| 14411. |
- Nyström, Sofia, 1977-, et al.
(författare)
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Continuing professional development : pedagogical practices of interprofessional simulation in health care
- 2017
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Ingår i: Studies in Continuing Education. - : Routledge. - 0158-037X .- 1470-126X. ; 39:3, s. 303-319
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Tidskriftsartikel (refereegranskat)abstract
- The increasing complexity of health care practice makes continuing professional development (CPD) essential for health care professionals. Simulation-based training is a CPD activity that is often applied to improve interprofessional collaboration and the quality of care. The aim of this study is to explore simulation as a pedagogical practice for the CPD of health care professionals. Specifically, the study focuses on how a professional development activity, the simulation, is enacted to support interprofessional collaboration and learning. A practice theory perspective is used as the theoretical framework. In this, the professional practice is conceptualised as being embodied, relational and situated in sociomaterial arrangements. Ten introduction and reflection sessions following interprofessional full-scale manikin-based simulations with professionals were video-recorded. The recordings were analysed following a stepwise qualitative collaborative approach developed for the purpose. The key findings suggest that the professional competence activity is enacted and interconnected with and governed by historical traditions of institutional teaching practices as well as simulation practices. Despite the intentions of team and interprofessional training, the institutional teaching and simulation practices constrain and hinder the intended outcomes of professional development in interprofessional collaboration.
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| 14412. |
- Nyström, Sofia, et al.
(författare)
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Debriefing practices in interprofessional simulation with students : A sociomaterial perspective
- 2016
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Ingår i: BMC Medical Education. - : BioMed Central. - 1472-6920. ; 16:148, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Background: The debriefing phase is an important feature of simulation activities for learning. This study applies a sociomaterial perspective on debriefing in interprofessional simulation with medical and nursing students. Sociomaterial perspectives are increasingly being used in order to understand professional practice and learning in new ways, conceptualising professional practice as being embodied, relational and situated in sociomaterial relations. The aim of the study is to explore how debriefing is carried out as a practice supporting students’ interprofessional learning.Methods: Eighteen debriefing sessions following interprofessional full-scale manikin-based simulation with nursing and medical students from two different universities were video-recorded and analysed collaboratively by a team of researchers, applying a structured scheme for constant comparative analysis.Results: The findings show how debriefing is intertwined with, and shaped by social and material relationships. Two patterns of enacting debriefing emerged. Debriefing as algorithm was enacted as a protocol-based, closed inquiry approach. Debriefing as laissez-faire was enacted as a loosely structured collegial conversation with an open inquiry approach.Conclusion: The findings indicate that neither an imposed structure of the debriefing, nor the lack of structure assured interprofessional collaboration to emerge as a salient topic for reflection, even though that was an explicit learning objective for the simulation.
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| 14413. |
- Näppä, Ulla, et al.
(författare)
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Avoiding harmful palliative chemotherapy treatment in the end of life : development of a brief patient-completed questionnaire for routine assessment of performance status
- 2012
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Ingår i: The journal of supportive oncology. - : Elsevier. - 1544-6794. ; 10:6, s. 230-237
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Earlier studies have shown that up to 43% of patients with incurable cancer are treated with palliative chemotherapy in the last month of their lives. Although pretreatment blood tests are acceptable, the patient's general condition may not permit further palliative chemotherapy treatment (PCT). Presently, there is no patient self-assessment tool available to monitor performance status during PCT.OBJECTIVES: To describe the development process of the Performance Status in Palliative Chemotherapy (PSPC) questionnaire, and the testing of its psychometric properties.METHODS: The questionnaire was developed by the authors based on the Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) scale as well as their clinical experience with PCT. Adult patients who were diagnosed with epithelial cancers (n = 118) were enrolled to test the PSPC questionnaire for reliability, sensitivity for change, and validity.RESULTS: After stepwise modifications of the PSPC questionnaire, psychometric tests revealed acceptable values for reliability (via a test-retest method), sensitivity for change (via a comparison of patients with progressive disease over time), and validity (via a comparison of the PSPC vs the Edmonton Symptom Assessment System [ESAS]).LIMITATIONS: At this stage of questionnaire development, we are unable to conclude whether the PSPC is superior to the conventional ECOG PSR in the evaluation of performance status and the prediction of chemotherapy response.CONCLUSION: Psychometric tests suggest that the PSPC questionnaire may be a useful patient-completed tool in the late stages of cancer disease to routinely monitor performance status in palliative chemotherapy treatments so as to minimize the risk of inflicting more harm than good.
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| 14414. |
- Näppä, Ulla, 1960-, et al.
(författare)
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Challenging situations when administering palliative chemotherapy : a nursing perspective
- 2014
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Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 18:6, s. 591-597
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Palliative chemotherapy treatments (PCT) are becoming more common for patients with incurable cancer; a basic challenge is to optimize tumour response while minimizing side-effects and harm. As registered nurses most often administer PCT, they are most likely to be confronted with difficult situations during PCT administration. This study explores challenging situations experienced by nurses when administering PCT to patients with incurable cancer.Methods: Registered nurses experienced in administering PCT were asked in interviews to recall PCT situations they found challenging. Inspired by the narrative tradition, stories were elicited and analysed using a structural and thematic narrative analysis.Results: A total of twenty-eight stories were narrated by seventeen nurses. Twenty of these were dilemmas that could be sorted into three storylines containing one to three dilemmatic situations each. The six dilemmatic situations broadly related to three interwoven areas: the uncertainty of the outcome when giving potent drugs to vulnerable patients; the difficulty of resisting giving PCT to patients who want it; and insufficient communication between nurses and physician.Conclusion: Nurses who administer PCT are engaged in a complex task that can give rise to a number of dilemmatic situations. The findings may be interpreted as meaning that at least some situations might be preventable if the knowledge and insight of all team members – nurses, physicians, patients, and relatives – are jointly communicated and taken into account when deciding whether or not to give PCT. Forming palliative care teams early in the PCT trajectory, could be beneficial for staff and patients.
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| 14415. |
- Näppä, Ulla, et al.
(författare)
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Palliative chemotherapy during the last month of life
- 2011
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Ingår i: Annals of Oncology. - : Oxford University Press. - 0923-7534 .- 1569-8041. ; 22:11, s. 2375-2380
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This study analyses the potential discriminative characteristics for patients with incurable cancer who received palliative chemotherapy during their last month of life.PATIENTS AND METHODS: The study includes all patients with epithelial cancer treated with palliative chemotherapy who died in 2008 in northern Sweden. Demographic parameters and care utilization data were registered. Data were analyzed using nonparametric methods.RESULTS: Of 374 included patients, 87 (23%) received chemotherapy during the last month of life. These patients had a significantly shorter survival time from first palliative treatment to death, were admitted more frequently to hospital, more often lacked a documented decision to cease treatment, and died less frequently at home.CONCLUSIONS: The results indicate covariations between palliative chemotherapy treatments in the last month of life and unfavorable patient outcomes. As almost one of four patients with incurable cancer received their last round of palliative chemotherapy <31 days before death, there is a potential for improved routines.
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| 14416. |
- Näslund, Annika, et al.
(författare)
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Reach performance and postural adjustments during standing in children with severe spastic diplegia using dynamic ankle-foot orthoses
- 2007
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 0001-5555. ; 39:9, s. 715-23
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the co-ordination between reaching, ground reaction forces and muscle activity in standing children with severe spastic diplegia wearing dynamic ankle-foot orthoses compared with typically developing children. DESIGN: Clinical experimental study. SUBJECTS: Six children with spastic diplegia (Gross Motor Function Classification System level III-IV) and 6 controls. METHODS: Ground reaction forces (AMTI force plates), ankle muscle activity (electromyography and displacement of the hand (ELITE systems) were investigated while reaching for an object. RESULTS: For the children with severe spastic diplegia who were wearing dynamic ankle-foot orthoses, co-ordination between upward and forward reach velocity differed regarding the temporal sequencing and amplitude of velocity peaks. During reaching, these children lacked interplay of pushing force beneath the reach leg and braking force beneath the non-reach leg and co-ordinated ankle muscle activity, compared with controls. CONCLUSION: The results suggest differences in reach performance and postural adjustments for balance control during a reaching movement in standing between children with spastic diplegia Gross Motor Function Classification System level III-IV, wearing dynamic ankle-foot orthoses compared with typically developing children.
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| 14417. |
- Näslund, Erik, et al.
(författare)
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Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Previous Myocardial Infarction and Severe Obesity A Nationwide Cohort Study
- 2021
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Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 0009-7322 .- 1524-4539. ; 143:15, s. 1458-1467
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Tidskriftsartikel (refereegranskat)abstract
- Background: The number of patients with myocardial infarction and severe obesity is increasing and there is a lack of evidence how these patients should be treated. The aim of this study was to investigate the association between metabolic surgery (Roux-en-Y gastric bypass and sleeve gastrectomy) and major adverse cardiovascular events in patients with previous myocardial infarction (MI) and severe obesity.Methods: Of 566 patients with previous MI registered in the SWEDEHEART registry (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) undergoing metabolic surgery and registered in the nationwide Scandinavian Obesity Surgery Registry, 509 patients (Roux-en-Y gastric bypass n=465; sleeve gastrectomy n=44) could be matched 1:1 to a control with MI from SWEDEHEART, but no subsequent metabolic surgery regarding sex, age (+/- 3 years), year of MI (+/- 3 years), and body mass index (+/- 3). The 2 groups were well matched, except for a lower proportion of reduced ejection fraction after MI (7% versus 12%), previous heart failure (10% versus 19%), atrial fibrillation (6% versus 10%), and chronic obstructive pulmonary disease (4% versus 7%) in patients undergoing metabolic surgery.Results: The median (interquartile range) follow-up time was 4.6 (2.7-7.1) years. The 8-year cumulative probability of major adverse cardiovascular events was lower in patients undergoing metabolic surgery (18.7% [95% CI, 15.9-21.5%] versus 36.2% [33.2-39.3%], adjusted hazard ratio, 0.44 [95% CI, 0.32-0.61]). Patients undergoing metabolic surgery had also a lower risk of death (adjusted HR, 0.45 [95% CI, 0.29-0.70]; MI, 0.24 [0.14-0.41]) and new onset heart failure, but there were no significant differences regarding stroke (0.91 [0.38-2.20]) and new onset atrial fibrillation (0.56 [0.31-1.01]).Conclusions: In severely obese patients with previous MI, metabolic surgery is associated with a low risk for serious complications, lower risk of major adverse cardiovascular events, death, new MI, and new onset heart failure. These findings need to be confirmed in a randomized, controlled trial.
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| 14418. |
- Näslund, Erik, et al.
(författare)
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Measuring arterial oxygen saturation from an intraosseous photoplethysmographic signal derived from the sternum
- 2020
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Ingår i: Journal of clinical monitoring and computing. - : SPRINGER HEIDELBERG. - 1387-1307 .- 1573-2614. ; 34:1, s. 55-62
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Tidskriftsartikel (refereegranskat)abstract
- Photoplethysmography performed on the peripheral extremities or the earlobes cannot always provide sufficiently rapid and accurate calculation of arterial oxygen saturation. The purpose of this study was to evaluate a novel photoplethysmography prototype to be fixed over the sternum. Our hypotheses were that arterial oxygen saturation can be determined from an intraosseous photoplethysmography signal from the sternum and that such monitoring detects hypoxemia faster than pulse oximetry at standard sites. Sixteen healthy male volunteers were subjected to incremental hypoxemia using different gas mixtures with decreasing oxygen content. The sternal probe was calibrated using arterial haemoglobin CO-oximetry (SaO2%). Sternal probe readings (SRHO2%) were then compared to SaO2% at various degrees of hypoxia. The time to detect hypoxemia was compared to measurements from standard finger and ear pulse oximeters. A significant association from individual regression between SRHO2% and SaO2% was found (r(2) 0.97), Spearman R ranged between 0.71 and 0.92 for the different inhaled gas mixtures. Limits of agreement according to Bland-Altman plots had a increased interval with decreasing arterial oxygen saturation. The sternal probe detected hypoxemia 28.7 s faster than a finger probe (95% CI 20.0-37.4 s, p < 0.001) and 6.6 s faster than an ear probe (95% CI 5.3-8.7 s, p < 0.001). In an experimental setting, arterial oxygen saturation could be determined using the photoplethysmography signal obtained from sternal blood flow after calibration with CO-oximetry. This method detected hypoxemia significantly faster than pulse oximetry performed on the finger or the ear.
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| 14419. |
- Näslund, Ulf, et al.
(författare)
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Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) : a pragmatic, open-label, randomised controlled trial
- 2019
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 393:10167, s. 133-142
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.
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| 14420. |
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