| 1. |
- Johansson, Anna, et al.
(författare)
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Perceptions of how sleep is influenced by rest, activity and health in patients with coronary heart disease : A phenomenographical study
- 2007
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 21:4, s. 467-475
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Tidskriftsartikel (refereegranskat)abstract
- A framework is needed for identifying internal and external factors essential for the nursing management of psychological supportive health care and education for patients' self-care in sleep. In order to generate more knowledge from the patient's perspective, the aim of this study was to describe how patients with coronary artery disease (CAD) perceive that their sleep is influenced by rest, activity and health in outpatient care. Qualitative interviews were performed with 33 outpatients. The data were analysed using a phenomenographic method. Three descriptive categories of the phenomenon were described: my lifestyle is reflected in my sleep behaviour, handling the practices around tiredness and sleep, and feelings of negative and positive efficacy. Feelings of tiredness, fatigue and sleepiness were different pre-sleep stages, but were also related to the patient's adaptation and recovery. Creating one's own personal time and feelings of efficacy gave an inner sense of strength which is indicated as being particularly important in managing stress and the demands of everyday life in a satisfactory manner. From a contextual, holistic perspective on health, it is important to identify the patient's needs, symptoms and intentional or unintentional self-care management strategies regarding sleep and lifestyle. To promote a positive health outcome it is essential to identify sleeplessness behaviour and perceived self-efficacy for self-care in sleep. © 2007 Nordic College of Caring Science.
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| 2. |
- Gustafsson, Ulla-Maria, 1957-
(författare)
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Anal Fistula : Aspects of Aetiology, Diagnosis and Prognosis After Surgical Treatment
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients with idiopathic anal fistula (n=85) were compared with 215 control subjects, matched for age and sex, through a 180-item questionnaire. Obesity, smoking, constipation and bowel symptoms associated with IBS were more common in the patients.Endoanal ultrasound (EUS) and magnetic resonance imaging (MRI) were compared in the preoperative evaluation of anal fistula in 23 patients. For classifying the primary tract, EUS and surgical findings agreed in 14 cases, and MRI and surgery for 11: for identifying an internal opening, the corresponding figures were 17 and 10.Healing and sphincter function were studied in 42 patients operated with fistula excision and closure of the internal opening. Twenty-three patients healed primarily and another 10 after one re-operation, whereas nine required further surgery until healed. Anal resting pressure was reduced after three and 12 months, and squeeze pressure after 12 months.Eighty-three patients were randomised to surgery with or without application of gentamicin-collagen underneath the flap: 26/42 of patients randomised to gentamicin-collagen healed primarily compared with 21/41 of patients randomised to surgery only (n.s).Micro perfusion in the flap was studied by laser Doppler flowmetry during surgery in 16 patients. No correlation was seen between change in blood flow during surgery and non-healing/recurrence of the fistula.In conclusion, obesity, functional bowel symptoms and possibly smoking are more common in patients with idiopathic anal fistula than in the general population. Endoanal ultrasound is a useful tool in the preoperative evaluation of anal fistula. Advancement flap repair has a reasonably high primary recurrence rate and healing is not significantly improved by local application of gentamicin-collagen: impaired intraoperative blood perfusion of the flap is an unlikely reason for non-healing. A decrease in continence occurs also after this kind of surgery, probably due to an impaired internal anal sphincter function.
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| 3. |
- Gustafsson, Ulla Maria, et al.
(författare)
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Randomized clinical trial of local gentamicin-collagen treatment in advancement flap repair for anal fistula
- 2006
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 93:10, s. 1202-1207
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Tidskriftsartikel (refereegranskat)abstract
- Background: Endoanal advancement flap repair is widely used in sphincter-preserving surgery for anal fistula, but the high recurrence rate is a major problem. A possible cause of non-healing is local infection of the flap. The aim of this study was to evaluate whether local antibiotic treatment with gentamicin-collagen improves healing after endoanal advancement flap repair for anal fistula. Methods: Eighty-three patients (52 men and 31 women; mean age 47 (range 17-71) years) who had endoanal advancement flap repair for anal fistula between September 1998 and January 2004 were randomized to surgery with (42 patients) or without (41 patients) application of gentamicin-collagen beneath the flap. Patients were evaluated at 1-3 and 12 months after surgery for healing and/or recurrence. Results: The overall healing rate with no recurrence at 1 year after surgery was 57 per cent (47 of 83). Twenty-six of 42 patients randomized to gentamicin-collagen healed primarily compared with 21 of 41 patients randomized to surgery only. There were no overall differences in healing rate according to sex, previous fistula surgery, complexity of fistula, smoking habit or body mass index. Conclusion: Endoanal advancement flap repair for anal fistula has a fairly high primary recurrence rate. Healing was not significantly improved by local application of gentamicin-collagen.
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| 4. |
- Monsén, Maria, et al.
(författare)
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Noise and sleep disturbance factors before and after implementation of a behavioural modification programme
- 2005
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 21:4, s. 208-219
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to examine sleep disturbance factors documented by the personnel and recorded noise level during two weeks before (measurement one M1) and after (measurement two M2) the implementation of a behavioural modification programme. The behavioural modification programme included non-disturbance periods on a neurointensive care unit (NICU) in a University hospital. Sleep disturbance factors were identified as general and specific nursing care, and medical treatment documented over fourteen 24-h periods. Minimum, maximum and peak mean noise levels in dBA were recorded continuously during fourteen 24-h periods by a decibel meter. The behavioural modified programme included changing nursing and medical routines and the introduction of afternoon and night non-disturbance periods. The most disturbing documented factors at both M1 and M2 were general nursing care activities. Noise levels showed great variation at both M1 and M2. At M2 minimum and maximum noise levels varied when compared to M1. Implementation of a behavioural modification programme and non-disturbance periods co-ordinated routines resulted in reduced sleep disturbance factors and partly reduced noise levels on the NICU. Changes of the physical care/working environment, preparations before non-disturbance periods, regular evaluations of routines and education are needed to improve sleep on NICUs. © 2004 Elsevier Ltd. All rights reserved.
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