| 1. |
- Bremander, Ann, 1957-, et al.
(författare)
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Cultural adaptation, validity, reliability and responsiveness of the Swedish version of the effective musculoskeletal consumer scale (EC-17)
- 2012
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Ingår i: Musculoskeletal Care. - Chichester : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 10:1, s. 43-50
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Endorsed by the Outcome MEasures in Rheumatoid Arthritis in Clinical Trials (OMERACT) group, The Effective Consumer Scale (EC-17) was developed in English for patients with musculoskeletal diseases to assess the skills and perceptions important for participating in and managing health care. The objective of this study was culturally to adapt the questionnaire into Swedish and to study its psychometric properties.METHODS: After translation of the questionnaire into Swedish, two different groups of outpatients from two specialist rheumatology departments participated in the study. Face validity was assessed, together with internal consistency, test-retest and responsiveness of the questionnaire. Construct validity was assessed using the Arthritis Self-Efficacy Scale (ASES), and responsiveness to a five day educational intervention was analysed using the standardized response mean (SRM).RESULTS: Analyses were based on 124 patients with inflammatory rheumatic diseases, of whom 50 attended the intervention. Data quality met the requirements, with missing values <5%, and floor and ceiling effects <15%. Item total correlations were all >0.4, ranging from 0.49 to 0.88. Cronbach's alpha was 0.93 and 0.95 for the two groups. The test-retest correlation (ICC₂.₁) was 0.94, and there was a significant improvement as a result of the intervention, with an SRM of 0.43. However, the questionnaire had a higher construct validity with the ASES subscale 'other symptoms' than hypothesized a priori (r(s) 0.75).CONCLUSION: The Swedish version of the EC-17 met the required recommendations for face validity, internal consistency, test-retest reliability and responsiveness. Its construct validity needs to be further established, and the questionnaire needs further testing in different groups of patients and in different interventions. © 2012 John Wiley & Sons, Ltd.
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| 2. |
- Karlsson, Therese, 1979, et al.
(författare)
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Increased vitamin D-binding protein and decreased free 25(OH)D in obese women of reproductive age.
- 2014
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Ingår i: European journal of nutrition. - : Springer Science and Business Media LLC. - 1436-6215 .- 1436-6207. ; 53:1, s. 259-267
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Obese subjects have lower circulating 25-hydroxyvitamin D (25(OH)D) than normal-weight subjects. Knowledge is scarce regarding differences in vitamin D-binding protein (DBP), free 25(OH)D, and intake of vitamin D between normal-weight and obese subjects. The purpose of this study was to examine intake and vitamin D status in obese compared with normal-weight women. METHODS: Between September 2009 and October 2011, 43 obese and 43 normal-weight women, 22-45years of age, mean BMI of 39.1±4.6 and 21.6±1.8kg/m(2), respectively, were recruited in the western Sweden region (latitude 57°N). Blood samples, data regarding diet, and sun exposure were collected. RESULTS: DBP concentrations were 320±121 and 266±104μg/mL (P=0.02) in obese and normal-weight women, respectively. Calculated free 25(OH)D was 13.3±5.5 (obese) and 23.7±10.7 (normal-weight) (P<0.001). The obese women had a 20.1nmol/L lower mean 25(HO)D concentration compared to normal-weight women (P<0.001). 56% of obese women and 12% of normal-weight women had 25(OH)D concentrations ≤50nmol/L. There was no statistically significant difference in total vitamin D intake between the groups. 39% of the women had a total vitamin D intake <7.5μg/day, the current national recommendation for vitamin D in Sweden. CONCLUSIONS: Obese women had higher DBP concentrations compared with normal-weight women and lower free 25(OH)D. The obese women were more likely to have 25(OH)D concentrations that could be considered suboptimal. Vitamin D intake was generally low in normal-weight and obese women of childbearing age.
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| 3. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic
- 2014
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 72, Suppl. 3, s. 139-140
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with chronic inflammatory arthritis (CIA) treated with biological therapy are usually monitored by rheumatologists. Research shows that a nurse-led rheumatology clinic is safe and effective in monitoring biological therapy (1) and contributed added value in patients within rheumatology care, because the encounter with the nurse led to a sense of security, familiarity and participation (2).Objectives: To compare the cost of monitoring biological therapy in a nurse-led rheumatology clinic with those of a rheumatologist-led clinic in patients with low disease activity or in remission.Methods: Cost comparison was based on data from a 12 month randomised controlled trial (1). A total of 107 patients were randomly assigned to either a rheumatologist-led clinic or to a nurse-led rheumatology clinic. The purpose of the intervention was to replace one of two annual monitoring visits at the rheumatologist-led clinic (control group; n=54) by a visit to a nurse-led rheumatology clinic (intervention group; n=53), based on person-centred care. Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. All outpatient visits, team rehabilitation and all the telephone advice at the Rheumatology Clinic were registered for the patients who participated in the trial. Main outcome measures were direct costs related to rheumatology care during the 12 month follow-up period.Results: After 12 months 97 patients completed the study. At the inclusion the patients had mean age of 55.4 years, disease duration of 16.7 years, and DAS28 was 2.1, with no significant differences between the two groups. There was no mean difference in changes in clinical outcome between the two groups (DAS28 -0.06; p=0.66). The total annual cost of team rehabilitation in rheumatology care, per patient monitored by the nurse-led rheumatology clinic was €580 compared with €1278 for monitoring by a rheumatologist-led clinic, translating in a €698 (55%) lower annual cost. The annual cost of just the outpatient rheumatology care provided by rheumatologist and rheumatology nurse, per patient was €457 for monitoring by the nurse-led rheumatology clinic compared with €598 for monitoring by a rheumatologist-led clinic, translating in a €141 (24%) lower annual cost.Conclusions: Patients with stable CIA undergoing biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic compared to a rheumatologist-led clinic, with no difference in clinical outcome as measured by DAS28.ReferencesLarsson et al. (2014). Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs, 70(1): 164-175.Larsson et al. (2012). Patients’ experiences of a nurse-led rheumatology clinic in Sweden – a qualitative study in patients undergoing biological therapy. Nurs Health Sci, 14(4): 501-507.
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| 4. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Biological therapy could be monitored by a rheumatology nurse-led clinic without any differences in outcome – a randomised controlled study
- 2012
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Konferensbidrag (refereegranskat)abstract
- Background: Patients with rheumatic diseases treated with biological therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients who are in low disease activity or remission.Objectives: To compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients treated with biological therapy with low disease activity or in remission.Methods: In a prospective controlled study 107 patients were randomised into two groups with six months follow up to a rheumatology nurse (intervention group; n=53) or to a rheumatologist (control group; n=54). Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. In the nurse-led rheumatology clinic the patients´ disease activity was assessed by examination of tender or swollen joints and laboratory tests. The rheumatology nurse also had a dialogue concerning the patient’s needs with regard to drug therapy, smoking habits and psychosocial aspects. After 12 months 97 patients completed the study. Main outcome was disease activity measured by DAS28.Results: Patients had mean age of 55.4 years and disease duration of 16.7 years. DAS28 was 2.1. At inclusion there were no significant differences in DAS28 between the groups. There were no differences (p=0.67) in change of DAS28 between the intervention group (0.14) or control group (0.20) from inclusion to 12 months.Conclusions: In patients with low disease activity biological therapy could be monitored by a nurse-led rheumatology clinic without any differences in outcome as measured by DAS28.
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| 5. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Nurse-led rheumatology clinic versus rheumatologist clinic in monitoring of biological therapy– a randomised controlled study
- 2012
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 71:Suppl. 3, s. 121-121
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with rheumatic diseases treated with biological therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients with low disease activity or in remission.Objectives: To compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients treated with biological therapy with low disease activity or in remission.Methods: In a prospective controlled study 107 patients were randomised into two groups with six months follow up to a nurse-led rheumatology clinic (intervention group; n=53) or to a rheumatologist clinic (control group; n=54). Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. In the nurse-led rheumatology clinic the patients´ disease activity was assessed by examination of tender or swollen joints and laboratory tests. The rheumatology nurse also had a dialogue concerning the patient’s needs with regard to drug therapy, smoking habits and psychosocial aspects. Main outcome was disease activity measured by DAS28.Results: After 12 months 97 patients completed the study. The patients had mean age of 55.4 years, disease duration of 16.7 years, and DAS28 was 2.1, with no significant differences between the two groups. In change of DAS28 there were no differences (p=0.66) between the intervention group (0.14) or control group (0.20) from inclusion to 12 months. There were no differences (p>0.05) in mean change after 12 months in ESR, swollen and tender joints, global health and pain visual analogue scales (VAS) or Health Assessment Questionnaire (HAQ) between the patients followed up at the nurse-led rheumatology clinic or the rheumatologist clinic, see table. Table. Comparison of the two groups intervention group (Nurse-led rheumatology clinic) and control group (Rheumatologist clinic).
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| 6. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Omvårdnad av patienter med en reumatisk sjukdom
- 2013. - 1
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Ingår i: Ortopedisk vård och rehabilitering. - Lund : Studentlitteratur. - 9789144060590 ; , s. 49-58
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Bokkapitel (populärvet., debatt m.m.)
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| 7. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Patients’ Perceptions of Drug Information Given by a Rheumatology Nurse : A Phenomenographic Study
- 2010
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Ingår i: Musculoskeletal Care. - New Jersey : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 8:1, s. 36-45
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain, stiffness and functional restriction of the joints are the main problems experienced by patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases require several drugs every day. Adherence is highest among patients who have repeatedly been given drug information by a nurse from the start of the treatment. When developing patient information, it is essential to utilise patients' experiences.Objectives: The purpose of this study was to describe variations in how patients with rheumatic diseases conceive drug information given by a rheumatology nurse.Methods: The study had a descriptive qualitative design with a phenomenographic approach. Fifteen in-patients with rheumatic diseases who had received a new drug agreed to take part in the study and were interviewed.Results: Three descriptive categories emerged: Autonomy, Power and Security. Autonomy was based on the patients' experiences of taking responsibility and participating. Power meant gaining knowledge and being motivated to take the drug. Security involved trust, experiencing care and access to a rheumatology nurse.Conclusions: Patients with a rheumatic disease experienced that drug information from a rheumatology nurse gave them autonomy, power and security. These factors could explain why information from a nurse increases drug treatment adherence.
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| 8. |
- Larsson, Ingrid, 1968-
(författare)
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Person-centred care in rheumatology nursing in patients undergoing biological therapy
- 2013
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Konferensbidrag (refereegranskat)abstract
- Person-centred care in rheumatology nursing in patients undergoing biological therapyBackground: The life of patients with chronic inflammatory arthritis (CIA) undergoing biological therapy is often lined by regular monitoring of both disease and biological therapy. The rheumatology nurse´s role has developed from that of an expert advisor to a co-actor, where the patients are necessary and equal participants. A rheumatology nurse with a person-centred care approach respects, supports and encourages patients to become co-actors and the rheumatology nurse is a complement to rheumatologists and other professionals in the multidisciplinary team.Aim: The overall aim was to explore and evaluate rheumatology nursing from a person-centred care perspective in patients undergoing biological therapy.Method: Focuses was on patients with CIA who were undergoing biological therapy at a rheumatology clinic in Sweden. Four studies were conducted and studies I and II had an explorative descriptive design with a phenomenographic approach. Interviews were conducted with 40 participants about their dependence on or independence of a nurse for the administration of their infusions or injections. The objective of the intervention in study III was to replace every second monitoring visit at a rheumatologist-led clinic by a visit to a nurse-led rheumatology clinic, based on person-centred care and had a randomised controlled design involving 107 patients in the trial. The primary outcome was disease activity measured by Disease Activity Score 28. Study IV had an explorative descriptive design with a qualitative content analysis approach. Interviews were conducted with 20 participants who attended the nurse-led rheumatology clinic.Findings: Dependence on a rheumatology nurse for administration of intravenous infusions was described as invigorating due to the regular contact with the nurse, which provided security and involvement (study I). Independence of a nurse for subcutaneous injections was achieved by struggling to cope with injecting themselves, learning about and participating in drug treatment (study II). Patients with stable CIA receiving biological therapy were monitored by a nurse-led rheumatology clinic without any difference in outcome when compared to monitoring carried out at a rheumatologist-led clinic. Replacing one of the two annual rheumatologist outpatient follow-up visits by a visit to a nurse-led clinic for the monitoring of biological therapy was found to be safe and effective (study III). A nurse-led rheumatology clinic, based on person-centred care, added value to the follow up care of patients with stable CIA undergoing biological therapy by providing a sense of security, familiarity and participation (study IV).Conclusion: Person-centred care is the core of rheumatology nursing in the area of biological therapy. The rheumatology nurse adds value to patient care when she/he gives patients an opportunity to talk about themselves as a person and allow their illness narrative to constitute a starting point for building collaboration, which encourages and empowers patients to play an active part in their biological therapy and become autonomous. A nurse who provides person-centred care and keeps the patients´ resources and needs in focus serves as an important guide during their healthcare journey. Rheumatology nursing will be further developed by a person-centred care approach.
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| 9. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy
- 2014
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Ingår i: Journal of Advanced Nursing. - West Sussex : Wiley. - 0309-2402 .- 1365-2648. ; 70:1, s. 164-175
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Tidskriftsartikel (refereegranskat)abstract
- AimTo compare and evaluate the treatment outcomes of a nurse-led rheumatology clinic and a rheumatologist-led clinic in patients with low disease activity or in remission who are undergoing biological therapy.BackgroundPatients with chronic inflammatory arthritis treated with biological therapy are usually monitored by rheumatologists. Nurse-led rheumatology clinics have been proposed in patients with low disease activity or in remission.DesignRandomized controlled trial.MethodsA 12-month follow-up trial was conducted between October 2009 and August 2011, where 107 patients were randomized into two groups with a 6-month follow-up to a nurse-led rheumatology clinic based on person-centred care (intervention group; n = 53) or to a rheumatologist-led clinic (control group; n = 54). The hypothesis was that the nurse-led clinic outcomes would not be inferior to those obtained from a rheumatologist-led clinic at the 12-month follow-up. The primary outcome was disease activity measured by Disease Activity Score 28.ResultsA total of 47 patients in the intervention group and 50 in the control group completed the 12-month trial. The trial revealed no statistically significant differences between groups in mean change of Disease Activity Score 28, Visual Analogue Scales for pain, the Health Assessment Questionnaire, satisfaction with or confidence in obtaining rheumatology care.ConclusionPatients with stable chronic inflammatory arthritis undergoing biological therapy could be monitored by a nurse-led rheumatology clinic without difference in outcome as measured by the Disease Activity Score 28.
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| 10. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Sjuksköterskemottagning för patienter med en reumatisk sjukdom behandlade med biologiska läkemedel – ett randomiserat, kontrollerat försök jämförande sjuksköterskemottagning med läkarmottagning
- 2012
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Konferensbidrag (refereegranskat)abstract
- Bakgrund Målet med behandling av reumatiska sjukdomar är att ta kontroll över ledsmärta och svullnad, reducera ledskador samt förebygga funktionsnedsättningar. För patienter med otillräcklig respons på traditionella läkemedel har forskningen inom reumatologin varit av stor betydelse och medfört utveckling av biologiska läkemedel. Behandling med biologiska läkemedel för patienter med reumatisk sjukdom följs vanligtvis upp av en reumatolog. För patienter som är lågaktiva i sin sjukdom eller i remission har uppföljning via en sjuksköterskemottagning föreslagits. Syfte var att jämföra sjuksköterskemottagning med läkarmottagning avseende behandlingsresultat för patienter behandlade med biologiska läkemedel med låg eller ingen sjukdomsaktivitet.Metod Ett randomiserat kontrollerat öppet försök med 12 månaders uppföljning genomfördes mellan oktober 2009 och augusti 2011. Avsikten var att ersätta ett av de två årliga läkarbesöken med ett sjuksköterskebesök. En sjuksköterskemottagning utformades utifrån en personcentrerad vård med patientens behov i fokus. Inklussionskriterier var patienter med en reumatisk sjukdom behandlade med biologiskt läkemedel och en sjukdomsaktivitet, Disease Active Score 28 (DAS28) ≤3.2. Av 107 patienter randomiserades 53 patienter till uppföljning av sjuksköterska och 54 patienter till uppföljning av läkare. Hypotesen var att behandlingsresultatet på en sjuksköterskemottagning inte skulle vara sämre än på en läkarmottagning vid 12 månaders uppföljning. Huvudutfallsmått var DAS28.Resultat Efter 12 månader hade 47 patienter i sjuksköterskegruppen och 50 patienter i läkargruppen fullföljt studien. Patienterna hade en medelålder på 55.4 år, sjukdomsduration på 16.7 år och DAS28 var 2.1. Det fanns ingen statistiskt signifikant skillnad mellan grupperna. Efter 12 månader var det inte någon statistisk signifikant skillnad (p=0.66) i förändring av DAS28 mellan sjuksköterskegruppen (0.14) eller läkargruppen (0.20). I utfallsmåtten sänka, svullna och ömma leder, global hälsa och smärta (VAS) eller Health Assessment Questionnaire (HAQ) var det inte heller någon statistisk signifikant skillnad i förändring efter 12 månader mellan grupperna. Båda grupperna var lika nöjda med vården och säkra på att få hjälp från reumatologmottagningen vid problem med lederna.Sammanfattning Patienter med en stabil reumatisk sjukdom behandlade med biologiskt läkemedel kan följas upp vid en sjuksköterskemottagning utan någon skillnad i behandlingsresultat med avseende på DAS28.
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