM test for a genetic variant of strong effect that aids the identification/diagnosis of a more homogeneous subset within a larger disease group or identifies a subset with different therapeutic requirements. However, for almost all complex diseases, the majority of patients do not carry established single-gene mutations with large effects. Thus, research is underway that seeks to determine the polygenic basis of many complex diseases. Nevertheless, most complex diseases are caused by the interplay of genetic, behavioural and environmental risk factors, which will likely necessitate models for prediction and diagnosis that incorporate genetic and non-genetic data.
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| 3. |
- Lenhard, Fabian, et al.
(författare)
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The Internet Intervention Patient Adherence Scale for Guided Internet-Delivered Behavioral Interventions: Development and Psychometric Evaluation.
- 2019
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Ingår i: Journal of medical Internet research. - : JMIR Publications Inc.. - 1438-8871. ; 21:10
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Tidskriftsartikel (refereegranskat)abstract
- Patient adherence is defined as the extent to which a patient complies with medical or health advice. At present, there is a lack of reliable and valid measures specifically designed to measure adherence to internet-delivered behavioral interventions.The objective of this study was to develop and psychometrically evaluate a novel measure of adherence to guided internet-delivered behavioral interventions.In collaboration with experienced clinicians and researchers in the field, a 5-item, clinician-rated internet intervention Patient Adherence Scale (iiPAS) was developed. The initial scale was tested in a sample of children and adolescents (N=50) participating in internet-delivered cognitive behavioral therapy (ICBT) studies. A revised version of the iiPAS was then administered to a larger sample of children and adolescents (N=148) with various behavioral problems participating in ICBT trials. The scale was evaluated according to a classical test theory framework.The iiPAS demonstrated excellent internal consistency. Factor analyses revealed one underlying factor, explaining about 80% of the variance, suggesting that the scale captures a homogeneous adherence construct. The iiPAS was strongly associated with objective measures of patient activity in ICBT (number of logins, number of written characters, and completed modules). Furthermore, mid- and posttreatment ratings of the iiPAS were significantly correlated with treatment outcomes. By contrast, objective measures of patient activity in the Web-based platform did not correlate with treatment outcomes.The iiPAS could be a useful tool to measure adherence in a broad range of internet-delivered behavioral interventions.
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| 5. |
- Rivera, Patricio, et al.
(författare)
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Mammary tumor development in dogs is associated with BRCA1 and BRCA2
- 2009
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Ingår i: Cancer Research. - 0008-5472 .- 1538-7445. ; 69:22, s. 8770-8774
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Tidskriftsartikel (refereegranskat)abstract
- Breast cancer is a major contributor to overall morbidity and mortality in women. Several genes predisposing to breast cancer have been identified, but the majority of risk factors remain unknown. Even less is known about the inherited risk factors underlying canine mammary tumors (CMT). Clear breed predispositions exist, with 36% of English springer spaniels (ESS) in Sweden being affected. Here, we evaluate 10 human breast cancer genes (BRCA1, BRCA2, CHEK2, ERBB2, FGFR2, LSP1, MAP3K1, RCAS1, TOX3, and TP53) for association with CMTs. Sixty-three single-nucleotide polymorphisms (SNPs; four to nine SNPs per gene) were genotyped by iPLEX in female ESS dogs, 212 CMT cases and 143 controls. Two genes, BRCA1 and BRCA2, were significantly associated with CMT (Bonferroni corrected P = 0.005 and P = 0.0001, respectively). Borderline association was seen for FGFR2. Benign and malignant cases were also analyzed separately. Those findings supported the association to BRCA1 and BRCA2 but with a stronger association to BRCA1 in malignant cases. Both BRCA1 and BRCA2 showed odds ratios of approximately 4. In conclusion, this study indicates that BRCA1 and BRCA2 contribute to the risk of CMT in ESS, suggesting that dogs may serve as a good model for human breast cancer.
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| 6. |
- Stenman, Tove, 1975-, et al.
(författare)
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“Daring to deal with the difficult and unexpected” registered nurses’ confidential conversations with patients with palliative care needs : a qualitative interview study
- 2023
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Ingår i: BMC Palliative Care. - : Springer Nature. - 1472-684X. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn palliative care, registered nurses provide advanced nursing care to relieve patients’ symptoms and increase their quality of life based on physical, mental, social and existential dimensions. Conversations, often about existential issues, are an important part of nursing and can affect quality of life positively. Confidential conversations between patients and nurses occur naturally while other nursing activities are being performed. Despite their great importance for palliative care these are rarely described.AimTo gain a deeper understanding of how nurses in palliative care experience and describe confidential conversations with patients.MethodSecondary analysis of data from 17 open-ended face-to-face interviews with registered nurses in palliative care was conducted. Qualitative content analysis using an inductive approach was used to gain a deeper understanding and analyse the latent content.ResultsThe confidential conversation was considered an important part of palliative care and is the nurse’s responsibility. This responsibility was described as complex and placed various demands on the nurses, both personal and professional. A prerequisite for the conversation was the interpersonal relationship. The conversation allowed the patient to process important matters not previously addressed or put into words. It had no predetermined content, was unplanned and entirely on the patient’s terms. For nurses the conversation could be experienced both as draining and a source of power and strength. The nurses also described safeguarding the patient through the conversation.ConclusionNurses’ confidential conversations with patients are essential in palliative care and must be highlighted more to increase the quality of palliative care. The confidential conversations often have an existential content and are challenging for the nurses. Therefore, nurses need time, knowledge, and supervision to increase their conversation skills.
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| 7. |
- Stenman, Tove, 1975-, et al.
(författare)
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Förtroliga samtal i palliativ vård - Personalens och patienters erfarenheter
- 2022
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: I palliativ omvårdnad identifierar, bedömer och bemöter sjuksköterskan fysisk, social, psykisk och existentiell hälsa för såväl patient som närstående samt planerar, genomför och utvärderar åtgärder. Samtal är en viktig omvårdnadshandling med syfte att förbättra patienternas livskvalitet och möjliggöra en värdig död. Samtalen om existentiella frågor har positiva effekter på livskvalitet och samtalet erbjuder existentiellt stöd i olika åldrar och sjukdomsgrupper vid obotlig sjukdom som exempelvis cancer, organsvikt, demenssjukdom. Det finns olika former av samtal i palliativ vård. Sjuksköterskans förtroliga samtal som ofta sker spontant vet vi lite om Det förtroliga samtalet finns inte heller explicit beskrivet som begrepp i vårdvetenskaplig forskning. Syfte: Att få en djupare förståelse för innebörden av förtroliga samtal i palliativ vård utifrån sjuksköterskors och patienters perspektiv. Metod: Kvalitativ ansats med sjuksköterskor och patienter som i intervjuer beskriver sina erfarenheter av förtroliga samtal. Resultat: Analys av insamlade data med sjuksköterskor pågår och beräknas avslutas hösten 2022. Rekrytering och insamling av data med patienter beräknas påbörjas hösten 2022. Preliminära resultat i delstudie I visar att samtalen är en viktig del i den palliativa omvårdanden och sjuksköterskans självklara ansvar. Såväl ansvaret som samtalet i sig beskrivs som komplext och ställer olika typer av krav på sjuksköterskan. I samtalet kan patienten med palliativ vårdbehov få möjlighet att bearbeta saker som inte tidigare bearbetats och sätta ord på det som behöver sättas ord på. Samtalet inte har något förutbestämt innehåll, sker ofta i anslutning till någon annan omvårdnadssituation och sker helt på patientens villkor då det är patienten somhåller i taktpinnen. Betydelse: Samtal är mycket viktig del av omvårdnaden, trots det upplever vårdpersonal av olika skälutmaningar i att genomföra samtal. Personalens vilja att hjälpa, lindra symtom och plågor samt att främja en värdig död är ofta en stark drivkraft. I förtroliga samtal med en sjuksköterska får patienter möjlighet att hantera sin situation, sin sjukdom, sina förluster, sitt beroende av hjälp och stöd samt sin livssituation vilket kan leda till ökad livskvalitet och känsla av oberoende och värdighet. Kontexten palliativ vård är viktig i det förtroliga samtalet, där livets sista tid, döendet och döden är närvarande. Studien med patienter kommer att ligga till grund för en digital interaktiv utbildningsintervention om existentiella samtal riktad till vårdpersonal. Det är centralt att medarbetare i teamet runt patienter med palliativ vårdbehov har kunskaper, förmåga och mod att initiera och samtala kring patienters existentiella tankar och funderingar vid obotlig sjukdom.
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| 8. |
- Stenman, Tove, 1975-, et al.
(författare)
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“Unless someone sees and hears you, how do you know you exist?” Meanings of confidential conversations – a hermeneutic study of the experiences of patients with palliative care needs
- 2024
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Ingår i: BMC Nursing. - : Springer Nature. - 1472-6955. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs. Methods: In-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations. Results: The patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life’s challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences. Conclusions: Patients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients’ suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients’ varying preferences.
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| 9. |
- Tollstern Landin, Teresia, et al.
(författare)
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Sexual Harassment in Clinical Practice—A Cross-Sectional Study Among Nurses and Nursing Students in Sub-Saharan Africa
- 2020
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Ingår i: Sage Open Nursing. - : Sage Publications. - 2377-9608. ; 6, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionSexual harassment (SH) at the workplace is a globally discussed topic and one deserving of scrutiny. It is an issue that is often avoided although around 25% of nurses worldwide have experienced some form of SH at their workplace. Consequences of SH at workplaces can be very serious and an occupation hazard for nurses around the world. In Sub-Saharan Africa there is also a need for more studies in the field.ObjectiveThe overall aim was to determine the prevalence, types, and consequences of sexual harassment among nurses and nursing students at a regional university hospital in Tanzania.MethodsThe study has a cross-sectional design. A study specific questionnaire was distributed to a total of 200 nurses and nursing students. Descriptive statistics were used for calculation of frequencies, prevalence, including gender differences, types, and consequences of sexual harassment.ResultsThe result show that 9.6% of the participants had experienced some form of SH at their workplace. Regarding the female nurses and students, 10.5% had been sexually harassed at work, whereas the number for males was 7.8%, but 36% knew about a friend who had been sexually harassed. The most common perpetrator were physicians. The victims of SH were uncomfortable going back to work, felt ashamed and angry.ConclusionsIn conclusion, nearly 10% of the participants had been exposed to sexual harassment. However, an even greater number of victims was found when including by proxy victims of sexual harassment. SH can become a serious occupational hazard and stigmatization for nurses. Enhanced knowledge is needed, and hospitals and medical colleges should emphasize their possibilities to give support and assistance to the victims of SH. Education about SH in all levels and prevention methods should also be emphasized.
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