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- Ekman, Inger, 1952, et al.
(författare)
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Person-centered care -ready for prime time.
- 2011
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 10:4, s. 248-251
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Tidskriftsartikel (refereegranskat)abstract
- Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.
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| 2. |
- Muth, Andreas, 1974, et al.
(författare)
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Patient-reported impacts of a conservative management programme for the clinically inapparent adrenal mass.
- 2013
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Ingår i: Endocrine. - : Springer Science and Business Media LLC. - 1559-0100 .- 1355-008X. ; 44:1, s. 228-236
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess patient-reported impacts and health-related quality of life (HRQL) of a 2-year follow-up programme in a large cohort of patients with stationary, non-functioning, adrenal incidentalomas (AIs) in western Sweden. 145 patients (mean age 68years, 62% females) with AI from a prospective study in western Sweden were studied. All had completed a 2-year follow-up programme by November 2007, without evidence of adrenal malignancy or hormone over-production. To evaluate patient-reported impacts and HRQL, an eight-item adrenal incidentaloma impact questionnaire was used retrospectively, together with the hospital anxiety and depression scale, and the short form-36. There were 111 patients (mean age 67years, 63% females) who responded to the questionnaire (response rate 77%). 77% reported that the AI diagnosis had caused them to be worried; however, fewer than 20% had thought about the lesion often during the follow-up programme, and only 3% had felt that it had a large impact on their current daily life. Only 4% stated that the follow-up programme had been a negative experience, nevertheless 10% reported a negative impact on their HRQL during the follow-up programme. Only 2% stated that release from follow-up caused worry to any degree. In total, 29% had possible anxiety, and 30% had possible depression, probably reflecting significant co-morbidity. Possible anxiety correlated with a more negative experience of the follow-up programme. In conclusion, the 2-year follow-up programme for patients with AI was well tolerated. Nonetheless, a small number remained worried throughout follow-up, suggesting the need for tailored counselling in individual patients to ameliorate negative impacts of follow-up.
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| 3. |
- Hallberg, Inger, 1956, et al.
(författare)
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Phases in development of an interactive mobile phone-based system to support self-management of hypertension
- 2014
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Ingår i: Integrated blood pressure control. - : Dove Medical Press. - 1178-7104. ; 7, s. 19-28
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Tidskriftsartikel (refereegranskat)abstract
- Hypertension is a significant risk factor for heart disease and stroke worldwide. Effective treatment regimens exist; however, treatment adherence rates are poor (30%–50%). Improving self-management may be a way to increase adherence to treatment. The purpose of this paper is to describe the phases in the development and preliminary evaluation of an interactive mobile phone-based system aimed at supporting patients in self-managing their hypertension. A person-centered and participatory framework emphasizing patient involvement was used. An interdisciplinary group of researchers, patients with hypertension, and health care professionals who were specialized in hypertension care designed and developed a set of questions and motivational messages for use in an interactive mobile phone-based system. Guided by the US Food and Drug Administration framework for the development of patient-reported outcome measures, the development and evaluation process comprised three major development phases (1, defining; 2, adjusting; 3, confirming the conceptual framework and delivery system) and two evaluation and refinement phases (4, collecting, analyzing, interpreting data; 5, evaluating the self-management system in clinical practice). Evaluation of new mobile health systems in a structured manner is important to understand how various factors affect the development process from both a technical and human perspective. Forthcoming analyses will evaluate the effectiveness and utility of the mobile phone-based system in supporting the self-management of hypertension.
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| 4. |
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| 5. |
- Kjellgren, Karin I, 1950, et al.
(författare)
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Optimizing adherence to hypertension treatment through a mobile phone-based self-report system
- 2012
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Ingår i: 5th Geneva Conference on Person-centered Medicine.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Nearly a third of all adults treated for hypertension have uncontrolled blood pressure (BP). Poor adherence to prescribed antihypertensive medications has been identified as one of the major contributors to uncontrolled BP. As individuals perform their own cost-benefit analyses in choosing to take medications as prescribed, a major challenge for healthcare is to help and support them in making informed decisions. Providing direct and personal feedback about how their medication and lifestyle behaviors affect their BP, hypertension-related symptoms and general wellbeing may help in this endeavour. The overall aim of our research program is to design and examine if a mobile phone-based self-report system, in combination with internet feedback can improve treatment and contribute to increased adherence, and in turn alleviate symptoms and improve wellbeing. Focus group interviews with persons with hypertension, as well as physicians, nurses and pharmacists were conducted to ascertain significant determinants of adherence. Both hypertensive persons and health providers considered regular monitoring of BP and symptoms to be of critical importance. Based on the interviews, a brief protocol was developed for mobile phone-based self-report of home-measured BP, medication intake, symptoms, lifestyle behaviors, etc. An internet graphical feedback system was designed to enable both the hypertensive persons and health providers to freely explore relationships of BP and hypertension symptoms with medication intake, lifestyle behaviors, etc. The value of this system in improving adherence is currently being evaluated in a pilot study.
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| 6. |
- Nordanstig, Joakim, et al.
(författare)
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Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants One-Year Results of the Invasive Revascularization or Not in Intermittent Claudication (IRONIC) Trial
- 2014
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Ingår i: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 130:12, s. 939-947
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Tidskriftsartikel (refereegranskat)abstract
- Background-The quality of evidence for invasive revascularization in intermittent claudication is low or very low. This prospective, randomized, controlled study tested the hypothesis that an invasive treatment strategy versus continued noninvasive treatment improves health-related quality of life after 1 year in unselected patients with intermittent claudication. Methods and Results-After clinical and duplex ultrasound assessment, unselected patients with intermittent claudication requesting treatment for claudication were randomly assigned to invasive (n=79) or noninvasive (n=79) treatment groups. Primary end point was health-related quality of life after 1 year, assessed with Medical Outcomes Study Short Form 36 version 1 and Vascular Quality of Life Questionnaire, and secondary end points included walking distances on a graded treadmill. The Medical Outcomes Study Short Form 36 version 1 physical component summary (P<0.001) and 2 Medical Outcomes Study Short Form 36 version 1 physical subscales improved significantly more in the invasive versus the noninvasive treatment group. Overall, Vascular Quality of Life Questionnaire score (P<0.01) and 3 of 5 domain scores improved significantly more in the invasive versus the noninvasive treatment group. Intermittent claudication distance improved significantly in the invasive (+124 m) versus the noninvasive (+50 m) group (P=0.003), whereas the change in maximum walking distance was not significantly different between groups. Conclusions-An invasive treatment strategy improves health-related quality of life and intermittent claudication distance after 1 year in patients with stable lifestyle-limiting claudication receiving current medical management. Long-term follow-up data and health-economic assessments are warranted to further establish the role for revascularization in intermittent claudication.
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| 7. |
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| 8. |
- Nordanstig, Joakim, et al.
(författare)
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Walking Performance and Health-related Quality of Life after Surgical or Endovascular Invasive versus Non-invasive Treatment for Intermittent Claudication - A Prospective Randomised Trial
- 2011
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884. ; 42, s. 220-227
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Despite limited scientific evidence for the effectiveness of invasive treatment for intermittent claudication (IC), revascularisation procedures for IC are increasingly often performed in Sweden. This randomised controlled trial compares the outcome after 2 years of primary invasive (INV) versus primary non-invasive (NON) treatment strategies in unselected IC patients. Materials/Methods: Based on arterial duplex and clinical examination, IC patients were randomised to INV (endovascular and/or surgical, n=100) or NON (n=101). NON patients could request invasive treatment if they deteriorated during follow-up. Primary outcome was maximal walking performance (MWP) on graded treadmill test at 2 years and secondary outcomes included health-related quality of life (HRQL), assessed with Short Form (36) Health Survey (SF-36). Results: MWP was not significantly (p=0.104) improved in the INV versus the NON group. Two SF-36 physical subscales, Bodily Pain (p<0.01) and Role Physical (p<0.05) improved significantly more in the INV versus the NON group. There were 7% crossovers against the study protocol in the INV group. Conclusions: Although invasive treatment did not show any significant advantage regarding MWP, the HRQL improvements associated with invasive treatment tentatively suggest secondary benefits of this regimen. On the other hand, a primary non-invasive treatment strategy seems to be accepted by most IC patients.
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| 10. |
- Arvidsdotter, Tina, et al.
(författare)
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Six-month effects of integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients - follow up from an open, pragmatic randomized controlled trial
- 2014
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Ingår i: Bmc Complementary and Alternative Medicine. - : Springer Science and Business Media LLC. - 1472-6882. ; 14:210
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Tidskriftsartikel (refereegranskat)abstract
- Background: To evaluate and compare 6-month effects of 8 weeks of an integrative treatment (IT), therapeutic acupuncture (TA), and conventional treatment (CT) in reducing symptoms of anxiety, depression and in improving health-related quality of life (HRQL) and sense of coherence (SOC) in psychologically distressed primary care patients. Methods: Patients who had participated in an open, pragmatic randomized controlled trial were followed up six months after treatment. The study sample consisted of 120 adults (40 per treatment arm) aged 20 to 55 years referred from four different primary health care centres in western Sweden for psychological distress. Assessments were made at baseline after eight weeks and after 24 weeks. Anxiety and depression were evaluated with the Hospital Anxiety and Depression scale (HADS), HRQL with the SF-36 Mental Component Summary scores (MCS) and SOC with the Sense of Coherence-13 questionnaire. Results: No baseline differences were found between groups on any outcome variable. At 24 weeks, IT and TA had significantly better values than CT on all variables. All three groups showed significant improvements from baseline on all variables, except HAD depression in CT; however, improvements were significantly greater in IT and TA than in CT. IT and TA did not differ on any outcome variable. Effect sizes were large in IT and TA for all variables and small or moderate in CT. Improvements on all variables seen after 8-weeks of IT and TA remained stable at 24 weeks and the CT group improved on HAD anxiety. Conclusions: IT and TA seem to be more beneficial than CT in reducing anxiety, depression, and in improving quality of life and sense of coherence after 24 weeks of follow up in patients with psychological distress. More research is needed to confirm these results.
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