| 1. |
- Ebben, Remco H. A., et al.
(författare)
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Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care : a systematic review
- 2018
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 8:11
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Forskningsöversikt (refereegranskat)abstract
- Objective Guideline and protocol adherence in prehospital and in-hospital emergency departments (EDs) is suboptimal. Therefore, the objective of this systematic review was to identify effective strategies for improving guideline and protocol adherence in prehospital and ED settings. Design Systematic review. Data sources PubMed (including MEDLINE), CINAHL, EMBASE and Cochrane. Methods We selected (quasi) experimental studies published between 2004 and 2018 that used strategies to increase guideline and protocol adherence in prehospital and in-hospital emergency care. Pairs of two independent reviewers performed the selection process, quality assessment and data extraction. Results Eleven studies were included, nine of which were performed in the ED setting and two studies were performed in a combined prehospital and ED setting. For the ED setting, the studies indicated that educational strategies as sole intervention, and educational strategies in combination with audit and feedback, are probably effective in improving guideline adherence. Sole use of reminders in the ED setting also showed positive effects. The two studies in the combined prehospital and ED setting showed similar results for the sole use of educational interventions. Conclusions Our review does not allow firm conclusion on how to promote guideline and protocol adherence in prehospital emergency care, or the combination of prehospital and ED care. For ED settings, the sole use of reminders or educational interventions and the use of multifaceted strategies of education combined with audit and feedback are all likely to be effective in improving guideline adherence.
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| 4. |
- Levander, Sara, 1975-, et al.
(författare)
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Assessing educational expertise in academic faculty promotion
- 2016
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Ingår i: Nordic Journal of Studies in Educational Policy. - : Informa UK Limited. - 2002-0317. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- During 19992010, eligible Swedish university lecturers had an unconditional right to apply for promotion tothe position of professor. Our aim was to discuss the motives of the reform and to problematise challenges inmaking qualitative assessments of educational expertise. We presented the results from an evaluation of thereform, and we focused on the weights that the peer reviewers in their assessment assign to the educationalcredentials of the applicants as opposed to those assigned to the research credentials. The empirical materialconsists of the dossiers from 294 cases of promotion. For research expertise and for educational expertise, wecreated one and three indices, respectively, where different types of credentials were given different weights.Changes over time were examined, as well as differences between disciplinary domains. In the assessment anddecision process, educational expertise was outweighed by research expertise, and mainly quantitative aspectsof the former were taken into account. There were signs that the peer review system underwent changes andthat its intended quality-promoting function diminished over time.
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| 6. |
- Madsen, Ulla Riis, et al.
(författare)
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A prospective study of short-term functional outcome after dysvascular major lower limb amputation
- 2018
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Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier BV. - 1878-1241 .- 1878-1292. ; 28, s. 22-29
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates functional status on Day 21 after dysvascular major lower limb amputation compared with one month pre-amputation and evaluates factors potentially influencing outcome. Methods: A prospective cohort study design was used. Data were collected via in-person interviews using structured instruments and covered functional level (Barthel index 100) one month pre-amputation and on Day 21. Out of a consecutive sample of patients having major lower limb amputation (tibia, knee or femoral) (n = 105), 51 participated on Day 21 follow-up. Clinical, demographic, body function and environmental data were analysed as factors potentially influencing outcome. Results: From pre-amputation to Day 21, participants' functional level decreased significantly in all ten activities of daily living activities as measured by the Barthel Index. Almost 60% of participants were independent in bed-chair transfer on Day 21. Being independent in transfer on Day 21 was positively associated with younger age and attending physiotherapy after discharge. Conclusions: The findings indicate that short-term functional outcome is modifiable by quality of the postoperative care provided and thus highlights the need for increased focus on postoperative care to maintain basic function as well as establish and provide everyday rehabilitation in the general population of patients who have dysvascular lower limb amputations.
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| 7. |
- Madsen, Ulla Riis, et al.
(författare)
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Age and health-related quality of life, general self-efficacy, and functional level 12 months following dysvascular major lower limb amputation : a prospective longitudinal study
- 2019
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 41:24, s. 2900-2909
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study investigates the effect of time and age on health-related quality of life, general self-efficacy, and functional level 12 months following dysvascular major lower limb amputation (LLA). Methods: A prospective cohort study design with assessments at baseline and follow-up 3, 6, and 12 months post-amputation. Data were collected via in-person interviews using Short Form 36, the General Self-efficacy scale and Barthel Index 100. Out of a consecutive sample of 103 patients having dysvascular major LLA (tibia, knee, or femoral), 38 patients completed the study. Outcome at follow-up was compared with baseline and analyzed in age groups. Results: All SF36 subscale scores were below population norms at baseline. At 12 months, two out of eight scores—physical function and role-physical—had not improved. Different patterns of change over the 12 months were detected among the subscales, and psychosocial problems persisted and fluctuated throughout the 12 months in all age groups. Large differences were identified between age groups in physical function with the loss of physical function almost solely evident among the oldest (aged 75+ years) patients. Conclusions: Special attention should be given to the oldest patients need for rehabilitation so that they gain higher quality of life.Implications for rehabilitationPsychosocial problems persist and fluctuate throughout the first 12 months after major LLAs in all age groups and rehabilitation services should include psychosocial support throughout the first year to all patients independent of age.Waiting for an unnecessarily long period of time for a prosthesis can negatively impact both physical and psychosocial aspects of health-related QOL, and interventions to reduce waiting time are warranted.Differences between age groups in functional level after 12 months exist, with the loss of function almost solely evident among the oldest patients (aged 75+ years). A special focus should be given to the oldest patients’ need of everyday rehabilitation to regain basic physical functions.
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| 8. |
- Riis Madsen, Ulla, et al.
(författare)
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Pendulating-A grounded theory explaining patients' behavior shortly after having a leg amputated due to vascular disease.
- 2016
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - London : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Although the group of vascular leg amputated patients constitutes some of the most vulnerable and frail on the orthopedic wards, previous research of amputated patients has focused on patients attending gait training in rehabilitation facilities leaving the patient experience shortly after surgery unexplored. Understanding patients' behavior shortly after amputation could inform health professionals in regard to how these vulnerable patients' needs at hospital can be met as well as how to plan for care post-discharge. Aim To construct a grounded theory (GT) explaining patients' behavior shortly after having a leg amputated as a result of vascular disease. Method In line with constructivist GT methodology, data from ethnographic observations and interviews were simultaneously collected and analyzed using the constant comparative method covering the patients' experiences during the first 4 weeks post-surgery. Data collection was guided by theoretical sampling and comprised 11 patients. A GT was constructed. Results Patients went through a three-phased process as they realized they were experiencing a life-changing event. The first phase was "Losing control" and comprised the sub-categories "Being overwhelmed" and "Facing dependency." The second phase was "Digesting the shock" and comprised the sub-categories "Swallowing the life-changing decision," "Detecting the amputated body" and "Struggling dualism." The third phase was "Regaining control" and comprised the sub-categories "Managing consequences" and "Building-up hope and self-motivation." "Pendulating" was identified as the core category describing the general pattern of behavior and illustrated how patients were swinging both cognitively and emotionally throughout the process. Conclusion The theory of "Pendulating" offers a tool to understand the amputated patients' behavior and underlying concerns and to recognize where they are in the process. Concepts from the theory could be used by health professionals who support patients coping with the situation by offering terms to express and recognize patients' reactions.
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| 9. |
- Riis Madsen, Ulla
(författare)
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Quality of life, functional level and needs of care after vascular major lower limb amputation
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis was designed to investigate health-related quality of life, functional level and needs of care the first year after dysvascular major lower limb amputation and consists of four studies with three different designs. A grounded theory was constructed in Study I. Data collection was guided by theoretical sampling and comprised of observations and interviews with eleven patients.The substantive theory of ‘Pendulating’ was constructed to explain patients' behavior shortly after having a leg amputated due to vascular disease. This theory shows that patients, independent of age and condition, go through a three-phased process as they realize they are experiencing a life-changing event. The results illustrates how cognitively and emotionally vulnerable patients are shortly after leg amputation. In Study II, a systematic review was conducted in accordance with the Cochrane Handbook for systematic reviews to assess the effects of early mobilisation interventions in dysvascular lower limb amputated patients. With only five studies identified which covered the aim of the study—none of which were high quality—a research evidence gap was identified, and it cannot be concluded whether early mobilisation is beneficial to this vulnerable population. It was found that ambulation of newly amputated patients is complex but possible if the necessary interdisciplinary team is dedicated to the task. A prospective longitudinal cohort study design was used in Studies III&IV. Short-term functional status was compared with status one month pre-amputation. Factors potentially influencing outcome were evaluated in Study III where characteristics of a consecutive sample of patients having amputation were also reported and participants were compared with non-participants. Effect of time and age on health related quality of life (HRQOL), general self-efficacy and functional level twelve months following dysvascular major lower limb amputation were investigated in Study IV. Data were collected via in-person interviews on functional level (Barthel index 100) at baseline and on Day 21(Study III) and HRQOL (SF36), functional level (Barthel index 100) and general self-efficacy (GSE) at baseline and after three, six and twelve months respectively (Study IV). Participants were consecutively recruited from patients having amputation at the tibia, knee or femoral level at two Danish hospitals. In all, 60 of 105 eligible patients participated at baseline. Fifty-one patients completed Study III and 38 completed Study IV. Short-term functional outcome (Study III) was positively associated with lower age and physiotherapy initiated after discharge and indicates that outcome is modifiable by care provided. Non-participants were significantly older than participants and had a high prevalence of dementia, acute confusion and severely deterioriated health and were therefore expected to have worse outcomes than partipants. Unique prospective longitudinal data on patients after dysvascular LLA who survived twelve months post-amputation were reported in Study IV. This study documents that significant improvement in more aspects of HRQOL can be achieved as soon as three months post-amputation. Independent of age, psychosocial problems persist and fluctuate throughout the first twelve months. Significant differences between age groups were identified in physical function over time with loss of physical function almost solely evident among the oldest patients after twelve months. This thesis provides unique insight into the lives of dysvascularly-amputated patients during the first twelve months after an amputation and shows that, as a group, they are vulnerable in more aspects even though leg amputation can result in better HRQOL in all domains except physical function. Dysvascularly-amputated patients constitute a heterogeneous group with widely different functional levels and psychosocial needs and have a range of complex needs of care not always met by healthcare provided. Quality improvements are required in several areas to optimize quality of life.
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| 10. |
- Riis Madsen, Ulla, et al.
(författare)
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Systematic review describing the effect of early mobilisation after dysvascular major lower limb amputations
- 2017
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 26:21-22, s. 3286-3297
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Forskningsöversikt (refereegranskat)abstract
- Aims and objectives: To assess the effect of early mobilisation of patients after dysvascular lower limb amputation and to compare the effectiveness of different mobilisation regimens. Background: Patients who have undergone dysvascular major lower limb amputations are at high risk of postoperative complications, which include loss of basic functions, and early mobilisation interventions might prevent these complications. Design: Systematic review. Methods: Systematic searches were performed on PubMed (including MEDLINE), CINAHL and EMBASE databases to identify studies investigating the effects of (early) mobilisation interventions in dysvascular lower limb-amputated patients. Data collection and quality assessment were performed using the Cochrane Effective Practice and Organization of Care Review Group data collection checklist and the Cochrane Handbook for Systematic Reviews of Interventions, respectively. Results: Five studies were included in the review: four pre- to post-case studies and one randomised controlled study. However, none of these studies were of high quality. Four studies investigated early mobilisation promoted by immediate postoperative prosthesis. One study investigated whether reorganizing care increases mobilisation and thereby functional outcome. Conclusions: This systematic review reveals a lack of evidence to determine whether early mobilisation interventions are beneficial to this vulnerable patient group. Nevertheless, ambulation from the first postoperative day with temporary prosthesis is possible among the heterogeneous population of dysvascular lower limb-amputated patients if the necessary interdisciplinary team is dedicated to the task. Relevance to clinical practice: Mobilisation is a fundamental care task often missed for several reasons. Moreover, mobilisation of the newly amputated patient is complex, and knowledge of effective strategies to promote postoperative mobilisation in this vulnerable population is desired. Nurses are urged to take responsibility for this fundamental care task and to engage the necessary collaborative interdisciplinary team to develop, implement and evaluate ambitious early mobilisation interventions.
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