| 1. |
- Joelsson-Alm, Eva, et al.
(författare)
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Perioperative bladder distension : a prospective study
- 2009
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Ingår i: Scandinavian Journal of Urology and Nephrology. - 0036-5599 .- 1651-2065. - 0036-5599 ; 43:1, s. 58-62
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Postoperative urinary retention and bladder distension are frequent complications of surgery. The aim of this study was to determine the incidence of perioperative bladder distension in a surgical setting and to identify predisposing factors among patients undergoing common general and orthopaedic procedures. Material and methods. This was a prospective observational study of 147 adult patients admitted to orthopaedic and surgical departments. Bladder volumes were measured with an ultrasound scanner on three occasions: after emptying the bladder before being transported to the operating theatre, and then immediately before and after surgery. Results. Thirty-three patients (22%) developed bladder distension (500 ml), eight preoperatively and 25 postoperatively. A total of 21 patients (14%) had a bladder volume 300 ml immediately before surgery. Orthopaedic patients were more likely to develop preoperative bladder distension than surgical patients and had significantly higher postvoid residual volumes. In the binary logistic regression analysis age, gender and time of anaesthesia could not predict bladder distension. Patients undergoing orthopaedic surgical procedures, however, were prone to bladder distension (odds ratio 6.87, 95% confidence interval 1.76 to 26.79, p=0.006). Conclusions. This study shows that orthopaedic surgical patients are more prone to bladder distension perioperatively. The conventional method of encouraging patients to void at the ward before being transported to the operating theatre does not necessarily mean an empty bladder at the start of the operation.
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| 2. |
- Georg, Carina, et al.
(författare)
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A Rubric to Assess Students' Clinical Reasoning When Encountering Virtual Patients
- 2018
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Ingår i: Journal of Nursing Education. - : Slack Incorporated. - 0148-4834 .- 1938-2421. ; 57:7, s. 408-415
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Training with virtual patients has been proposed as a suitable learning activity to improve clinical reasoning skills for nursing students. However, published instruments with the capacity to assess students' reasoning process in the encounter with virtual patients are lacking.METHOD: Deductive and abductive analyses were used to adapt the Lasater Clinical Judgment Rubric (LCJR) to assess nursing students' clinical reasoning skills in the encounter with virtual patients. The new rubric's ability to capture nursing students' clinical reasoning processes was tested using deductive analysis and statistical analysis.RESULTS: A grading rubric for virtual patients, the vpLCJR, was developed. Cronbach's alpha showed .892, indicating good internal consistency.CONCLUSION: The rubric vpLCJR, which deconstructs aspects of clinical reasoning for both students and faculty members, can be used to clarify expectations, assess students' clinical reasoning process, and provide feedback for learning when nursing students encounter virtual patients. [J Nurs Educ. 2018;57(7):408-415.].
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| 3. |
- Georg, Carina, et al.
(författare)
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Psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric
- 2019
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Ingår i: Nurse Education in Practice. - : Churchill Livingstone. - 1471-5953 .- 1873-5223. ; 38, s. 14-20
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Tidskriftsartikel (refereegranskat)abstract
- A number of studies attest to the effectiveness of virtual patients in fostering and assessing students' development of clinical reasoning. An objective assessment of students' clinical reasoning is, however, challenging. This study focused on determining the psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric, a rubric that is aimed at assessing nursing students' clinical reasoning processes when encountering virtual patients. A nonexperimental design was used in which data from 125 students' reflections on solving two different virtual patient scenarios were included in the analysis. First, a deductive content analysis was conducted using the categories of the rubric as a lens. After that, each student's performance was quantified according to the different levels of the rubric. Exploratory factor analysis and test of normality and reliability, including the Kaiser-Meyer-Olkin test, Bartlett's test, the Shapiro-Wilk test, and Cronbach's alpha were used in the analysis. The result suggested three factors: "Understanding the patient", "Care planning" and "Reflecting" that explained 81.8% of the variance. Cronbach's alpha was 0.931. The result showed the rubric to be a valid assessment instrument for assessing nursing students' clinical reasoning when encountering virtual patients.
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| 4. |
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| 5. |
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| 6. |
- Joelsson-Alm, Eva, et al.
(författare)
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Perioperative bladder distension : a prospective study
- 2009
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa Healthcare. - 0036-5599 .- 2168-1813 .- 1651-2065. ; 43:1, s. 58-62
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Postoperative urinary retention and bladder distension are frequent complications of surgery. The aim of this study was to determine the incidence of perioperative bladder distension in a surgical setting and to identify predisposing factors among patients undergoing common general and orthopaedic procedures. Material and methods. This was a prospective observational study of 147 adult patients admitted to orthopaedic and surgical departments. Bladder volumes were measured with an ultrasound scanner on three occasions: after emptying the bladder before being transported to the operating theatre, and then immediately before and after surgery. Results. Thirty-three patients (22%) developed bladder distension (500 ml), eight preoperatively and 25 postoperatively. A total of 21 patients (14%) had a bladder volume 300 ml immediately before surgery. Orthopaedic patients were more likely to develop preoperative bladder distension than surgical patients and had significantly higher postvoid residual volumes. In the binary logistic regression analysis age, gender and time of anaesthesia could not predict bladder distension. Patients undergoing orthopaedic surgical procedures, however, were prone to bladder distension (odds ratio 6.87, 95% confidence interval 1.76 to 26.79, p=0.006). Conclusions. This study shows that orthopaedic surgical patients are more prone to bladder distension perioperatively. The conventional method of encouraging patients to void at the ward before being transported to the operating theatre does not necessarily mean an empty bladder at the start of the operation.
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| 7. |
- Kristoffersson, Annica, 1980-, et al.
(författare)
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Teknik i hemmet - tekniska förutsättningar
- 2019. - 1
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Ingår i: Hemsjukvård. - : Liber. - 9789147112777 ; , s. 396-421
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Bokkapitel (populärvet., debatt m.m.)abstract
- I och med den fjärde industriella revolutionen – Industri 4.0 – kommer en nygeneration av teknik att finnas tillgänglig. Det förutspås att robotik och virtualreality kommer att transformera inte bara arbetsplatser utan även utvecklaandra domäner, såsom smarta städer och möjligheten till livsstils- och hälsomonitoreringhemma.Antalet tillgängliga konsument- och medicintekniska produkter ökar irask takt. Hälso- och sjukvårdssystemet ställs inför utmaningar, såsom behovetav att utveckla verktyg för att hantera ny teknologi men också att förändraarbetsprocesser och anpassa organisationen för att kunna hantera teknologin.Det här kapitlet ger en översikt över kommande teknologier, förslag på hurteknologi kan användas i hemmiljöer, en översikt över hur sådan teknik utvärderatssamt inte minst en reflektion kring hur dessa teknologier kan harmoniseramed nuvarande organisatoriska processer.
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| 8. |
- Ulfvarson, Johanna
(författare)
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Drug treatment of elderly : the need for changing behaviour among providers and patients
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Medication-related illness is a great problem, particularly among the elderly. Elderly people use many different drugs, they have many diseases and symptoms, and also experience natural signs of aging. Altogether, the treatment of an elderly patient is complex and assessment of the appropriateness of a drug therapy is difficult. In order to make a treatment as effective as possible and to achieve the best possible health it is important that the care personnel can identify problems associated with drug treatment. Such problems, e.g. polypharmacy, may lead to non-compliance. The overall aim of this thesis was to explore the drug utilization among elderly people in order to develop methods for rational drug audits and to get a knowledge of the patient’s view on the use of drugs. In the first study, we studied drug treatment of nursing home patients who had cardiovascular diseases (heart failure, post-myocardial infarction, angina pectoris, hypertonia, or cardiac valvular disease), and assessed the effect of medication advice given. We found that intervention did not affect the cardiovascular symptoms, i.e. medication could be decreased or even disrupted with no (harmful) effect on the health of the patients. Revisions of drug treatment should therefore be practiced on a regular basis in order to decrease the risk for polypharmacy and also decrease unnecessary costs. Revisions should involve more than one class of drugs in order to be cost-effective. In the second study, we investigated the effects of withdrawing SSRI drugs for nursing home patients who had no documented diagnosis or symptoms of depression. We found that treatment with SSRI drugs in patients without a clinically major depression or anxiety disorder often was unjustified and seemed to have had no essential effect. The medication with SSRI drugs should discontinued in those patients. In the third study, the relationship among elderly people between adherence to prescribed drugs and the patient’s perception of the care and information given was explored. We found that better perceived health was related to higher adherence. Patients in the non-adherent group reported a higher consumption of drugs. Moreover, patients who felt they did not get an opportunity to ask the physicians questions were over-represented in the non-adherent group. Care-providers should therefore increase their efforts to communicate with the patients. The fourth study was designed to analyse the relationship between the attitude to drugs, general health, psychological well-being, stress coping ability, and adherence to prescribed drugs in an elderly population. We found that of the mentioned factors the number of drugs prescribed and consumed is the most important factor for adherence to a drug treatment. The higher the number of prescribed drugs, the lower the proportion of adherent patients will be. The study also showed that non-adherent patients who took too many or too few drugs possibly may be approached in a different way in order to improve their adherence to the drug treatment. Drugs are essential for a successful management of diseases. Although the prescription of a drug is well intended, its use can bring about serious consequences. It is important to reconsider medication after some period of time as the indication no longer may be valid. When a patient chooses to take a drug or not to take it, the responsibility lies with the patient, and the patient should therefore be given tools to make a rational decision. It is the care-providers who can supply the patient with these tools. The patient should be given adequate information on the possible adverse effects of drugs and be encouraged to report adverse reactions. The patient’s participation and involvement in decisions concerning his/her care and treatment is an important principle in nursing.
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| 9. |
- Ulfvarson, Johanna, et al.
(författare)
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Medication reviews with computerised expert support : evaluation of a method to improve the quality of drug utilisation in the elderly
- 2010
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862 .- 1758-6542. ; 23:6, s. 571-82
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This paper aims to examine whether a computerised system for medication reviews can support physicians' decisions and improve the quality of drug treatment in the elderly.DESIGN/METHODOLOGY/APPROACH: This is a descriptive intervention study. The study included 275 patients living in community settings and nursing homes in Stockholm, Sweden. Patient data were analysed using computer software and scrutinised by a clinical pharmacologist. Pharmaco-therapeutic advice was sent to the physician responsible for each patient. The main outcome measures were initiation and discontinuation of drugs, changes of doses and rates of identified drug-related problems.FINDINGS: Expert opinions were given by the clinical pharmacologist, for 275 patients, mean age 85 years; 70 per cent female. An average of 3.3 remarks was given concerning unsuitable drugs, unclear indication, dosing when the kidney function was decreased, drug-drug interactions and quality indicators. On average 1.5 drug-related problems (DRP) per patient were attended to by the responsible physician at each unit. The most common action taken was withdrawal of a drug (n = 208). On average the drug use decreased from 10.4 to 9.5 drugs per patient, and several quality indicators were met. The drug costs decreased, and resulted in a more cost-effective drug therapy.ORIGINALITY/VALUE: The paper develops and tests a method for intervention in the care of elderly patients. The method is based on a computerised expert support system for medication reviews at a distance and on education of the staff. A safer drug therapy with improved quality and cost-effectiveness is thus provided.
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