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- Bolse, Kärstin
(författare)
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Caring for Patients with an Implantable Cardioverter Defibrillator Experiences of Patients and Healthcare Professionals
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: An Implantable Cardioverter Defibrillator (ICD) is a technical device used in the treatment of ventricular arrhythmias. After the implantation of an ICD the entire life situation can be affected with psychological and social consequences for the patient and his/her next of kin. The healthcare professionals play a vital role in providing educational information, support, and technical follow-up of the device. During recent years more and more hospitals have introduced a more team based organisation where the physicians collaborate with specialised ICD nurses. Aim: The overall aim of the thesis was to explore how patients with an ICD experienced their life situation and howhealthcare professionals described their experiences of delivering care to ICD patients. Methods: The design was descriptive, combining both quantitative and qualitative approaches, and the data was collected from Sweden and the USA. The Uncertainty of Illness Scale (MUIS-C) and Quality of life Index (QLI) instruments were used to determine the level of uncertainty and satisfaction with life (I), in-depth interviews with a phenomenographic approach was used to describe how Swedish and US patients living with an ICD conceived their life situation (II, III) and how healthcare professionals’ experienced delivering care to patients with an ICD, (IV). Finally, to explore clinical aspects of ICD care in Sweden, the Delivery of ICD Questionnaire (DOIQ) was used to describe the healthcare professionals’ experiences and a content analysis was used to describe the written educational information material provided to patients (V). Results: There were no differences in uncertainty between pre and post ICD implantation either in Swedish or the US patients. Satisfaction with life was significantly higher among US patients compared to Swedish patients both before and after ICD implantation within the health-functioning, socio-economic and psychological-spiritual domains. The Swedish ICD patients experienced a significantly higher satisfaction with life within the socioeconomic domain after 3 months. (I). The patients felt safe in having an ICD implanted, but the conceptions varied from seeing the device as a life saver to being worried about what could happen. Gratitude at having an ICD varied from happiness at being alive to something that was alien and disturbed the patient. Being more or less dependent included how patient experienced feelings from well-being to grief. Having a network varied from having sufficient support to loneliness. Having a belief in the future ranged from having confidence to look forward to resignation. Gaining awareness described patients’ adaptation to living with an ICD and limitations due to the ICD (II). The patients also underwent a transition from becoming aware of the restriction in the life situation through a process of adaption and having trust in the ICD. This phase was followed by a reorientation phase where they adapted to their life situation and the patient and his/her family regained of their lives (III). The healthcare professionals strove to provide competent and individualised care and infuse confirmation to the patients in form of information, education and support. They gave the patients tools to handle their life situation, through existential support and mediating security (IV). Half of the hospitals had nurse-based clinic and others planned to introduce them. Three hospitals performed follow-up in the form of remote home monitoring. The nurse had specific ICD education from ICD companies and/or various university courses. In the educational information material the biophysical dimensions dominated while the emotional dimension was scarcely described, and the spiritual-existential was not referred to at all (V). Conclusions: This thesis offers a further contribution to the scholarly discussion about the relationship between technology and human existence and how to cope with this transition. Our studies revealed that the embodiment of the ICD reflects a merger of experiences about its presence and potential from both patients’ and healthcare professionals’ perspective. This research hopefully encourages healthcare professionals to carefully reflect on what it is like to live with an ICD and to consider practice improvement for the patients’ and the next of kin.
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| 2. |
- Kåring Wagman, Anna, 1970-
(författare)
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Stadens melodi : Information och reklam i Stockholms kommun 1930-1980
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Song of Stockholm investigates the information and promotion produced by the municipality of Stockholm from 1930 to 1980. It focuses on three target groups: inhabitants, companies and tourists. Important questions are: Why did the City create a self-image? What images were presented? How did the activities change over time?The information and promotion are seen as two sides of the same phenomenon: the construction of a self-image. The theoretical perspective stresses the municipality’s dependence on other actors and the way the activities were means to handle the dependency and to gain political and economic resources. They are related to the changing nature of the tasks of the municipalities (to produce service, democracy and economic efficiency), to different instructions expressed by the State, and to economical and political problems within and outside Stockholm.The images presented to tourists and companies show that it was important to achieve balance: Stockholm was described as neither too big, modern or self-confident, nor too small, old or modest. The images intended for the inhabitants changed over time: sometimes the municipality presented itself as a harsh parent, sometimes it became more humble and wanted to communicate with the citizens.The activities point at different dilemmas. The information to the inhabitants shows that it was a way to accomplish legitimacy, but that it sometimes was simplified and accused of resembling political propaganda. The promotion addressed to companies questioned the solidarity between municipalities and affected the sensitive relation to the State. The study of the tourist promotion highlights problems in the cooperation between public and private actors.So, why did Stockholm engage in the activities? Economical problems were important, especially unemployment, but also uninterested citizens, the central regional policies and a widely spread scepticism against the capital.
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| 3. |
- Nordgren, Lena
(författare)
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När kroppen sätter gränser : En studie om att leva med hjärtsvikt i medelåldern
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the present thesis was to describe the meaning of living with heart failure as a middle-aged person. In particular, the relation between the persons’ life-situations and formal care was explored. An additional aim was to uncover the meaning of support as experienced by people living with heart failure in middle age. The study used a caring science perspective and a reflective lifeworld approach, founded on phenomenological philosophy. Interviews were used for data collection and data were analyzed using essence-seeking analysis. The thesis is based on four empirical studies and the results were synthesized into a general structure, presented in the thesis.The results of study I illuminate influences and changes to the life-situation that people living with heart failure in middle age can experience. The social world, i.e. intersubjective relationships, vocational situations, and formal care emerge as fundamental to the individuals, as well as the individuals’ own experiences of themselves and their body. The life-situation is frail and depicted by insecurity and uncertainty. The results of study II illuminate that people living with heart failure in middle age experience exposure and vulnerability in relation to formal care. While the context of formal care provides alleviation and medical treatments, the results at the same time revealed experiences of dependency and unclear participation. The results from studies III and IV clarify that support means to know that help is available concerning practical matters or flexibility at work. However, it also reveals that support means a sense of security or safety in relation to other people, such as friends, families, employees, and formal carers. Knowledge, and control are central aspects of the phenomenon of support in relation to heart failure.The phenomenon’s general structure illustrate that living with heart failure as a middle-aged person is depicted by ambiguity in relation to other persons, daily life and formal care. The general structure is intertwined with an altered experience of the body, and a life-situation in a borderland between health and illness. The phenomenon is illuminated by the meaning constituents: A borderland between health and illness, and A tension between what is supportive and what is not. The phenomenon’s outer horizon is understood as A changed body and a threat against life, meaning that the phenomenon stands out against a background of the limits which the body sets on the persons.The present study illustrates that support from others give people living with heart failure in middle age inner strength which they need if they are to adjust their life goals. However, the results also revealed that formal care at times is insufficient and the support which the patient’s need is forsaken. When people living with heart failure in middle age are to take on their own responsibilities for their health process they need information, knowledge and to be participating in care. Furthermore, formal carers need to focus more on the patient’s social roles and networks. A lifeworld-led perspective in formal care can unite a biomedical and a caring science perspective, and formal carers will be able to pay more attention to the patients’ changed life-situation rather than focusing the patient’s failing hearts.
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| 4. |
- Strömberg, Sara, 1979-
(författare)
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Antibody-based Profiling of Expression Patterns using Cell and Tissue Microarrays
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis, methods to study gene and protein expression in cells and tissues were developed and utilized in combination with protein-specific antibodies, with the overall objective to attain greater understanding of protein function.To analyze protein expression in in vitro cultured cell lines, a cell microarray (CMA) was developed, facilitating antibody-based protein profiling of cell lines using immunohistochemistry (IHC). Staining patterns in cell lines were analyzed using image analysis, developed to automatically identify cells and immunohistochemical staining, providing qualitative and quantitative measurements of protein expression. Quantitative IHC data from CMAs stained with nearly 3000 antibodies was used to evaluate the adequacy of using cell lines as models for cancer tissue. We found that cell lines are homogenous with respect to protein expression profiles, and generally more alike each other, than corresponding cancer cells in vivo. However, we found variability between cell lines in regards to the level of retained tumor phenotypic traits, and identified cell lines with a preserved link to corresponding cancer, suggesting that some cell lines are appropriate model systems for specific tumor types. Specific gene expression patterns were analyzed in vitiligo vulgaris and malignant melanoma. Transcriptional profiling of vitiligo melanocytes revealed dysregulation of genes involved in melanin biosynthesis and melanosome function, thus highlighting some mechanisms possibly involved in the pathogenesis of vitiligo. Two new potential markers for infiltrating malignant melanoma, Syntaxin-7 and Discs large homolog 5, were identified using antibody-based protein profiling of melanoma in a tissue microarray format. Both proteins were expressed with high specificity in melanocytic lesions, and loss of Syntaxin-7 expression was associated with more high-grade malignant melanomas.In conclusion, the combination of antibody-based proteomics and microarray technology provided valuable information of expression patterns in cells and tissues, which can be used to better understand associations between protein signatures and disease.
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