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| 4. |
- Andersson, Inger S., et al.
(författare)
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Perceptions of nursing care quality, in acute hospital settings measured by the Karen instruments
- 2013
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Ingår i: Journal of Nursing Management. - : Blackwell Publishing. - 0966-0429 .- 1365-2834. ; 21:1, s. 87-93
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Tidskriftsartikel (refereegranskat)abstract
- Aims The objectives of this study were to measure the quality of nursing care from the perspectives of patients and personnel and to compare these perspectives. Background The perception of quality in nursing care is affected by patient needs and it is common that patients and personnel disagree on the nature of the quality. Thus, it is important to measure the quality from both perspectives. Method A total of 95 patients and 120 personnel from surgical and medical wards at a hospital in Sweden participated. The Karen instruments were used for data collection. A scale index was used for comparison of the perspectives. Results The patients and personnel were satisfied with the quality of care and there were no obvious differences in the total index. The different subscales indicated areas of lower care quality in need of improvement. Conclusion The quality of the care seemed to be satisfactory from the perspectives of both the patients and the personal. Further analysis from the subscale or a variable level is needed to define areas of lower care quality. Implications for Nursing Management Measurements have to be carried out continuously to guarantee care quality over time, as a result of organisational changes and financial cutbacks.
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| 5. |
- Aspán, Margareta, 1965-
(författare)
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Delade meningar : Om värdepedagogiska invitationer för barns inflytande och inkännande
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In two studies efforts to enhance children’s possibilities to participate and to improve the school as a social meeting place are followed. The first focuses on a three year project, aimed to work out new forms for pupils (grades 6-9) to participate in the school organization. The second study follows younger children (grades 1-5) in specific lessons where social dilemmas are discussed and solved, which can be characterized as social and emotional learning. Both studies concern the school’s option to handle the child fostering to individual actors, their independence and ability to take part through ’self-expression’, and at the same time instill the society’s ‘common value system’. By following pedagogical interventions by participant observations and interviews, it appears that there is little interest to let the children get involved out of their own questions and problem definitions. In the participation project it appears that children often are rather strictly directed by adults, and they are not so often let to use their critical and reflective thinking. In the second study each exercise is scrutinized for what it affords the children. Also these results show that the underlying intentions are not to create pedagogical conditions that support communication that involves the children’s own perspectives and interests, in an ‘exploratory’ speech in learning about one’s self, about the other and the world. The children’s resistance to perform properly can be seen as a way to recapture some of their autonomy to break the ‘ritualized' communication. In both studies children’s use of a field of free action is restricted. The interventions are analyzed through the concept of intersubjectivity and of child perspective. I conclude that the basis for why and how these efforts are done can be seen in a cultural childhood narrative: they are in certain aspects seen as ‘not yets’ despite the late modern emphasis on competence and responsibility.
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| 6. |
- Bader, Dan, et al.
(författare)
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Laboratory measurement of the interface pressures applied by active therapy support surfaces : A consensus document
- 2010
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Ingår i: Journal of Tissue Viability. - : Elsevier BV. - 0965-206X. ; 19:1, s. 2-6
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Tidskriftsartikel (refereegranskat)abstract
- A key element in pressure ulcer prevention and management is the selection of appropriate pressure redistributing (PR) patient support surfaces for use while seated and in bed. However little explicit guidance exists allowing standardised quantitative comparison of different PR surfaces based upon their ability to redistribute pressure from anatomical landmarks such as the heels and sacrum. In 2008 a working group was established in Europe through the US National Pressure Ulcer Advisory Panel (NPUAP) support surface standardisation initiative (S3I) and under the aegis of the European Pressure Ulcer Advisory Panel with the specific remit of developing test methods for the evaluation of active therapy support surfaces (alternating pressure air mattresses). This report describes a consensus development process to agree test methods appropriate to compare active therapy surfaces based upon their ability to redistribute pressure from the sacrum and the heels.
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| 7. |
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| 8. |
- Bergstrand, Sara, et al.
(författare)
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Blood flow measurements at different depths using photoplethysmography and laser Doppler techniques
- 2009
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Ingår i: Skin research and technology. - : Wiley-Blackwell. - 0909-752X .- 1600-0846. ; 15:2, s. 139-147
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Tidskriftsartikel (refereegranskat)abstract
- Background/purpose: This study has evaluated a multi-parametric system combining laser Doppler flowmetry and photoplethysmography in a single probe for the simultaneous measurement of blood flow at different depths in the tissue. This system will be used to facilitate the understanding of pressure ulcer formation and in the evaluation of pressure ulcer mattresses.Methods: The blood flow in the tissue over the sacrum was measured before, during and after loading with 37.5 mmHg, respectively, 50.0 mmHg. The evaluation of the system consisted of one clinical part, and the other part focusing on the technicalities of the probe prototype.Results: An increase in blood flow while loading was the most common response, but when the blood flow decreased during loading it was most affected at the skin surface and the blood flow responses may be different due to depths of measurement. Reactive hyperaemia may occur more frequently in the superficial layers of the tissue.Conclusion: The study showed that the new system is satisfactory for measuring tissue blood flow at different depths. The laser Doppler complements the photoplethysmography, and further development of the system into a thin flexible probe with the ability to measure a larger area is required.
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| 9. |
- Bergstrand, Sara, et al.
(författare)
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Existence of Tissue Blood Flow in Response to External Pressure in the Sacral Region of Elderly Individuals - Using an Optical Probe Prototype
- 2010
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Ingår i: MICROCIRCULATION. - : Taylor and Francis. - 1073-9688 .- 1549-8719. ; 17:4, s. 311-319
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Tidskriftsartikel (refereegranskat)abstract
- Pandgt;Objective: The aim was to investigate the existence of sacral tissue blood flow at different depths in response to external pressure and compression in elderly individuals using a newly developed optical probe prototype. Methods: The tissue blood flow and tissue thickness in the sacral area were measured during load in 17 individuals using laser Doppler flowmetry and photoplethysmography in a combined probe, and digital ultrasound. Results: The mean age was 68.6 +/- 7.0 years. While loading, the mean compression was 60.3 +/- 11.9%. The number of participants with existing blood flow while loading increased with increased measurement depth. None had enclosed blood flow deep in the tissue and at the same time an existing more superficial blood flow. Correlation between tissue thickness and BMI in unloaded and loaded sacral tissue was shown: r = 0.68 (P = 0.003) and r = 0.68 (P = 0.003). Conclusions: Sacral tissue is highly compressed by external load. There seems to be a difference in responses to load in the different tissue layers, as occluded blood flow in deeper tissue layers do not occur unless the blood flow in the superficial tissue layers is occluded.
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| 10. |
- Bergstrand, Sara, et al.
(författare)
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Microcirculatory responses of sacral tissue in healthy individuals and in patients on different pressure-redistribution mattresses
- 2015
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Ingår i: Journal of Wound Care. - : Mark Allen Group. - 0969-0700 .- 2052-2916. ; 24:8, s. 346-358
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to explore the interaction between interface pressure and pressure-induced vasodilation and reactive hyperemia with different pressureredistribution mattresses.Method: A cross-sectional study was performed with a convenience sample of 42 healthy individuals between 18 and 64 years of age, 38 healthy individuals 65 years or older, and 35 inpatients 65 years or older at a university hospital in Sweden. Blood flow was measured at depths of 1 mm, 2 mm, and 10 mm using a combined system of laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses.Results: There were significant differences between the three foam mattresses with regard to average sacral pressure, peak sacral pressure, and local probe pressure with the lowest values at the visco-elastic foam/air mattress (23.5 ± 2.5 mmHg, 49.3 ± 11.1 mmHg, 29.2 ± 14.0 mmHg respectively). A greater proportion of subjects had affected blood flow in terms of lack of pressure-induced vasodilation on the visco-elastic foam/air mattress compared to the alternating pressure mattress at tissue depths of 2 mm (39.0% vs. 20.0%, respectively) and 10 mm (56.9 % vs. 35.1%, respectively). Eleven individuals, including subjects in all three subject groups were identified with no pressure-induced vasodilation or reactive hyperemia in any mattress, and this was considered a high-risk blood flow response.Conclusion: Interface pressure magnitudes considered not harmful during pressure-exposure lying on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared to the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow indicating a more affected blood flow. Three young healthy individuals were identified with the high-risk blood flow response, indicating an innate vulnerability to pressure exposure and may not benefit from pressure-redistribution mattresses. Finally it was shown that the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible but assessment of pressure-induced vasodilation and reactive hyperemia could be a new possibility to assess individualized physiological measurements of mechanisms known to be related to pressure ulcer development.
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| 11. |
- Bergstrand, Sara, et al.
(författare)
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Pressure-induced vasodilation and reactive hyperemia at different depths in sacral tissue under clinically relevant conditions
- 2014
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Ingår i: Microcirculation. - : John Wiley & Sons. - 1073-9688 .- 1549-8719. ; 21:8, s. 761-771
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To characterize pressure-induced vasodilatation and reactive hyperemia at different sacral tissue depths in different populations under clinically relevant pressure exposure.METHODS: Forty-two subjects (< 65 years), 38 subjects (≥ 65 years), and 35 patients (≥ 65 years) participated. Interface pressure, skin temperature, and blood flow at tissue depths of 1 mm, 2 mm, and 10 mm (using laser Doppler flowmetry and photoplethysmography) were measured in the sacral tissue before, during, and after load in a supine position.RESULTS: pressure-induced vasodilatation and reactive hyperemia were observed at three tissue depths. At 10 mm depth, the proportion of subjects with a lack of pressure-induced vasodilatation was higher compared to superficial depths. The patients had higher interface pressure during load than the healthy individuals, but there were no significant differences in blood flow. Twenty-nine subjects in all three study groups were identified with a lack of pressure-induced vasodilatation and reactive hyperemia.CONCLUSIONS: pressure-induced vasodilatation and reactive hyperemia can be measured at different tissue depths. A lack of these responses was found in healthy individuals as well as in patients indicating an innate susceptibility in some individuals, and are potential important factors to evaluate in order to better understand the etiology of pressure ulcers.
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| 12. |
- Bergstrand, Sara, 1978-
(författare)
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Preventing pressure ulcers by assessment of the microcirculation in tissue exposed to pressure
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to combine optical methods into a system with the ability to simultaneously measure blood flow changes at different tissue depths. The goal of such a system was to reveal vascular mechanisms relevant to pressure ulcer etiology under clinically relevant conditions and in relation to the evaluation of pressure-redistribution support surfaces.This thesis consists of four quantitative, cross-sectional studies measuring blood flow responses before, during, and after pressure exposure of the sacral tissue. Two optical methods – photoplethysmography and laser Doppler flowmetry – were combined in a newly developed system that has the ability to discriminate blood flows at different tissue depths. Studies I and II explored blood flow responses at different depths in 17 individuals. In Study I the blood flow was related to tissue thickness and tissue compression during pressure exposure of ≥ 220 mmHg. In Study II, the sacral tissue was loaded with 37.5 mmHg and 50.0 mmHg, and the variation in blood flow was measured. Studies III and IV included 42 healthy individuals < 65 years, 38 healthy individuals ≥ 65 years, and 35 patients ≥ 65 years. Study III included between-subject comparisons of blood flow and pressure between individuals in the three study groups lying in supine positions on a standard hospital mattress. Study IV added within-subject comparisons while the individual was lying on four different types of mattress. The studies explored the vascular phenomena pressure-induced vasodilation (PIV) and reactive hyperemia (RH).The most common blood flow response to tissue exposure in this thesis was PIV, although a decrease in blood flow (a lack of PIV) was observed in some individuals. The patients tended to have higher interface pressure during pressure exposure than the healthy groups but no differences in blood flow responses were seen. Our results showed that pressure levels that are normally considered to be harmless could have a significant effect on the microcirculation in different tissue structures. Differences in individual blood flow responses in terms of PIV and RH were seen, and a larger proportion of individuals lacked these responses in the deeper tissue structures compared to more superficial tissue structures.This thesis identified PIV and RH that are important vascular mechanisms for pressure ulcer development and revealed for the first time that PIV and RH are present at different depths under clinically relevant conditions. The thesis also identified a population of individuals not previously identified who lack both PIV and RH and seem to be particularly vulnerable to pressure exposure. Further, this thesis has added a new perspective to the microcirculation in pressure ulcer etiology in terms of blood flow regulation and endothelial function that are anchored in clinically relevant studies. Finally, the evaluation of pressureredistribution support surfaces in terms of mean blood flow during and after tissue exposure was shown to be unfeasible, but the assessment of PIV and RH could provide a new possibility for measuring individual physiological responses that are known to be related to pressure ulcer development.
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| 14. |
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| 15. |
- Bergstrand, Sara, 1978-
(författare)
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Tissue Blood Flow Responses to External Pressure Using LDF and PPG : Testing a System Developed for Pressure Ulcer Research
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pressure ulcers are a problem for immobile individuals, and having pressure ulcers impact and restrict the daily and are often associated with pain. Pressure ulcers occur frequently and cause high costs for the health care system. The prevention of pressure ulcers by focussing on different mattresses and overlays aimed to reduce the interface pressure or the pressure exposure of the tissue. The problem is the poor evaluation of this type of equipment. There are important factors regarding pressure ulcer development, pressure, shear, temperature and humidity. People are affected by external pressure in different ways and therefore it is preferable to measure the effect of pressure as a complement to the pressure measurement and thus we consider blood flow measurements to be a suitable method.Aims: The aim of Study I, the first part in this thesis was to investigate the existence of sacral tissue blood flow at different depths in response to external pressure in elderly individuals as a part of evaluation of a. newly developed system. The aim of Study II, the second part was to evaluate a multiparametric system combining LDF and photoplethysmography into a single probe, for the simultaneous measurement of blood flow at different depths in the sacral tissue when the tissue is exposed to external load. This new system will be used to facilitate the understanding of pressure ulcer formation.Methods: To be able to observe tissue blood flow, the non-invasive optical methods laser Doppler flowmetry and photoplethysmography were used. In this thesis a newly developed prototype probe was used, combining the two methods. Green light and infrared light were used in the PPG instrument for penetrating the depths of approximately 2 mm, 8 mm and 20 mm depths. A HeNe laser was used to measure the superficial skin blood flow, <1 mm depth. The prototype probe, made of silicone was fixed in a stiff 10×10 cm plate.Seventeen active individuals over the age of 60 were recruited for the two studies. In Study I, the subject´s sacral blood flow and tissue thickness (using ultrasound) were measured in unloaded position and in supine position loading the area with their own body weight. In Study II, the sacral area was provoked with external load at 37.5 mmHg and 50.0 mmHg and the relative change in blood flow at different depths was observed before, during and after load.Results: Study I showed that the sacral tissue in elderly individuals is highly affected by load and is compressed by 60.3 ± 11.9%. The mean sacral tissue thickness was 26 ± 13 mm in unloaded tissue and 10 ± 6 mm in loaded tissue. Correlations were found between BMI and tissue thickness: both TTunload r=0.68 (p=0.003) and TTload r=0.68 (p=0.003). Almost all subjects had affected blood flow superficially but only occasionally deeper in the tissue and findings may indicate that the blood flow is occluded in the superficial layer before it is occluded deeper in the tissue structure. The most common response in Study II was an increase in blood flow while loading. In those occasions when the blood flow decreased, it was mostly affected at the skin surface and the reactive hyperaemia occurred more frequently in the superficial tissue structures. The blood flow responses may be different in the different tissue layers.Conclusions: The newly developed system was found to be suitable for measuring tissue blood flow at different depths; however the prototype probe had some limitations that will be solved in the further development of the system into a thin flexible probe with ability to measure a larger area.
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| 16. |
- Björk, Elisabeth, et al.
(författare)
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Single-stage hydrocyclone fractionation of refined bleached softwood pulp
- 2017
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Ingår i: Paper Conference and Trade Show, PaperCon 2017: Renew, Rethink, Redefine the Future. - : TAPPI Press. ; , s. 878-905, s. 878-905
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Refined bleached chemical softwood was fractionated using a hydrocyclone in a fine and a coarse fraction. The trials were done at three inject concentrations, three coarse fraction volume ratios, and with pulps refined with two refining levels.A large difference in sheet properties between fine and coarse fraction was observed. Compared with the feed pulp, the relative change in the sheet properties increased more in the fine fractions than it decreased in the coarse fractions. Increased fines proportion had a positive effect on all properties up to a certain level when a further improvement could not be observed. Interestingly, the fine fractions of both refining levels reached the same absolute strength level, both for the tensile properties and z-strength. The fine fractions at the highest coarse fraction mass ratios contained more fines, and the mean fibre was shorter and narrower. This led to higher density but also a decrease of the stretch-at-break and z-strength values.When comparing these results with previous fractionation results for unrefined pulp, it was found that inject concentration did not have a large effect on thickening in the present study. As for the refined pulp, the tensile index increased with fines proportion for the unrefined pulp, however, only up to a certain fines proportion where a maximum values was reached. The increase was larger for the refined pulps which had higher fines proportion.
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| 17. |
- Bretzner, Martin, et al.
(författare)
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Radiomics-Derived Brain Age Predicts Functional Outcome After Acute Ischemic Stroke.
- 2023
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Ingår i: Neurology. - 1526-632X .- 0028-3878. ; 100:8
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Tidskriftsartikel (refereegranskat)abstract
- While chronological age is one of the most influential determinants of poststroke outcomes, little is known of the impact of neuroimaging-derived biological "brain age." We hypothesized that radiomics analyses of T2-FLAIR images texture would provide brain age estimates and that advanced brain age of patients with stroke will be associated with cardiovascular risk factors and worse functional outcomes.We extracted radiomics from T2-FLAIR images acquired during acute stroke clinical evaluation. Brain age was determined from brain parenchyma radiomics using an ElasticNet linear regression model. Subsequently, relative brain age (RBA), which expresses brain age in comparison with chronological age-matched peers, was estimated. Finally, we built a linear regression model of RBA using clinical cardiovascular characteristics as inputs and a logistic regression model of favorable functional outcomes taking RBA as input.We reviewed 4,163 patients from a large multisite ischemic stroke cohort (mean age = 62.8 years, 42.0% female patients). T2-FLAIR radiomics predicted chronological ages (mean absolute error = 6.9 years, r = 0.81). After adjustment for covariates, RBA was higher and therefore described older-appearing brains in patients with hypertension, diabetes mellitus, a history of smoking, and a history of a prior stroke. In multivariate analyses, age, RBA, NIHSS, and a history of prior stroke were all significantly associated with functional outcome (respective adjusted odds ratios: 0.58, 0.76, 0.48, 0.55; all p-values < 0.001). Moreover, the negative effect of RBA on outcome was especially pronounced in minor strokes.T2-FLAIR radiomics can be used to predict brain age and derive RBA. Older-appearing brains, characterized by a higher RBA, reflect cardiovascular risk factor accumulation and are linked to worse outcomes after stroke.
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| 18. |
- Dini, Francesca, et al.
(författare)
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Volatile Emissions from Compressed Tissue
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 8:7
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Tidskriftsartikel (refereegranskat)abstract
- Since almost every fifth patient treated in hospital care develops pressure ulcers, early identification of risk is important. A non-invasive method for the elucidation of endogenous biomarkers related to pressure ulcers could be an excellent tool for this purpose. We therefore found it of interest to determine if there is a difference in the emissions of volatiles from compressed and uncompressed tissue. The ultimate goal is to find a non-invasive method to obtain an early warning for the risk of developing pressure ulcers for bed-ridden persons. Chemical analysis of the emissions, collected in compresses, was made with gas-chromatography – mass spectrometry and with a chemical sensor array, the so called electronic nose. It was found that the emissions from healthy and hospitalized persons differed significantly irrespective of the site. Within each group there was a clear difference between the compressed and uncompressed site. Peaks that could be certainly deemed as markers of the compression were, however, not identified. Nonetheless, different compounds connected to the application of local mechanical pressure were found. The results obtained with GC-MS reveal the complexity of VOC composition, thus an array of non-selective chemical sensors seems to be a suitable choice for the analysis of skin emission from compressed tissues; it may represent a practical instrument for bed side diagnostics. Results show that the adopted electronic noses are likely sensitive to the total amount of the emission rather than to its composition. The development of a gas sensor-based device requires then the design of sensor receptors adequate to detect the VOCs bouquet typical of pressure. This preliminary experiment evidences the necessity of studies where each given person is followed for a long time in a ward in order to detect the insurgence of specific VOCs pattern changes signalling the occurrence of ulcers.
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| 19. |
- Edqvist, Malin, 1971, et al.
(författare)
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Midwives' Management during the Second Stage of Labor in Relation to Second-Degree Tears-An Experimental Study
- 2017
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Ingår i: Birth. - : Wiley. - 0730-7659 .- 1523-536X. ; 44:1, s. 86-94
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Most women who give birth for the first time experience some form of perineal trauma. Second-degree tears contribute to long-term consequences for women and are a risk factor for occult anal sphincter injuries. The objective of this study was to evaluate a multifaceted midwifery intervention designed to reduce second-degree tears among primiparous women.METHODS: An experimental cohort study where a multifaceted intervention consisting of 1) spontaneous pushing, 2) all birth positions with flexibility in the sacro-iliac joints, and 3) a two-step head-to-body delivery was compared with standard care. Crude and Adjusted OR (95% CI) were calculated between the intervention and the standard care group, for the various explanatory variables.RESULTS: A total of 597 primiparous women participated in the study, 296 in the intervention group and 301 in the standard care group. The prevalence of second-degree tears was lower in the intervention group: [Adj. OR 0.53 (95% CI 0.33-0.84)]. A low prevalence of episiotomy was found in both groups (1.7 and 3.0%). The prevalence of epidural analgesia was 61.1 percent. Despite the high use of epidural analgesia, the midwives in the intervention group managed to use the intervention.CONCLUSION: It is possible to reduce second-degree tears among primiparous women with the use of a multifaceted midwifery intervention without increasing the prevalence of episiotomy. Furthermore, the intervention is possible to employ in larger maternity wards with midwives caring for women with both low- and high-risk pregnancies.
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| 20. |
- Edqvist, Malin, 1971, et al.
(författare)
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Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth
- 2016
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Whether certain birth positions are associated with perineal injuries and severe perineal trauma (SPT) is still unclear. The objective of this study was to describe the prevalence of perineal injuries of different severity in a low-risk population of women who planned to give birth at home and to compare the prevalence of perineal injuries, SPT and episiotomy in different birth positions in four Nordic countries. Methods: A population-based prospective cohort study of planned home births in four Nordic countries. To assess medical outcomes a questionnaire completed after birth by the attending midwife was used. Descriptive statistics, bivariate analysis and logistic regression were used to analyze the data. Results: Two thousand nine hundred ninety-two women with planned home births, who birthed spontaneously at home or after transfer to hospital, between 2008 and 2013 were included. The prevalence of SPT was 0.7 % and the prevalence of episiotomy was 1.0 %. There were differences between the countries regarding all maternal characteristics. No association between flexible sacrum positions and sutured perineal injuries was found (OR 1.02; 95 % CI 0.86-1.21) or SPT (OR 0.68; CI 95 % 0.26-1.79). Flexible sacrum positions were associated with fewer episiotomies (OR 0.20; CI 95 % 0.10-0.54). Conclusion: A low prevalence of SPT and episiotomy was found among women opting for a home birth in four Nordic countries. Women used a variety of birth positions and a majority gave birth in flexible sacrum positions. No associations were found between flexible sacrum positions and SPT. Flexible sacrum positions were associated with fewer episiotomies.
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| 23. |
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| 26. |
- Fredriksson, I, et al.
(författare)
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Risk factors for local recurrence after breast-conserving surgery
- 2003
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 90:9, s. 1093-1102
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is not clear whether risk factors for local recurrence after breast-conserving surgery differ in women having surgery for in situ or invasive cancer. Furthermore, the Nottingham Prognostic Index (NPI) and Nottingham Histological Grade (NHG) have been little studied as determinants of local recurrence risk. Method: In a case-control study (491 cases and 1098 controls) nested within a cohort of 7502 women who had surgery for in situ or invasive cancer of the breast, patient characteristics, tumour characteristics and treatment-related variables were evaluated as risk factors for local recurrence. Results: Multivariate conditional logistic regression analyses showed that age below 40 years, tumour multicentricity and an unclear or unknown surgical margin were significant risk factors for local recurrence. Radiotherapy to the breast and adjuvant hormone therapy were protective. Cancer in situ was not associated with a higher risk of local recurrence than invasive cancer (odds ratio 1.0, 95 per cent confidence interval 0.8 to 1.3). NHG and NPI were not helpful in determining risk of local recurrence. Conclusion: Margin status, age, tumour multicentricity, and use of radiotherapy and adjuvant hormone therapy were important determinants of risk of local recurrence. With the exception of surgical margin, variables related to the quality of surgical management did not predict risk of local recurrence.
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| 27. |
- Gulyas, Miklos, et al.
(författare)
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COX-2 expression and effects of celecoxib in addition to standard chemotherapy in advanced non-small cell lung cancer.
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Tidskriftsartikel (refereegranskat)abstract
- Inhibition of cyclooxygenase-2 (COX-2) is proposed as a treatment option in several cancer types. However, in non-small cell lung cancer (NSCLC), phase III trials have failed to demonstrate a benefit of adding COX-2 inhibitors to standard chemotherapy. The aim of this study was to analyse COX-2 expression in tumor and stromal cells as predictive biomarker for COX-2 inhibition.Methods: In the multicenter phase III trial, 316 patients with advanced NSCLC were randomized to receive celecoxib (400 mg b.i.d.) or placebo up to one year in addition to a two-drug platinum-based chemotherapy combination. In a subset of 122 patients, archived tumor tissue was available for immunohistochemical analysis of COX-2 expression in tumor and stromal cells.Results: An updated analysis of all 316 patients included in the original trial, and of the 122 patients with available tumor tissue, showed no survival differences between the celecoxib and placebo arms (HR 1.01; 95%CI 0.81-1.27 and HR 1.12; 95%CI 0.78-1.61, respectively). Similarly, in patients with high COX-2 expression in tumor cells (n=71) or stromal cells (n=55), survival did not differ significantly between patients who received celecoxib or placebo (HR 1.07; 95%CI 0.74-1.54 and HR 0.80; 95%CI 0.56-1.15). No significant interaction effect between COX-2 score in tumor or stromal cells and celecoxib effect on survival was detected (p=0.48 and 0.25, respectively).Conclusion: In this subgroup analysis of patients with advanced NSCLC, we could not detect any significant interaction between COX-2 expression in tumor or stromal cells and outcome of celecoxib treatment in addition to standard chemotherapy.
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| 28. |
- Gulyas, Miklos, et al.
(författare)
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COX-2 expression and effects of celecoxib in addition to standard chemotherapy in advanced non-small cell lung cancer.
- 2018
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Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 57:2, s. 244-250
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Inhibition of cyclooxygenase-2 (COX-2) is proposed as a treatment option in several cancer types. However, in non-small cell lung cancer (NSCLC), phase III trials have failed to demonstrate a benefit of adding COX-2 inhibitors to standard chemotherapy. The aim of this study was to analyze COX-2 expression in tumor and stromal cells as predictive biomarker for COX-2 inhibition.Methods: In a multicenter phase III trial, 316 patients with advanced NSCLC were randomized to receive celecoxib (400 mg b.i.d.) or placebo up to one year in addition to a two-drug platinum-based chemotherapy combination. In a subset of 122 patients, archived tumor tissue was available for immunohistochemical analysis of COX-2 expression in tumor and stromal cells. For each compartment, COX-2 expression was graded as high or low, based on a product score of extension and intensity of positively stained cells.Results: An updated analysis of all 316 patients included in the original trial, and of the 122 patients with available tumor tissue, showed no survival differences between the celecoxib and placebo arms (HR 1.01; 95% CI 0.81–1.27 and HR 1.12; 95% CI 0.78–1.61, respectively). High COX-2 scores in tumor (n = 71) or stromal cells (n = 55) was not associated with a superior survival outcome with celecoxib vs. placebo (HR =0.96, 95% CI 0.60–1.54; and HR =1.51; 95% CI 0.86–2.66), and no significant interaction effect between COX-2 score in tumor or stromal cells and celecoxib effect on survival was detected (p = .48 and .25, respectively).Conclusions: In this subgroup analysis of patients with advanced NSCLC treated within the context of a randomized trial, we could not detect any interaction effect of COX-2 expression in tumor or stromal cells and the outcome of celecoxib treatment in addition to standard chemotherapy.
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| 29. |
- Hagblad, Jimmie, et al.
(författare)
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A technique based on laser Doppler flowmetry and photoplethysmography for simultaneously monitoring blood flow at different tissue depths
- 2010
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Ingår i: Medical and Biological Engineering and Computing. - : Springer Science Business Media. - 0140-0118 .- 1741-0444. ; 48:5, s. 415-422
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to validate a non-invasive optical probe for simultaneous blood flow measurement at different vascular depths combining three photoplethysmography (PPG) channels and laser Doppler flowmeter (LDF). Wavelengths of the PPG were near-infrared 810 nm with source-to-detector separation of 10 and 25 mm, and green 560 nm with source-to-detector separation of 4 mm. The probe is intended for clinical studies of pressure ulcer aetiology. The probe was placed over the trapezius muscle, and depths from the skin to the trapezius muscle were measured using ultrasound and varied between 3.8 and 23 mm in the 11 subjects included. A provocation procedure inducing a local enhancement of blood flow in the trapezius muscle was used. Blood flows at rest and post-exercise were compared. It can be concluded that this probe is useful as a tool for discriminating between blood flows at different vascular tissue depths. The vascular depths reached for the different channels in this study were at least 23 mm for the near-infrared PPG channel (source-to-detector separation 25 mm), 10-15 mm for the near-infrared PPG channel (separation 10 mm), and shallower than 4 mm for both the green PPG channel (separation 4 mm) and LDF.
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| 30. |
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| 31. |
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| 32. |
- Harle, Karolina, et al.
(författare)
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Experience of living with an enterocutaneous fistula
- 2015
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Ingår i: Journal of Clinical Nursing. - : Wiley: 12 months. - 0962-1067 .- 1365-2702. ; 24:15-16, s. 2175-2183
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. The purpose of this study was to describe patients experiences of living with an enterocutaneous fistula. Background. An enterocutaneous fistula is a complex and serious illness that usually occurs as a complication from surgery or spontaneously as a result of an underlying disease. The illness is demanding both physically and mentally and causes substantial medical and nursing problems for the afflicted individual. Design. A descriptive design with a qualitative approach. Methods. In-depth interviews were performed with nine participants who had experiences of living with an enterocutaneous fistula. The analysis was conducted using descriptive phenomenology according to Giorgi. Results. The essence of this study was that living with an enterocutaneous fistula is about handling an illness that causes several limitations in daily life and the following five themes emerged from the data: restrictions in daily life, approaches to illness, emotions, dependence and need of support. A constant fear of leakage from the fistula appliance, being dependent on intravenous fluids and being dependent on health care professionals caused isolation and social restriction. Conclusions. The participants had many strategies for handling their illness. By being well trained, engaged and having a positive and understanding approach, health care professionals can encourage hope, motivation and self-care. This can lead to decreased dependence and help the patient to better handle their illness. Relevance to clinical practice. The competence of health care professionals is essential in the care of patients with an enterocutaneous fistula.
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| 33. |
- Hellman, Eva, et al.
(författare)
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Radiographers' perceptions of patients care needs during a computed tomography examination
- 2014
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Ingår i: Journal of Radiology Nursing. - : Elsevier BV. - 1546-0843 .- 1555-9912. ; 33:4, s. 206-213
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the radiographers' perceptions of the patient care that is needed by the latter undergoing a computed tomography (CT) examination. The study was conducted using phenomenography methodology. Eight female and four male radiographers were interviewed at three radiology departments in central Sweden. The radiographers highlighted that the patients' need for information regarding the whole examination was important for them to understand the procedure. The radiographers' perception was that the time required for a CT examination needs to be adjusted so that there is sufficient time for individualized patient care, while at the same time taking into account the patient's age and illness. There was also a need for the examination to be carried out by a knowledgeable professional radiographer. In conclusion, this study shows that patients are in need of good communication, information, physical/psychological care, and individualized adapted examination time. Radiographers' knowledge and ability to understand patients' needs have a significant impact if patients are involved in their examination.
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| 34. |
- Höglund, Berit, 1955-, et al.
(författare)
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Midwives’ knowledge of, attitudes towards and experiences of caring for women with intellectual disability during pregnancy and childbirth : a cross-sectional study in Sweden
- 2013
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 29:8, s. 950-955
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Tidskriftsartikel (refereegranskat)abstract
- Objective: to investigate midwives' knowledge of, attitudes towards andexperiences of caring for women with intellectual disability (ID) during pregnancy andchildbirth. Design/setting: a cross-sectional study among six hundred midwives working at antenatal care and labour wards in Sweden. Results: more than four out of five (81.5%) midwives had experience of caring for womenwith ID. Almost all midwives (97.1%) reported that caring for women with ID is different fromcaring for women without ID. Almost one-half (47.3%) had not received any education aboutpregnancy and delivery of women with ID, and a majority of the midwives (95.4%) requested evidence-based knowledge of women with ID in relation to childbirth. High proportion (69.7%) of the midwives were of the opinion that women with ID cannot satisfactorily manage the mother role, and more than one-third (35.7%) of the midwives considered that womenwith ID should not be pregnant and give birth at all. Most midwives partly/totally agreed that children of women with ID should grow up with their parents supported by the social authorities, but nearly one-fifth (19.1%) partly/totally agreed that the children should grow up in foster care. Conclusions: even if the majority of midwives had experience of caring for women with ID, they were uncertain about how to adapt and give advice and they needed more knowledgeabout these women. Some midwives had negative attitudes towards childbearing amongwomen with ID. Health Service providers should encourage midwives to update theirknowledge and provide supportive supervision in midwifery care for women with ID.
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| 35. |
- Höglund, Berit, 1955-, et al.
(författare)
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Newborns of mothers with intellectual disability have a higher risk of perinatal death and being small-for-gestational age
- 2012
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:12, s. 1409-1414
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Tidskriftsartikel (refereegranskat)abstract
- Objective.To study mode of birth, perinatal health and death in children born to mothers with intellectual disability (ID) in Sweden.Design. Population based register study.Setting. National registers; the National Patient Register linked to the Medical Birth Register.Sample. Children of first-time mothers with ID (n = 326) (classified in the ICD 8–10) were identified and compared to 340 624 children of first-time mothers without ID or any other psychiatric diagnosis during 1999 and 2007.Methods. Population-based data were extracted from the National Patient Register and the Medical Birth Register.Main Outcome Measures. Mode of birth, preterm birth, small-for-gestational age, Apgar score, stillbirth and perinatal death.Results. Children born to mothers with ID were more often stillborn (1.2% vs. 0.3%) or died perinatally (1.8% vs. 0.4%) than children born to mothers without ID. They had a higher proportion of cesarean section birth (24.5% vs. 17.7%), preterm birth (12.2% vs. 6.1%), were small-for-gestational age (8.4% vs. 3.1%) and had lower Apgar scores <7 points at 5 minutes (3.7% vs 1.5%), compared to children born to mother without ID. Logistic regression adjusted for maternal characteristics confirmed an increased risk of small-for-gestational age (odds ratio 2.25), stillbirth (odds ratio 4.53) and perinatal death (odds ratio 4.25) in children born to mothers with ID.Conclusions. Unborn and newborn children of mothers with ID should be considered a risk group, and their mothers may need better individual-based care and support.
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| 36. |
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| 37. |
- Höglund, Berit, 1955-, et al.
(författare)
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Pregnancy and birth outcomes of women with intellectual disability in Sweden : a national register study between 1999 and 2007
- 2012
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:12, s. 1381-1387
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the antenatal health and demographic factors as well as pregnancy and delivery outcomes in women with intellectual disability (ID) in Sweden.Design. A population-based register study.Setting. The National Patient Register (NPR) linked to the Medical Birth Register (MBR). Sample. Women with ID classified as International Classification of Diseases (ICD) 8–10 who gave birth in 1999–2007 (n = 326), identified from the NPR linked to the MBR, were compared with all first-time, singleton mothers without ID or any other psychiatric diagnoses during this period in Sweden (n = 340 624).Methods. Population-based data were extracted from the NPR and the MBR.Main outcome measures. Health and socio-demography at first antenatal visit, mode of delivery, pain relief during labor, preterm birth and discharge from hospital.Results. A higher proportion of women with ID were teenagers (18.4 vs. 3.3%), obese (20.1 vs. 8.6%) and single (36.6 vs. 6.2%) compared with women without ID, and women with ID smoked more often (27.9 vs. 7.9%). Women with ID had more often a preterm birth (12.2 vs. 6.1%), a cesarean section (CS) (24.5 vs. 17.7%) and used less nitrous oxide as pain relief during labor (59.5 vs. 75.8%). Women with ID had a higher risk for preterm birth [odds ratio (OR) 1.68], CS (OR1.55), non-use of nitrous oxide (OR 1.89) and discharge from hospital to a place other than home (OR 2.24). Conclusion. Pregnant women with ID should be considered a risk group suggesting that better tailored pre- and intrapartum care and support are needed for these women.
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| 38. |
- Höglund, Berit, 1955-
(författare)
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Pregnancy, Childbirth and Midwifery Care among Women with Intellectual Disability in Sweden : Epidemiological and Descriptive Studies
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate pregnancy and childbirth in women with intellectual disability (ID), in Sweden, the health of their newborns and midwifery care for these women. Two register studies and two descriptive studies are included. Pregnancy and birth outcomes as well as data on the newborns’ health were examined by linking data from the National Patient Register and the Medical Birth Register (I-II). The women’s experience of pregnancy and delivery was investigated with repeated interviews (III). Midwives’ knowledge of, experience of and attitudes towards pregnancy and childbirth in women with ID were evaluated with questionnaires (IV). Mothers with ID were more often teenagers, smoked more during pregnancy and had more Caesarean Sections. Their children had a higher proportion of pre-term births, were small-for-gestational-age, stillborn or died in the perinatal period. The women with ID struggled to attain motherhood and feared to lose custody of the child. The pregnancy was seen as a happy event, even though relatives did not always approve. Parent education was considered important, but not adequately adapted to their needs. The birth process was overwhelming and difficult to understand, but the child was welcomed with warm feelings, and breastfeeding was natural. Midwives stated it was different to care for women with ID and requested additional knowledge. The majority of midwives affirmed that women with ID could not manage the mother role satisfactorily, and one-third expressed that women with ID should refrain from having children. A majority of the midwives considered that the children should grow up with the parents with support from family and society, but one out of five stated that the children should grow up in foster care.Conclusion: Women with ID and their children should be considered as risk groups in pregnancy and childbirth. Professionals in maternity services need to elucidate their knowledge and skills for counselling and supporting this particular group of pregnant women in pre-, intra- and post-partum care.
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| 39. |
- Jonsson, Annika, et al.
(författare)
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Blodflödesmätningar for att studera uppkomst uppkomst och förebyggande av trycksår
- 2006
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Konferensbidrag (refereegranskat)abstract
- Bakgrund: Trycksar ar ett alltjamt vanligt forekommande problem inom dagens sjukvard. Antalet personer i riskzonen att utveckla trycksar okar i takt med att vi blir allt aldre och sjukare samtidigt som allt mer allvarligt skadade personer idag kan raddas till livet. Den primara orsaken till trycksar ar ischemi men antalet sekundara faktorer ar stort. Den yttre belastningen av vavnaden som orsakar ischemi innefattar bade normal- och skjuvkrafter. Skjuvkrafter ar krafter som appliceras tangentiellt mot vavnaden och som leder till att kapillarernas diameter minskar och att blodflodet genom dem darmed minskar eller upphor.Idag ar det framforallt tryckmatningar av olika slag som anvands i forskning rorande trycksaretiologi. Tryckmatningar gors ocksa vid utvardering av de specialmadrasser som anvands for att forebygga och underlatta lakningen av redan uppkomna trycksar. Eftersom ar ischemi ar den primara orsaken till trycksar anser vi att blodflodet en mer direkt parameter att studera.Metod: Forandringar av blodflodet i sakrum vid yttre belastning har studerats i tva separata studier. I den forsta studien anvandes de tva vedertagna metoderna laser Doppler och fotopletysmografi. Genom olika kombinationer av vaglangd pa ljuset och avstand mellan ljuskalla och detektor kunde ett flertal olika matdjup erhallas. I den andra studien anvandes en Laser Doppler Flowmeter med tva kanaler for att studera forandringar av blodflodet vid anlaggande av skjuvkraft.Resultat: Vara studier har visat att bade normalkrafter och skjuvkrafter kan minska blodflodet i vavnaden. Det som visade sig speciellt intressant efter de forsta preliminara analyserna av resultaten fran studien med flera matdjup ar att blodflodet pa olika djup, det vill saga i de olika vavnadslagren, paverkas olika. Resultatet fran den andra studien visar att belastning av skjuvkrafter paverkar framfor allt det ytliga blodflodet negativt.Sammanfattning: Det ar viktigt att observera att det vid belastning av huden i princip ar omojligt att separera paverkan fran tryck respektive skjuvkrafter. Dock visar vara resultat att bade tryck och skjuvkrafter kan paverka blodflodet negativt. Vidareutveckling av metoden for blodflodesmatning mojliggor studier av hur blodflodet i ett storre vavnadsomrade paverkas av yttre belastning. Matningar i ett storre omrade bor kunna ge nya ron om etiologin bakom trycksar samt vara anvandbara vid utvardering av trycksarmadrasser.
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| 40. |
- Jonsson, A., et al.
(författare)
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Evaluation of antidecubitus mattresses
- 2005
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Ingår i: Medical and Biological Engineering and Computing. - 0140-0118 .- 1741-0444. ; 43:5, s. 541-547
-
Forskningsöversikt (refereegranskat)abstract
- Pressure sores are a current problem in hospitals and care of the elderly, leading to protracted hospital stays and a high care burden. The trauma for the patients is severe, and the cost of pressure sore prevention and treatment, is considerable. Antidecubitus mattresses are used for prevention and in treatment, but they also contribute to the cost of treating pressure sores. The problem highlighted in the review is that the mattresses' effectiveness in preventing and treating pressure sores has not been sufficiently evaluated. When antidecubitus mattresses are evaluated, it is often only with regard to aspects of the interface pressure and the mattresses' ability to redistribute the pressure. The review points out the important observation that, to be able to evaluate the efficacy of the antidecubitus mattress, the mattress's effect on tissue viability needs to be studied. The parameters that ought to be considered when evaluating a support surface are: interface pressure, pressure and blood flow distribution, temperature and humidity in the skin-support surface interface. The authors propose that the effect on tissue viability of external loading can be assessed by simultaneous measurement of the interface pressure and tissue perfusion. © IFMBE: 2005.
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| 41. |
- Jonsson, Annika, 1978-
(författare)
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Pressure sore etiology - highlighted with optical measurements of the blood flow
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In line with the quality awareness of good prevention of pressure sores and in treatment of those sores already developed, evaluation of antidecubitus mattresses plays an important role. However, there are shortages in the evaluations performed today, since often interface pressure is the only parameter regarded. Since ischaemia in the tissue is the primary cause of pressure sore, the focus in this thesis is on blood flow measurements in tissue exposed external loading. To study the tissue blood flow would give a better and more direct indication on the mattress effectiveness in minimizing the negative effects on the tissue viability.The results presented in this thesis reveal that the superficial blood flow in areas prone to pressure sore development, is affected by increased skin temperature and external loading of the tissue. Both the effects from pressure and shear stress have been studied.Measurements of the tissue blood flow is interesting to relate to the two theories about at which tissue layer the pressure sores start to develop. To achieved more knowledge about the pressure sore etiology and also be able to non-invasively measure the tissue blood flow for evaluations of antidecubitus mattresses an optical sensor has been developed. The sensor combines the two optical methods, laser Doppler flowmetry and photoplethysmography. With the design of the sensor, measurements of the superficial skin blood flow and the deeper blood flow, even the muscle blood flow, can be performed. Measurement depths of 2 mm, 8 mm, and 20 mm into the tissue is assumed.Preliminary result from measurements performed with the optical sensor in four test subjects, revealed great individual differences in blood flow, but also different response to the same external loading at different measurement depths, in the same individual. This new optical sensor is likely to be of great value in future studies of pressure sore etiology and in future evaluations of antidecubitus mattresses.
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| 42. |
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| 43. |
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| 44. |
- Karlsson, Matilda, et al.
(författare)
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Dressing the split-thickness skin graft donor site: a randomized clinical trial
- 2014
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Ingår i: Advances in Skin & Wound Care. - : Lippincott Williams & Wilkins. - 1527-7941 .- 1538-8654. ; 27:1, s. 20-25
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The primary objective of this study was to compareAquacel (ConvaTec, Skillman, New Jersey), Allevyn (Smith &Nephew, St Petersburg, Florida), and Mediskin I (Mo¨ lnlycke, HealthCare AB, Gothenburg, Sweden) in the treatment of split-thicknessskin graft donor sites.DESIGN: This study was performed as a prospective randomized,3-arm, clinical study.SETTING: A clinical study performed at a hand and plastic surgerydepartment with burn unit.PARTICIPANTS: The study included 67 adults with a total of73 donor sites, which were on the thigh, not reharvested, andranged between 30- and 400-cm2 area.INTERVENTIONS: Subjects were randomly assigned to treatmentwith Aquacel, Allevyn, or Mediskin I.MAIN OUTCOME MEASURES: The donor site was assessed onpostoperative days 3, 14, and 21 for healing, infection, pain,impact on everyday life, ease of use, and cost.MAIN RESULTS: The obtained results demonstrate significantlyfaster re-epithelialization for patients treated with Aquacel orMediskin I compared with Allevyn. Regarding infections, therewere no significant differences between the groups. Patientswearing Aquacel experienced significantly less pain changing thedressing and less impact on everyday life than the patientswearing Allevyn. Aquacel was shown to be significantly easier forthe caregiver to use than Allevyn and Mediskin I. There is asignificant difference in cost of treatment between the dressings,whereas Mediskin I is the most expensive.CONCLUSION: The authors’ results support the use of Aquacel in thetreatment of split-thickness skin graft donor sites. Aquacel has alow cost per unit, is user friendly, gives short healing time, andminimizes patient discomfort.
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| 45. |
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| 46. |
- Källman, Ulrika, et al.
(författare)
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Blood flow responses over sacrum in nursing home residents during one hour bed rest
- 2016
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Ingår i: Microcirculation. - : WILEY-BLACKWELL. - 1073-9688 .- 1549-8719. ; 23:7, s. 530-539
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo describe individual BF responses in a nursing home resident population for one-hour periods of bed rest. MethodsBF was measured for one hour over the sacrum in 0 degrees supine position and 30 degrees supine tilt position in 25 individuals aged 65 y or older while lying on a pressure-redistributing mattress. Measurements were made at three tissue depths (1, 2, and 10 mm) using the noninvasive optical techniques, LDF and PPG. ResultsEleven participants had a PIV response at 1mm depth in both positions and seven participants had a lack of this response at this depth and positions. The BF response at 1mm depth appeared immediately and remained over, or below, baseline for the entire 60min of loading in both positions. These BF patterns were also seen in deeper tissue layers. ConclusionsThe cutaneous BF response among the nursing home residents was distinct, appeared early, and remained during the one hour of loading.
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| 47. |
- Källman, Ulrika, et al.
(författare)
-
Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients
- 2013
-
Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 69:1, s. 133-144
-
Tidskriftsartikel (refereegranskat)abstract
- Aim. To report a study to compare the effects of different lying positions on tissue blood flow and skin temperature in older adult patients. This article reports the evaluation of study design and procedures. Background. To reduce risk of pressure ulcers, repositioning of immobile patients is a standard nursing practice; however, research into how different lying positions effect tissue microcirculation is limited. Design. Descriptive comparative design. Methods. From MarchOctober 2010, 20 inpatients, aged 65 years or older, were included in the study. Tissue blood flow and skin temperature were measured over bony prominences and in gluteus muscle in four supine and two lateral positions. Results. The blood flow over the bony prominence areas was most influenced in the superficial skin and especially in the 30 degrees lateral position, where the blood flow decreased significantly in comparison with the supine positions. There were significant individual differences in blood flow responses, but no common trend was identified among the patients considered at risk for pressure ulcer development. The study procedure worked well and was feasible to perform in an inpatient population. Conclusion. The lying positions seem to influence the tissue blood flow over the bony prominences in different ways in older adult inpatients, but further study is needed to confirm the results and to make recommendations to clinical practice. The study procedure worked well, although some minor adjustments with regard to heat accumulation will be made in future studies.
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| 48. |
- Källman, Ulrika, 1968-
(författare)
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Evaluation of Repositioning in Pressure Ulcer Prevention
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: To reduce the risk for pressure ulcers, repositioning of immobile patients is an important standard nursing practice. However, knowledge on how this preventive intervention is carried out among elderly immobile patients is limited and to what extent patients perform minor movements between nursing staff-induced repositionings is largely unknown, but these movements might have implications for the repositioning intervention. Different lying positions are used in repositioning schedules, but there is lack of evidence to recommend specific positions.Aim: The overall aim of this thesis was to describe and evaluate how repositioning procedures work in practice in the care of elderly immobile patients. The aim was also to compare the effects of different positions with regard to interface pressure, skin temperature, and tissue blood flow in elderly patients lying on a pressure-redistribution mattress.Methods: This thesis consists of four quantitative studies. In Study I, 62 elderly immobile patients were included. All movements the patients made, either with help from the nursing staff or spontaneously, were registered continuously over the course of three days. Study II served to pilot the procedure for Study III. Tissue blood flow and skin temperature were measured in hospital patients (n = 20) for 5 minutes in two supine, two semi-Fowler, and two lateral positions. In Study III, a new sample was recruited (n = 25) from three nursing homes. Measurement of interface pressure was added, and the measurements were extended from 5 minutes to 1 hour. The six positions were reduced to four by excluding the two semi-Fowler positions. Blood flow was measured using photopletysmography (Study II-IV) and laser Doppler flowmetry (Studies III and IV). In Study IV a deeper analysis of the individual pressure-induced vasodilation (PIV) responses was performed on the sample from Study III. An age of 65 years or older was an inclusion criterion in all studies.Results: Study I showed that there was a large variation in the extent to which the elderly immobile patients made spontaneous movements, and these movements were positively related to taking analgesics and negatively related to taking psycholeptics. Patients scored as high risk for pressure ulcer development were repositioned more frequently than patients scored as low risk. However, the spontaneous movement frequency was not associated with any risk scores. Study II showed that the different lying positions influenced the blood flow in different ways. In Study III, it was found that the overall blood flow response during one hour of loading was significantly higher in the 30° supine tilt position than in the 0° supine, 30° lateral, and 90° lateral positions. The overall blood flow in the 90° lateral position did not differ compared to the 30° lateral position, although the interface pressure was significant higher in the 90° lateral position. In patients lacking a PIV response (Study IV), the blood flow decreased immediately and remained below baseline during the one hour of loading.Conclusions: Although elderly and immobilized, some patients frequently perform minor movements while others do not. Patients who cannot perform minor movements are important for the nursing staff to identify because they very likely need more intensive repositioning interventions. The spontaneous movement frequency was not associated with the risk assessment score, and this implies that some immobile patients assessed as low risk might need to be repositioned as often as patients assessed as high risk. Of the positions evaluated, the 30° supine tilt position was concluded to be most beneficial. There was no great difference in how the blood flow was affected in the 90° lateral position compared to the 30° lateral position, which question the appropriateness of the recommendation to avoid the 90° lateral position. The patients with lacking a PIV response might be particularly vulnerable to pressure, which also implies that these patients might need to be repositioned more frequently.
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| 49. |
- Källman, Ulrika, et al.
(författare)
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Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.
- 2016
-
Ingår i: International Wound Journal. - : Wiley-Blackwell. - 1742-4801 .- 1742-481X. ; 13:6, s. 1168-1175
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.
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| 50. |
- Källman, Ulrika, et al.
(författare)
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Predictive validity of 4 risk assessment scales for prediction of pressure ulcer development in a hospital setting
- 2014
-
Ingår i: Advances in Skin & Wound Care. - : Lippincott Williams & Wilkins. - 1527-7941 .- 1538-8654. ; 27:2, s. 70-76
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:The aims of this study were to examine and compare the predictive validity of 4 risk assessment scales used for the prediction of pressure ulcer (PrU) development and to identify risk factors.DESIGN:Cross-sectional descriptive study.SETTING:A general hospital in Sweden.PARTICIPANTS:Patients (all aged ≥18 years) admitted to medical, surgical, orthopedic, oncology, and rehabilitation wards. Of 412 patients available, a total of 346 patients participated in the study.METHOD:Data were collected using the Swedish version of the European Pressure Ulcer Advisory Panel minimum data set as well as the Norton, Modified Norton, Braden, and Risk Assessment Pressure Sore (Ulcer) (RAPS) scales. The predictive validity was estimated by measuring sensitivity, specificity, positive predictive value, and negative predictive value. Multiple logistic regression analysis was used to determine risk factors associated with PrUs.RESULTS:The RAPS scale reached best balance between sensitivity and specificity at the recommended cutoff level of ≤29, followed by the Braden scale and the Norton scale at recommended cutoff levels ≤18 versus ≤16, respectively. The modified Norton scale also reached an acceptable balance between sensitivity and specificity but at the cutoff level of ≤23, which is a higher cutoff level than recommended. General physical condition, physical activity, moisture, friction, and shear emerged as significant risk factors.CONCLUSIONS:The results support that the recommended cutoff levels of the RAPS, Norton, and Braden scales are valid in a general hospital setting. However, the recommended cutoff level of the modified Norton scale (≤20) has to be increased when used in this care context.
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