| 1. |
- Anistratov, Pavel, 1990-
(författare)
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Autonomous Avoidance Maneuvers for Vehicles using Optimization
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To allow future autonomous passenger vehicles to be used in the same driving situations and conditions as ordinary vehicles are used by human drivers today, the control systems must be able to perform automated emergency maneuvers. In such maneuvers, vehicle dynamics, tire–road interaction, and limits on what the vehicle is capable of performing are key factors to consider. After detecting a static or moving obstacle, an avoidance maneuver or a sequence of lane changes are common ways to mitigate the critical situation. For that purpose, motion planning is important and is a primary task for autonomous-vehicle control subsystems. Optimization-based methods and algorithms for such control subsystems are the main focus of this thesis.Vehicle-dynamics models and road obstacles are included as constraints to be fulfilled in an optimization problem when finding an optimal control input, while the available freedom in actuation is utilized by defining the optimization criterion. For the criterion design, a new proposal is to use a lane-deviation penalty, which is shown to result in well-behaved maneuvers and, in comparison to minimum-time and other lateral-penalty objective functions, decreases the time that the vehicle spends in the opposite lane.It is observed that the final phase of a double lane-change maneuver, also called the recovery phase, benefits from a dedicated treatment. This is done in several steps with different criteria depending on the phase of the maneuver. A theoretical redundancy analysis of wheel-torque distribution, which is derived independently of the optimization criterion, complements and motivates the suggested approach.With a view that a complete maneuver is a sequence of two or more sub-maneuvers, a decomposition approach resulting in maneuver segments is proposed. The maneuver segments are shown to be possible to determine with coordinated parallel computations with close to optimal results. Suitable initialization of segmented optimizations benefits the solution process, and different initialization approaches are investigated. One approach is built upon combining dynamically feasible motion candidates, where vehicle and tire forces are important to consider. Such candidates allow addressing more complicated situations and are computed under dynamic constraints in the presence of body and wheel slip. To allow a quick reaction of the vehicle control system to moving obstacles and other sudden changes in the conditions, a feedback controller capable of replanning in a receding-horizon fashion is developed. It employs a coupling between motion planning using a friction-limited particle model and a novel low-level controller following the acceleration-vector reference of the computed plan. The controller is shown to have real-time performance.
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| 2. |
- Hjelmfors, Lisa, 1984-
(författare)
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Communication about the Heart Failure Trajectory in Patients, their Families and Health Care Professionals
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: There is an increasing awareness in the field of cardiology regarding the need for improved delivery of palliative care in patients with heart failure (HF). Professional guidelines have drawn attention to the importance of discussing the heart failure trajectory with patients and their families. These discussions can include, for example, talking about the prognosis, expectations for the future, and care at the end-of-life. It seems difficult for health care professionals to choose the right time for initiating these discussions. They often avoid these conversations because they are afraid of taking away hope and make the patients and their families anxious.Aim: The overall aim of this thesis was to improve communication about the heart failure trajectory in patients, their families, and health care professionals.Design and methods: This thesis includes five studies using different designs and data collection methods. Study I has a cross-sectional design using a questionnaire to collect data to describe heart failure nurses’ perceptions of and practice in discussing prognosis and end-of-life care with heart failure patients. Study II has a descriptive and comparative design, where a survey was performed to describe Swedish and Dutch heart failure nurses’ reasons for discussing or not discussing prognosis and end-of-life care with patients. Study III has an inductive and exploratory design, where HF patients participated in focus groups or individual interviews. Data was collected based on their perceptions of communication about the heart failure prognosis. Study IV was a small-scale ethnographic study describing and evaluating the delivery of a simulation when teaching third-year nursing students about end-of-life care at a Swedish university. Study V used co-design in which patients with HF from primary care, their family members and health care professionals (physicians and nurses) from palliative and HF care were invited to be constructive participants in the design process of a communication intervention. Health care professionals participated in a first feasibility testing of the intervention.Results: Most Swedish HF nurses had discussed prognosis (96%) and end-of-life care (84%) with a HF patient at some point in clinical practice. The nurses often reported that a physician was to have the main responsibility for such discussions (69%), but that the nurse was also believed to have a role to play (I). Prognosis and end-of-life care were, together with sexual activity, () the three least frequently discussed topics in HF clinics in both Sweden and the Netherlands (II). In conversations with 1,809 Swedish and Dutch HF patients, prognosis was discussed with 38% of the patients and end-of-life care was discussed with 10%. In study III, patients expressed different experiences of and preferences for communication about their HF prognosis. Many patients described that the health care professionals had not provided them with any prognosis information at all. The patients had different understandings of HF as a chronic illness, which had an impact on their preferences for communication about their prognosis (III). The simulation training described in the ethnographic study (IV) was part of an end-of-life care simulation during the last term of the 3- year bachelor degree level nursing education program, where students learn and practice basic palliative care. The students felt that the simulation training was a good opportunity to practice handling end-of- life situations as it gave them a chance to experience this situation and their own feelings and thoughts on death and dying. In study V, an intervention to improve communication about prognosis and end-of-life care in HF care was developed and some areas were feasibility tested. Heart failure patients, their families and health care professionals working in HF care or palliative care participated in the development process. Health care professionals (nurses and physicians) participated in the following feasibility testing of the intervention.Conclusions: This thesis shows that prognosis and end-of-life care are seldom discussed with HF patients in Swedish and Dutch heart failure care. and that many heart failure nurses have ambiguous attitudes towards discussing these topics with patients and their families (I+II). The patients described that they receive different messages concerning their heart failure, and that they also have different preferences for discussing the heart failure trajectory with health care professionals. The professionals need to understand the impact of heart failure on each patient and adapt the communication to each individual (III). End-of-life care simulation with skilled supervisors shows great promise for health care professionals to learn good communication skills in end-of-life care conversations (IV). A Question Prompt List and a communication course might be useful for improving communication about the heart failure trajectory in patients, their families, and health care professionals
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| 3. |
- Nahlen Bose, Catarina
(författare)
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Coping and emotional well-being in patients with chronic heart failure
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Chronic heart failure (CHF) is a serious illness, with a profound impact on the patient. Poor health-related quality of life (HRQoL) as well as anxiety and depression are prevalent in CHF and predict mortality and rehospitalization, yet, psychosocial factors are infrequently treated and cared for.Aim: To gather scientific evidence on illness perception and coping strategies to predict emotional well-being in patients with CHF and to establish a measurement model of coping strategies. Furthermore, to evaluate a nurse-led psychoeducational intervention, Coping Effectiveness Training (CET) adapted for patients with CHF.Methods: Studies I-III were cross sectional. Study IV was a randomized controlled trial aimed to improve emotional well-being (one-year follow-up). All studies used patient reported outcome measures and clinical data via medical journals.Results: Younger age and male gender were associated with higher levels of alcohol usage and/or drugs to cope, p < 0.01. Poor sense of coherence was associated with maladaptive coping (I). A four factorial model of Brief COPE displayed the best psychometric properties (II). Avoidant coping influenced negative affect (NA) (I), worse HRQoL (II) and greater anxiety and depression (III). CET (IV) improved personal control in the intervention group (IG) compared to the control group (CG), p = 0.036. Improved scores for the IG were detected in emotional well-being and HRQoL, p = ns. The IG demonstrated reduced NA, p = 0.022, excluding cases with clinical anxiety and depression. Time to cardiovascular readmission or death was non-significantly lower in the IG vs the CG (Hazard ratio 0.58 [0.29-1.18]) adjusted p = 0.135.Conclusions: Personal resources seemed to influence the coping strategies used by patients with CHF. Avoidant coping had an adverse influence on emotional wellbeing and illness perception in CHF. The perceived sense of control and illness burden were of importance for emotional well-being. A CET intervention for patients with CHF increased sense of control over the illness. CET also reduced NA in patients with no or mild symptoms of anxiety and depression.
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| 4. |
- Hasan, Baha, 1977-
(författare)
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An Ontological Approach to support Knowledge Sharing between Product Design and Assembly Process Planning (APP)
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Modern manufacturing organizations have to cope with several critical issues arising from the need for mass customization such as short product life-cycles, an increasing number of product variants and frequently changing customer requirements. One of the main factors that could aid overcoming those challenges is the use of information and communication technology (ICT) applications over a collaborative manufacturing environment, in which all stakeholders share and exchange knowledge across different manufacturing domains and applications. However, the use of ICT applications over a collaborative manufacturing environment is limited at the domain level by semantic conflicts arising from the use of different ways to describe the same objects and facts arising from different conceptualizations. Similarly, ICT usage is limited on the application level by interoperability problems arising from diverse heterogeneity between different ICT applications and tools.This research presents a semantic approach to support knowledge sharing within the assembly domain. More specifically, this research is focusing on capturing and sharing assembly design knowledge and integrating the assembly design domain and the Assembly Process Planning (APP) domain. Assembly design and APP are very important engineering domains for successful manufacturing system design, which requires an efficient collaborative environment for best utilization of the assembly resources. However, though these domains represent different perspectives in understanding of the same concepts, both domains use different software applications, which might cause interoperability issues.In this thesis, a novel integration approach has been proposed; this approach is composed of two stages: the first stage includes modelling and recognition of assembly knowledge semantics from SolidWorks (SW) CAD software by using SolidWorks’ Application Programmable Interface (SW-API). The second stage includes sharing the recognized assembly knowledge semantics by using a knowledge-based system in the form of a three-layer ontology architecture which provides a common semantic base to support knowledge sharing across assembly design and APP both on the domain and the application level. Each ontology layer shares a set of concepts from the most generic level to the most specialized level. The foundation ontology layer represents the general key concepts in the assembly design and APP domains. More specialized assembly design concepts and APP concepts are represented both in the domain ontology layer, and the application ontology layer. In the latter, concepts related to SolidWorks CAD software and to assembly robotic devices are represented.
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| 5. |
- Jiang, Nan
(författare)
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Radiation-Induced Xerostomia in Chinese Patients with Head and Neck Cancer – An Explorative and Interventional study
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Radiation-induced xerostomia is a common oral complication of patients with head and neck cancer (HNC) undergoing radiotherapy (RT). This can lead to a series of functional oral disorders, particularly dental caries, and ultimately negatively affect their oral health and health-related quality of life (HRQoL).Aims: The overall aim of this thesis was to understand the living experience of radiation-induced xerostomia and to determine the effects of an integrated supportive program based on multicomponent oral care strategies in Chinese patients with HNC.Methods: A qualitative descriptive study was conducted to describe how patients (13 men and 7 women) with HNC experienced radiation-induced xerostomia (Ⅰ). A cross-sectional study of patients (n=80) with HNC was conducted to accomplish the validation of the Chinese version of the xerostomia questionnaire (XQ) (Ⅱ). A randomized controlled trial (n=79) was conducted to determine the effect of an integrated supportive program (with a combination of face-to-face health education and coaching sections) on xerostomia, saliva characteristics (Ⅲ), oral health, and HRQoL (IV).Results: Five categories emerged from the manifest content of the interviews: communication problems, physical problems, psychosocial problems, treatment problems, and relief strategies. The meaning underlying these categories formed a theme, which was the latent content of the interview: Due to lack of information regarding xerostomia, patients had to find their own ways to deal with the problem (Ⅰ). The Chinese version of XQ was a unidimensional scale (1-factor solution explained 75.6 of the total variance) and had good psychometric properties with excellent internal consistency (Cronbach’s α of 0.95), test-retest reliability (intraclass correlation coefficient of 0.92), and good criterion-related validity and content validity (Ⅱ). The integrated supportive program showed significant inter-group differences in xerostomia (P=0.046), unstimulated saliva flow rate (P=0.035), plaque index (P=0.038), Oral Health Impact Profile-14 (P=0.002), and Functional Assessment Cancer Therapy-Head & Neck (P=0.001) over the 12-month follow-up, with better outcomes in the intervention group (Ⅲ & Ⅳ).Conclusion: This thesis contributes knowledge regarding the experiences of living with xerostomia from a patient perspective, noting that xerostomia has a profound impact on a patient's physical, psychological, and social quality of life. There is lack of assessment tools for xerostomia in the Chinese population, and the Chinese version of XQ proved to be a valid and simple self-administered tool to measure and monitor the xerostomia level in patients with HNC. The integrated supportive program with multicomponent oral care strategies demonstrated positive effects on relieving xerostomia, increasing unstimulated saliva flow rate, and improving their oral health and HRQoL. These findings provide a basis for improvement in the management of xerostomia and oral health of Chinese patients with HNC through the integration of oral care in nursing.
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| 6. |
- Karlsson, Kåre
(författare)
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Health problems and work-related stress in Swedish ambulance personnel
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Previous studies have shown a high incidence of both acute and post-traumatic stress among ambulance personnel. It has been shown that ambulance personnel are at a higher risk of being affected of heart disease, high blood pressure and cancer. Studies have also seen a higher incidence of substance abuse and suicide. One cause of these health problems can be work-related stress. No previous research has focused on the body's physical reactions in the form of changes in heart rate and stress hormones in ambulance personnel in connection with work-related stress. Nor is there any overall picture of what actually affects Swedish ambulance personnel in terms of reported morbidity.Aim: The overall aim of the thesis is to investigate health problems in Swedish ambulance personnel and to study if there are any factors related to the work environment and the special conditions occurring in the prehospital environment that can be linked to the findings that appear.The questions that should be answered are: Are there health problems that affect Swedish ambulance personnel to a higher extent than other professions in Sweden? Are there any factors relating to morbidity that can be linked to the profession and can be regarded as potentially dangerous? If so, are there methods to prevent health problems that can be implemented in daily work?Methods: Studies I, II and III were all studies where stress markers (heart rate and cortisol levels) were measured during different conditions linked to the profession. Study I was a study where this was measured during physical exertion e.g. to carry a stretcher. Study II was a validated theoretical stress test to see how the ambulance personnel reacted to unknown factors. Study III meant measuring stress markers during priority-1 alarms. Study IV was carried out as a longitudinal register study where data about ICD-codes was collected from Statistics Sweden and the National Board of Health and Welfare.Results: In study I it was shown that the use of lifting aids reduced the measurable stress in the form of both reduced heart rate and decreased cortisol levels. Study II showed that personnel were stressed of the unknown test though women had the highest salivary cortisol levels before the Trier social stress test while the highest value for men occurred 10 to 20 minutes after the test. Study III showed that there was an increase in heart rate during priority-1 alarms that could not be linked to physical activity. It also indicated/showed that traffic accidents, patients with heart attacks in need of acute PCI or thrombectomy and alarms regarding children generate the highest stress onset seen as prolonged elevation of cortisol levels. This was seen regardless of gender, age, education or experience in all three studies. Study IV showed that Swedish ambulance personnel run the risk of being affected by certain diseases such as cardiac arrhythmias and injuries as arthrosis of the knee, dorsopathies and intervertebral disc disorders to a greater extent compared to other health care workers and other professions in Sweden.Conclusion: Swedish ambulance personnel have a higher incidence of certain health problems and diseases such as paroxysmal tachycardia, atrial fibrillation and flutter, other cardiac arrhythmias, high blood pressure, of the knee and dorsopathies and intervertebral disc disorders compared to other professions. These conditions can be caused by work-related stress, although they are not the only cause. Some factors that cause a stress reaction that can be linked to the ambulance profession have emerged in the studies. But the extent to which these factors alone cause the health problems that Swedish ambulance personnel suffer from is more difficult to determine with certainty based on these studies. Using shoulder straps reduces both heart rate and cortisol secretion.Clinical implications: Greater use of aids both in terms of lifting, moving and carrying heavy loads should mean that the physical load on the body would be reduced. These aids could also prevent some musculoskeletal problems that have emerged in this thesis by relieving and distributing the burden throughout the body. An important aspect in preventing work-related stress is that sufficient time is given for recovery. The organizations need to be dimensioned so that there is sufficient standby time so that there is time for recovery and reflection but also time for education and training. This is something that is far from reality in many Swedish ambulance organizations. It is also time to seriously discuss what is an actual reality in many countries, namely that employees in the ambulance service can benefit from a lower retirement age after a certain number of years of service.
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| 7. |
- Lovén Wickman, Ulrica, 1966-
(författare)
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Self-care: the way to find balance in life : development and evaluation of a self-care questionnaire for patients with inflammatory bowel disease
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Inflammatory bowel disease (IBD), ulcerative colitis (UC), and Crohn’s disease (CD) occur worldwide and are life-long chronic conditions. The symptoms, which include abdominal pain and frequent diarrhea, cause limitations in life. Thus, patients with IBD need self-care in accordance with their symptoms, their own commitment to maintaining health, and decisions on symptom management. To strengthen self-care, there is a need for a tool that assesses self-care in patients with IBD, which aims to support the patient dialogue about self-care.The overall aim of this thesis was to develop and evaluate a questionnaire for the clinical assessment of self-care, and to explore self-care in relation to disease activity and to health-related quality of life (HRQOL) in patients with IBD.Design and method: The thesis includes four studies, where studies I, II and IV were conducted in Sweden, and study III was conducted in the United States (U.S.). In study I, a descriptive design, interviews were conducted with twenty adult patients, in order to explore self-care in patients with IBD. In study II, the self-care questionnaire was developed and tested with 193 patients with IBD in Sweden. In study III, a crosssectional descriptive design, the self-care questionnaire was translated into English, and the responses of 67 patients in the U.S. were evaluated. Finally, in study IV, a cross-sectional exploratory design was used to explore self-care in relation to patient characteristics, disease activity, and HRQOL among 234 patients. For a total of 421 patients, the data was analyzed using content analysis, and descriptive and analytic statistics (studies I, II, III and IV).Results: Among patients with IBD, self-care relates to symptom recognition, handling of symptoms, planning life, and seeking new options. Self-care varied according to how the patient managed daily life with regard to the symptoms of the disease (study I). Based on the results from study I, the self-care questionnaire was developed in Swedish, resulting in a valid and reliable questionnaire comprising 22 items (study II). The questionnaire was translated to English, and performed self-care activities were associated with a lower degree of well-being in relation to age and gender (study III). The patients were taking medication for IBD, paying attention to their intestinal symptoms, adapting their diet, managing their stress, planning their day and avoiding activities (studies III and IV). Self-care was more frequent in patients with CD when it came to paying attention to psychological symptoms; diet adaption; avoiding various activities including sex; and looking for new approaches to living with IBD. A greater degree of self-care activities was associated with a lower degree of HRQOL (IV).Conclusion: The results indicate the importance of identifying the total symptom experience, and of the patient’s need to discuss self-care, in order to strengthen selfcare and achieve better treatment. The self-care questionnaire can be a useful tool to benefit the discussion of self-care for the patient, and to secure health literacy, medication adherence, and HRQOL. The valid and reliable self-care questionnaire is available for patients with IBD at gastroenterology clinics or out-patient clinics, as primary care. Disease activity affects self-care, and consequently the self-care activities.
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| 8. |
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| 9. |
- Tingsvik, Catarina
(författare)
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Weaning from mechanical ventilation – from the patient, next-of-kin and healthcare professionals’ perspective
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Critically ill patients with failing respiratory and vital body functions might need invasive mechanical ventilation (IMV). When the patient’s condition improves, the need for respiratory support decreases and weaning from IMV begins. Even though weaning is a central part of intensive care, a stringent and well-accepted definition of this concept is lacking, implying that meanings, descriptions, strategies, and routines vary. The weaning process involves the expertise of diverse healthcare professionals (HCP), whose roles differ between different contexts. Today, person-centred care (PCC) is common and widely spread in healthcare. Still, it is unclear how PCC is recognised, used,and implemented in intensive care and during weaning. The overall aim of the thesis was to explore and describe the process when weaning patients from invasive mechanical ventilation in the ICU from thepatient, next-of-kin, and health care professionals’ perspective. To achieve the thesis's overall and specific aims, four studies (study I-IV) using a qualitative, explorative and descriptive design were conducted. In study I, the patients’ perspectives on weaning were explored, i.e., their lived experience of being on IMV during weaning. Data were collected through 20 interviews and analysed by using a hermeneutic phenomenological approach. Study II explored the meaning of being a next-of-kin when the patient was weaning. The study included eight next-of-kin who were asked to write diary notes based on their experience while the patient was weaning, followed by interviews after the patient’s time in the intensive care unit (ICU). Data were analysed using a hermeneutic phenomenological approach. Study III and IV described and explored the HCP’ perspectives on weaning and the factors that influenced their decision-making. Twenty ICU nurses (study III) and 16 physicians (study IV) were interviewed to describe and explore the factors that influenced decision-making when weaning patients from IMV. Data were inductively analysed using qualitative content analysis.It was found that weaning was not a separate phenomenon for the patient and next-of-kin. It was challenging to distinguish and was intertwined with experiences of intensive care. Patients and next-of-kin had both favourable and depressing experiences, but the favourable ones were more clearly described than in previous research. Moreover, it was essential for the patients to be treated with humanity. This helped them endure the physical and cognitive strains of IMV and intensive care, gain confidence in their body’sability, be given hope, and experience a safe environment. This was strengthened by several circumstances where the relationship with others was central. For next-of-kin, it was essential to be close to the patient as this gave them strength to get through the ICU-time and with their support, patients’less favourable experiences were alleviated. Furthermore, their resources, capabilities, and suffering varied between persons and over time.Weaning was a delimited process with a clear goal for HCP, which was strongly influenced and linked to other care processes. ICU nurses and physicians conducted the weaning and decision-making aligned with the patient’s medical condition, strengths, and wishes. Weaning rarely followed any protocol and planning was not done consistently. Understanding the importance of a caring relationship for decision-making and how this could affect patients and the experiences of next-of-kin was lacking. Moreover, there seem to be ambiguities and unspoken expectations within and between the professions in the allocation of responsibilities regarding weaning.Furthermore, the teamwork dynamic influenced the weaning process, decision-making, and the prerequisites for person-centred weaning.These findings contribute to new, current, and in-depth knowledge of the weaning process. Based on this thesis's four perspectives, the concept of person-centred weaning appeared, which means to strive to retain and consider the patient as a capable person despite failing vital functions, voicelessness, vulnerability, and extended need for support and assistance. Furthermore, HCP need to be aware of the dynamic within the weaning process and the impact of the care culture on the quality and experience of the weaning. There is a need to optimise the team's prerequisites, collaboration, and resources at an organisational level to perform person-centred weaning and maybe optimise the weaning process.
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| 10. |
- Wu, Eline
(författare)
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Enhanced external counterpulsation treatment in patients with refractory angina pectoris with emphasis on physical capacity, health-related quality of life and safety : An explorative and interventional study
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimised medical therapy. In addition, frequent angina symptoms are strongly associated with psychological distress. The challenging management of RAP and the severe limitations and symptomatology experienced by these patients underscore the need for further research in more novel treatment approaches. Enhanced external counterpulsation (EECP) is a potential non-invasive treatment that can decrease limiting symptoms in patients with RAP and is generally given as 35 one-hour sessions (i.e., one course) over seven weeks.Aim: The overall aim was to obtain a deeper understanding of patients’ experiences undergoing EECP treatment and to evaluate the effects of the treatment with focus on physical capacity, HRQoL and safety.Methods: An explorative and interventional study comprising both qualitative (paper I) and quantitative (papers II, III, and IV) study designs were performed. In paper I, semi-structured interviews took place with 15 strategically selected patients who had finished an EECP course at the two existing EECP clinics in Sweden. Data were analysed using inductive qualitative content analysis. In paper II, a quasi-experimental study with one-group pre-test/post-test design with a six-month follow-up was performed with 50 patients who had undergone one EECP course. The following pre- and post-treatment data were collected: medication use, six-minute walk test (6MWT), functional class according to the Canadian Cardiovascular Society (CCS), self-reported (i.e., questionnaire data) cardiac anxiety, and HRQoL. The questionnaires were also completed at a six-month follow-up. In paper III and IV, sociodemographic, medical, and clinical data related to EECP were collected by reviewing medical records of 119 patients with RAP who had undergone one EECP course and a 6MWT pre- and post-treatment. An increased walking distance by 10% post treatment, measured with 6MWT, was considered an adequate treatment response.Results: In paper I, the findings were divided into four content areas, each comprising three categories: (1) experiences before EECP was initiated comprised of uncharted territory, be given a new opportunity and gain insight; (2) experiences during EECP sessions comprised physical discomfort, need of distraction, and sense of security; (3) experiences between EECP sessions comprised physical changes, socializing, and coordinating everyday life; and (4) experiences after one course of EECP treatment comprised improved physical well-being, improved mental well-being and maintaining angina in check. In paper II, patients used significantly less short-acting nitrates (p <. 001), walking distance increased on average by 46 m (p < .001), and CCS class improved after one EECP course (p < .001). In addition, all but one subscale of cardiac anxiety and all HRQoL components improved significantly, and the positive effects were maintained at the six-month follow-up (p < .05). In paper III, 49 (41.2%) of the 119 patients, were responders to EECP. CCS class ≥ 3, left ventricle ejection fraction < 50%, and previous revascularisation (i.e., ≤ one type of intervention) were predictors of response (p < .05). In paper IV, the treatment completion rate was high, and the occurrence of adverse events (AE) was low. Most device-related AE required nursing actions, while medical actions were needed more in the non-device-related AE. The AE distribution did not differ between responders and non-responders. Skin lesion/blister occurred mostly in responders and paraesthesia occurred mostly in non-responders.Conclusions: The EECP treatment was perceived as an unknown option among these patients but also as be given a new opportunity to get better. The presence and care provided by the cardiac nurse contributed to a sense of security during treatment. The treatment resulted in reduced symptom burden, improved physical capacity and HRQoL, and less cardiac anxiety, leading to increased physical activity and enhanced life satisfaction for patients with RAP. Moreover, the EECP should be considered preferentially for patients who have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularisation. The EECP treatment appears to be a safe and well-tolerated treatment option in patients with RAP.
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| 11. |
- Holmlund, Lena, 1967-
(författare)
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Patients’ experiences of atrial fibrillation and an evaluation of a nurse-led person-centred clinic
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Living with and managing atrial fibrillation (AF) can be complex. Some people have no symptoms, while others have a significant symptom burden. Health-related quality of life (HRQoL) is often low and partly associated with symptom burden. However, the impact of the condition on daily life differs between those affected and is not fully understood. Therefore, more knowledge is needed about patients’ experiences of AF and factors influencing HRQoL. Research indicates that the care of patients with AF needs to change and be more based on personal preferences and values.Aim: The overall aim of this thesis was to explore patients’ experiences of AF and to evaluate the effects of a nurse-led, person-centred clinic.Methods: The thesis contains four studies. Study I was based on interviews with 15 patients about their experiences of living with symptomatic AF. Studies II and III were based on data from questionnaires completed before and 6 months after scheduled electrical cardioversion. Study II was a cross-sectional study with 52 women and 115 men describing illness perceptions and HRQoL and exploring their relationship. Study III was a longitudinal study comparing 53 newly diagnosed (<6 months) and 76 previously diagnosed patients with AF (≥6 months) regarding HRQoL, illness perceptions, symptoms, symptom burden, anxiety and depression. Study IV was a randomised controlled trial evaluating the effects of a nurse-led, person-centred clinic on patient-reported outcomes measures in patients with AF. Patients were randomly assigned to a nurse-led intervention group (n=50) or a control group with a physician visit (n=53) and completed questionnaires on the same subjects as in Study III at baseline before the visit to the clinic and 6 months after. Study I were analysed with qualitative content analysis. The other studies are quantitative and were analysed with descriptive statistics (Studies II–IV), comparative statistics (Studies II–IV), and correlation analysis and multiple linear regression analysis (Study II).Results: In Study I, three themes (striving for illness control, becoming a receiver or an active partner in care, and dealing with a changed self-image) were reflected in the main theme, balancing life. The participants described their struggles in understanding AF, preventing recurrence and managing anxiety. Some were not involved in decision-making, lacked continuity of care, felt that most information focused on medical issues and requested more support and self-care advice. Study II showed that HRQoL was related to and negatively affected by attributing more symptoms, severe consequences, and negative emotions (e.g., anxiety, anger) to AF and perceiving AF as recurrent. Women reported worse HRQoL and lower personal control than men. Study III showed that newly diagnosed (vs. previously diagnosed) patients at baseline reported AF as a more temporary condition to a greater extent and had stronger belief that the illness was controllable. After 6 months, newly diagnosed patients reported better HRQoL, higher personal control, and lower symptom burden than previously diagnosed patients. Over time, HRQoL improved and AF symptom burden and symptoms of anxiety decreased in newly diagnosed patients, who viewed the illness as chronic to a greater extent than at baseline. Study IV showed that, in the nurse-led intervention group, the patients’ negative emotions towards AF decreased more than in the control group. In addition, their concerns regarding AF decreased and their personal control increased. In both groups, HRQoL and patients’ understanding of AF improved.Conclusions: This thesis demonstrates that for many, AF meant a change in life in which they had to manage anxiety and symptoms and oscillate between being strong and weak and a changed self-image. Men (vs. women) and newly diagnosed (vs. previously diagnosed) patients reported more positive outcomes, such as better HRQoL and greater belief in their ability to control AF. Worse HRQoL was associated with negative illness perceptions, such as more perceived recurrences, symptoms, severe consequences, and negative emotions. The findings in Study IV suggest that the support from a nurse-led person-centred clinic may reduce patients’ negative emotions and concerns attributed to AF and improve their personal control.
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| 12. |
- Karlsson, Erik, 1982-
(författare)
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Catalysts for Oxygen Production and Utilization : Closing the Oxygen Cycle: From Biomimetic Oxidation to Artificial Photosynthesis
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis describes the development and study of catalysts for redox reactions, which either utilize oxygen or hydrogen peroxide for the purpose of selectively oxidizing organic substrates, or produce oxygen as the necessary byproduct in the production of hydrogen by artificial photosynthesis.The first chapter gives a general introduction about the use of environmentally friendly oxidants in the field of organic synthesis, and about the field of artificial photosynthesis. The second chapter describes a computational study of the mechanism of palladium-catalyzed oxidative carbohydroxylation of allene-substituted conjugated dienes. The proposed mechanism, which was supported by DFT calculations, involves an unusual water attack on a (π-allyl)palladium complex. The third chapter describes a computational study of the oxidation of unfunctionalized hydrocarbons, ethers and alcohols with hydrogen peroxide, catalyzed by methyltrioxorhenium (MTO). The mechanism was found to proceed via rate-limiting hydride abstraction followed by hydroxide transfer in a single concerted, but highly asynchronous, step as shown by intrinsic reaction coordinate (IRC) scans. The fourth chapter describes the use of a new hybrid (hydroquinone-Schiff base)cobalt catalyst as electron transfer mediator (ETM) in the palladium-catalyzed aerobic carbocyclization of enallenes. Covalently linking the two ETMs gave a fivefold rate increase compared to the use of separate components. The fifth chapter describes an improved synthetic route to the (hydroquinone-Schiff base)cobalt catalysts. Preparation of the key intermediate 5-(2,5-hydroxyphenyl)salicylaldehyde was improved by optimization of the key Suzuki coupling and change of protecting groups from methyl ethers to easily cleaved THP groups. The catalysts could thus be prepared in good overall yield from inexpensive starting materials.Finally, the sixth chapter describes the preparation and study of two catalysts for water oxidation, both based on ligands containing imidazole groups, analogous to the histidine residues present in the oxygen evolving complex (OEC) and in many other metalloenzymes. The first, ruthenium-based, catalyst was found to catalyze highly efficient water oxidation induced by visible light. The second catalyst is, to the best of our knowledge, the first homogeneous manganese complex to catalyze light-driven water oxidation.
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| 13. |
- Strömbäck, Ulrica
(författare)
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The second myocardial infarction : A known but different experience
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore the second myocardial infarction (MI) and describe experiences of the second myocardial infarction from the perspectives of patients and personnel in cardiac rehabilitation (CR).This thesis includes four studies. Studies using quantitative method (I, II) and qualitative method (III, IV) were performed. Studies I and II were retrospective cohort studies based on data from the Northern Sweden’s MONICA myocardial infarction registry. A paired design was used. Study I included 1017 participants, and the corresponding figure for Study II was 820 participants. The participants had at least two MI events recorded in the MONICA MI registry from 1990 – 2009 (I) and 1986 – 2009 (II). The two MI events studied were the first and second events. Study III included eight patients who suffered two MIs. The data were collected through interviews about the experience of suffering a second MI. In Study IV, personnel working with CR were interviewed about the experience of working with patients suffering from a second MI and data from study III were used for describing the patients expressed needs during CR. Data were analysed by descriptive and analytic statistics (I, II) and by qualitative content analysis (III, IV).Both men and women had higher risk factor burdens when suffering the second MI compared when they suffered the first MI. Women had a higher risk factor burden at both first and second MI compared with men. Women also suffered the second MI with a shorter time interval than men did (I). The most common symptom reported in men and women at both MI events were typical symptoms. In men, 10.6 % reported different types of symptoms at first and second MI, and the corresponding figure for women was 16.2 % (II). The number of patients with a prehospital delay < 2 hours increased at the second MI. Furthermore, the results showed that patients with a prehospital delay ≥ 2 hours at the first MI were more likely to have a prehospital delay ≥ 2 hours at the second MI (II). Suffering a second MI is a known but different event compared to the first MI, it makes afflicted people realise the seriousness and the importance of making lifestyle changes (III). People express they are more affected after having the second MI, both physically and psychologically (III). In the analysis of congruence between the needs patients expressed linked to CR and personnel’s description of how they worked, a theme emerged: “Be seen as a unique person” 2(IV). The patients expressed a need of customised care, and the personnel described that it was important for them to individualise the care given to these patients.Suffering a second MI is experienced as a different and more serious event that the first one. The patients had gained valuable knowledge due to their previous experience and the second MI was a wake-up call for life style changes. A majority of the patients had typical symptoms at both MI events and an increased number of patients had a prehospital delay < 2 hours at the second MI. We suggest that the personnel in CR pay attention to first-time MI patients’ illness representation to enhance the patient’s awareness of the seriousness of the illness and the fact that they suffer from a chronic illness. The care given after an MI, including cardiac rehabilitation should be person-centred to involve the patient as an active participator in the care and were the patient’s resources and needs are in focus.
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| 14. |
- Wang, Lan
(författare)
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A health coaching self-management programme for patients with Chronic Obstructive Pulmonary Disease : An explorative and interventional study
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Chronic Obstructive Pulmonary Disease (COPD) is a primary cause of chronic morbidity and mortality and contributes to an increased economic and social burden on patients and families. Self-management education as one non-pharmacological treatment approach is highlighted in guidelines. Although self-management programmes have shown positive effects for COPD, lack of disease-specific self-management skills, high dropout rates, and poor attendance of participants are problems which should be taken under consideration. One way to cope with the problems is to use amore motivational approach which focuses on patients’ health decisions in cooperation with healthcare practitioners, combined with systematic and structured health coaching. However, there is a lack of such studies, which are needed to explore the effects of self-management on patients with COPD by health coaching, not least in China.Aims: The overall aim of this thesis was to explore sociodemographic and clinical factors influencing self-management and to test and evaluate a health coaching self-management programme for patients with COPD in China.Methods: The study’s design was explorative, prospective, and longitudinal, with both quantitative and qualitative approaches. Specifically, a quantitative method with a cross-sectional approach was used to explore the self-management status of patients with COPD and examine the associations with socio-demographic and clinical variables (I). Furthermore, a prospective randomized controlled trial was conducted to study the longitudinal effects of the health coaching self-management programme using a repeated-measures analysis of variance model of patients with COPD (II & III). A qualitative study implementing inductive content analysis was used to describe and explore participants’ experiences of the health coaching self-management programme of patients with COPD (IV).Results: High physical activity, high salary, and low age affected the self-management of patients with COPD most positively (I). The health coaching programme improved lung function, physical activity, quality of life, and self-management skills, as well as psychological status in both the short and long term (II & III). Participants expressed their experiences of the health coaching self-management programme as making them more aware of the importance of knowledge of the disease and their own responsibilities, taking action to maintain a healthy lifestyle, feeling supported by the programme, and being hindered by individual and programme limitations (IV).Conclusions: This thesis contributes to knowledge about the self-management skills of patients with COPD, which is low in China. A health coaching self-management programme with iterative interactions between patients and healthcare professionals represented a valuable and effective intervention designed to improve health-related outcomes. Moreover, low literacy, poor physical condition, and family and economic burdens should be taken into account in the development of future self-management programmes in China.
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| 15. |
- Wieslander, Inger
(författare)
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Women’s recovery after a first myocardial infarction from an organisational, a relational and an individual perspective
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore and describe women’s recovery after a first myocardial infarction (MI) from an organisational, a relational and an individual perspective. In this thesis a longitudinal, explorative and descriptive design combining both quantitative (papers I-II) and qualitative (papers III-IV) methods has been used. Data was collected from healthcare professionals at 18 acute hospitals (paper I), which on two occasions answered a questionnaire dealing with cardiac rehabilitation efforts. From these 18 hospitals, 240 women who had suffereda first MI (paper II) were consecutively chosen to answer a questionnaire on three occasions on the subject of social support and social network. Descriptive and inferential statistics were used to analyse data over time. Paper III and IV had an exploratory and descriptive design based on an inductive, qualitative content analysis approach. Interviews were conducted with 20 cardiac rehabilitation nurses (CRN) (paper III) and with 26 women suffering a first MI (paper IV).The results showed that patients with MI, and their next of kin, were offered a well-functioning cardiac rehabilitation on both measurement occasions. None of the hospitals offered a CRP that was specifically designed for women (paper I). The women perceived that the extent of general support, support from relatives, and professional support changed positively over time (paper II). The CRNs experienced that women’s recovery was influenced by their ability to cope with the stresses of life, if they wanted to be involved in their own personal care and how they related to themselves, and their opportunities to receive support (paper III). Women experienced that ability to approach the new perspective of life depended on how they embraced the three dimensions; behaviour, i.e. women’s acting and engaging in various activities, social i.e. how women receive and give support in their social environment, and psychological i.e. their way of thinking, reflect and appreciate life (paper IV).In conclusion, the four studies show that women’s recovery after a first MI is depending on factors emerging from an organisational, a relational and an individual perspective. Using knowledge from these three perspectives the possibility of a holistic approach to women’s recovery process to health will increase and the risk of a reductionist thinking will decrease.
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| 16. |
- Hjelmfors, Lisa, et al.
(författare)
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Variables Related to Communication About Prognosis Between Nurses and Patients at Heart Failure Clinics in Sweden and the Netherlands.
- 2018
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Ingår i: Journal of Cardiovascular Nursing. - : Lippincott Williams & Wilkins. - 0889-4655 .- 1550-5049. ; 33:2, s. E1-E6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In contrast to recommendations in recent guidelines, prognosis is not optimally discussed with patients with heart failure (HF). Reasons for not doing so can be related to both patient and provider characteristics.PURPOSE: The purpose of the study was to explore which patient- and nurse-related variables influence discussing prognosis with patients at an HF clinic.METHOD: Data from a previous survey on attitudes and clinical practice of HF nurses on discussing prognosis that was conducted in Sweden and the Netherlands were combined with data from a registration on topics that nurses discussed with their patients during a prespecified week at the HF clinic. Multivariable logistic regression analysis was performed to assess which variables are related to discussing prognosis.RESULTS: A total of 275 HF nurses (mean age, 49 years) and data of 1633 patients with HF (mean age, 71 years) were included in the study. Prognosis was discussed with 42% of all patients during the visit at the HF clinic. Patients with whom prognosis was discussed were more often in New York Heart Association classes III to IV (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.44-2.26). Nurses discussing prognosis reported more knowledge on the topic (OR, 1.71; 95% CI, 1.36-2.16) and discussed more topics with the patient (OR, 1.27; 95% CI, 1.21-1.32). Dutch HF nurses were more likely to discuss prognosis compared with their Swedish colleagues (OR, 1.83; 95% CI, 1.43-2.33).CONCLUSIONS: Discussing prognosis with patients with HF by nurses at the HF clinic is related to the characteristics of patients and HF nurses. Future interventions to improve communications about prognosis therefore should have a broad approach.
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| 17. |
- Luttik, Maria, et al.
(författare)
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Attitudes of nurses towards family involvement in the care for patients with cardiovascular diseases
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:4, s. 299-308
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: There is increasing evidence supporting the relationship between family support and patient outcomes. Therefore, involving families in the care of cardiovascular patients is expected to be beneficial for patients. The quality of the encounter with families highly depends on the attitudes of nurses towards the importance of families in patient care.AIM: The aim of this study was to describe the attitudes of nurses towards family involvement in patient care and to investigate the individual contributions of demographic, professional and regional background characteristics.METHOD: A survey was distributed among cardiovascular nurses attending an international conference in Norway and a national conference in Belgium. Nurses were asked to complete a questionnaire, including the Families' Importance in Nursing Care - Nurses' Attitudes scale. The study population consisted of respondents from Belgium (n = 348) and from Scandinavian countries (Norway, Sweden and Denmark; n = 77).RESULTS: In general, nurses viewed the family as important in care. However, attitudes towards actively inviting families to take part in patient care were less positive. Higher educational level and a main practice role in research, education or management were significantly associated with more positive attitudes. Furthermore, the attitudes of respondents living in Scandinavia were more positive as compared to the attitudes of respondents living in Belgium.CONCLUSION: Education on the importance of families and active family involvement in patient care seems to be necessary in basic, undergraduate education, but also in clinical practice. More research is necessary in order to explore the cultural and regional differences in the attitudes of nurses towards the involvement of families in patient care.
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| 18. |
- Unis, Brian, 1958-
(författare)
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Sexual health and sexual health promotion in the transition from adolesence to emerging adulthood
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: This thesis aims to explore the transition from adolescence to emerging adulthood, related to adolescents’ sexual behavior, conceptions concerning sex, sexual relationships and sex education, their need for knowledge and support related to sexuality. A further aim was to explore professionals’ views on promotion of sexual health, and interprofessional collaboration in relation to adolescents’ sexual health. Methods: Both quantitative methods (I) and qualitative methods (II, III, IV) were used. In study I, 139 adolescents responded to a cross-sectional survey. The qualitative data was obtained through focus group interviews with 32 adolescents (II) and individual, pair and group interviews (III) with 26 adolescents. Further, 24 professionals participated in focus group interviews (IV). Findings: Adolescents’ reported a low level of sexual risk behavior and high self-esteem, yet put themselves at risk by inconsistent condom use (I). Learning about sex and relationships included values, knowledge and practical skills in relation to maturity, enabling internalization of different aspects of sexuality, creating meaning and fostering autonomy and identity (II). Developing sexuality involved changing needs for knowledge, discussing, interacting with others, and gaining experience (III). Professionals reached out to adolescents through competence and trusting relationships. It was important to keep up to date with changes regarding sexuality, to reach vulnerable groups, and include questions about sexuality in all health care contexts involving adolescents (IV). Conclusions: Adolescents’ needs for knowledge and support were constantly changing with development through learning, experience and interaction with peers, parents, and health professionals. Different efforts are necessary in sexual health promotion depending on age, maturity or gender in order to provide high quality nursing interventions in relation to adolescents’ sexual health.
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| 19. |
- Vellone, Ercole, et al.
(författare)
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Cognitive impairment in patients with heart failure : an international study
- 2020
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Ingår i: ESC Heart Failure. - : John Wiley & Sons. - 2055-5822. ; 7:1, s. 47-54
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients.Methods and results: A secondary analysis from the baseline data of the Wii-HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short-term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients' older age, lower education, and lower 6MWT scores (R2 = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores.Conclusions: CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.
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| 20. |
- Verheijden Klompstra, Leonie, 1982-, et al.
(författare)
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Exergaming through the eyes of patients with heart failure : A qualitative content analysis study
- 2017
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Ingår i: Games for Health Journal. - : Mary Ann Liebert. - 2161-783X .- 2161-7856. ; 6:3, s. 152-158
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Exergaming appears to be a promising tool to increase exercise capacity in patients with chronic heart failure (HF). Therefore, it is important to obtain more in-depth knowledge about preferences, attitudes, use, and abilities in regard to exergaming. The aim of this study was to describe the experiences of patients with HF when using an exergame platform at home.Materials and Methods: A qualitative descriptive study using content analysis was conducted on interviews with 14 patients with HF (6 women, ages ranging between 56 and 81 years). The patients were recruited from three centers in Sweden included in a randomized controlled study. These patients had access to an exergame platform at home and were advised to exergame for 30 minutes per day.Results: The analysis resulted in three categories describing patients' experience of exergaming: (1) making exergaming work, (2) added value of exergaming, and (3) low appeal of exergaming.Conclusion: This is the first study that explores how patients with HF experience using an exergame platform at home. The study provided important information on what aspects to discuss when initiating an exergame platform at home and following patients who may want to use an exergame platform at home. The results also revealed that this technology may be suitable for some patients, while others prefer other kinds of physical activity.
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| 21. |
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| 22. |
- von Vogelsang, Ann-Christin
(författare)
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Impact on life after intracranial aneurysm rupture : health-related quality of life and epidemiologic outcomes
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe impact on life up to ten years after intracranial aneurysm rupture in terms of health-related quality of life, changes in everyday life and descriptive epidemiology with the intention to contribute to an increased understanding of the long-term perceived consequences of that impact.Study I aimed to describe changes and transitions in everyday life during the first two years following an intracranial aneurysm rupture. A consecutive sample of 88 patients was followed-up at three time points. A majority of respondents perceived changes in their everyday life during the first two years following aneurysm rupture. Transitions were revealed within changes in personality, changed social roles and relationships, and changed abilities and behavior.In Study II epidemiology in relation to gender differences and treatment modalities ten years after aneurysm rupture was investigated. Ten years after the onset, 63.9% of the 468 admitted patients were still alive. The incidence in women was higher than that of men; they were older at onset and were diagnosed with more aneurysms. There were no significant differences in survival times between patients treated with different active aneurysm treatments, or between men and women.In Study III survivors from study II (n=217) were followed-up with questionnaires and telephone interviews, aiming to describe psychological, physical and cognitive functions ten years after intracranial aneurysm rupture. Compared to reference groups, the aneurysm respondents scored higher levels of anxiety and depression. Respondents with ruptured aneurysms in the posterior circulation of the brain scored significantly more symptoms of anxiety and depression. A small proportion, 2.8%, scored for severe physical disability and 21.7% scored below the cut-off value, indicating cognitive impairments.Study IV used the same sample as study III (n=217), and a general population sample (n=434) from the Stockholm Public Health Survey, matched by age and sex. The aim was to measure health-related quality of life (HRQoL), and to explore factors affecting HRQoL, ten years after intracranial aneurysm rupture. Compared to general population, the aneurysm sample reported significantly more problems with mobility, self-care, usual activities and anxiety/depression and had significantly lower overall HRQoL values. HRQoL in the aneurysm sample was most affected in respondents with worse neurological outcome, respondents with comorbidities, and respondents with low perceived recovery.In conclusion, intracranial aneurysm ruptures impacts upon life in several ways for an extensive period of time after the onset. The results indicate a need for follow-up and support, and to identify subgroups of aneurysm patients who might benefit from support: patients with ruptured aneurysms in the posterior circulation of the brain; patients with worse neurological outcome at hospital discharge; patients with comorbidities; and patients with low perceived recovery. Ten years after the onset of aneurysm rupture the majority of patients were still alive. Differences between men and women were apparent in incidence and clinical presentation at the onset of aneurysm rupture, not in survival times. Survival time was equal between patients within active treatment modalities.
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| 23. |
- Östman, Malin, 1968-
(författare)
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Kontinuitet som grund för vårdande och hälsa vid hjärtsvikt : patienters, närståendes och sjuksköterskors perspektiv
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim was to examine continuity of care for persons with heart failure from the patients’, next of kin’s and nurses’ perspectives.Methods: This thesis has a caring science approach and consists of four qualitative studies conducted in a health care context. Studies I and II are based on patients’ experiences of continuity in heart failure. The data were collected through individual interviews and a group interview that was analysed using the grounded theory method. Study III is based on next of kin’s perceptions of continuity of care in heart failure. The data were collected with individual interviews and analysed using a phenomenographic method. Study IV is based on nurses’ perceptions of continuity of care for patients with heart failure. The data were collected with focus group interviews and analysed using a phenomenographic method.Results: Continuity of care supports caring and health. To patients, continuity is what connects care and life. Continuity of care creates conditions that support the patient’s health processes and vitality; it contributes to the patient being able to maintain continuity in life. To the next of kin, continuity of care contributes to a feeling of being in “good hands”. Continuity can be the support that next of kin need to integrate care into their daily life with the patient and to find a balance between responsibility and commitment in the patient’s care. Nurses have a unique opportunity to create continuity of care in a way that meets the needs and conditions of both patients and next of kin. When continuity is created based on patients’ needs, in a way that is meaningful and relevant to patients’ health, continuity contributes to well-being, safety and autonomy for patients and next of kin. Continuity of care also makes it easier for nurses to collaborate with the patients, next of kin and other professionals.Conclusion: Continuity makes care caring. Continuity of care supports patients and next of kin to manage life adaptation that accompanies the disease and preserve their well-being and health as much as possible. Continuity of care supports nurses’ professional practice.
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