| 1. |
- Jangland, Eva, et al.
(författare)
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A mentoring programme to meet newly graduated nurses' needs and give senior nurses a new career opportunity : A multiple-case study
- 2021
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Ingår i: Nurse Education in Practice. - : Elsevier. - 1471-5953 .- 1873-5223. ; 57
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the implementation of a multifaceted mentoring programme in a large university hospital and describe its value from the perspectives of newly graduated nurses, experienced nurses and the hospital organisation.Background: Healthcare organisations need long-term competence-planning strategies to retain nurses, prevent their premature departure from the profession and use their competencies. This paper reports a mentoring programme focused on supporting newly graduated nurse' transition to practice and senior nurses' professional development as supervisors.Design: A multiple-case study.Methods: We performed 35 interviews with nurses, supervisors and nurse managers in the five units that implemented the programme, mapped the programme at the hospital level and extracted the nurses' working hours. The interviews were analysed thematically using the theoretical lens of the head-heart-hand model to interpret the results.Results: Of 46 units in the hospital, 14 had implemented one or several of the components in the mentoring programme. The programme corresponded to the newly graduated nurses' needs, gave senior nurses a new career opportunity and contributed to an attractive workplace. The main theme, Giving new nurses confidence, experienced nurses a positive challenge and the organisation an opportunity to learn, reflects the value of the programme's supervisory model to new and experienced nurses and to the organisation as a whole.Conclusion: The mentoring programme appeared to be a promising way to smooth the transition for newly graduated nurses. The experienced supervising nurses were key to the success of this complex programme, supporting the new nurses at the bedside and being available to respond to their questions and reflections. Embedding the supervisors in the units' daily practice was necessary to the success of the different parts of the programme. Despite the strategic and well-designed implementation of this mentoring programme aimed to solve the everyday challenge of nurse shortages in the hospital, it was a challenge to implement it fully in all the units studied.
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| 2. |
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| 3. |
- Törnkvist, Anna, et al.
(författare)
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Interference of the electrospray voltage on chromatographic separations using porous graphitic carbon columns
- 2004
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Ingår i: Journal of Mass Spectrometry. - : Wiley. - 1076-5174 .- 1096-9888. ; 39:2, s. 216-222
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Tidskriftsartikel (refereegranskat)abstract
- The electrospray ionization (ESI) voltage is shown to interfere with liquid chromatographic separations performed with packed porous graphitic carbon (PGC) capillary columns. This interference is ascribed to the presence of an electric field over the conductive column in the absence of an earth point between the column and the ESI emitter. The current evolved alters the chromatographic behavior of the catecholamine metabolite 3-O-methyl-DOPA significantly, as both peak splitting and a dramatic decrease in the retention time were observed. Furthermore, the response from the mass spectrometer was decreased by 33% at the same time. A related compound, tyrosine, exhibited decreased retention times but no peak splitting, whereas no shifts in the retention times (or peak splitting) were seen for the less retained dopamine and noradrenaline. When the current through the PGC column was eliminated by the use of an earth point between the column and the ESI emitter, the chromatographic behavior of the column was found to return slowly to normal after hours of equilibration with 60 : 40 (v/v) methanol-ammonium formate buffer of pH 2.9. The behavior of the PGC column with and without the earth point was found to be highly reproducible during a period of 1 month. We propose that the effect of the ESI voltage on the chromatographic behavior of the PGC column is due to associated redox reactions affecting both the PGC particles and the analytes. It is concluded that (for analytical reasons), care should be taken to ensure that no current is flowing through the chromatographic system when interfacing PGC columns, and conducting parts in general, to ESI mass spectrometry.
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| 4. |
- Åkerblom, Ylva, 1967-
(författare)
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Experiences of pain and associations between pain, disease severity and individual quality of life in people with motor neuron diseases
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Many people with the incurable and often times fatal motor neuron diseases have pain, but there is lack of knowledge about people’s experiences of living with pain. Further, the correlation between pain and their quality of life is not well understood, and previous studies have not used individual quality of life, namely that people with their own words express what quality of life is. The aim of these studies was to explore the experiences of pain and the association between pain and quality of life in people with MND.Methods: Study I was explorative about the individual experience of pain, while study II was correlational between pain, pain severity, disease severity and IQOL. Study I was qualitative, whereas study II used both qualitative and quantitative analysis.Results and conclusions: People with motor neuron diseases experienced pain to have multiple characteristics and impact. However, the results emphasise that the individual experienced some pain characteristics as difficult and that pain could worsen functions that were already affected by the disease. The experience was also that it could be challenging to manage pain. However, the symptom of pain could pass unnoticed in contacts with healthcare professionals (study I). The three most important areas for individual quality of life in both participants with and without pain were: Social relations, followed by Activities for amusement and relaxations, and Being in the outdoor environment. Individual quality of life was noticed to be good regardless of pain. Pain and pain severity were not found to be associated with satisfaction of individual quality of life in patients with motor neuron diseases, neither was disease severity. The results support previous findings, that strong associations between symptoms of MND and IQoL are not obvious. However, this does not infer that pain in people with MNDs should be neglected and undertreated. On the contrary, it seems to be important for healthcare to pay more attention to pain in people with motor neuron diseases and that pain continuously is measured, individually treated and followed. Regardless of whether persons with MND have pain or not, the results point to the importance of healthcare professionals providing support to not only the patient but also the patient’s family and friends, as well as assisting in various forms of relaxing activities and possibility of being in the outdoor environment.
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| 5. |
- Arakelian, Erebouni, 1973-, et al.
(författare)
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How Anesthesiologists and Nurse Anesthetists Assess and Handle Patients' Perioperative Worries Without a Validated Instrument
- 2019
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier BV. - 1089-9472 .- 1532-8473. ; 34:4, s. 810-819
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To study how nurse anesthetists and anesthesiologists assess and handle patients' perioperative anxiety without using a validated instrument.DESIGN: Qualitative study.METHODS: Individual in-depth face-to-face interviews were conducted with nurse anesthetists (n = 9) and anesthesiologists (n = 5) from a university hospital in Sweden. Data were analyzed with thematic analysis according to Braun and Clark.FINDINGS: Two themes were identified: (1) I ask about anxiety, look for visual signs, and observe communication and (2) I handle patients' anxieties individually. In addition to subthemes describing assessment and handling of adults, it appeared that parents played an important role in children's perioperative anxiety.CONCLUSIONS: When not using a validated instrument, assessing perioperative anxiety is commonly based on the anesthesiologist's and nurse anesthetist's experience, knowledge, views, and attitudes. The evaluator's capability of using different strategies in the assessment and handling of perioperative anxiety is important.
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| 6. |
- Arakelian, Erebouni, 1973-, et al.
(författare)
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Nurses anaesthetists' versus patients' assessment of anxieties in an ambulatory surgery setting.
- 2019
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Ingår i: Journal of perioperative practice. - : Sage. - 2515-7949 .- 1750-4589. ; 29:12, s. 387-415
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Failure to assess patients' anxiety perioperatively by means of a validated instrument makes the assessment arbitrary. Studies are lacking about how well nurse anaesthetists estimate patients' preoperative worries.PURPOSE: To compare the nurse anaesthetists' estimations of patients' preoperative anxieties with the patients' own assessment of their anxieties.DESIGN: Quantitative prospective design.METHODS: Eighty-five pairs of patients and nurse anaesthetists in two ambulatory surgery units in a university hospital in Sweden were included. Patients' perioperative anxieties were graded using the Numeric Visual Analogue Anxiety Scale.RESULTS: The nurse anaesthetist overestimated the patients' level of preoperative anxiety in 53% of patients and underestimated patients' anxieties in 31% of the patients. Consensus was seen in 16% of the pairs. In fifty-six pairs (65%), the difference between the estimation of level of patients' anxiety according to Numeric Visual Analogue Anxiety Scale was between -3 (overestimation) and +3 levels (underestimation). Median levels of anxiety were estimated as 3 within the patient group and 4 among the nurse anaesthetists.CONCLUSIONS: Systematic assessment of patients' level of anxiety could lead to identifying patients with severe anxiety levels and to offer more individualised treatment. The patients' own estimation must form the basis for the discussion and treatment.
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| 7. |
- Braun, Madelen, et al.
(författare)
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Levels of inflammatory cytokines MCP-1, CCL4, and PD-L1 in CSF differentiate idiopathic normal pressure hydrocephalus from neurodegenerative diseases
- 2023
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Ingår i: Fluids and Barriers of the CNS. - : BioMed Central (BMC). - 2045-8118. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Background: Neuroinflammatory processes have been suggested to play a role in the pathophysiology of neurodegenerative diseases and post-hemorrhagic hydrocephalus, but have rarely been investigated in patients with idiopathic normal pressure hydrocephalus (iNPH). The aim of this study was to investigate whether levels of inflammatory proteins in CSF are different in iNPH compared to healthy controls and patients with selected neurodegenerative disorders, and whether any of these markers can aid in the differential diagnosis of iNPH.Methods: Lumbar CSF was collected from 172 patients from a single center and represented iNPH (n = 74), Alzheimer's disease (AD) (n = 21), mild cognitive impairment (MCI) due to AD (n = 21), stable MCI (n = 22), frontotemporal dementia (n = 13), and healthy controls (HC) (n = 21). Levels of 92 inflammatory proteins were analyzed using a proximity extension assay. As a first step, differences between iNPH and HC were investigated, and proteins that differed between iNPH and HC were then compared with those from the other groups. The linear regressions were adjusted for age, sex, and plate number.Results: Three proteins showed higher (MCP-1, p = 0.0013; CCL4, p = 0.0008; CCL11, p = 0.0022) and one lower (PD-L1, p = 0.0051) levels in patients with iNPH compared to HC. MCP-1 was then found to be higher in iNPH than in all other groups. CCL4 was higher in iNPH than in all other groups, except in MCI due to AD. PD-L1 was lower in iNPH compared to all other groups, except in stable MCI. Levels of CCL11 did not differ between iNPH and the differential diagnoses. In a model based on the four proteins mentioned above, the mean area under the receiver operating characteristic curve used to discriminate between iNPH and the other disorders was 0.91.Conclusions: The inflammatory cytokines MCP-1 and CCL4 are present at higher-and PD-L1 at lower-levels in iNPH than in the other investigated diagnoses. These three selected cytokines may have diagnostic potential in the work-up of patients with iNPH.
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| 8. |
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| 9. |
- Elf, Kristin, et al.
(författare)
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Electroencephalographic Patterns During Common Nursing Interventions in Neurointensive Care : A Descriptive Pilot Study
- 2019
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Ingår i: Journal of Neuroscience Nursing. - 0888-0395 .- 1945-2810. ; 51:1, s. 10-15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many patients with neurological insults requiring neurointensive care have an increased risk of acute symptomatic seizures. Various nursing interventions performed when caring for these patients may elicitpathological cerebral electrical activity including seizures and stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs). The aim was to explore changes in electroencephalogram (EEG) due to neurointensive care nursing interventions.Methods: A convenience sample was recruited between November 2015 and April 2016, consisting of 12 adult patients with impaired consciousness due to a neurosurgical condition. Continuous EEG and simultaneous video recordings of nursing interventions were collected 48 continuous hours for each patient. Two analysts categorized the video recordings for common nursing interventions, and a neurophysiologist analyzed the EEGs.Results: In total, 976 nursing interventions were observed. Epileptiform activity was observed in 4 patients (33%), during 1 nursing intervention episode each (0.4%). The 4 observed episodes of epileptiform activity occurred during multiple simultaneous nursing interventions (n = 3) and hygienic interventions (n = 1). Stimulus-induced rhythmic, periodic, or ictal discharges were observed in 1patient (8%), in 1 single nursing intervention (0.1%). The observed SIRPID soccurred during repositioning of thepatient. All patients had muscle artifacts, during 353 nursing interventions (36.3%). The duration of nursing interventions was longer for those with simultaneous muscle artifacts (median, 116 seconds) than those without muscle artifacts, epileptiform activity, or SIRPIDs (median, 89.0 seconds). With regard to epileptiform activityand SIRPIDs, the median durations of the nursing interventions were 1158 and 289 seconds, respectively.Conclusion: The results of this pilot study indicate that muscle artifacts seem prevalent during nursing interventions and may be a sign of stress. Nurses should be aware of the risk of inducing stress by performing regular nursing interventions in daily practice, consider shorter or fewer interventions at a time in sensitive patients, and administer sedation accordingly. Considering that this was a pilot study, more research that investigates correlations between EEG patterns and nursing interventions in larger samples is needed.
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| 10. |
- Fischerström, Ann, et al.
(författare)
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Acute neurosurgery for traumatic brain injury by general surgeons in Swedish county hospitals : A regional study
- 2014
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 156:1, s. 177-185
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Tidskriftsartikel (refereegranskat)abstract
- Traditionally acute life-saving evacuations of extracerebral haematomas are performed by general surgeons on vital indication in county hospitals in the Uppsala-A-rebro health care region in Sweden, a region characterized by long distances and a sparsely distributed population. Recently, it was stated in the guidelines for prehospital care of traumatic brain injury from the Scandinavian Neurosurgical Society that acute neurosurgery should not be performed in smaller hospitals without neurosurgical expertise. The aim of this study was to investigate: how often does acute decompressive neurosurgery occur in county hospitals in the Uppsala-A-rebro region today, what is the indication for surgery, and what is the clinical outcome? Finally, the goal was to evaluate whether the current practice in the Uppsala-A-rebro region should be revised. Patients referred to the neurointensive care unit at the Department of Neurosurgery in Uppsala after acute evacuation of intracranial haematomas in the county hospitals 2005-2010 were included in the study. Data was collected retrospectively from the medical records following a predefined protocol. The presence of vital indication, radiological and clinical results, and long-term outcome were evaluated. A total of 49 patients (17 epidural haematomas and 32 acute subdural haematomas) were included in the study. The operation was judged to have been performed on vital indication in all cases. The postoperative CT scan was improved in 92 % of the patients. The reaction level and pupillary reactions were significantly improved after surgery. Long-term outcomes showed 51 % favourable outcome, 33 % unfavourable outcome, and in 16 % the outcome was unknown. Looking at the indication for acute neurosurgery, the postoperative clinical and radiological results, and the long-term outcome, it appears that our regional policy regarding life-saving decompressive neurosurgery in county hospitals by general surgeons should not be changed. We suggest a curriculum aimed at educating general surgeons in acute neurosurgery.
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| 11. |
- Fällmar, David, et al.
(författare)
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Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism
- 2021
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Ingår i: Fluids and Barriers of the CNS. - : BioMed Central (BMC). - 2045-8118. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vascular dementia (VaD) and atypical parkinsonism often present with symptoms that can resemble idiopathic normal pressure hydrocephalus (iNPH) and enlarged cerebral ventricles, and can be challenging differential diagnoses. The aim was to investigate frequencies of imaging features usually associated with iNPH and their radiological diagnostic accuracy in a sample containing the relevant differential diagnoses VaD, progressive supranuclear palsy (PSP), multiple system atrophy parkinsonian type (MSA-P), and healthy controls.Methods: Nine morphological imaging features usually associated with iNPH were retrospectively investigated in MR images of 55 patients with shunt-responsive iNPH, 32 patients with VaD, 30 patients with PSP, 27 patients with MSA-P, and 39 age-matched healthy controls. Logistic regression and receiver operating characteristic curves were used to assess diagnostic accuracy, sensitivity, and specificity for each imaging finding.Results: In a logistic regression model using iNPH diagnosis as a dependent variable, the following imaging features contributed significantly to the model: callosal angle (OR = 0.95 (0.92-0.99), p = 0.012), Evans' index * 100 (OR = 1.51 (1.23-1.86), p < 0.001), enlarged Sylvian fissures (OR = 6.01 (1.42-25.40), p = 0.015), and focally enlarged sulci (OR = 10.18 (1.89-55.02), p = 0.007). Imaging features with 95% specificity for iNPH were: callosal angle <= 71 degrees, temporal horns >= 7 mm, Evans' index >= 0.37, iNPH Radscale >= 9, and presence of DESH, bilateral ventricular roof bulgings or focally enlarged sulci. A simplified version of the iNPH Radscale with only four features resulted in equally high diagnostic accuracy as the original iNPH Radscale.Conclusions: There is a notable overlap between some of the commonly used imaging markers regarding iNPH, VaD and atypical parkinsonism, such as PSP. However, this study shows that the specificity of imaging markers usually associated with iNPH was high even when comparing with these challenging differential diagnoses. The callosal angle was the single imaging feature with highest diagnostic accuracy to discriminate iNPH from its mimics. A simplified rating scale using only a few selected features could be used with retained specificity.
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| 12. |
- Galos, Peter, et al.
(författare)
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Capturing of intracranial pressure treatment during neurointensive care in patients with acute brain injury using a novel tablet-based method
- 2022
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Ingår i: Journal of clinical monitoring and computing. - : Springer Nature. - 1387-1307 .- 1573-2614. ; 36:6, s. 1731-1738
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Tidskriftsartikel (refereegranskat)abstract
- Critical care is complex and stressful. It is difficult to register in real time data not recorded by automatic systems. Time-specific knowledge of manual measures is important for understanding pathophysiology and for analyzing treatment and quality of care. Therefore, a novel iPad-based method for registration of manual measures was developed, which many can build themselves. Using a configuration for intracranial pressure (ICP) management, the methodology was validated, ICP treatment captured, and the quality of ICP management evaluated. Twenty-two patients with acute brain injuries were studied. The iPad-system was totally used for 2538 h. Thirteen-hundred-five manual measures were entered. Thirty-nine episodes of predefined ICP insults were identified. During 16/39 episodes, ICP treatments were registered. For 4/39 episodes treatments were registered within 90 s before or after the episode. For 3/39 episodes it was registered that treatment was intentionally refrained. In 15/16 episodes without registered treatment, the insult was mild or reasonable explanations were found when medical records and the Patient data management system were reviewed. In one situation without particular circumstances, morphine and clonidine were given to decrease ICP but not registered. No episodes of downtime or loss of data occurred. The developed methodology appears to be stable and robust as well as feasible and user-friendly. It was possible to capture the treatment of ICP insults with high temporal resolution, and to evaluate the quality of ICP management. An own developed novel tablet-based system like our system may be a promising potential tool useful in various future intensive care applications.
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| 13. |
- Georgiopoulos, Charalampos, et al.
(författare)
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Quantitative brain stem assessment in discriminating neurodegenerative disorders from normal pressure hydrocephalus
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Ingår i: Journal of Neuroimaging. - 1051-2284.
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: Differentiating idiopathic normal pressure hydrocephalus (iNPH) from neurodegenerative disorders such as progressive supranuclear palsy (PSP), Multiple System Atrophy—parkinsonian type (MSA-P), and vascular dementia (VaD) is challenging due to overlapping clinical and neuroimaging findings. This study assesses if quantitative brain stem and cerebellum metrics can aid in this differentiation. Methods: We retrospectively compared the sagittal midbrain area, midbrain to pons ratio, MR parkinsonism index (MRPI), and cerebellar atrophy in 30 PSP patients, 31 iNPH patients, 27 MSA-P patients, 32 VaD patients, and 25 healthy controls. Statistical analyses determined group differences, sensitivity, specificity, and the area under the receiver operating characteristic curves. Results: There was an overlap in midbrain morphology between PSP and iNPH, as assessed with MRPI, midbrain to pons ratio, and midbrain area. A cutoff value of MRPI > 13 exhibited 84% specificity in distinguishing PSP from iNPH and 100% in discriminating PSP from all other conditions. A cutoff value of midbrain to pons ratio at <0.15 yielded 95% specificity for differentiating PSP from iNPH and 100% from all other conditions. A cutoff value of midbrain area at <87 mm2 exhibited 97% specificity for differentiating PSP from iNPH and 100% from all other conditions. All measures showed low sensitivity. Cerebellar atrophy did not differ significantly among groups. Conclusion: Our study questions MRPI's diagnostic performance in distinguishing PSP from iNPH. Simpler indices such as midbrain to pons ratio and midbrain area showed similar or better accuracy. However, all these indices displayed low sensitivity despite significant differences among PSP, MSA-P, and VaD.
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| 14. |
- Hult, Ludvig, et al.
(författare)
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Challenges in CATE estimation for NCCU data
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Sudden increase in intercranial pressure is a severe complication for patients in neuro-critical care. Machine learning models have been developed to predict such events, but they may suffer from confounding, not accounting for the impact of treatment decisions. Causal inference may be employed to estimate the impact of treatment, helping medical staff attend to those patients where treatment are effective. This work investigates the feasibility of conditional average treatment effect estimation on observational data from the neurocriticalcare unit at Uppsala Akademiska Hospital. We find that the selected CATE estimators have difficulties in estimating the treatment effect on a semisynthetic dataset. When used on the real dataset, the CATE estimators show poor agreement. We discuss the challenges and suggest future work to address them.
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| 15. |
- Hutton, Katrin, 1968-, et al.
(författare)
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Self-rated mental health and socio-economic background : a study of adolescents in Sweden
- 2014
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Ingår i: BMC Public Health. - London : BioMed Central. - 1471-2458. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adolescents' mental health is a major public health issue. Previous research has shown that socio-economic factors contribute to the health status of adolescents. The present study explores the association between socio-economic status and self-rated mental health among adolescents.Methods: Cross sectional data from the Halmstad Youth Quality of Life cohort was collected in a town in Sweden. In all, 948 adolescents (11-13 younger age group and 14-16 older age group) participated. Information on self-rated mental health was collected from the subscale Psychological functioning in the Minneapolis Manchester Quality of Life instrument. The items were summarized into a total score and dichotomized by the mean. Indicators measuring socio-economic status (SES) were collected in a questionnaire using the Family Affluence Scale (FAS) and additional factors regarding parents' marital status and migration were added. Logistic models were used to analyze the data.Results: Girls were more likely to rate their mental health below the mean compared to boys. With regard to FAS (high, medium, low), there was a significantly increased risk of self-rated mental health below the mean among younger boys in the medium FAS score OR; 2.68 (95% CI 1.35;5.33) and among older boys in the low FAS score OR; 2.37 (1.02;5.52) compared to boys in the high FAS score. No such trend was seen among girls. For younger girls there was a significant protective association between having parents born abroad and self-rated mental health below mean OR: 0.47 (0.24;0.91).Conclusions: A complex pattern of associations between SES and self-rated mental health, divergent between age and gender groups, was shown. The total FAS score was only associated with boys' self-rated mental health in both age groups, whereas parents' migratory status influenced only the girls' self-rated mental health. Because of the different association for girls' and boys' self-rated mental health and SES, other factors than SES should also be considered when investigating and exploring the mental health of adolescents in affluent communities. © 2014 Hutton et al.; licensee BioMed Central Ltd.
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| 16. |
- Jangland, Eva, Docent, et al.
(författare)
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Effective learning activity to facilitate post-graduate nursing students' utilization of nursing theories : Using the fundamentals of care framework
- 2023
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 79:3, s. 1082-1093
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To explore how postgraduate nursing students used the Fundamentals of Care framework in a written assignment based on a clinical situation, and describe their learning process in using the framework.DESIGN: A qualitative descriptive study design applying the Fundamentals of Care framework.METHODS: Postgraduate nursing students' theoretical written assignments (n = 35) based on self-experienced clinical cases were included. The data were collected in 2021 in five specialties in a postgraduate nursing programme in Sweden. The data were analysed using content analysis.RESULTS: Applying the framework to a self-experienced clinical case illuminated the importance of nurse-patient relationships and clarified the meaning of person-centred care. The students assessed the framework as easy-to-use bedside as a guide to providing nursing care. By using the framework, the students were aided in reasoning about the fundamental values of care such as ethics, equality in healthcare and patient rights. When students reflected on their learning process, they stated that the assignment taught them how to use the framework, as well as paving the way for finding and applying other theories of nursing.CONCLUSION: Learning activities with an opportunity to practice analysing nursing care guided by a theory, combined with a self-evaluating element, are conducive to deepening students' learning and improving their ability to use theories in clinical practice.IMPACT: The framework illuminated the importance of the nurse-patient relationship in nursing care to the students and made them recognize and value the clinical use of theories. It is the responsibility of leaders in nurse education and healthcare to provide the next generation of specialist nurses-future nursing leaders-with regular opportunities to analyse nursing care through theories and frameworks. Nurses call for continuous learning on theories; leaders in nurse education and healthcare must meet these needs.
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| 17. |
- Lenell, Samuel, et al.
(författare)
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Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care
- 2019
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Ingår i: Acta Neurochirurgica. - : SPRINGER WIEN. - 0001-6268 .- 0942-0940. ; 161:6, s. 1243-1254
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Tidskriftsartikel (refereegranskat)abstract
- Background: The probability of favorable outcome after traumatic brain injury (TBI) decreases with age. Elderly,≥60 years, are an increasing part of our population. Recent studies have shown an increase of favorable outcome in elderly over time. However,the optimal patient selection and neurointensive care (NIC) treatments may differ in the elderly and the young. The aims of this study were to examine outcome in a larger group of elderly TBI patients receiving NIC and to identify demographic and treatmentrelated prognostic factors.Methods: Patients with TBI≥60 years receiving NIC at our department between 2008 and 2014 were included. Demographics, co-morbidity, admission characteristics, and type of treatments were collected. Clinical outcome at around 6 months was assessed. Potential prognostic factors were included in univariate and multivariate regression analysis with favorable outcomeas dependent variable.Results: Two hundred twenty patients with mean age 70 years (median 69; range 60–87) were studied. Overall, favorable outcome was 46% (Extended Glasgow Outcome Scale (GOSE) 5–8), unfavorable outcome 27% (GOSE 2–4), and mortality 27% (GOSE 1). Significant independent negative prognostic variables were high age (p< 0.05), multiple injuries (p<0.05),GCSM≤3 on admission (p< 0.05), and mechanical ventilation (p<0.001).Conclusions: Overall, the elderly TBI patients> 60 years receiving modern NIC in this study had a fair chance of favorable outcome without large risks for severe deficits and vegetative state, also in patients over 75 years of age. High age, multiple injuries, GCS M≤3 on admission, and mechanical ventilation proved to be independent negative prognostic factors. The results underline that a selected group of elderly with TBI should have access to NIC
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| 18. |
- Lenell, Samuel, et al.
(författare)
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Updated periodic evaluation of standardized neurointensive care shows that it is possible to maintain a high level of favorable outcome even with increasing mean age
- 2015
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 157:3, s. 417-425
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Tidskriftsartikel (refereegranskat)abstract
- Periodic evaluation of neurointensive care (NIC) is important. There is a risk that quality of daily care declines and there may also be unrecognized changes in patient characteristics and management. The aim of this work was to investigate the characteristics and outcome for traumatic brain injury (TBI) patients in the period 2008-2009 in comparison with 1996-1997 and to some extent also with earlier periods. TBI patients 16-79 years old admitted from 2008 to 2009 were selected for the study. Glasgow Coma Scale Motor score at admission (GCS M), radiology, surgery, and outcome (Glasgow Outcome Extended Scale) were collected from Uppsala Traumatic Brain Injury Register. The study included 148 patients (mean age, 45 years). Patients > 60 years old increased from 16 % 1996-1997 to 30 % 2008-2009 (p < 0.01). The proportion of GCS M 4-6 were similar, 92 vs. 93 % (NS). In 1996-1997 patients, 73 % had diffuse injury (Marshall classification) compared to 77 % for the 2008-2009 period (NS). More patients underwent surgery during 2008-2009 (43 %) compared to 1996-1997 (32 %, p < 0.05). Good recovery increased and mortality decreased substantially from 1980-1981 to 1987-1988 and to 1996-1997, but then the results were unchanged in the 2008-2009 period, with 73 % favorable outcome and 11 % mortality. Mortality increased in GCS M 6-4, from 2.8 % in 1996-1997 to 10 % in 2008-2009 (p < 0.05); most of the patients that died had aggravating factors, e.g., high age, malignancy. A large-proportion favorable outcome was maintained despite that patients > 60 years with poorer prognosis doubled, indicating that the quality of NIC has increased or at least is unchanged. More surgery may have contributed to maintaining the large proportion of favorable outcome. For future improvements, more knowledge about TBI management in the elderly is required.
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| 19. |
- Ljungkrona-Falk, Lena, et al.
(författare)
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In order to prevent child obesity: New tool helps Nurses to talk about healthier habits to parents
- 2010
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Ingår i: Special Issue: Abstracts of the 11th International Congress on Obesity, 11-15 July 2010, Stockholm, Sweden. - Chichester, England : Wiley-Blackwell. ; , s. 88-88
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Konferensbidrag (refereegranskat)abstract
- Introduction: A new tool for nurses to communicate healthier habits to parents of children at 18 months and 3 years of age has been developed and implemented by a registered dietitian at the children’s health care centre (CHCC) in Skaraborg, Sweden. The tool contains questions and information about meal order, drinks, candy, snacks, fat and physical activity. Our aim was to describe the nurses’ experiences of the tool and supervision from the registered dietician at the CHCC. Methods: The tool was evaluated after 14 months in practice. In three focus groups 17 nurses participated. A structured interview guide was used and the interviews were transcribed verbatim. The transcripts were analyzed using qualitative content analysis. Findings were triangulated by a questionnaire within all nurses in Skaraborg (n = 76). Results: The nurses described their experiences in terms of comparison with the previous tool, practicability, parent’s reactions and improvement. Using the previous tool the nurses felt uncertain when talking about healthier habits. With the new tool the nurses expressed that they felt more confident. Parents were also more engaged in the dialogue. The discussion regarding physical activity was not satisfactory and the question needed improvement. The questionnaire showed, 98% of the nurses wanted to continue with the tool, and 86% found the question about physical activity needed revision. Conclusion: This is a new approach to prevent child obesity. The tool simplified the communication with parents and with supervision from dietitian, it lead to a higher quality in promoting healthier habits at CHCC.
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| 20. |
- Ljungkrona-Falk, Lena, et al.
(författare)
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Swedish nurses encounter barriers when promoting healthy habits in children.
- 2014
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Ingår i: Health promotion international. - Oxford : Oxford University Press (OUP). - 1460-2245 .- 0957-4824. ; 29:4, s. 730-738
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Tidskriftsartikel (refereegranskat)abstract
- To increase the understanding of difficulties in promoting healthy habits to parents, we explore barriers in health-care provision. The aim of this study is to describe nurses' perceived barriers when discussing with parents regarding healthy food habits, physical activity and their child's body weight. A mixed method approach was chosen. Nurses (n = 76) working at 29 different Child Health Care Centers' in an area in west Sweden were included in the study. Three focus group interviews were conducted and 17 nurses were selected according to maximum variation. Data were categorized and qualitative content analysis was the chosen analysis method. In the second method, data were obtained from a questionnaire distributed to all 76 nurses. The latent content was formulated into a theme: even with encouragement and support, the nurses perceive barriers of both an external and internal nature. The results identified four main barriers: experienced barriers in the workplace-internal and external; the nurse's own fear and uncertainty; perceived obstacles in nurse-parent interactions and modern society impedes parents' ability to promote healthy habits. The nurses' perceived barriers were confirmed by the results from 62 of the nurses who completed the questionnaire. Despite education and professional support, the health professionals perceived both external and internal barriers in promoting healthy habits to parents when implementing a new method of health promotion in primary care. Further qualitative studies are needed to gain deeper understanding of the perceived barriers when promoting healthy habits to parents.
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| 21. |
- Merzo, Abraham, et al.
(författare)
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Promising clinical outcome of elderly with TBI after modern neurointensive care
- 2016
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 158:1, s. 125-133
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Tidskriftsartikel (refereegranskat)abstract
- The increasing number of elderly patients with traumatic brain injury (TBI) leads to specific neurointensive care (NIC) challenges. Therefore, elderly subjects with TBI need to be further studied. In this study we evaluated the demographics, management and outcome of elderly TBI patients receiving modern NIC. Patients referred to our NIC unit between 2008 and 2010 were included. Patients were divided in two age groups, elderly (E) a parts per thousand yen65 years and younger (Y) 64-15 years. Parameters studied were the dominant finding on CT scans, neurological motor skills and consciousness, type of monitoring, neurosurgical procedures/treatments and Glasgow Outcome Scale Extended score at 6 months after injury. Sixty-two E (22 %) and 222 Y (78 %) patients were included. Falls were more common in E (81 %) and vehicle accidents were more common in Y patients (37 %). Acute subdural hematoma was significantly more common in E (50 % of cases) compared to Y patients (18 %). Intracranial pressure was monitored in 44 % of E and 57 % of Y patients. Evacuation of significant mass lesions was performed more common in the E group. The NIC mortality was similar in both groups (4-6 %). Favorable outcome was observed in 72 % of Y and 51 % of E patients. At the time of follow-up 25 % of E and 7 % of Y patients had died. The outcome of elderly patients with TBI was significantly worse than in younger patients, as expected. However, as much as 51 % of the elderly patients showed a favorable outcome after NIC. We believe that these results encourage modern NIC in elderly patients with TBI. We need to study how secondary brain injury mechanisms differ in the older patients and to identify specific outcome predictors for elderly patients with TBI.
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| 22. |
- Mullaney, Tara, 1980-, et al.
(författare)
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The influence of a department's psychosocial climate and treatment environment on cancer patients' anxiety during radiotherapy
- 2016
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Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 20, s. 113-118
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The objective of this study is to determine whether there is a relationship between cancer patients' perceptions of the person-centeredness of their treatment experience and their anxiety levels during treatment.METHOD: A questionnaire was distributed to adult cancer patients going through external beam radiotherapy (RT) with curative intent at a university hospital in Sweden (n = 892), which included two surveys, the State Trait Anxiety Inventory-state specific questions (STAI-S), and the Patient-centered Climate Questionnaire (PCQ) and additional treatment-specific questions. Eligible patients were provided with the questionnaire on their seventh day of RT by an RT-nurse.RESULTS: Statistical analysis showed a significant negative relationship between STAI-S scores and PCQ scores, and a significant positive relationship between the Treatment Environment questions and the STAI-S scores. Multivariate regression modeling found the PCQ subscale of safety to have the strongest negative association with STAI-S scores, showing that a climate of safety can significantly decrease patient situational anxiety levels. On the other hand, difficulty tolerating the overall treatment experience, worry about the treatment equipment, or feelings of isolation or claustrophobia within the treatment room all significantly factor into increases in patient-reported situational anxiety levels.CONCLUSION: Both the treatment environment and the psychosocial climate of the RT clinic significantly impact cancer patient state anxiety levels. These findings suggest that actively employing a person-centered approach during RT, and designing the treatment environment to be more attentive to the patient experience can both play a significant role in decreasing patient situational anxiety during treatment.
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| 23. |
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| 24. |
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| 25. |
- Nyholm, Lena, et al.
(författare)
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Introduction of the Uppsala Traumatic Brain Injury register for regular surveillance of patient characteristics and neurointensive care management including secondary insult quantification and clinical outcome
- 2013
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 118:3, s. 169-180
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Tidskriftsartikel (refereegranskat)abstract
- Background. To improve neurointensive care (NIC) and outcome for traumatic brain injury (TBI) patients it is crucial to define and monitor indexes of the quality of patient care. With this purpose we established the web-based Uppsala TBI register in 2008. In this study we will describe and analyze the data collected during the first three years of this project. Methods. Data from the medical charts were organized in three columns containing: 1) Admission data; 2) Data from the NIC period including neurosurgery, type of monitoring, treatment, complications, neurological condition at discharge, and the amount of secondary insults; 3) Outcome six months after injury. Indexes of the quality of care implemented include: 1) Index of improvement; 2) Index of change; 3) The percentages of 'Talk and die' and `Talk and deteriorate' patients. Results. Altogether 314 patients were included 2008-2010: 66 women and 248 men aged 0-86 years. Automatic reports showed that the proportion of patients improving during NIC varied between 80% and 60%. The percentage of deteriorated patients was less than 10%. The percentage of Talk and die/Talk and deteriorate cases was <1%. The mean Glasgow Coma Score (Motor) improved from 5.04 to 5.68 during the NIC unit stay. The occurrences of secondary insults were less than 5% of good monitoring time for intracranial pressure (ICP) >25 mmHg, cerebral perfusion pressure (CPP) <50 mmHg, and systolic blood pressure <100 mmHg. Favorable outcome was achieved by 64% of adults. Conclusion. The Uppsala TBI register enables the routine monitoring of NIC quality indexes.
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| 26. |
- Nyholm, Lena, 1973-
(författare)
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Nursing Care
- 2019. - 1
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Ingår i: Neurointensive Care. - New Deli : Oxford University Press. - 9780199481439 ; , s. 543-553
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Neurointensive care patients are vulnerable, in a stressful situation and in the mercy of the personnel. Therefore all care has to be performed with integrity. All nursing interventions are performed with the aim to prevent complications and to offer comfort. On the other hand, nursing interventions can cause increased intracranial pressure in a patient with exhausted intracranial adaptive capacity. Thus, the balance between performing nursing interventions to prevent possible future secondary insults and avoiding secondary insults directly related to nursing interventions is essential to achieve best possible outcome. This chapter covers, hygienic interventions, skin care management, surgery wound management, airways, maintenance of therapeutic milieu and care of next-of-kin.
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| 27. |
- Nyholm, Lena, et al.
(författare)
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Predictive Factors That May Contribute to Secondary Insults With Nursing Interventions in Adults With Traumatic Brain Injury
- 2017
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Ingår i: Journal of Neuroscience Nursing. - 0888-0395 .- 1945-2810. ; 49:1, s. 49-55
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Tidskriftsartikel (refereegranskat)abstract
- Background: Nursing interventions pose risks and benefits to patients with traumatic brain injury at a neurointensive care unit. Objectives: The aim of this study was to investigate the risk of inducing high intracranial pressure (ICP) related to interventions and whether intracranial compliance, baseline ICP, or autoregulation could be used as predictors. Methods: The study had a quantitative, prospective, observational design. Twenty-eight patients with TBI were included, and 67 interventions were observed. The definition of a secondary ICP insult was ICP of 20 mm Hg or greater for 5 minutes or more within a continuous 10-minute period. Results: Secondary ICP insults related to nursing interventions occurred in 6 patients (21%) and 8 occasions (12%). Patients with baseline ICP of 15 mm Hg or greater had 4.7 times higher risk of developing an insult. The predictor with the best combination of sensitivity and specificity was baseline ICP. Conclusions: Baseline ICP of 15 mm Hg or greater was the most important factor to determine the risk of secondary ICP insult related to nursing intervention.
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| 28. |
- Nyholm, Lena
(författare)
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Quality systems to avoid secondary brain injury in neurointensive care
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Outcome after traumatic brain injury (TBI) depends on the extent of primary cell death and on the development of secondary brain injury. The general aim of this thesis was to find strategies and quality systems to minimize the extent of secondary insults in neurointensive care (NIC).An established standardized management protocol system, multimodality monitoring and computerized data collection, and analysis systems were used.The Uppsala TBI register was established for regular monitoring of NIC quality indexes. For 2008-2010 the proportion of patients improving during NIC was 60-80%, whereas 10% deteriorated. The percentage of ‘talk and die’ cases was < 1%. The occurrences of secondary insults were less than 5% of good monitoring time (GMT) for intracranial pressure (ICP) > 25 mmHg, cerebral perfusion pressure (CPP) < 50 mmHg and systolic blood pressure < 100 mmHg. Favorable outcome was achieved by 64% of adults.Nurse checklists of secondary insult occurrence were introduced. Evaluation of the use of nursing checklists showed that the nurses documented their assessments in 84-85% of the shifts and duration of monitoring time at insult level was significantly longer when secondary insults were reported regarding ICP, CPP and temperature. The use of nurse checklist was found to be feasible and accurate. A clinical tool to avoid secondary insults related to nursing interventions was developed. Secondary brain insults occurred in about 10% of nursing interventions. There were substantial variations between patients. The risk ratios of developing an ICP insult were 4.7 when baseline ICP ≥ 15 mmHg, 2.9 when ICP amplitude ≥ 6 mmHg and 1.7 when pressure autoregulation ≥ 0.3.Hyperthermia, which is a known frequent secondary insult, was studied. Hyperthermia was most common on Day 7 after admission and 90% of the TBI patients had hyperthermia during the first 10 days at the NIC unit. The effects of hyperthermia on intracranial dynamics (ICP, brain energy metabolism and BtipO2) were small but individual differences were observed. Hyperthermia increased ICP slightly more when temperature increased in the groups with low compliance and impaired pressure autoregulation. Ischemic pattern was never observed in the microdialysis samples. The treatment of hyperthermia may be individualized and guided by multimodality monitoring.
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| 29. |
- Nyholm, Lena, 1973-, et al.
(författare)
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Secondary insults related to nursing interventions in neurointensive care : a descriptive pilot study
- 2014
-
Ingår i: Journal of Neuroscience Nursing. - 0888-0395 .- 1945-2810. ; 46:5, s. 285-291
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Tidskriftsartikel (refereegranskat)abstract
- The patients at a neurointensive care unit are frequently cared for in many ways, day and night. The aim of this study was to investigate the amount of secondary insults related to oral care, repositioning, endotracheal suctioning, hygienic measures, and simultaneous interventions at a neurointensive care unit with standardized care and maximum attention on avoiding secondary insults. The definition of a secondary insult was intracranial pressure > 20 mm Hg, cerebral perfusion pressure < 60 mm Hg and systolic blood pressure < 100 mm Hg for 5 minutes or more in a 10-minute period starting from when the nursing intervention began. The insult minutes did not have to be consecutive. The study included 18 patients, seven women and 11 men, aged 36-76 years with different neurosurgical diagnoses. The total number of nursing interventions analyzed was 1,717. The most common kind of secondary insults after a nursing measure was high intracranial pressure (n = 93) followed by low cerebral perfusion pressure (n = 43) and low systolic blood pressure (n = 14). Repositioning (n = 39) and simultaneous interventions (n = 32) were the nursing interventions causing most secondary insults. There were substantial variations between the patients; only one patient had no secondary insult. There were, overall, a limited number of secondary insults related to nursing interventions when a standardized management protocol system was applied to reduce the occurrence of secondary insults. Patients with an increased risk of secondary insults should be recognized, and their care and treatment should be carefully planned and performed to avoid secondary insults.
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| 30. |
- Nyholm, Lena, 1973-, et al.
(författare)
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Sleep in neurointensive care patients, and patients after brain tumor surgery
- 2023
-
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Severely brain injured patients treated in the neuro intensive care unit (NICU) are usually sedated. Sedation may affect not only the ability to sleep, but also the EEG rhythms used to identify sleep.Aim: The aims were: To study if sleep patterns could be identified in the severely brain injured and sedated patients in the NICUTo study if sleep patterns could be identified in patients the night after brain tumor surgery in the neurointermediate care unit (NIMCU)To search for risk factors for not being able to sleep after brain tumor surgeryStudy design: Two populations were included; one with patients affected by severe brain injury and one with patients who had undergone planned brain tumor surgery. This was a quantitative observational study using EEG. Eligible neurointensive care patients for this study had to be suffering from a neurosurgical condition (for example subarachnoid haemorrhage, acute subdural hematoma, intracerebral haemorrhage and meningitis), have affected consciousness and age over 18 years. Thirty-seven patients were included from NICU. Ninety-eight patients, with a suspected glioma (WHO grade II-IV) planned for surgery were also included.Results: Neuro intensive care patients, sedated and treated in ventilator, showed no EEG sleep patterns at all. After brain tumor surgery, sleep occurred in 74% of the patients, despite frequent wake-up tests. The patients with sleep patterns were on average 8 years younger, p = 0.03.Conclusions: Patients with severe brain injury are at risk of having no sleep when treated at the NICU, whereas after brain tumor surgery, sleep occurs in three-fourths of the patients. Further studies and new methods are warranted to identify sleep and investigate how the loss of sleep affects these patients and how sleep disturbances can be managed.
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| 31. |
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| 32. |
- Nyholm, Lena, 1973-, et al.
(författare)
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The influence of hyperthermia on intracranial pressure, cerebral oximetry and cerebral metabolism in traumatic brain injury
- 2017
-
Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 122:3, s. 177-184
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Hyperthermia is a common secondary insult in traumatic brain injury (TBI). The aim was to evaluate the relationship between hyperthermia and intracranial pressure (ICP), and if intracranial compliance and cerebral blood flow (CBF) pressure autoregulation affected that relationship. The relationships between hyperthermia and cerebral oximetry (B(ti)pO(2)) and cerebral metabolism were also studied. Methods: A computerized multimodality monitoring system was used for data collection at the neurointensive care unit. Demographic and monitoring data (temperature, ICP, blood pressure, microdialysis, B(ti)pO(2)) were analyzed from 87 consecutive TBI patients. ICP amplitude was used as measure of compliance, and CBF pressure autoregulation status was calculated using collected blood pressure and ICP values. Mixed models and comparison between groups were used. Results: The influence of hyperthermia on intracranial dynamics (ICP, brain energy metabolism, and B(ti)pO(2)) was small, but individual differences were seen. Linear mixed models showed that hyperthermia raises ICP slightly more when temperature increases in the groups with low compliance and impaired CBF pressure autoregulation. There was also a tendency (not statistically significant) for increased B(ti)pO(2), and for increased pyruvate and lactate, with higher temperature, while the lactate/pyruvate ratio and glucose were stable. Conclusions: The major finding was that the effects of hyperthermia on intracranial dynamics (ICP, brain energy metabolism, and B(ti)pO(2)) were not extensive in general, but there were exceptional cases. Hyperthermia treatment has many side effects, so it is desirable to identify cases in which hyperthermia is dangerous. Information from multimodality monitoring may be used to guide treatment in individual patients.
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| 33. |
- Nyholm, Lena, et al.
(författare)
-
The use of nurse checklists in a bedside computer-based information system to focus on avoiding secondary insults in neurointensive care
- 2012
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Ingår i: ISRN Neurology. - : Hindawi Limited. - 2090-5505 .- 2090-5513. ; 2012, s. 903954-
-
Tidskriftsartikel (refereegranskat)abstract
- The feasibility and accuracy of using checklists after every working shift in a bedside computer-based information system for documentation of secondary insults in the neurointensive care unit were evaluated. The ultimate goal was to get maximal attention to avoid secondary insults. Feasibility was investigated by assessing if the checklists were filled in as prescribed. Accuracy was evaluated by comparing the checklists with recorded minute-by-minute monitoring data for intracranial pressure-ICP, cerebral perfusion pressure CPP, systolic blood pressure SBP, and temperature. The total number of checklist assessments was 2,184. In 85% of the shifts, the checklists were filled in. There was significantly longer duration of monitoring time at insult level when Yes was filled in regarding ICP (mean 134 versus 30 min), CPP (mean 125 versus 26 min) and temperature (mean 315 versus 120 min). When a secondary insult was defined as >5% of monitoring time spent at insult level, the sensitivity/specificity for the checklist assessments was 31%/100% for ICP, 38%/99% for CPP, and 66%/88% for temperature. Checklists were feasible and appeared relatively accurate. Checklists may elevate the alertness for avoiding secondary insults and help in the evaluation of the patients. This concept may be the next step towards tomorrow critical care.
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| 34. |
- Nyholm, Lena, 1973-
(författare)
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Traumatiska hjärnskador
- 2021. - 1
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Ingår i: Traumaomvårdnad. - Stockholm : Liber. - 9789147127818
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 35. |
- Olausson, Kristina, 1972-, et al.
(författare)
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What matters to you? : Free-text comments in a questionnaire from patients undergoing radiotherapy
- 2020
-
Ingår i: Technical Innovations & Patient Support in Radiation Oncology. - : Elsevier. - 2405-6324. ; 13, s. 11-16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most cancer patients undergo external radiotherapy (RT) at some stage during their treatment trajectory and RT is often associated with unfamiliar procedures in a highly technical environment. The purpose of this study was to explore how patients experience RT and the related processes, as described in free-text comments in a large Swedish survey with questionnaires including items on psychosocial climate and treatment environment.Methods: The data consisted of free-text comments from one open-ended question: "Is there anything else you want us to know" and were analysed using qualitative content analysis.Results: Of 825 returned questionnaires, 261 contained free-text comments from patients (32%). The hand-written, free-text comments reflected the patients' experience of the RT process and were abstracted into the four major categories with sub-categories: experiencing the high-tech RT environment, understanding the RT procedures and side effects, dealing with daily life during RT, and the nurses' role and performance. The categories reflect the patients' experiences and emphasize how important it is to evaluate what really matters to the patients when changing procedures, practices, and how to minimize disturbances in the patients' daily lives.Conclusion: The main conclusions from this study are that the involvement of patients in choosing daily appointment times, providing good information during the RT process to make the patients feel safe, experience and attitude of the staff and respect for the patient's autonomy are highly ranked values for patients. An implementation of person-centred care may help relieve many of these problems.
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| 36. |
- Olausson, Kristina, 1972-, et al.
(författare)
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What matters to you? – Free-text comments in a questionnaire from patients undergoing radiotherapy
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Most cancer patients undergo external radiotherapy (RT) at some stage during their treatment trajectory and RT is often associated with unfamiliar procedures in a highly technical environment. The purpose of this study was to explore how patients experience RT and the related processes, as described in free-text comments in a large Swedish survey with questionnaires including items on psychosocial climate and treatment environment. Methods: The data consisted of free-text comments from one open-ended question: “Is there anything else you want us to know” and were analysed using qualitative content analysis. Results: Of 825 returned questionnaires, 261 contained free-text comments from patients (32%). The analysis of the data resulted in four major categories: experiencing the high-tech RT environment, understanding the RT procedures and side effects, dealing with daily life during RT, and the nurses’ role and performance. Conclusion: The categories reflect the patients’ experiences and emphasize how important it is to evaluate what really matters to the patients when changing procedures, practices, and how to minimize disturbances in the patients’ daily lives.
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| 37. |
- Olausson, Kristina, 1972-, et al.
(författare)
-
What matters to you? – Free-text comments in a questionnaire from patients undergoing radiotherapy
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Most cancer patients undergo external radiotherapy (RT) at some stage during their treatment trajectory and RT is often associated with unfamiliar procedures in a highly technical environment. The purpose of this study was to explore how patients experience RT and the related processes, as described in free-text comments in a large Swedish survey with questionnaires including items on psychosocial climate and treatment environment. Methods: The data consisted of free-text comments from one open-ended question: “Is there anything else you want us to know” and were analysed using qualitative content analysis. Results: Of 825 returned questionnaires, 261 contained free-text comments from patients (32%). The analysis of the data resulted in four major categories: experiencing the high-tech RT environment, understanding the RT procedures and side effects, dealing with daily life during RT, and the nurses’ role and performance. Conclusion: The categories reflect the patients’ experiences and emphasize how important it is to evaluate what really matters to the patients when changing procedures, practices, and how to minimize disturbances in the patients’ daily lives.
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| 38. |
- Rystedt, Alma, et al.
(författare)
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A Comparison of Botox 100 U/mL and Dysport 100 U/mL Using Dose Conversion Ratio 1: 3 and 1: 1.7 in the Treatment of Cervical Dystonia : A Double-Blind, Randomized, Crossover Trial
- 2015
-
Ingår i: Clinical neuropharmacology. - 0362-5664 .- 1537-162X. ; 38:5, s. 170-176
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Intramuscular injections of botulinum toxin (BTX) are used as symptomatic treatment for cervical dystonia. Botox and Dysport are commercial products containing BTX; however, dosage and concentration of the prepared solution vary considerably among studies. The concentration of BTX in the prepared solution affects clinical outcome. This double-blind, randomized crossover trial compares Botox and Dysport in 2 different dose conversion ratios (1:3 and 1:1.7) when diluted to the same concentration (100 U/mL).Methods: Forty-six patients with cervical dystonia received 3 different treatments, Botox in 2 different doses and Dysport as control treatment. The efficacy was evaluated 4 and 12 weeks after treatment using 5 instruments, including Toronto Western Spasmodic Torticollis Rating Scale.Results and Conclusion: The primary outcome was the estimated median Toronto Western Spasmodic Torticollis Rating Scale total score, which was 1.96 points higher for Botox (1:3) compared with Dysport at week 4, but the difference was not statistically significant (confidence interval, -0.88–4.61; P = 0.0799). No significant differences were seen between Botox (1:1.7) and Dysport. At week 12, a statistically significant difference in effect between Botox (1:3) and Dysport was observed, suggesting a shorter duration of effect for Botox when this ratio (low dose) was used. Furthermore, the patients' assessments showed that the ratio 1:3 resulted in suboptimal efficacy of Botox. These secondary outcome observations indicate that the dose conversion ratio between Dysport 100 U/mL and Botox 100 U/mL may be lower than 1:3, but this must be further validated in a larger patient material.
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| 39. |
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| 40. |
- Spörndly-Nees, Sören, et al.
(författare)
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Pain in patients with motor neuron disease : Variation of pain and association with disease severity, health-related quality of life and depression – A longitudinal study
- 2023
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Ingår i: Palliative & Supportive Care. - : Cambridge University Press. - 1478-9515 .- 1478-9523.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo describe levels of pain over time during disease progression in individual patients and for a total sample of patients with motor neuron disease (MND), respectively, and to examine associations between pain, disease severity, health-related quality of life (HRQOL), and depression.MethodsA prospective cohort study was conducted on 68 patients with MND, including data collected on five occasions over a period of 2 years. Pain was assessed using the Brief Pain Inventory – Short Form. Depression was assessed using the Amyotrophic Lateral Sclerosis (ALS)-Depression-Inventory (ADI-12). Disability progression was measured using the Amyotrophic Lateral Sclerosis Functional Rating Scale – Revised Version (ALSFRS-R). HRQOL was assessed using the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-5).ResultsParticipants reported great individual variation over time. The median level of pain was 4 (min 0 and max 10). Higher levels of pain during the last 24 h were associated with higher depression scores (ADI-12), poorer quality of life (ALSAQ-5), and lower reporting of fine and gross motor skills (ALSFRS-R). Baseline pain levels did not predict future values of depression and function. Individuals reporting average pain >3 experienced more hopelessness toward the future and reported higher depression scores compared with participants reporting average pain <3.Significance of resultsGreat within-individual variation of pain intensity was reported. Pain intensity was associated with depression, function and HRQOL cross-sectionally, but it did not have a strong prognostic value for future depression, function, or HRQOL. Patients with MND should be offered frequent assessment of pain and depressive symptoms in person-centered care, allowing for individualization of treatment.
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| 41. |
- Svedung Wettervik, Teodor, et al.
(författare)
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Decompressive craniectomy in traumatic brain injury : usage and clinical outcome in a single centre
- 2018
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Ingår i: Acta Neurochirurgica. - : SPRINGER WIEN. - 0001-6268 .- 0942-0940. ; 160:2, s. 229-237
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Tidskriftsartikel (refereegranskat)abstract
- Background: Two randomised controlled trials (RCTs) of decompressive craniectomy (DC) in traumatic brain injury (TBI) have shown poor outcome, but there are considerations of how these protocols relate to real practice. The aims of this study were to evaluate usage and outcome of DC and thiopental in a single centre.Method: The study included all TBI patients treated at the neurointensive care unit, Akademiska sjukhuset, Uppsala, Sweden, between 2008 and 2014. Of 609 patients aged 16 years or older, 35 treated with DC and 23 treated with thiopental only were studied in particular. Background variables, intracranial pressure (ICP) measures and global outcome were analysed.Results: Of 35 DC patients, 9 were treated stepwise with thiopental before DC, 9 were treated stepwise with no thiopental before DC and 17 were treated primarily with DC. Six patients received thiopental after DC. For 23 patients, no DC was needed after thiopental. Eighty-eight percent of our DC patients would have qualified for the DECRA study and 38% for the Rescue-ICP trial. Favourable outcome was 44% in patients treated with thiopental before DC, 56% in patients treated with DC without prior thiopental, 29% in patients treated primarily with DC and 52% in patients treated with thiopental with no DC.Conclusions: The place for DC in TBI management must be evaluated better, and we believe it is important that future RCTs should have clearer and less permissive ICP criteria regarding when thiopental should be followed by DC and DC followed by thiopental.
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| 42. |
- Åkerblom, Ylva, 1967-, et al.
(författare)
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Pain, disease severity and associations with individual quality of life in patients with motor neuron diseases
- 2021
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Ingår i: BMC Palliative Care. - : BioMed Central (BMC). - 1472-684X. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Background: Up to 85% of people with motor neuron disease (MND) report pain, but whether pain has negative impact on quality of life is unclear. The aim was to study associations between pain, disease severity and individual quality of life (IQOL) in patients with MND.Methods: In this cross sectional study, 61 patients were recruited from four multidisciplinary teams in Sweden, whereof 55 responded to the pain measure (The Brief Pain Inventory – Short form) and were included in the main analyses. Disease severity was measured with the Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised Version, and individual quality of life was measured with a study-specific version of the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting.Results: Forty-one (74%) of the participants who answered BPI-SF (n = 55) reported pain. Thirty-nine (71%) of those reported pain during the past 24 h. The severity of pain was on average moderate, with eight participants (14%) reporting severe pain (PSI ≥ 7). Satisfaction with IQOL for the entire sample was good (scale 1-7, where 1 equals poor quality of life): median 5, interquartile range (IQR) 2.75 and there was no difference in satisfaction with IQOL between those reporting pain/not reporting pain (median 5, IQR 2/median 5, IQR 3.5, Mann-Whitney U = 249, p = 0.452). There was neither any correlation between pain severity and satisfaction with IQOL, nor between disease severity and satisfaction with IQOL.Conclusions: The results add to the hypothesis that associations between non-motor symptoms such as pain prevalence and pain severity and IQOL in MND are weak. Pain prevalence was high and the results pointed to that some participants experienced high pain severity, which indicate that pain assessments and pain treatments tailored to the specific needs of the MND population should be developed and scientifically evaluated.
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- Östberg, Anna-Lena, et al.
(författare)
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Tooth loss and obesity in a defined Swedish population
- 2009
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Ingår i: Scandinavian Journal of Public Health. - London, England : Sage Publications. - 1403-4948 .- 1651-1905. ; 37:4, s. 427-433
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore the association between tooth loss and obesity in an adult Swedish population, and to investigate the influence of socioeconomy, life-style, and co-morbidity.Methods: A cross-sectional population health survey conducted in 2001-2005 in 2816 randomly selected Swedish men and women (age: 30-74 years; participation rate 76%). Main measures were; tooth loss: < 20 remaining teeth (self-reported), general obesity: BMI[≥]30 kg m-2, abdominal obesity: waist circumference > 88 in women and > 102 cm in men. Adjustments were made for socioeconomy, life-style, and co-morbidity.Results: 420 individuals (21.2%) had < 20 remaining teeth: 30-59 years 6.0%, 60-74 years 53.5%. Mean BMI was similar in men and women (26.9 kg m-2), however, both general and abdominal obesity was still more frequent among women (both p < 0.001). There was a significant interaction between age and tooth loss in the association with both general (p = 0.004) and abdominal obesity (p < 0.011) in men. In participants below 60 years of age, the association between tooth loss and general obesity (OR 2.17 [95% CI 1.51 - 3.12]) and abdominal obesity (2.23 [1.58 - 3.15]), respectively, was statistically significant independent of age and gender, and remained so also when accounting for differences in socioeconomy, life-style, and co-morbidity. There was no similar association in those 60 years or older. The findings in men and women were robust and concordant.Conclusions: Common mechanisms for oral health and obesity should be explored more also including longitudinal designs. The findings are important for targeting comprehensive interventions against obesity and tooth loss, especially among younger adults.
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