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| 2. |
- Freedman, J, et al.
(författare)
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Vasoconstrictor effects in spinal cord of the substance P antagonist [D-Arg, D-Trp7,9 Leu11]-substance P (Spantide) and somatostatin and interaction with thyrotropin releasing hormone
- 1988
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Ingår i: Neuroscience. - : Elsevier BV. - 1873-7544 .- 0306-4522. ; 27:1, s. 267-278
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Tidskriftsartikel (refereegranskat)abstract
- The present study was undertaken to investigate the possible effects of Spantide [D-Arg1, D-Trp7,9 Leu11]-substance P, a substance P antagonist, and of somatostatin on spinal cord blood flow. The experiments were performed with the laser-doppler technique on the L1 spinal cord segment exposed by laminectomy. The effect of Spantide was also studied in the rat with the [14C]iodoantipyrine technique. In addition, experiments were performed on rabbit skeletal muscle in vivo after administration of Spantide to the local vasculature. In the experiments on spinal cord, approximately the same doses were employed as those earlier shown to be "neurotoxic". When the vehicle alone (0.9% saline) was administered intrathecally, a slight decrease of brief duration was noted in the blood flow. Spantide, however, caused a dose-dependent decrease, where 2 micrograms caused an immediate drop of the blood flow to approx. 20% of its normal value. A total circulatory arrest was found in several animals. In most cases, the flow was gradually normalized, whereas the effect persisted for up to 60 min in others. Virtually the same effect was exerted by somatostatin. The experiments using the iodoantipyrine technique confirmed the effect of Spantide. Here, the high resolution of this method showed that the gray matter was affected preferentially, with a complete ischemic state or a drastically reduced flow in 4 out of 5 animals 10 min after 2 micrograms of Spantide; one animal was unaffected, and this animal did not show any signs of motor impairment. The vasoconstriction of Spantide was not affected by simultaneous injections with substance P. However, after i.v. pretreatment with thyrotropin-releasing hormone, at a dose that previously has been reported to be protective against the neurodegenerative effects of Spantide, blood flow was markedly increased as compared to Spantide alone. Results from the experiments using intravital microscopy flow studies in the rabbit tenuissimus muscle revealed that Spantide at the doses used had no vasoconstrictor effect in the skeletal muscle of this species. The results suggest that previous demonstrations of motor impairment and "neurotoxic" actions of intrathecally injected substance P antagonists and somatostatin may be related to a marked decrease in spinal cord blood flow. Counteraction of the effect of Spantide by thyrotropin-releasing hormone may be explained by its effect to increase blood flow.
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| 3. |
- Årestedt, Kristofer, 1968-, et al.
(författare)
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Symptom relief and palliative care during the last week of life among patients with heart failure
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16, s. S58-S59
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Heart failure is a disease with high morbidity, mortality and physical and psychological burden. Patients with heart failure have symptoms as severe and distressing as those of cancer patients. Likewise, the knowledge about care oriented towards palliation provided close to death is sparse.Purpose: To describe symptom prevalence and key aspects of palliative care the last week of life for patients with heart failure, from the perspective of health care professionals.Methods: Data was taken from the Swedish Register of Palliative Care, 2011 and 2012 (n=3981). Inclusion criteria were; heart failure as underlying cause of death (ICD-10; I50.0, I50.1 & I50.9), expected death and 18 years or older. During this period, the register covered 58% of all deaths in Sweden. Variables were described using univariate statistics.Results: The sample consisted of 3981 patients (63% women) with a mean age of 88.1 (SD=7.1) years. The most common reported symptom was pain (62%), followed by rattles (51%), anxiety (39%), shortness of breath (29%), confusion (25%), and nausea (11%). Symptom relief was most prominent for pain and anxiety. Still, 25% and 38% respectively were partly or not relieved. Poorer relief was found for patients suffering shortness of breath, nausea and rattles. More than half of patients were partly or not reviled, 61%, 58% and 55% respectively. Poorest symptom relief was showed for patients with confusion, 85 % were partly or not reviled. Validated self-rating scales were seldom used to assess symptoms. Pain was more often assessed (12%) than other symptoms (8%). Two third of the patients (72%) and almost half of family members (39%) did not have an end of life discussions with a physician. One fifth (17%) died alone without family members or health care professionals present.Conclusions: Our findings indicate that the palliative care is inadequate for patients with heart failure during their last week of life. Symptom management needs to be improved, for example by structured use of validated symptom rating scales. End of life discussions needs to be improved, both for patients and family members.
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| 6. |
- Friberg, Febe, et al.
(författare)
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Context and Methodological Decontextualisation in Nursing Research with Examples from Phenomenography
- 2000
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell Publishing Ltd.. - 0283-9318 .- 1471-6712. ; 14:1, s. 37-43
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Tidskriftsartikel (refereegranskat)abstract
- In both human science and nursing research the concept of context is important. However, context can be understood in different ways. The aim of this article is to elucidate, discuss and problematize context, decontextualization and recontextualization in some health care-related phenomenographical studies. A further aim is to problematize the concet of context in a wider perspective of human complex ohenomena which characterize nursing research demand a broad contextual understanding. Both the local or immediate experiences of the phenomen of interest as well as the socio-cultural discourse. A balance between openness and pliability t the phenomenon is suggested. Reflection is considered an important tool in this process. Within phenomenography, the interest i s directed towards conceptions of certain aspects of the worlds. Thus, context in a wider sense is given a subordinate role. Accordingly, phenomenography is considered to have limited applicability in nursing research when complex phenomena are to be studied.
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| 8. |
- Hommel, A, et al.
(författare)
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Lägg förslaget om förändrad utbildning i papperskorgen
- 2016
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Ingår i: Dagens medicin. - 1104-7488.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Skapa specialistutbildningar för sjuksköterskor som motsvarar vårdens behov både i dag och i framtiden, skriver Ami Hommel, ordförande Svensk sjuksköterskeförening, och nio vårdprofessorer.
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| 9. |
- Hommel, A, et al.
(författare)
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Lägg förslaget om förändrad utbildning i papperskorgen
- 2016
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Ingår i: Dagens medicin. - 1104-7488.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Skapa specialistutbildningar för sjuksköterskor som motsvarar vårdens behov både i dag och i framtiden, skriver Ami Hommel, ordförande Svensk sjuksköterskeförening, och nio vårdprofessorer.
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| 10. |
- Hudson, P L, et al.
(författare)
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Strategies and checklist for designing and conducting palliative care research with family carers : EAPC international expert elicitation study
- 2023
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Ingår i: Palliative Medicine. - : Sage Publications. - 0269-2163 .- 1477-030X. ; 37:1, s. 163-173
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Palliative care services seek to improve the wellbeing of family carers of people living with serious and life-limiting illness. To help achieve this goal, systematic reviews have recommended priority areas for family carer research and the need to improve the quality of study design. Policy makers have also advocated for enhanced family carer support. However, there are specific methodological considerations and challenges in designing and conducting carer research conducted during the course of the serious illness trajectory and in bereavement.AIM: To develop strategies to improve the design and conduct of research with family carers.DESIGN: Expert elicitation study using an adapted version of the 'Identify, Discuss, Estimate and Aggregate' elicitation protocol, supplemented with strategies from peer-reviewed literature.SETTING/PARTICIPANTS: Nine members of the management committee of the European Association for Palliative Care's Reference group on family carer research, comprising international senior research academics in family caregiving.RESULTS: A compilation of recommended strategies and checklist was created to: (a) help researchers plan research involving family carers focussing on: preparation, conduct and dissemination and (b) assist ethics committees and funding bodies to evaluate proposals.CONCLUSIONS: The strategies and checklist for conducting research with family carers may enhance methodologically rigorous research. Consequently, researchers, practitioners and policy makers will not only gain a more comprehensive understanding of the unmet needs of family carers but also promote the development of empirically sound interventions.
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| 11. |
- Håkanson, Cecilia, 1968-, et al.
(författare)
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A population-level study of place of death and associated factors in Sweden
- 2015
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 43:7, s. 744-751
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aims of this study were to examine, on a population level, where people die in Sweden, and to investigate associations between place of death and underlying cause of death, socioeconomic and environmental characteristics, with a particular interest in people dying from life-limiting conditions typically in need of palliative care. Methods: This population-level study is based on death certificate data for all deceased individuals in Sweden in 2012, with a registered place of death (n=83,712). Multivariable logistic regression was performed to investigate associations between place of death and individual, socioeconomic and environmental characteristics. Results: The results show that, in 2012, 42.1% of all deaths occurred in hospitals, 17.8% occurred at home and 38.1% in nursing home facilities. Individuals dying of conditions indicative of potential palliative care needs were less likely to die in hospital than those dying of other conditions (OR = 0.73; 95% CI = 0.70-0.77). Living at home in urban areas was associated with higher likelihood of dying in hospital or in a nursing home (OR = 1.04 and 1.09 respectively). Educational attainment and marital status were found to be somewhat associated with the place of death. Conclusions: The majority of deaths in Sweden occur in institutional settings, with comparatively larger proportions of nursing home deaths than most countries. Associations between place of death and other variables point to inequalities in availability and/or utilization of health services at the end of life.
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| 14. |
- Nilsson, Stefan, 1972, et al.
(författare)
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Evaluating pictorial support in person-centred care for children (PicPecc) : A protocol for a crossover design study
- 2021
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction This study protocol outlines the evaluation of the pictorial support in person-centred care for children (PicPecc). PicPecc is a digital tool used by children aged 5-17 years to self-report symptoms of acute lymphoblastic leukaemia, who undergo high-dose methotrexate treatments. The design of the digital platform follows the principles of universal design using pictorial support to provide accessibility for all children regardless of communication or language challenges and thus facilitating international comparison.Methods and analysis Both effect and process evaluations will be conducted. A crossover design will be used to measure the effect/outcome, and a mixed-methods design will be used to measure the process/implementation. The primary outcome in the effect evaluation will be self-reported distress. Secondary outcomes will be stress levels monitored via neuropeptides, neurosteroids and peripheral steroids indicated in plasma blood samples; frequency of in-app estimation of high levels of distress by the children; children's use of analgesic medicine and person centeredness evaluated via the questionnaire Visual CARE Measure. For the process evaluation, qualitative interviews will be carried out with children with cancer, their legal guardians and case-related healthcare professionals. These interviews will address experiences with PicPecc in terms of feasibility and frequency of use from the child's perspective and value to the caseworker. Interview transcripts will be analysed using an interpretive description methodology.Ethics and dissemination Ethical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02392; 2020-02601; 2020-06226). Children, legal guardians, healthcare professionals, policymaking and research stakeholders will be involved in all stages of the research process according to Medical Research Council's guidelines. Research findings will be presented at international cancer and paediatric conferences and published in scientific journals.Trial registration ClinicalTrials.gov; NCT04433650.
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| 19. |
- Öhlén, Joakim, 1958, et al.
(författare)
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Is it possible to integrate tensions in opposing views related to notions of individualization and generalization in palliative care?
- 2015
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Ingår i: International Philosophy Of Nursing Society (IPONS) Conference. August 24-26, Stockholm, Sweden..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- There are concurrent societal, demographic and epidemiological conflicting challenges related to palliative care. Trends in globalization have led to culturally diverse and pluralistic societies with a range of perspectives of death and dying, and different expectations for palliative care. In addition, people are living longer with life-limiting conditions. Although specialized palliative care is available, including in Sweden and Canada, most people who are dying from chronic life-limiting conditions do not receive specialized palliative care, but rather utilize other health services, such as chronic disease management, primary care, intensive care or emergency room services. Within the field of palliative care the aim of the project is to integrate person-centred perspectives with standardization and measurement (including standard care plans, evidence-based practice guidelines, and patient- and family-reported outcomes and experience measures). Specifically, this presentation will focus on the initial and tentative exploration of tensions related to notions of individualization as opposed to generalization in palliative care. For the initial exploration we applied different lenses and perspectives including equity, cross-cultural, global health, person-centeredness, measurement validation, and quality indicators. Then tentative tensions between apparently opposing views were identified. For the integration of different views of international relevance to palliative care, a hermeneutic approach that is dialectic and communicative (based on Paul Ricoeur’s hermeneutics) was applied. This perspective articulates possibilities to relate opposing views without neutralizing or diffusing their central features; thus a theoretical resource to not end up in a fixed or oversimplifying “model”. This analysis is on-going. As a Swedish-Canadian collaborative initiative, with senior and junior researchers and graduate students from both countries, we target conceptual issues influencing ways societies and professionals respond to pressing, global needs in relation to the care of people with chronic life-limiting conditions approaching end-of-life.
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| 20. |
- Öhlén, Joakim, 1958, et al.
(författare)
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Symptom alleviation profiles during the last week of life. A register based quality of end-of-life study
- 2015
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Ingår i: International Society for Quality of Life Research 22nd Annual Conference. October 21-24, Vancouver, Canada.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aims: To examine symptom alleviation profiles as quality indicators that reflect care and wellbeing of patients during the last week of life and improve understanding of patterns. Methods: A cross-sectional design was chosen using data from the Swedish Palliative Care Registry, a national register for all deaths that contains professionals’ retrospectively-reported data about quality indicators reflecting care and wellbeing of patients during the last week of life. All deceased adults (>18 years) with expected deaths, registered in the register in 2012 and 2013 (approximately 60% of the total death population in Sweden each year) were included. Descriptive statistical analysis of the sample and a preliminary latent class analysis have been performed to identify symptom alleviation profiles, including alleviation of pain, nausea, anxiety, shortness of breath, confusion, and breathing rattles. Analyses of demographic and health-related characteristics predictive of latent class membership are ongoing. Results: 38766 men and 49117 women were included. 65% were 18-59 years of age, 19.0% were 60-79 years of age, and 16.0% were 80-110 years of age. Neoplasms (36.7%), cardiovascular diseases (31.1 %) and dementia (12.4%) were the most common underlying causes of death. Nursing home (39,7%), hospital wards (27,7%), hospice and specialised palliative care in-patient units (11,5%), municipality short-term facilities (8,8%) and specialised palliative home care (6,8%) were the most common locations of care. The most frequent symptoms were pain (70.9%), breathing rattles (52.4%), anxiety (46.1%), confusion (29.0%), and shortness of breath (25.2%). Total symptom relief was reported for 52.4% of patients experiencing pain, 23.7% of those experiencing breathing rattles, 8.5% of those experiencing anxiety, 5.1% experiencing confusion and 9.0% experiencing breathlessness. Preliminary results suggest 5 latent classes that represent unique symptom alleviation profiles, with class sizes ranging from 9% to 33%. Conclusion: Symptom alleviation is a quality indicator for palliative care that is of significant importance to the wellbeing of people during their last week of life. A better understanding of profiles and predictors of symptom alleviation can inform the development of care quality for the purpose of enhanced quality of end-of-life across different diagnoses and locations of care.
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