| 1. |
- Melin, Eva O, et al.
(författare)
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Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20
- 2010
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Ingår i: BioPsychoSocial Medicine. - : Springer Science and Business Media LLC. - 1751-0759. ; 4:5, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Alexithymia is a disturbance associated with psychosomatic disorders, pain syndromes, and a variety of psychiatric disorders. The Affect School (AS) based on Tomkins Affect Theory is a therapy focusing on innate affects and their physiological expressions, feelings, emotions and scripts. In this pilot study we tried the AS-intervention method in patients with chronic benign pain. Methods: The AS-intervention, with 8 weekly group sessions and 10 individual sessions, was offered to 59 patients with chronic non-malignant pain at a pain rehabilitation clinic in Sweden 2004-2005. Pre and post intervention assessments were done with the Hospital Anxiety and Depression scale (HAD), the Toronto Alexithymia Scale-20 (TAS- 20), the Visual Analogue Scale for pain assessment (VAS-pain), the European Quality of Life health barometer (EQoL) and the Stress and Crisis Inventory-93 (SCI-93). After the group sessions we used Bergdahl's Questionnaire for assessing changes in interpersonal relations, general well-being and evaluation of AS. Results: The AS intervention was completed by 54 out of 59 (92%) patients. Significant reductions in total TAS-20 posttest scores (p = 0.0006) as well as TAS-20 DIF and DDF factors (Difficulties Identifying Feelings, and Difficulties Describing Feelings) were seen (p = 0.0001, and p = 0.0008) while the EOT factor (Externally Oriented Thinking) did not change. Improvements of HAD-depression scores (p = 0.04), EQoL (p = 0.02) and self-assessed changes in relations to others (p < 0.001) were also seen. After Bonferroni Correction for Multiple Analyses the TAS-20 test score reduction was still significant as well as Bergdahl's test after group sessions. The HAD, EQoL, SCI-93, and VAS-pain scores were not significantly changed. The AS-intervention was ranked high by the participants. Conclusions: This pilot study involving 59 patients with chronic benign pain indicates that the alexithymia DIF and DDF, as well as depression, social relations and quality of life may be improved by the Affect School therapeutic intervention.
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| 2. |
- Thulesius, Helle L, et al.
(författare)
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Pharyngometric correlations with obstructive sleep apnea syndrome.
- 2004
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Ingår i: Acta Oto-Laryngologica. - 0001-6489 .- 1651-2251. ; 124:10, s. 1182-6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The primary objective of this study was to investigate the relationship between obstructive sleep apnea syndrome (OSAS) and pharyngometric dimensions as clinical predictors of OSAS.MATERIAL AND METHODS: Pharyngometry included tonsil size, the breadth of the uvula (UB), the distance between the uvula and the posterior pharyngeal wall and open mouth standardized photographic measurement of the dimension of the free oropharynx (FOP). We also assessed modified Mallampati grade (MMP). In addition, clinical data on body weight, height, nasal obstruction and cardiovascular disease were included in our analysis.RESULTS: A total of 96 consecutive patients of both sexes with sleep disorders were investigated with somnography. Of these, 35 were considered to have OSAS, with an apnea-hypopnea index (AHI) of > or = 10. Body mass index (BMI), FOP, UB, the use of cardiovascular medication and hypertension were significantly related to AHI, and tonsil size showed borderline significance. Regression models were used to determine an OSAS index using the parameters BMI and FOP. The index had a positive predictive value of 82% and a negative predictive value of 77%.CONCLUSIONS: We showed that a photographic assessment of pharyngeal dimensions was significantly associated with OSAS. We also confirmed previous findings of associations between OSAS, BMI and cardiovascular morbidity.
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| 3. |
- Thulesius, Helle L, et al.
(författare)
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What happens to patients with nasal stuffiness and pathological rhinomanometry left without surgery?
- 2009
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Ingår i: Rhinology. - 0300-0729 .- 1996-8604. ; 47:1, s. 24-7
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Tidskriftsartikel (refereegranskat)abstract
- In this study we explored long term outcomes of patients with nasal stuffiness and high nasal airway resistance (NAR) that did not undergo nasal surgery. The same investigation was repeated on average 8 years after a baseline investigation with an ENT-examination, a rhinomanometric survey and a rhinomanometry. We did follow-up investigations in 44 out of 59 non-operated patients with a pathological NAR on at least one side. At follow-up 2 persons (4%) had no complaints, 14 (32%) had reduced, 22 (50%) unchanged, and 6 (14%) increased complaints of nasal stuffiness. Rhinomanometry showed that NAR values decreased significantly between baseline and follow-up on both wider and narrower sides after decongestion. There was no correlation between subjective nasal complaints and NAR-values. In logistic regression models increasing age and allergy prevalence at baseline were significantly associated with having no, or reduced nasal stuffiness at follow-up. The results show that both NAR and subjective nasal stuffiness decreased with age. Consequently, we suggest that NAR normal values should be age adjusted. Also, a wait and see policy towards nasal stuffiness seems relevant since 36% of our patients had no or reduced nasal stuffiness while their NAR-values were reduced after 8 years.
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| 4. |
- Lindahl, Jeanette, et al.
(författare)
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Assessing the Supportiveness of Healthcare Environments' Light and Color : Development and Validation of the Light and Color Questionnaire (LCQ)
- 2021
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Ingår i: Health Environments Research & Design Journal. - : Sage Publications. - 1937-5867 .- 2167-5112. ; 14:2, s. 130-144
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to develop and evaluate a self-report instrument measuring patients', family members', and staff's perceived support from light and color in the physical environment of an emergency department (ED)-the Light and Color Questionnaire (LCQ). Background: The physical care environment is an important part of a comprehensive caring approach in all levels of care not only for patients but also for family members and staff. However, no existing self-report questionnaire assessing the extent to which light and color are perceived as being supportive in the physical care environment from the users' perspective was found. Method: The LCQ was developed as part of a pre-post study in which an ED serving 125,000 people was refurbished and remodeled using evidence-based design. The LCQ consists of six items for light and five items for color and assesses awareness/orientation, safety/security, functional abilities, privacy, personal control, and stimulation. The study was carried out in four steps: constructions of items, assessment of face validity, data collection, and data analysis. Result/Conclusion: Psychometric evaluation of the two versions, LCQ-Patient/Family member and LCQ-Staff, showed satisfactory content and internal validity (>90%) and high internal consistency (Cronbach's coefficient alpha = .9) to support the use of the questionnaire for research and development purposes. Explorative factor analysis of a total of 600 questionnaire responses confirmed light and color as distinctive and independent dimensions creating perceptions of more or less supportiveness for respondents. The LCQ instrument may be useful for architects, administrators, and researchers of healthcare environments.
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| 5. |
- Lindahl, Jeanette
(författare)
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Optimerad fysisk vårdmiljö på akutmottagning : ur patienters, närståendes och personals perspektiv
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: This dissertation called the COPE (Caring Optimized Physical Environment) project, aimed to evaluate the perceptions of patients, family members, and staff regarding support from the physical environment, with a focus on light, color, and person-centered climate, before and after there furbishment and remodeling of an emergency department (ED).Methods: A quasi-experimental design was employed, implementing evidence-based design principles for light and color in the ED. The study evaluated the perceived support and person-centered climate among participants using a newly developed and validated questionnaire, the Light and Color Questionnaire (LCQ). It also validated a Swedish version of the Person-centered Climate Questionnaire for family members (PCQ-F). A total of 600 participants, including patients, family members, and staff, were included in the study.Results: The scores for the perceptions of light and color and person centered climate were higher after the redesign than before for patients, family members, and staff. Thus, redesign of a healthcare environment based on knowledge and experience in light and color design corresponded with a positive change in self rated perceived support of that environment to all three groups: patients, family members, and staff. The redesign involved enhancing access to natural daylight by incorporating additional windows and diverse artificial lighting options. The redesign also included the use of color coding to facilitate way finding and uniform colors for shared floor surfaces and contrasting colors for non-patient areas to enhance safety.Conclusion: The intervention, which focused on optimizing lighting and color in the ED, coincided with an increased perceived support from light and color for patients, family members, and staff. Further, the changes in light and color, along with the overall redesign, concurred with a higher score for perceived person-centered climate. These findings emphasize the importance of evidence-based design interventions and highlight the potential benefits they can bring to staff and patients in other health care settings.
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| 6. |
- Lindahl, Jeanette, et al.
(författare)
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The Perceived Support From Light and Color Before and After an Evidence-Based Design Intervention in an Emergency Department Environment: A Quasi-Experimental Study
- 2023
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 16:2, s. 109-124
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate patients’ and family members’ perceived support from light and color before, compared with after an evidence-based design (EBD) intervention at an emergency department (ED) using a validated instrument—the Light and Color Questionnaire (LCQ). Background: EDs offer acute care day and night. Thus, a supportive physical environment where light and color is crucial for how the milieu is experienced is vital. Research is limited on how care settings are perceived as supportive by users. Methods: Quasi-experimental evaluation of the refurbishing and remodeling of an ED by an expert group of nurse managers, nursing staff, nursing researchers and architects in south Sweden. LCQ includes dimensions “maximizing awareness and orientation,” “maximizing safety and security,” “supporting functional abilities,” “providing privacy,” “opportunities for personal control” (not for LCQ-Color), and “regulation and quality of stimulation.” LCQ was analyzed and compared in 400 surveys from 100 patients and 100 family members before the intervention and 100 patients and 100 family members after the intervention. Results: The LCQ total score significantly improved after the intervention for both patients and family members. Four of the six dimensions of LCQ Light subscale scores were significantly higher for family members, and three of the six dimensions were significantly higher for patients after the intervention. The LCQ Color subscale score showed significant improvements for all five dimensions for both patients and family members after the intervention. Conclusion: This study showed improved perceived support from light and color in the physical environment for patients and family members after an EBD intervention at an emergency department using a validated instrument—the Light and Color Questionnaire.
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| 7. |
- Thulesius, Helle L., et al.
(författare)
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Can we always trust rhinomanometry?
- 2011
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Ingår i: Rhinology. - 0300-0729. ; 49:1, s. 46-52
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Rhinomanometry before and after decongestion distinguishes a nasal airway organic stenosis from congestion of nasal mucosa in patients with nasal stuffiness. Together with rhinoscopy and patient history, it is used to decide if nasal surgery would benefit the patient. Rhinomanometry measurements should thus be reliable and reproducible. Materials and methods: We performed repetitive active anterior rhinomanometry in 9 persons during 5 months to test reproducibility of nasal airway resistance (NAR) over time. We also did test-retest measurements in several participants. Xylometazoline hydrochloride was applied in each nasal cavity to minimize effects of mucosal variation and the nasal cavity was examined with rhinoscopy. The participants evaluated subjective nasal stuffiness on a visual analogue scale (VAS). Results: The long term mean coefficient of variation (CV) of NAR over time was 27% for the whole group while the short term CV was 7 - 17% for test-retest within an hour. Mean NAR reduction after decongestion was 33%, but 13% of NAR values were not reduced after decongestion. Participants had difficulties estimating stuffiness on a VAS in 15% of the assessments, but there was no correlation between the VAS estimates and NAR. Conclusion: We found a high NAR variation over a period of five months. This implies low long-term rhinomanometry reproducibility and we suggest future research on standardised decongestion to increase the reproducibility.
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| 8. |
- Thulesius, Helle L., et al.
(författare)
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Treatment with a topical glucocorticoid, budesonide, reduced the variability of rhinomanometric nasal airway resistance
- 2014
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Ingår i: Rhinology. - 0300-0729. ; 52:1, s. 19-24
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous rhinomanometry studies have shown significant long-term variability of the nasal airway resistance and questioned the clinical validity of rhinomanonnetry. Research question: Could treatment with a topical glucocorticoid, budesonide, influence the long-term variability of active anterior rhinomanometry? Methods: Eight healthy volunteers participated in an unblinded controlled trial without, and later with, nasal budesonide once a day for 5 months. Their nasal airway resistance was measured every two weeks with active anterior rhinomanometry before and after decongestion with xylometazoline hydrochloride. In addition, subjective nasal obstruction was evaluated on a Visual Analogue Scale before each measurement.The participants had a year earlier been investigated with rhinomanometry every two weeks during 5 months but without budesonide treatment. We compared the variability of nasal airway resistance during the two periods with and without treatment with topical budesonide. Results: Budesonide significantly reduced mean nasal airway resistance and the standard deviation of the mean after decongestion for 6 of 8 participants. The mean reduction of the nasal airway resistance was 40% for the decongested nasal cavity compared to the period without treatment with nasal budesonide. Subjective nasal obstruction assessed by Visual Analogue Scale was reduced in 3 of the 8 participants. Conclusion: The variability of nasal airway resistance was significantly reduced by treatment with topical budesonide for 6 out of 8 healthy volunteers participating in an unblinded repeated 5 month trial where the participants served as their own controls.
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| 9. |
- Thulesius, Helle
(författare)
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Rhinomanometry in clinical use. A tool in the septoplasty decision making process.
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Subjective nasal obstruction is a common chronic complaint caused by mucosal disease, skeletal abnormality or a combination of both. The challenge is to determine the main cause and to decide whether the intervention should be medical or surgical. Diagnosis is done by a combination of rhinoscopy, subjective and objective assessments of nasal obstruction. Rhinomanometry measures the nasal airway resistance (NAR) for each nasal cavity. Septal deviations are common with prevalences of up to 58% with the majority having no nasal complaints. Septoplasty can straighten the septum. In Sweden on average 24% of patients are dissatisfied 6 months after their septoplasty. The principal aim of this thesis was to investigate the clinical use of rhinomanometry in the septoplasty decision making process. This resulted in a checklist to increase the patients’ satisfaction with the operation. We found that higher age and allergic rhinitis were factors giving significant odds for a spontaneous long term improvement of the nasal obstruction without septoplasty. That was in spite of septal deviation and pathological NAR. In a study of 1000 patients with nasal obstruction we found that there has to be a certain NAR side difference between the nasal cavities before the patient could significantly assess it on a Visual Analogue Scale. When rhinomanometry was performed in 9 participants every two weeks during 5 months, we found a high variability of the NAR, where tested subjects could move from pathological to normal. Intervention with topical budesonide treatment during a new five month period reduced both NAR and it’s variability significantly.
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| 10. |
- Thulesius, Helle, et al.
(författare)
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The importance of side difference in nasal obstruction and rhinomanometry: a retrospective correlation of symptoms and rhinomanometry in 1000 patients
- 2012
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Ingår i: Clinical Otolaryngology. - : Wiley. - 1749-4486 .- 1749-4478. ; 37:1, s. 17-22
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The correlation between subjective and objective outcomes of nasal obstruction is still a matter of controversy. The aim of this study was to determine the minimal level of side difference in nasal airway resistance (NAR measured by Broms' v2) between the two nasal cavities, which could be discerned subjectively by the patient on a visual analogue scale (VAS). Nasal airway resistance was calculated from rhinomanometric measurements of nasal airflow and transnasal pressure after decongestion of the nasal mucosa. Design: A retrospective study. Setting: ENT department, Vaxjo Central Hospital, Sweden. Participants: We studied 1000 active anterior rhinomanometries from patients with nasal obstructions. Main outcome measures: We compared the side difference of nasal airway resistance with the side difference of VAS estimated immediately prior to the rhinomanometry. Each measurement was performed after nasal decongestion. Results: When the difference in nasal airway resistance between the two nasal cavities was larger than 20 degrees (Broms' v(2)) or R-2 > 0.36 Pa/cm(3)/s, we found a significant correlation between side differences of the objective measurement and the subjective assessment (VAS). With a nasal airway resistance side difference over 20 degrees, an additional 20 degrees difference corresponded to a 0.9 centimetre average VAS change. The more obstructed side of the nose could be determined by VAS in 823 (82.3%) of 1000 patients. Yet, 177 (17.7%) patients had a paradoxical sensation of nasal obstruction with the low resistance side of the nose experienced as the most congested side. Conclusion: A significant correlation between the side differences of nasal airway resistance and VAS can serve as a supplement to rhinoscopy in decisions about nasal surgery. This study also showed that in 17.7% of patients, there was a negative correlation between subjective and objective evaluations of nasal airway resistance. But in this group, the nasal airway resistance side difference was mostly under 20 degrees. Results: When the difference in nasal airway resistance between the two nasal cavities was larger than 20 degrees (Broms' v2) or R2 > 0.36 Pa/cm(3)/s, we found a significant correlation between side differences of the objective measurement and the subjective assessment (VAS). With a nasal airway resistance side difference over 20 degrees, an additional 20 degrees difference corresponded to a 0.9 centimetre average VAS change. The more obstructed side of the nose could be determined by VAS in 823 (82.3%) of 1000 patients. Yet, 177 (17.7%) patients had a paradoxical sensation of nasal obstruction with the low resistance side of the nose experienced as the most congested side. Conclusion: A significant correlation between the side differences of nasal airway resistance and VAS can serve as a supplement to rhinoscopy in decisions about nasal surgery. This study also showed that in 17.7% of patients, there was a negative correlation between subjective and objective evaluations of nasal airway resistance. But in this group, the nasal airway resistance side difference was mostly under 20 degrees.
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