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1.	Sundberg, K., et al. (författare) Feasibility and acceptability of an interactive mobile phone application for early detection of patient reported symptom distress in prostate cancer 2013 Ingår i: European Journal of Cancer. - : Elsevier. - 0959-8049 .- 1879-0852. ; 49, s. S280-S280 Tidskriftsartikel (refereegranskat)abstract Introduction: For immediate and continuous dialogue between patients and caregivers new approaches in modern technology are encouraged today. In cooperation with a Swedish health management company, we developed an interactive mobile phone application for the assessment of symptom distress, evidence-based self-care advice and an alerting function of severe symptoms with instant access to professionals in real time. By using this technique patients can communicate symptoms with instant support while cared for out-side hospital but at the same time reassured that their condition is monitored by the professionals. The objective of this study was to evaluate the feasibility and acceptability of the application for patients with prostate cancer during radiotherapy and for the involved health care staff.Material and Methods: Evidence-based symptoms and related selfcareadvices were implemented in the application after literature review and interviews with patients and health care professionals. Nine patients diagnosed with prostate cancer undergoing radiotherapy treatment were recruited to test the application for two weeks. The patients reported in the electronic symptom questionnaire daily. After the two weeks they were interviewed about their experience. Nurses directly involved in the care and treatment of the participating patients were interviewed at the end of study.Results: Overall, patients and nurses reported positive experiences of using the mobile phone system. The patients considered the application helpful and easy to use although there were some suggestions for further development of the electronic questionnaire. Most of the patients had read the self-care advice and found them useful. The alerting system was activated in several cases; the nurses found it useful to identify and manage problematic symptoms early and the patients felt safe and well cared for. Some of the nurses considered the monitoring system time-consuming and made suggestions for improvement.Conclusions: Both patients and nurses could see the potential for using the mobile application in clinical practice. The system enables the involvement of the patients and the alerts showed problematic symptoms promoting timely interventions. The results support further development and testing of the system in full-scale.
2.	Blomberg, Karin, 1970-, et al. (författare) Symptoms and self-care strategies during and six months after radiotherapy for prostate cancer : Scoping the perspectives of patients, professionals and literature 2016 Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 21, s. 139-145 Tidskriftsartikel (refereegranskat)abstract Purpose: Under-diagnosed and uncontrolled symptoms in patients with prostate cancer during radiotherapy can have a negative impact on the individual's quality of life. An opportunity for patients to report their symptoms systematically, communicate these symptoms to cancer nurses and to receive self-care advice via an application in an Information and Communication Technology-platform could overcome this risk. The content in the application must precisely capture symptoms that are significant to both patients and health care professionals. Therefore, the aim of the study was to map and describe symptoms and self-care strategies identified by patients with prostate cancer undergoing radiotherapy, by health care professionals caring for these patients, and in the literature.Methods: The study combines data from interviews with patients (n ¼ 8) and health care professionals (n ¼ 10) and a scoping review of the literature (n ¼ 26) focusing on the period during and up to 6 months after radiotherapy.Results: There was a concordance between the patients, health care professionals, and the literature on symptoms during and after radiotherapy. Urinary symptoms, bowel problems, pain, sexual problems, fatigue, anxiety, depression, cognitive impairment and irregular symptoms were commonly described during the initial treatment period. Self-care strategies were rarely described in all three of the sources.Conclusions: The results show which symptoms to regularly assess using an Information and Communication Technology-platform for patients with newly-diagnosed prostate cancer during radiotherapy. The next step is to evaluate the efficacy of using the platform and the accuracy of the selected symptoms and self-care advice included in a smartphone application.
3.	Hälleberg-Nyman, Maria, 1968-, et al. (författare) An issue but of varying impact : a descriptive study of hip surgery patients’ experiences of bladder emptying and urinary catheterisation Annan publikation (övrigt vetenskapligt/konstnärligt)abstract Background: The capacity of bladder emptying in connection with hip surgery is affected by pain, medication and confinement to bed. In connection with such surgery urinary catheterisation is often performed, either intermittent or indwelling. Hip surgery patients' experiences of urinary catheterisation and urination have not been studied before.Objectives: The aim of the study was to describe patients' experiences of bladder emptying and urinary catheterisation in connection with hip surgery.Design: A qualitative study with descriptive design was conducted among hip surgery patients.Setting: The study was carried out at an orthopaedic department at a university hospital in Sweden.Participants: Purposive sample of 30 hip surgery patients, 17 with fractures and 13 with osteoarthritis.Method: Face-to-face interviews were conducted and analysed with inductive qualitative content analysis.Results: The main category "An issue but of varying impact" illustrated the patients' experiences of bladder emptying and urinary catheterisation. The findings are reported under five generic categories: ability to urinate, catheter is convenient, bothersome bladder emptying, intrusion upon dignity and concern about complications. Irrespectively of whether the patients were able to urinate or were catheterised, bladder emptying was not as usual. It was described as uncomplicated and experienced as being positive if the patients were able to urinate by themselves or when catheterisation was experienced as convenient. Some patients did not want to be catheterised, approving it only reluctantly. Independently of the method for bladder emptying, the patients in our study would choose the same method next time.Conclusions: The patients undergoing hip surgery seem to experience bladder emptying as an issue but of varying impact. Both bladder emptying through micturition and bladder emptying through catheterisation are described in positive as well as negative terms.
4.	Hälleberg-Nyman, Maria, 1968-, et al. (författare) Patients' experiences of bladder emptying in connection with hip surgery : an issue but of varying impact 2013 Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 69:12, s. 2686-2695 Tidskriftsartikel (refereegranskat)abstract Aim: To describe patients' experiences of bladder emptying and urinary catheterization in connection with hip surgery.Background: The capacity of bladder emptying in connection with hip surgery is affected by pain, medication and confinement to bed. In connection with such surgery urinary catheterization is often performed, either intermittent or indwelling. Hip surgery patients' experiences of urinary catheterization and urination have not been studied before.Design: A qualitative study with descriptive design was conducted among hip surgery patients.Methods: Thirty face-to-face interviews were conducted from October 2009-March 2010 and analysed with inductive qualitative content analysis.Results: The main category An issue but of varying impact' illustrated the patients' experiences of bladder emptying and urinary catheterization. Five generic categories were identified: ability to urinate, catheter is convenient, bothersome bladder emptying, intrusion on dignity and concern about complications. Irrespectively of whether the patients were able to urinate or were catheterized, the bladder emptying situation was not as usual. It was described as uncomplicated and experienced as being positive if the patients were able to urinate by themselves or when catheterization was experienced as convenient. Some patients did not want to be catheterized, approving it only reluctantly. Independently of the method for bladder emptying, the patients in our study would choose the same method next time.Conclusions: The patients undergoing hip surgery seem to experience bladder emptying as an issue but of varying impact. Both bladder emptying through micturition and bladder emptying through catheterization are described in positive and negative terms.
5.	Lindner, Helen, 1967- (författare) The Assessment of Capacity for Myoelectric Control : Psychometric evidence and comparison with upper limb prosthetic outcome measures 2013 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Evaluation of outcomes using validated prosthetic outcome measures (OMs) is a current priority in upper limb (UL) prosthetics, and OMs with psychometric evidence toward UL prosthesis users are thus necessary. The “Assessment of Capacity for Myoelectric Control” (ACMC) is a tool that assesses the ability to control a myoelectric prosthetic hand. Some psychometric aspects of the ACMC have been previously investigated, but others are still lacking. A major part of this thesis was thus to search and assess the psychometric evidence of the ACMC. Data were collected from prosthesis users of different ages, prosthetic sides, and sexes. Rasch analysis was used to search for validity evidence and activity influence on the users’ ACMC ability measures, while reliability statistics was used to search for reliability evidence. Overall, the validity evidence was satisfactory in terms of unidimensionality, item technical quality, item difficulty, and relation to prosthetic wearing time. In terms of activity influence, the majority of prosthesis users received similar ability measures in different activities. Reliability evidence was also satisfactory in terms of test-retest reliability and rater agreements (intra- and interrater).Besides the ACMC, several other prosthetic OMs have been developed in recent years. A comparison of these OMs would help professionals to select appropriate tools for clinical practice. Thus, a comparison of the validated UL prosthetic OMs was performed with an emphasis on what health aspects they cover. Eight OMs were chosen, and their contents were linked to the “International Classification of Functioning, Disability and Health” (ICF). The results showed that the contents from different OMs were linked to the ICF categories in “Body functions,” “Activity and Participation,” and “Environmental Factors.”In conclusion, the use of a mixture of OMs is recommended to cover different aspects of health. Based on the evidence in this thesis, the ACMC can be recommended to measure the ability to control a myoelectric hand.
6.	Lyngå, Patrik, et al. (författare) Weight monitoring in patients with severe heart failure (WISH). A randomized controlled trial. 2012 Ingår i: European Journal of Heart Failure. - : John Wiley & Sons. - 1388-9842 .- 1879-0844. ; 14:4, s. 438-444 Tidskriftsartikel (refereegranskat)abstract AIMS: This multicentre, randomized controlled trial hypothesized that daily electronic transmission of body weight to a heart failure (HF) clinic will reduce cardiac hospitalization in patients recently hospitalized with HF.METHODS AND RESULTS: A total of 344 patients were randomized to either an intervention group (IG) or a control group (CG). Of the 319 patients included in the final analysis, the mean age was 73 years (SD 10.2), 75% were males, and 57% had a left ventricular ejection fraction (LVEF) <30%. Patients in both groups were recommended to weigh themselves daily and, in the case of sudden weight gain >2 kg in 3 days, to contact the HF clinic. Patients in the IG were given an electronic scale and the weight was automatically transmitted to and monitored at the HF clinic. No significant differences were found for the primary endpoint, cardiac re-hospitalization [70/153 CG, 70/166 IG; hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.65-1.26, P = 0.54], or for the secondary endpoints, which included all-cause hospitalization (84/153 CG, 79/166 IG; HR 0.83, 95% CI 0.61-1.13, P = 0.24), death from any cause (8/153 CG, 5/166 IG; HR 0.57, 95% CI 0.19-1.73, P = 0.32), or the composite endpoint of cardiac hospitalization and death from any cause (78/153 CG, 75/166 IG; HR 0.90, 95% CI 0.65-1.26, P = 0.54). Subgroup analyses did not show any benefits for patients in the IG despite their more frequent monitoring; 398 occasions compared with 30 occasions in the CG.CONCLUSION: Daily electronic transmission of body weight and monitoring three times a week did not decrease hospitalization or death in HF patients followed up at a HF clinic.
7.	Rydholm Hedman, Ann-marie, et al. (författare) Self-reported Quality of Life in women with breast cancer – a 1 year follow-up study 2011 Konferensbidrag (refereegranskat)
8.	Sundberg, Kay, et al. (författare) E-hälsa på patientens villkor - så mycket bättre. Säker och lättillgänglig vård för patienter med prostatacancer 2012 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
9.	Sundberg, Kay, et al. (författare) Feasibility and acceptability of an interactive mobile phone system for collecting and managing patient reported symptoms in prostate cancer 2012 Ingår i: 6th NOVO Symposium. - : Novo. - 9789163723803 ; , s. 52-52 Konferensbidrag (refereegranskat)
10.	Sundberg, Kay, et al. (författare) Feasibility of an interactive ICT-platform for early assessment and management of patient-reported symptoms during radiotherapy for prostate cancer 2015 Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 19:5, s. 523-528 Tidskriftsartikel (refereegranskat)abstract Purpose: The aim of this study was to test the feasibility and acceptability of an Information and Communication Technology platform for assessing and managing patient reported symptoms during radiotherapy for prostate cancer.Methods: In cooperation with a health management company, using a patient experience co-design, we developed the platform operated by an interactive application for reporting and managing symptoms in real time. Nine patients diagnosed with prostate cancer and receiving radiotherapy were recruited from two university hospitals in Sweden. Evidence-based symptoms and related self-care advice specific to prostate cancer were implemented in the application based on a literature review and interviews with patients and health care professionals. In the test of the platform the patients reported symptoms, via a mobile phone, daily for two weeks and were afterwards interviewed about their experiences.Results: Overall, the patients found the symptom questionnaire and the self-care advice relevant and the application user friendly. The alert system was activated on several occasions when the symptoms were severe leading to a nurse contact and support so the patients felt safe and well cared for.Conclusions: The platform enabled increased patient involvement and facilitated symptom assessment and communication between the patient and the health care provider. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations.
11.	Algilani, Samal, 1981-, et al. (författare) An interactive ICT-platform for early assessment and management of patient-reported concerns among older adults living in ordinary housing : development and feasibility 2017 Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 26:11-12, s. 1575-1583 Tidskriftsartikel (refereegranskat)abstract Aim and objectives: To develop and test feasibility and acceptability of an interactive ICT-platform integrated in a tablet for collecting and managing patient reported concerns of older adults in home care.Background: Using different ICT-applications, e.g. interactive tablets for self-assessment of health and health issues, based on health monitoring as well as other somatic and psychiatric monitoring systems may improve quality of life, staff and patient communication and feelings of being reassured. The European Commission hypothesize that introduction of ICT-applications to the older population will enable improved health. However, evidence-based and user-based applications are scarce.Design: The design is underpinned by the Medical Research Council's complex intervention evaluation framework. A mixed-method approach was used combining interviews with older adults and healthcare professionals, and logged quantitative data.Methods: In cooperation with a health management company, a platform operated by an interactive application for reporting and managing health related problems in real time was developed. Eight older adults receiving home care were recruited to test feasibility. They were equipped with the application and reported three times weekly over four weeks, and afterwards interviewed about their experiences. Three nurses caring for them were interviewed. The logged data was extracted as a coded file.Results: The older adults reported as instructed, in total 107 reports (mean 13). The most frequent concerns were pain, fatigue and dizziness. The older adults experienced the application as meaningful with overall positive effects as well as potential benefits for the nurses involved.Conclusions The overall findings in this study indicated high feasibility among older adults using the ICT-platform. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations.Relevance to practice: An ICT-platform increased the older adults' perception of involvement and facilitated communication between the patient and nurses.
12.	Algilani, Samal, 1981-, et al. (författare) Can assessment of health on a ICT-platform improve optimal functionality and lead to participatory care among older adults? 2014 Ingår i: eTELEMED 2014, The Sixth International Conference on eHealth, Telemedicine and Social Medicine. - Wilmington DE : International Academy, Research and Industry Association (IARIA). - 9781612083278 ; , s. 201-204 Konferensbidrag (refereegranskat)abstract The number of people reaching old age is increasing rapidly, challenging the society and healthcare to promote healthy and meaningful aging. There is, and has been for a few years, a big interest in collecting patient reported outcomes (PROs) as a base for clinical management. Information and communication technology (ICT) and assistive technology in elderly care increase and may facilitate the care of older adults as they are moved from nursing homes to private homes. An ICT-platform for reporting health issues with immediate access to self-care advice and direct communication with healthcare professionals has been developed. The overall aim of this project is to evaluate the effects of the interactive ICT-platform regarding optimal functionality and participatory care. The project will be conducted in three phases: development of the ICT-platform, evaluating feasibility and evaluation of effects. The platform is unique by integrating interactive components for direct clinical management and needs to be thoroughly evaluated before implementation in daily practice. It is hypothesized that by using an interactive ICT-platform, it will promote participatory care and enhance the communication between older adults and their professional carers. The platform will be further developed, as well as test in a full-scale study.
13.	Algilani, Samal, 1981-, et al. (författare) Individualised care with modern technology : Usability and Feasibility of an E-health platform including a Health measure, Self-Care advices and Alarms 2013 Konferensbidrag (refereegranskat)
14.	Barimani, Mia, et al. (författare) Professional support and emergency visits during the first 2 weeks postpartum 2014 Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 28:1, s. 57-65 Tidskriftsartikel (refereegranskat)abstract Objectives: The aim of the study was to assess mothers' perceived satisfaction with professional support during the first 2 weeks after childbirth and the extent to which mothers seek emergency care during the same period. Design: A cross-sectional study was conducted of all mothers (n = 546) in Stockholm County, Sweden, who gave birth to a live baby during the same week in 2009. Ethical issues: The study was approved by the regional Research and Ethics Committee at the Karolinska Insititutet, Sweden. Methods: The mothers responded to a study-specific questionnaire on perceived satisfaction with professional support and the sense of coherence scale, which measures coping strategies. The mothers also provided information about their socio-demographic background, obstetric and infant data, and visits to hospital emergency departments. Descriptive and logistic regression analyses were performed. Results: Fifty-three percent of the mothers rated the support received as sufficient or more than sufficient, 29.7% as neither sufficient nor insufficient and 17.7% as insufficient or completely insufficient. The results indicate a lack of continuity in postpartum care. As many as 17% of the mothers in the study population visited hospital emergency departments during the first 2 weeks after childbirth, as a result of problems related to delivery, breastfeeding or infant health. A higher frequency of such emergency visits was associated with poor perception of professional support, low sense of coherence and delivery complications. Conclusions: Relative to otherwise comparable mothers, mothers who experience complications with delivery are less satisfied with professional support and turn more frequently to hospital emergency departments for support. © 2013 Nordic College of Caring Science. Published by Blackwell Publishing Ltd.
15.	Berggren, Elisabeth (författare) Daily life after Subarachnoid Haemorrhage : Identity construction, patients' and relatives' statements about patients' memory, emotional status and activities of living 2012 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The overall aim of this thesis was to describe patients’ experience and reconstruction regarding the onset of, and events surrounding being struck by a Subarachnoid Haemorrhage (SAH), and to describe patients’ and relatives’ views of patients’ memory ability, emotional status and activities of living, in a long-term perspective.Methods: Both inductive and deductive approaches were used. Nine open interviews were carried out in home settings, in average 1 year and 7 seven months after the patients’ onset, and discourse analysis was used to interpret the data. Eleven relatives and 11 patients, 11 years after the onset, and 15 relatives and 15 patients, 6 years after the onset, participated in two studies. Interviews using a questionnaire with structured questions and memory tests were used to collect data. Fischer’s exact test and Z-scores were used for the statistical analysis.Results: Patients with experience of a SAH were able to judge their own memory for what happened when they became ill. The reconstruction of the illness event may be interpreted as an identity creating process. The process of meaning-making is both a matter of understanding SAH as a pathological event and a social and communicative matter, where the SAH is construed into a meaningful life history, in order to make life complete (I). Memory problems, changes in emotional status and problems with activities of living were common (II-IV). There was correspondence between relatives’ and patients’ statements regarding the patients’ memory in general and long-term memory. Patients judged their own memory ability better than relatives, compared with results on memory tests. Relatives stated that some patients had meta-memory problems (II). The episodic memory seemed to be well reserved, both concerning the onset and in the long-term perspective (I, II). There were more problems with social life than with P- and I-ADL (III), and social company habits had changed due to concentration difficulties, mental fatigue, and patients’ sensitivity to noisy environments and uncertainty (IV). Relatives rated the patients’ ability concerning activities of living and emotional status, and in a similar manner to patients’ statements (III-IV).Conclusions: The reconstruction of the illness event can be used as a tool in nursing for understanding the patient’s identity-construction. Relatives and patients stated the patients’ memory, emotional status and activities of living in a similar manner, and therefore both patients’ and relatives’ statements can be used as a tool in nursing care, in order to support the patient. However, the results showed: meta-memory problems (relatives’ statements) and that the patients’ judged their own memory ability better than relatives in comparison with results on memory tests. Nevertheless, there was a high degree of concordance between relatives’ and patients’ evaluations concerning patients´ memory ability, emotional status, emotional problems, social company habits and activities of living. Therefore both relatives’ and patients’ statements can be considered to be reliable. However, sometimes the patients and the relatives judge the patients’ memory differently. Consequently, memory tests and formalized dialogues between the patient, the relative and a professional might be required, in order to improve the mutual family relationship in a positive way. Professionals however, must first assume that patients can judge their own memory, emotional status and ability in daily life.
16.	Börjeson, Sussanne, et al. (författare) State of Science Conference in Cancer Care - identification of front line research topics 2010 Ingår i: Acta Oncologica. - London, United Kingdom : Informa Healthcare. - 0284-186X .- 1651-226X. ; 49:2, s. 134-135 Tidskriftsartikel (refereegranskat)
17.	Christiansen, Mats, et al. (författare) High acceptability of a smartphone application for daily symptom reporting and management during radiotherapy for prostate cancer 2016 Konferensbidrag (refereegranskat)
18.	Christiansen, Mats, 1972- (författare) Patient experiences and the influence on health literacy and self-care using mHealth to manage symptoms during radiotherapy for prostate cancer 2019 Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract Introduction: Prostate cancer is a diagnosis that can affect the men’s quality of life both due to the symptoms related to the disease and the treatment the men receive. Treatment with radiotherapy for prostate cancer in Sweden takes place at outpatient clinics, where the patient visits daily for radiotherapy and then returns home. Most of the time the patient is experiencing the symptoms and side-effects at home without health-care professionals easily accessible. To facilitate person-centered care and improve clinical management when hospital care is moving to outpatient care, the app (Interaktor) for smartphones and tablets was developed. Using patient-reported outcomes (PRO), the app was intended to identify symptoms early, assess them in real time, and provide symptom-management support during radiotherapy for prostate cancer. Aims: The overall objective of the intervention described in this thesis, was to facilitate symptom management for patients with prostate cancer assisted with an interactive app during radiotherapy treatment.Methods: The two studies included in this thesis come from one trial. A descriptive investigation evaluated the intervention group’s use and perception of the using the app, and a quasi-experimental investigation compared those using the app with a historical control group not using the app to evaluate the effect on health literacy and self-care agency. The patients (n=130) were recruited consecutively from two university hospitals in Sweden between April 2012 and October 2013. The intervention group (n=66) had access to the app during 5-7 weeks of radiotherapy and three additional weeks. The intervention group’s use of the app was logged. Health literacy was measured using the Swedish Functional Health Literacy Scale (FHL) and the Swedish Communicative and Critical Health Literacy Scale (CCHL), and the Appraisal of Self-care Agency scale, version A (patient’s assessment) (ASA-A) for self-care agency. Transcribed notes from phone or face-to-face interviews about participants’ experiences of using and reporting in the app were analyzed.Results: In the intervention group using the app, adherence to daily reports was 87% (Md 92%, 16-100%), and generated 3,536 reports. All listed symptoms were used, where the most common being: urinary urgency, fatigue, hot flushes, and difficulties in urinating. A total of 1,566 alerts were generated, with 1/3 being severe (red alert). The app was reported in the interviews as easy to use, the reporting became routine; to report facilitated reflection over symptoms, the symptoms were relevant although some found that nuancing severity was hard. Using the app was reported as providing a sense of security. Substantial portions of the participants showed inadequate FHL and CCHL at baseline for both groups. CCHL changed significantly for the intervention group from baseline to three months after ended treatment (p = 0.050). Functional health literacy and self-care agency did not reveal any statistically significant differences over time for either group. Conclusions: The conclusions to draw from this thesis are that an mHealth intervention, the app Interaktor, served as a supportive tool for the patients to assess and manage symptoms during the radiotherapy for prostate cancer. The intervention provided the patients with a sense of safety, increased awareness of own well-being and a significant improvement in communicative and critical health literacy was found. The portions of inadequate levels of health literacy reported leave substantial groups of patients more vulnerable in assessing and managing symptoms when treated with radiotherapy for prostate cancer. Although health literacy levels include notable portions of patients in this study that have inadequate levels of both functional and communicative and critical health literacy, the adherence of using the app was high.
19.	Crafoord, Marie-Therése, et al. (författare) Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer : Mixed Methods Study 2020 Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 22:8 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Using mobile technology for symptom management and self-care can improve patient-clinician communication and clinical outcomes in patients with cancer. The interactive app Interaktor has been shown to reduce symptom burden during cancer treatment. It includes symptom assessment, an alert system for contact with health care professionals, access to self-care advice, and visualization of symptom history. It is essential to understand how digital interventions operate; one approach is to examine engagement by assessing usage and exploring user experiences. Actual usage in relation to the intended use-adherence-is an essential factor of engagement.OBJECTIVE: This study aimed to describe engagement with the Interaktor app among patients with breast or prostate cancer during treatment.METHODS: Patients from the intervention groups of two separate randomized controlled trials were included: patients with breast cancer receiving neoadjuvant chemotherapy (n=74) and patients with locally advanced prostate cancer receiving treatment with radiotherapy (n=75). The patients reported their symptoms daily. Sociodemographic and clinical data were obtained from baseline questionnaires and medical records. Logged data usage was retrieved from the server and analyzed descriptively and with multiple regression analysis. Telephone interviews were conducted with patients about their perceptions of using the app and analyzed using content analysis.RESULTS: The median adherence percentage to daily symptom reporting was 83%. Most patients used the self-care advice and free text message component. Among the patients treated for breast cancer, higher age predicted a higher total number of free text messages sent (P=.04). Among the patients treated for prostate cancer, higher age (P=.01) and higher education level (P=.04), predicted an increase in total views on self-care advice, while higher comorbidity (P=.004) predicted a decrease in total views on self-care advice. Being married or living with a partner predicted a higher adherence to daily symptom reporting (P=.02). Daily symptom reporting created feelings of having continuous contact with health care professionals, being acknowledged, and safe. Being contacted by a nurse after a symptom alert was considered convenient and highly valued. Treatment and time-related aspects influenced engagement. Daily symptom reporting was perceived as particularly meaningful at the beginning of treatment. Requests were made for advice on diet and psychological symptoms, as well as for more comprehensive and detailed information as the patient progressed through treatment.CONCLUSIONS: Patient engagement in the interactive app Interaktor was high. The app promoted patient participation in their care through continuous and convenient contact with health care professionals. The predictive ability of demographic variables differed between patient groups, but higher age and a higher educational level predicted higher usage of specific app functions for both patient groups. Patients' experience of relevance and interactivity influenced their engagement positively.
20.	Crafoord, Marie-Therése, et al. (författare) Patients' Individualized Care Perceptions and Health Literacy Using an Interactive App During Breast and Prostate Cancer Treatment 2023 Ingår i: Computers, Informatics, Nursing. - : Wolters Kluwer. - 1538-2931 .- 1538-9774. ; 41:9, s. 706-716 Tidskriftsartikel (refereegranskat)abstract The use of symptom management mobile apps can reduce patients' symptom burden during cancer treatment, but the evidence is lacking about their effect on care. Moreover, if patients' health literacy can be improved, it needs to be more rigorously tested. This study aimed to evaluate patients' perceptions of individualized care and health literacy using an interactive app in two randomized trials. Patients undergoing neoadjuvant chemotherapy for breast cancer (N = 149) and radiotherapy for prostate cancer (N = 150) were consecutively included and randomized into one intervention or control group. Outcome measures were Individualized Care Scale, Swedish Functional Health Literacy Scale, and Swedish Communicative and Critical Health Literacy Scale. In the breast cancer trial, no group differences were observed regarding individualized care or health literacy. Most patients had sufficient health literacy levels. In the prostate cancer trial, intervention group patients rated higher perceived individualized care regarding decision control at follow-up than the control group. Less than half had sufficient health literacy levels and intervention group patients significantly improved their ability to seek, understand, and communicate health information. Education level explained significant variance in health literacy in both trials. Using an interactive app can positively affect individualization in care and health literacy skills among patients treated for prostate cancer, although further research is warranted.
21.	Ehrsson, Ylva Tiblom, et al. (författare) Explorative study on the predictive value of systematic inflammatory and metabolic markers on weight loss in head and neck cancer patients undergoing radiotherapy 2010 Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 18:11, s. 1385-1391 Tidskriftsartikel (refereegranskat)abstract Purpose This study aimed to explore the predictive value of systematic inflammatory and metabolic markers in head and neck (H&N) cancer patients during radiotherapy (RT). Methods Twenty-seven patients were evaluated. The protocol included serial blood tests [highly sensitive C-reactive protein (hsCRP), albumin, insulin-like growth factor 1 (IGF-1), IGF binding protein 1 (IGFBP-1) and ghrelin], measurements of body weight and assessment of oral mucositis. Results The mean nadir of weight loss was observed at the end of RT. At the time of diagnosis, mean hsCRP was 5.2 +/- 1.0 mg/L. HsCRP significantly increased during RT and decreased during the post-RT period. Mean maximum hsCRP was 35.8 +/- 8.5 mg/L, with seven patients reaching >40 mg/L. A numerical decrease of albumin (by 18.2%) and only small changes in IGF-1, IGFBP-1 and ghrelin levels were observed. None of the metabolic parameters was significantly associated with weight loss. Conclusions HsCRP increased in response to RT for H&N cancer as a sign of irradiation-induced inflammation. Weight loss was not preceded by changes of the metabolic parameters, indicating that assessment of the blood markers used in this study is of little value. Regular body weight measurement and assessment of oral mucositis are feasible, cheap and important procedures to control the metabolic homeostasis during RT.
22.	Ehrsson, Ylva Tiblom, et al. (författare) Head and neck cancer patients' perceptions of quality of life and how it is affected by the disease and enteral tube feeding during treatment 2015 Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 120:4, s. 280-289 Tidskriftsartikel (refereegranskat)abstract AIM: To explore individual quality of life in patients with head and neck cancer from diagnosis up to 3 months after termination of radiotherapy.RESEARCH QUESTIONS: 1) Which areas in life are important to quality of life, and which are influenced by the disease and by having oral or enteral nutrition; and 2) Which areas in life are influenced by having a nasogastric feeding tube (NGT) or a percutaneous endoscopic gastrostomy (PEG) tube?MATERIAL AND METHODS: Data were collected in 36 patients. Semi-structured interviews were conducted using an extended version of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) and analysed with content analysis.RESULTS: Negative and positive experiences of quality of life in general were about relation to family, own health, and leisure activities. Negative impacts on physical, psychological, existential and social problems, but also positive experiences are described by the patients related to the disease. More than half expressed eating-related problems. Enteral nutrition entailed negative and positive experiences, and no greater variations were described by the patients with NGT or PEG tube. Overall, there were interindividual variations.CONCLUSIONS: The patients' perception of general or disease-related quality of life was not affected by whether they had enteral nutrition or not. From the patients' perspective neither of the two feeding tubes (NGT or PEG) was clearly in favour. We suggest that more studies are needed on how the choice of enteral feeding tube can be evidence-based, and incorporating the patients' perspective.
23.	Ehrsson, Ylva Tiblom, et al. (författare) Nutritional surveillance and weight loss in head and neck cancer patients 2012 Ingår i: Supportive Care in Cancer. - New York : Springer-Verlag New York. - 0941-4355 .- 1433-7339. ; 20:4, s. 757-765 Tidskriftsartikel (refereegranskat)abstract This retrospective single-institution cohort study aims to evaluate if therapeutic approach, tumour site, tumour stage, BMI, gender, age and civil status predict body weight loss and to establish the association between weight loss on postoperative infections and mortality. Consecutive patients with head and neck cancer were seen for nutritional control at a nurse-led outpatient clinic and followed-up for 2 years after radiotherapy. Demographic, disease-specific and nutrition data were collected from case records. The primary outcome measure was maximum body weight loss during the whole study period. The nadir of body weight loss was observed 6 months after radiotherapy. In total, 92 patients of 157 (59%) with no evidence of residual tumour after treatment received enteral nutrition. The mean maximum weight loss for patients receiving enteral nutrition and per oral feeding was 13% and 6%, respectively (p < 0.001). Using multivariate analysis, tumour stage (p < 0.001) was the only independent factor of maximum weight loss. Weight loss was not significantly related to risk for postoperative infection. Weight loss is frequently noted among head and neck cancer patients during and after treatment. Weight loss was not found to be associated with postoperative infections and mortality. Nutritional surveillance is important in all patients, but special attention should be given to those on enteral nutrition and those with more advanced disease.
24.	Faag, Carina (författare) A comprehensive nurse-led intervention for patiens with peripheral vestibular disorders : the feasibility and benefits 2015 Licentiatavhandling (övrigt vetenskapligt/konstnärligt)
25.	Faag, Carina, 1970- (författare) A comprehensive nurse-led intervention for patients with peripheral vestibular disorders : the feasibility and benefits 2015 Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract Dizziness and balance problems are common symptoms at all ages, the symptoms are more common in women than in men and increases with age. Several studies clearly demonstrate that peripheral vestibular disorders symptoms may lead to the patients reporting functional consequences of a physical, mental and social character. The overall aim of this thesis was to investigate the efficacy and feasibility of an intervention for patients with peripheral vestibular disorders that contains patient education in groups in combination with individual support. The study is a randomized controlled trial (RCT). Thirty-six patients participated in the study: the intervention group (n = 18), who received the intervention and standard care, and patients in a control group (n = 18), who received standard care. The intervention includes a patient education program and individualized nursing support during a six-month period. Outcomes were collected by self-assessment questionnaires about dizziness-related symptoms, well-being, sense of coherence, and self-care measured at baseline before randomization and at six and nine months later. All patients were also instructed to complete a diary where they recorded symptoms that arose during an episode of dizziness. The main results show that the patients who received the intervention rated statistically significant fewer vertigo-related symptoms and a higher sense of coherence than the control group at the ninemonth follow-up. The intervention was feasible and seems to support the patients to manage symptoms. The effects were small and must be considered in relation to the efforts of the intervention. Confirmative studies are warranted.
26.	Faag, Carina, et al. (författare) Feasibilitiy and effects of a nursing internvention for patients with peripheral vestibular disorders Annan publikation (övrigt vetenskapligt/konstnärligt)
27.	Faag, Carina, et al. (författare) Feasibility and Effects of a Nursing Intervention for Patients with Peripheral Vestibular Disorders 2017 Ingår i: Rehabilitation Nursing. - : Ovid Technologies (Wolters Kluwer Health). - 0278-4807 .- 2048-7940. ; 42:5, s. 274-281 Tidskriftsartikel (refereegranskat)abstract Purpose: To explore the feasibility and possible outcomes of a nursing intervention in patients with peripheral vestibular disorders. Design: A randomized controlled trial (RCT). Methods: Thirty-six patients participated in the study: the intervention group (n = 18), who received the intervention, and patients in a control group (n = 18), who received standard care. The intervention includes patient education and individualized nursing support during a 6-month rehabilitation period. Outcomes were symptoms, well-being, sense of coherence, and self-care measured at baseline before randomization and at 6 and 9 months later. Findings: At the 9-month follow up, the patients who received the intervention rated significantly fewer vertigo-related symptoms and a higher sense of coherence than the control group. Conclusion: The intervention was feasible and seems to support the patients to manage symptoms, but confirmative studies are warranted. Clinical Relevance: Patient education in combination with individual support may be beneficial to help patients with peripheral disorders during their rehabilitation.
28.	Faag, Carina, 1970-, et al. (författare) Feasibility and effects of a nursing intervention for patients with peripheral vestibular disorders Annan publikation (övrigt vetenskapligt/konstnärligt)
29.	Fjell, Maria, et al. (författare) Patients’ Experiences of Care With or Without the Support of an Interactive App During Neoadjuvant Chemotherapy for Breast Cancer: Interview Study 2022 Ingår i: JMIR Nursing. - : JMIR Publications. - 2562-7600. ; 5:1 Tidskriftsartikel (refereegranskat)abstract Background: Neoadjuvant chemotherapy (NACT) is often recommended for patients with breast cancer with more aggressive tumor characteristics. As with all chemotherapies, they can cause substantially disturbing symptoms. Most patients receive their treatment as outpatients, which means that they must take responsibility for self-care and management of symptoms at home for a long period. Patients with breast cancer undergoing chemotherapy may not receive sufficient support for management of treatment-related symptoms. For patients undergoing NACT, it has been concluded that information and supportive needs are not always met. In our previous study, the use of mobile health to support patients with breast cancer undergoing NACT reduced symptoms during treatment with the support of an interactive app. Therefore, it is important to investigate how patients experience their care and explore any specific contribution that the app may have brought in care.Objective: This study aims to explore patients' experiences of care with or without the support of an interactive app during NACT for breast cancer.Methods: This qualitative study was part of a larger randomized controlled trial and included 40 individual face-to-face interviews conducted with patients in both intervention and control groups after the end of NACT. The interviews were audio recorded, and the data were analyzed inductively using thematic analysis.Results: No major differences in experience of care were observed between the groups. A total of 4 overarching themes emerged. In the first theme, The health care context, patients described care as assessible, although sometimes there was a lack of time and continuity with nurses. In the second theme, Being a recipient of care, it emerged that the patients experienced a warm and positive atmosphere at the clinics. In the third theme, Taking an active role as a patient, patients described being active in searching for information and various ways of participation in their own care. In the fourth theme, The value of the app, patients who had used the app experienced it as a complementary source of information, creating a sense of security. Using the app provided patients with the support of being contacted by a nurse if needed, enabled self-care, and facilitated the planning of daily activities.Conclusions: Overall, patients' experiences of care were similar and mostly positive. However, for patients using the app, it provided additional support for information and self-care and enhanced participation in their own care. The easy access to a nurse gave patients a sense of security. The findings suggest integrating an interactive app as a complement to standard care to support patients with breast cancer during treatment.International registered report identifier (irrid): RR2-DOI: 10.1186/s12885-017-3450-y.
30.	Fjell, Maria, et al. (författare) Patients’ experiences of using an interactive appduring treatment for breast cancer 2018 Ingår i: Quality of Life Research. - : Springer. - 0962-9343 .- 1573-2649. ; 27:s1, s. s20- Tidskriftsartikel (refereegranskat)abstract Aims: To evaluate patients' experiences of using an interactive app for reporting symptoms during neoadjuvant chemotherapy treatment for breast cancer.Methods: The research project is a multicenter Randomized Controlled Trial with a mixed method approach. The content of the interactive app (Interaktor) was developed from the perspective of patients, health care professionals and literature. It is made for use in a smart device including a 14‐symptom questionnaire based on a risk assessment model, which generates alerts to a nurse at the clinic if symptoms are severe. Patients have continuous access to self‐care advice and can follow their symptoms in graphs. The study includes patients recruited from two university hospitals in Sweden, 75 using the app during treatment in comparison to control group (n = 75) with standard care routines. Data was collected between 2015 and 2017 including logged data, interviews with patients and nurses concerning experiences of using the app and participation in care. Outcomes were collected at three time points by questionnaires including symptom distress, health literacy, perceptions of individualized care, sense of coherence and quality of life. Analysis of outcome data is currently ongoing.Results: Results: including logged data showed an 80% adherence to reporting in the app. A total of 16.299 symptoms were reported during the study period and the most frequent symptoms reported were fatigue, sleeping difficulties, pain, nausea, sadness and oral discomfort. Results: from interviews showed that patients using the app noted that it was easy to use with few technical problems. They considered the app as a source for information with the self‐care advice, helping them manage symptoms. Knowing that nurses at the clinic monitored them, led to a feeling of being looked after and cared for. The app was an easy way of getting in contact with the health care if symptoms were severe, which increased the interaction with caregivers, leading to a feeling of security, personalized and participatory care.Conclusions: Using the app during treatment for breast cancer can facilitate management of symptoms, participatory and individualized care.
31.	Fjell, Maria, et al. (författare) Reduced symptom burden with the support of an interactive app during neoadjuvant chemotherapy for breast cancer - A randomized controlled trial 2020 Ingår i: Breast. - : Elsevier. - 0960-9776 .- 1532-3080. ; 51, s. 85-93 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: Neoadjuvant chemotherapy causes distressing symptoms, which have to be managed by patients at home. Assessing and acting upon relevant patient-reported symptoms regularly with the support of mHealth such as apps, has shown to decrease symptom burden and improve health-related quality of life (HRQoL). There is a lack of apps for patients with breast cancer which are tested in rigorous trials and only a few include interactive components for immediate clinical management. The aim of this study was to evaluate whether the use of the interactive app Interaktor improves patients' levels of symptom burden and HRQoL during neoadjuvant chemotherapy for breast cancer.MATERIALS AND METHODS: This randomized controlled trial included patients in an intervention group (n = 74) and a control group (n = 75), recruited at two university hospitals in Stockholm, Sweden. The intervention group used Interaktor for symptom reporting, self-care advice and support from health-care professionals during treatment, and the control group received standard care alone. Self-reported symptoms and HRQoL were assessed at two time points to determine differences between the groups.RESULTS: The intervention group rated statistically significant less symptom prevalence in nausea, vomiting, feeling sad, appetite loss and constipation. Overall symptom distress and physical symptom distress were rated statistically significant lower in the intervention group. Further, emotional functioning was rated statistically significant higher in the intervention group.CONCLUSIONS: By using the Interaktor app in clinical practice, patients get individual support when managing treatment-related symptoms during neoadjuvant chemotherapy for breast cancer, leading to decreased symptom burden and improved emotional functioning.
32.	Gellerstedt, Linda, et al. (författare) Men's experiences of receiving a prostate cancer diagnosis after opportunistic screening : A qualitative descriptive secondary analysis 2022 Ingår i: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 25:5, s. 2485-2491 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Prostate cancer is one of the most common types of cancer in men and could occur without symptoms. Screening has been debated but remains controversial and, in most countries, organized population-based screening does not exist. The aim of this study was to describe men's experiences of receiving a prostate cancer diagnosis after opportunistic screening.METHODS: This study is a secondary analysis from interviews with 17 men (aged 56-80 years) who had undergone curative treatment for prostate cancer. Data were collected in an urban region of Sweden through interviews conducted face to face or by telephone. An inductive content analysis was used with Consolidated criteria for Reporting Qualitative research as a reporting checklist.RESULTS: Two main categories were identified. Screening is a lifesaver enclosed by ethical dilemmas reflects how men considered screening as a lifesaving test. Testing was surrounded by injustice and an eagerness to encourage other men to undergo screening. Facing challenges during diagnosis reflects the men's experiences of being in an unknown field yet expected to engage in decision-making concerning appropriate treatment. Receiving the diagnosis rendered mixed emotions about having a cancer disease, that the treatment could cause lifelong symptom distress and the men described being hesitant to talk about their diagnosis.CONCLUSIONS: The findings highlight men's opinions about screening and that the lack of routine screening represents injustice. The men considered this as an ethical question of lifesaving justice, while stakeholders may argue that screening could lead to unnecessary suffering and overtreatment. Men do not always talk openly about their diagnosis, linked to the fact that it concerns intimate areas. It is important to balance the information in relation to shared decision-making regarding treatment. Health care professionals have an ethical responsibility to support and coach the patient in their decision.PATIENT OR PUBLIC CONTRIBUTION: This study was based on interviews with men who had experienced a diagnosis of prostate cancer.
33.	Gustavell, Tina, et al. (författare) Symptoms and self-care following pancreaticoduodenectomy : Perspectives from patients and healthcare professionals - Foundation for an interactive ICT application 2017 Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 26, s. 36-41 Tidskriftsartikel (refereegranskat)abstract PurposePoor prognosis and a problematic recovery period after pancreaticoduodenectomy means that patients may benefit from early detection of symptoms and support for self-management. Interactive Information and Communication Technology tools can be used for this purpose, but the content needs to be relevant to patients as well as healthcare professionals. To facilitate development of the content of an application for this purpose, the aim of this study was to explore common symptoms and self-care in the first six months after pancreaticoduodenectomy, as identified by patients and healthcare professionals.MethodData were collected through individual interviews with patients (n = 14), along with two focus group interviews and one individual interview with healthcare professionals (n = 10). Data were analysed using qualitative content analysis.ResultsCommon symptoms after surgery were those related to eating, bowel function and emotional wellbeing, along with fatigue and pain. Some self-care activities and advice were mentioned in the interviews. The patients often experienced a lack of advice on self-care at discharge.ConclusionsThe results render knowledge of the symptoms it is important to be aware of and to assess regularly after pancreaticoduodenectomy. The results also contribute to knowledge about specific self-care related to these symptoms, even though it was not extensively described, and further research is needed to define evidence-based self-care advice.
34.	Göransson, Carina, 1967-, et al. (författare) An app for supporting older people receiving home care - usage, aspects of health and health literacy : a quasi-experimental study 2020 Ingår i: BMC Medical Informatics and Decision Making. - London : BioMed Central. - 1472-6947. ; 20:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: During the last decade, there has been an increase in studies describing use of mHealth, using smartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people's usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time.METHODS: A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6-month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics.RESULTS: The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people's communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time.CONCLUSIONS: The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, and which aspects of health of importance to support by an app.
35.	Göransson, Carina, 1967-, et al. (författare) Evaluating an app for older people : interaction, health and health literacy, a quasi-experimental study Annan publikation (övrigt vetenskapligt/konstnärligt)
36.	Göransson, Carina, 1967-, et al. (författare) Perspectives of health and self-care among older persons-To be implemented in an interactive information and communication technology-platform 2017 Ingår i: Journal of Clinical Nursing. - Chichester : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 26:23-24, s. 4745-4755 Tidskriftsartikel (refereegranskat)abstract AIM AND OBJECTIVES: To acquire knowledge regarding the contents to be implemented in an interactive information and communication technology-platform perceived to be relevant to health and self-care among older persons based on the literature, healthcare professionals and the older persons themselves.BACKGROUND: The growing ageing population places demands on the healthcare system to promote healthy ageing and to strengthen the older person's self-care ability. This requires innovative approaches to facilitate communication between the older person and healthcare professionals, and to increase the older person's participation in their care. An information and communication technology-platform could be used for this purpose, but the content needs to be relevant to both the older persons and the healthcare professionals.DESIGN: Descriptive qualitative design.METHODS: This study was based on three samplings: a scoping review of the literature (n = 20 articles), interviews with healthcare professionals (n = 5) and a secondary analysis of interviews with older persons (n = 8) and nursing assistants (n = 7). The data were analysed using qualitative content analysis.RESULTS: Four areas were identified to be of relevance to older persons' perceived health: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care. Self-care was described in the literature and by the healthcare professionals more than by the older persons.CONCLUSIONS: The results show a concordance in the data samplings that give a clear indication of the areas relevant to older persons' health and self-care that can be integrated in an interactive information and communication technology-platform for use in regular daily care assessments. Descriptions of self-care were limited indicating a possible gap in knowledge that requires further research.RELEVANCE TO CLINICAL PRACTICE: Areas relevant to older persons' health and self-care could be used for regular assessment to support and promote healthy ageing.
37.	Göransson, Carina, 1967-, et al. (författare) Self-care ability and sense of security among older persons when using an app as a tool for support 2020 Ingår i: Scandinavian Journal of Caring Sciences. - Chichester : Blackwell Publishing. - 0283-9318 .- 1471-6712. ; 34:3, s. 772-781 Tidskriftsartikel (refereegranskat)abstract THE STUDY'S RATIONALE: The need for home care among older persons is increasing, and mHealth is evolving to help meet the challenge. When developing an app to help maintain their health, it is essential to incorporate older persons' preferences.AIMS AND OBJECTIVES: To describe and evaluate the experiences of self-care support and sense of security among older persons using an interactive app to report health concerns.METHODOLOGICAL DESIGN AND JUSTIFICATION: The study had a descriptive and evaluative design. Qualitative and quantitative methods were applied to achieve a broader understanding.ETHICAL ISSUES AND APPROVAL: Ethical approval was obtained from the Regional Ethical Review Board. The older persons received verbal and oral information about the study and gave written informed consent.RESEARCH METHODS: Questionnaires (n = 17 older persons) answered at baseline, end of the intervention and at a 6-month follow-up were analysed with statistical analysis. Interviews (n = 17 older persons) conducted at the end of the intervention were analysed using a qualitative directed approach.MEASUREMENTS AND INTERVENTION: The questionnaire included the Appraisal of Self-care Agency Scale and a question concerning sense of security. For 3 months, the older persons used an app for regular reporting of health concerns. The app included self-care advice, graphs and a risk assessment model that generated alerts directly to the nurses.RESULTS: The older persons described how self-care and sense of security increased at the end of intervention, but statistically, it was shown to decrease afterwards.STUDY LIMITATIONS: The small sample size for statistical analysis.CONCLUSIONS: This study shows that an app can be a complementary tool to conventional home care that can increase older persons' sense of security and self-care ability. The results mirror the older persons' awareness that the support they received with the app was only temporary. Larger studies are needed for generalisation.
38.	Göransson, Carina, 1967-, et al. (författare) Self-care ability and sense of security among older persons when using an app as a tool for support Annan publikation (övrigt vetenskapligt/konstnärligt)
39.	Göransson, Carina, 1967-, et al. (författare) Testing an app for reporting health concerns-Experiences from older people and home care nurses 2018 Ingår i: International Journal of Older People Nursing. - Hoboken : Wiley-Blackwell. - 1748-3735 .- 1748-3743. ; 13:2 Tidskriftsartikel (refereegranskat)abstract Aims and objectives: To explore the experiences of using an app among older people with home-based health care and their nurses. Background: Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. Design: Explorative qualitative design. Methods: For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. Results: The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. Conclusions: The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. Implications for practice: The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care. © 2017 John Wiley & Sons Ltd
40.	Hermansson, Liselotte M. N., 1954-, et al. (författare) Test-retest reliability and rater agreements of the Assessment of Capacity for Myoelectric Control version 2.0. 2014 Ingår i: MEC'14. - Frederiction, New Brunswick, Cananda : University of New Brunswick, Fredericton, Canada. Konferensbidrag (refereegranskat)abstract Introduction: The Assessment of Capacity for Myoelectric Control (ACMC) is an observation-based tool that evaluates ability to control a myoelectric prosthetic hand [1]. Validity evidence led to ACMC version 2.0, but test - retest reliability and minimal detectable change (MDC) of ACMC have never been evaluated. For instruments that have an evaluative purpose, such as ACMC, the MDC is a useful clinical value to suggest whether a change is due to measurement error or true change. Investigation of rater agreements in this version was also needed because it has new definitions in certain rating categories and items.Methods: Upper limb prosthesis users (n=25, 13/12 male/female, 15/10 congenital/acquired; mean age 27.5, range 7-72, years) performed one standardized activity twice, 2–5 weeks apart. Activity performances were video-recorded and assessed by two ACMC raters. The item raw scores were converted to Rasch interval ability measures. Ordinal data were analyzed by weighted κ; interval data were analyzed by intraclass correlation coefficient (ICC) and Bland–Altman limit of agreement (LOA) method.Results: For test–retest reliability, ICC2,1 was 0.94. Average weighted κ was 0.76 and percentage agreement (PA) was 85%. In individual items, weighted κ agreements were fair to excellent (0.52・1.00) and PAs were ≥6・100%. MDC95 was ≤.55 logits (1 rater) and 0.69 logits (2 raters). All MDC95 values were ≤5% of the total ability logit range. In the Bland-Altman plot the upper and lower LOA were 0.86 and -0.88 respectively. All except one participant were within the 95% LOA. For inter-rater reliability, weighted κ agreements were fair to excellent in both sessions (0.44–1.00), and ICC2,1 was 0.95 (test) and 0.92 (retest). Intra-rater agreement (rater 1) was excellent (ICC3,1 0.98). The weighted κ values of the test session were all >0.80 and the PAs for each item were ≥6%.Conclusion: The results of the present study demonstrate different aspects of the reliability of ACMC 2.0. Based on these results, we can recommend ACMC as a tool to follow the progress of users in controlling their myoelectric prostheses. The MDC is clinically useful for ACMC raters as a guideline when following the client’s changes over time.
41.	Holmefur, Marie, 1968-, et al. (författare) Measurement properties of the 13-item sense of coherence scale using Rasch analysis 2015 Ingår i: Quality of Life Research. - : Springer Netherlands. - 0962-9343 .- 1573-2649. ; 24:6, s. 1455-1463 Tidskriftsartikel (refereegranskat)abstract Purpose: The sense of coherence (SOC) scale is widely used and has an extensive history in research. The psychometric properties of the SOC scale have been investigated using classic test theory, but modern test theory enables a more multifaceted investigation of the properties of the SOC scale. The aim of this study was to explore the measurement properties of the SOC scale using the Rasch measurement model.Methods: SOC questionnaires from a sample of 623 healthy adults were analysed using Rasch analysis. Aspects analysed were rating scale functioning, item fit, unidimensionality, differential item functioning (DIF), targeting, and reliability.Results: Rating scale analysis showed that the seven scale steps were not utilized in the intended manner and that a shortening to five categories would be beneficial. Twelve out of the 13 items showed acceptable goodness-of-fit and 43 % of the variance was explained by the SOC dimension in the principal components analysis. There was no DIF between subgroups in the sample. The items were well targeted to the sample SOC level with no ceiling or floor effects. Item and person reliability were good and the person separation index was 2.05 indicating that the scale can separate three different levels of SOC, which corresponds well to its theoretical base.Conclusions: The SOC scale is generally well functioning; however, the three components of SOC seem to influence the PCA results. The scale would benefit from a reduction from seven to five scale steps, which would need to be investigated further.
42.	Hälleberg-Nyman, Maria, 1968-, et al. (författare) Intermittent versus indwelling urinary catheterisation in hip surgery patients : a randomised controlled trial with cost-effectiveness analysis Annan publikation (övrigt vetenskapligt/konstnärligt)abstract Background: Hip surgery is associated with a risk for postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). Presently, there is limited knowledge whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery.Objectives: The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness.Design: Randomised controlled trial with cost-effectiveness analysis. Setting: The study was carried out at an orthopaedic department at a Swedish university hospital.Method: One hundred seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge. Results: Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (p = 0.618). The patients in the intermittent catheterisation group were more often catheterised (p <0.001) and required more bladder scans (p <0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p <0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods.Conclusions: In the perspective of cost-effectiveness both indwelling and intermittent methods could be appropriate in clinical praxis. Both methods have advantages and disadvantages but by not using indwelling catheterisation routinely in this patient group unnecessary catheterisations might be avoided.
43.	Hälleberg-Nyman, Maria, 1968-, et al. (författare) Intermittent versus indwelling urinary catheterisation in hip surgery patients : a randomised controlled trial with cost-effectiveness analysis 2013 Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 50:12, s. 1589-1598 Tidskriftsartikel (refereegranskat)abstract Background Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery.Objectives The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness.Design Randomised controlled trial with cost-effectiveness analysis.Setting The study was carried out at an orthopaedic department at a Swedish University Hospital.Methods One hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge.Results Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (absolute difference 2.4%, 95% CI −6.9–11.6%) The patients in the intermittent catheterisation group were more often catheterised (p < 0.001) and required more bladder scans (p < 0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p < 0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods.Conclusions Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group.
44.	Hälleberg Nyman, Maria, 1968-, et al. (författare) Patients' Perspective on Participation in Care With or Without the Support of a Smartphone App During Radiotherapy for Prostate Cancer : Qualitative Study 2017 Ingår i: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 5:7 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Patients with prostate cancer are often cared for as outpatients during radiotherapy, which can be an aggravating circumstance for patient participation. There is a need to evaluate whether an interactive smartphone app could enable participation in care, specifically during treatment for prostate cancer. The interactive app (Interaktor) used in this study is developed in codesign with patients and health care professionals; it includes daily reports of symptoms, a risk assessment model, evidence-based self-care advice, along with the provision of immediate access to clinicians.OBJECTIVE: The aim of this study was to explore how patients with prostate cancer perceived their participation with or without the support of the smartphone app during radiotherapy.METHODS: A total of 28 prostate cancer patients receiving adjuvant radiotherapy were interviewed about their perceived participation in their own care. All the patients interviewed in this study participated in an intervention study where the control group received standard care that comprised having access to a contact nurse to turn to with any concerns during their treatment. In addition to standard care, the patients in the intervention group received the app downloaded in a smartphone. The patients' age ranged between 57 and 77 years; 17 patients used the smartphone app. The interviews were analyzed with directed qualitative content analysis.RESULTS: The four dimensions of patient participation, which include mutual participation, fight for participation, requirement for participation, and participation in getting basic needs satisfied, were confirmed as valid perspectives in the interviews with the patients with prostate cancer, irrespective of whether they used the smartphone app. However, the patients who had used the smartphone app described it as a facilitating factor, especially for mutual participation.CONCLUSIONS: Using innovative ways to communicate with patients, such as an interactive app for symptom management with contact with health care in real time, can successfully help achieve increased patient participation in care.
45.	Hälleberg-Nyman, Maria, 1968- (författare) Urinary catheter policies for short-term bladder drainage in hip surgery patients 2012 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients.In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation.In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.
46.	Johansson, Birgitta, et al. (författare) Editorial comment on "Disregarding clinical trial-based patient-reported outcomes is unwarranted : Five advances to substantiate the scientific stringency of quality-of-life measurement". 2010 Ingår i: Acta Oncologica. - Oslo, Norway : Taylor & Francis. - 0284-186X .- 1651-226X. ; 49:2, s. 163-165 Tidskriftsartikel (refereegranskat)
47.	Johansson, Birgitta, et al. (författare) Editorial comment on "Disregarding clinical trial-based patient-reported outcomes is unwarranted: Five advances to substantiate the scientific stringency of quality-of-life measurement". : in Acta Oncologica(ISSN 0284-186X) vol 49, issue 2, pp 163-165 2010 Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 49:2, s. 163-165 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Abstract Not available
48.	Khanjari, Sedigheh, et al. (författare) Lower sense of coherence, negative religious coping, and disease severity as indicators of a decrease in quality of life in Iranian family caregivers of relatives with breast cancer during the first 6 months after diagnosis 2012 Ingår i: Cancer Nursing. - Philadelpha, USA : Lippincott Williams & Wilkins. - 0162-220X .- 1538-9804. ; 35:2, s. 148-156 Tidskriftsartikel (refereegranskat)abstract Background: Breast cancer challenges not only the patients who suffer from the disease but also their family caregivers. Little is known about how Iranian family caregivers are influenced.Objective: The objective of the study was to describe quality of life (QoL), well-being, sense of coherence (SOC), spirituality, and religious coping in family caregivers of patients with breast cancer at the time of diagnosis (T1) and 6 months after diagnosis (T2) and identify predictive factors of change in QoL.Methods: Data were collected from 150 family caregivers. The Persian version of Caregiver Quality of Life Index-Cancer, Sense of Coherence Scale, Spirituality Perspective Scale, Religious Coping Scale, and the Health Index were used at T1 and T2.Results: The results showed significant increase in overall QoL (P = .00) and well-being (P = .03) at T2. However, ratings of their SOC (P = .03), spirituality (P = .01), and negative religious coping (P = .00) decreased. Multiple regression analyses revealed the rating of QoL at T1 as the strongest predictor in the rating of quality-of-life change at T2 followed by the degree of SOC, negative religious coping, and patients having more severe breast cancer (R-2 = 0.64).Conclusion: Despite improved QoL in the sample from diagnosis to 6 months, family caregivers struggle to cope with the situation.Implications for Practice: It is suggested to develop and investigate the effects of support programs targeting coping ability in Iranian family caregivers to women with breast cancer.
49.	Khanjari, Sedigheh, et al. (författare) Psychometric testing of the Caregiver Quality of Life Index-Cancer scale in an Iranian sample of family caregivers to newly diagnosed breast cancer women 2012 Ingår i: Journal of Clinical Nursing. - Malden, USA : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 21:3-4, s. 573-584 Tidskriftsartikel (refereegranskat)abstract Aim: To translate and test the reliability and validity of the Persian version of the Caregiver Quality of Life Index-Cancer scale.Background: Research across many countries has determined quality of life of cancer patients, but few attempts have been made to measure the quality of life of family caregivers of patients with breast cancer. The Caregiver Quality of Life Index-Cancer scale was developed for this purpose, but until now, it has not been translated into or tested in the Persian language.Design: Methodological research design. Methods. After standard translation, the 35-item Caregiver Quality of Life Index-Cancer scale was administered to 166 Iranian family caregivers of patients with breast cancer. A confirmatory factor analysis was carried out using LISREL to test the scale's construct validity. Further, the internal consistency and convergent validity of the instrument were tested. For convergent validity, four instruments were used in the study: sense of coherence scale, spirituality perspective scale, health index and brief religious coping scale.Results: The confirmatory factor analysis resulted in the same four-factor structure as the original, though, with somewhat different item loadings. The Persian version of the Caregiver Quality of Life Index-Cancer scales had satisfactory internal consistency ( 0 72-0 90). Tests of convergent validity showed that all hypotheses were confirmed. A hierarchical multiple regression analysis additionally confirmed the convergent validity between the total Caregiver Quality of Life Index-Cancer score and sense of coherence ((beta) over cap = 0 34), negative religious coping ((beta) over cap = -0 21), education ((beta) over cap = 0 24) and the more severe stage of breast cancer ((beta) over cap = 0 23), in total explaining 41% of the variance.Conclusion: The Persian version of the Caregiver Quality of Life Index-Cancer scale could be a reliable and valid measure in Iranian family caregivers of patients with breast cancer.Relevance to clinical practice: The Persian version of the Caregiver Quality of Life Index-Cancer scale is simple to administer and will help nurses to identify the nursing needs of family caregivers.
50.	Khanjari, Sedigheh, et al. (författare) Quality of life, Sense of Coherence, Religious and Spiritual aspects in a sample of Iranian family caregivers of patients with breast cancer at the time of diagnosis and six months later 2010 Ingår i: Quality of Life Research. - Amsterdam, Netherlands : Springer. - 0962-9343 .- 1573-2649. ; 19, s. 47-47 Tidskriftsartikel (refereegranskat)

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