| 11. |
- Björling, Gunilla, Docent, et al.
(författare)
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Clinical use and material wear of polymeric tracheostomy tubes
- 2007
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Ingår i: The Laryngoscope. - : Lippincott Williams & Wilkins. - 0023-852X .- 1531-4995. ; 117:9, s. 1552-1559
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The objectives were to compare the duration of use of polymeric tracheostomy tubes, i.e., silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU), and to determine whether surface changes in the materials could be observed after 30 days of patient use. METHODS: Data were collected from patient and technical records for all tracheostomized patients attending the National Respiratory Center in Sweden. In the surface study, 19 patients with long-term tracheostomy were included: six with Bivona TTS Si tubes, eight with Shiley PVC tubes, and five with Trachoe Twist PU tubes. All tubes were exposed in the trachea for 30 days before being analyzed by scanning electron microscopy (SEM) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR). New tubes and tubes exposed in phosphate-buffered saline were used as reference. RESULTS: Si tubes are used for longer periods of time than those made of PVC (P < .0001) and PU (P = .021). In general, all polymeric tubes were used longer than the recommended 30-day period. Eighteen of the 19 tubes exposed in patients demonstrated, in one or more areas of the tube, evident surface changes. The morphologic changes identified by SEM correlate well with the results obtained by ATR-FTIR. CONCLUSIONS: Si tracheostomy tubes are in general used longer than those made of PVC and PU. Most of the tubes exposed in the trachea for 30 days suffered evident surface changes, with degradation of the polymeric chains as a result.
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| 12. |
- Björling, Gunilla, Docent
(författare)
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Long-term tracheostomy : How to do it
- 2009
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Ingår i: Breathe: continuing medical education for respiratory professionals. - Lausanne, Switzerland : European Respiratory Society. - 1810-6838. ; 5:3, s. 204-213
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Tidskriftsartikel (refereegranskat)abstract
- The overall aim for long-term tracheostomy care is to help those with respiratory failure to achieve a high-quality active life. A long-term tracheostomy does not necessarily mean an increased need for hospital care. With an optimally fitted tracheostomy tube, patient and staff education and regular follow-ups, serious complications can be avoided. This article describes predictors of good long-term tracheostomy care, such as tube selection, indications of change and follow-up.
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| 13. |
- Björling, Gunilla, Docent
(författare)
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Long-Term Tracheostomy : Outcome, Cannula care, and Material Wear
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Do people with long-term tracheostomy need hospital care? Which cleaning method is most appropriate for decontamination of inner cannulae? Are tracheostomy tubes changed for rational reasons? There is clearly a lack of evidence based research in this field and the clinical guidelines available are often based on local practice. A tracheostomy is a created opening in trachea to facilitate breathing. It is a direct entry to the deeper airways, e.g. for micro-organisms causing a potential risk for lung infections. Indications for long-term tracheostomy can be, e.g. upper airway obstruction, malformations, or chronic hypoventilation, when ventilation via nasal mask is not possible. The research of the present thesis was conducted at the National Respiratory Centre (NRC) at Danderyd Hospital in Stockholm, Sweden. This unit opened in 1982, with the expressed goal of supporting outpatients with long-term tracheostomy. The overall aims of the thesis were to evaluate the outcome of patients with long-term tracheostomy and to conduct evidence based studies concerning their care.A comparison was made for the number of days in hospital care during the 2-year periods before and after the tracheostomy was established. The life expectancy of the general population and the observed life span of a cohort of tracheostomized patients from the start of NRC in 1982 were also compared. Interestingly enough, the need for hospital care was unchanged despite of the tracheostomy. The patients’ observed life spans were remarkably high and for many patients not lower than the life expectancy of Swedish people in general.To find a practical and safe decontamination method for inner cannulae we compared two different cleaning methods; detergent followed by chlorhexidine-alcohol, or detergent alone. Samples for bacterial culture were taken before and after cleaning and the numbers of bacteria colonies were counted. The effectiveness of both cleaning methods was greater than expected and the results showed a nearly total elimination of organisms. Thus, the methods investigated were equivalent in achieving decontamination.The duration of use in our unit for polymeric tracheostomy tubes, i.e. silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU) was determined and compared. We found, that Si tubes were used for longer periods (three months) than tubes made of PU or PVC (both two months).Whether or not surface changes could be observed on the tracheostomy tubes after 30 days’, three and six months’ exposure in the trachea were investigated in collaboration with the Royal Institute of Technology and Sophiahemmet University College in Stockholm, Sweden. The analyzing methods were Scanning Electron Microscopy, Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy, and Differential Scanning Calorimetry. All tubes, except one, showed changes in the surface after 30 days’ exposure. The surface changes had progressed significantly after three and six months' exposure, compared to the changes detected after 30 days. The SF-36 questionnaire and a study specific questionnaire were used to describe the patients’ health-related quality of life and experiences of long-term tracheostomy. The results show that all patients were satisfied with their tracheostomy and demonstrated a numerically mean mental health status score above that of the general population.In summary, long-term tracheostomy does not increase the need for hospital care nor does it reduce a patient’s life span. Cleaning the tracheostomy inner cannula with detergent and water is sufficient to achieve decontamination. Si tracheostomy tubes are used longer compared to those made of PVC or PU. The polymeric material investigated suffered evident surface changes after 30 days’ use. Clinical use of polymeric tracheostomy tubes beyond three months cannot be recommended, as we found extensive surface changes and degradation of the polymeric chains. All patients were, in general content, with their tracheostomy. The findings from the present thesis contribute to making the care of long-term tracheostomized patients’ evidence based.
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| 14. |
- Björling, Gunilla, Docent, et al.
(författare)
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Tracheostomy inner cannula care : a randomized crossover study of two decontamination procedures
- 2007
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Ingår i: American Journal of Infection Control. - : Elsevier BV. - 0196-6553 .- 1527-3296. ; 35:9, s. 600-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Today several methods for decontaminating inner cannulae exist. These methods are not based on scientific data, but often on local clinical tradition. This study compares two different decontamination methods. The aim was to find a practical and safe decontamination method. It is a randomized, single-blinded, comparative crossover study. METHODS: Fifty outpatients with long-term tracheostomy with an inner cannula were consecutively included and randomly allocated to begin with one of two different treatment sequences: detergent and chlorhexidine-alcohol (A) or detergent (B). Samples for bacterial culture were taken before and after decontamination, and the number of bacteria colonies was counted. RESULTS: Before decontamination, the inner cannulae grew high numbers of bacteria, which were parts of the normal flora of the upper respiratory tract and did not differ significantly between the two sequences (AB; BA). The primary variable was the culture count value after chlorhexidine-alcohol/detergent (A) and detergent (B). The effects of both methods were larger than expected, and the results showed a nearly total elimination of organisms. The equivalence criterion, ratio of mean colony counts (A/B) >0.8, was met at a significance level of P<0.001. CONCLUSIONS: Cleaning the tracheostomy inner cannula with detergent and water is sufficient to achieve decontamination.
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| 15. |
- Bygren, Lars Olov, 1936-, et al.
(författare)
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Cultural Participation and Health : A Randomized Controlled Trial Among Medical Care Staff
- 2009
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Ingår i: Psychosomatic Medicine. - : Wolters Kluwer. - 0033-3174 .- 1534-7796. ; 71:4, s. 469-473
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Population studies demonstrate that attending cultural events is conducive to improved health when baseline health, income, education, and health habits are taken into account. Animal experiments suggest possible mechanisms. We studied the link in humans between attending cultural events and health in a randomized controlled trial. Methods: Members of the local government officers' union in the health services in Umea, Sweden, were invited to the experiment and 101 people registered for fine arts visits once a week for 8 weeks. They chose films, concerts, or art exhibitions visits, or singing in a choir and were then randomized into 51 cases, starting at once, and 50 controls starting after the trial. Health was assessed before randomization and after the experimental period using the instrument for perceived health, short form (SF)-36, and tests of episodic memory, saliva-cortisol and immunoglobulin. The results were analyzed using a mixed design analysis of variance. Results: The SF-36 Composite Score called physical health improved in the intervention group and decreased among controls during the experiment (F(1,87) = 7.06, p = .009). The individual factor of the SF-36 called social functioning, improved more in the intervention group than among controls (F(1,98) = 8.11, p = .005) as well as the factor vitality (F(1,98) = 5.26, p = .024). The six other factors and the Mental Health Composite Score, episodic memory, cortisol and immunoglobulin levels did not change otherwise than among controls. Mechanisms are left to be identified. Conclusion: Fine arts stimulations improved perceived physical health, social functioning, and vitality.
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| 16. |
- Cadstedt, Jenny
(författare)
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Influence and Invisibility : Tenants in Housing Provision in Mwanza City, Tanzania
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A high proportion of urban residents in Tanzanian cities are tenants who rent rooms in privately owned houses in unplanned settlements. However, in housing policy and in urban planning rental tenure gets very little attention. This study focuses on the reasons for and consequences of this discrepancy between policy and practice. Perspectives and actions of different actors involved in the housing provision process in Mwanza City, Tanzania, have been central to the research. The examined actors are residents in various housing tenure forms as well as government officials and representatives at different levels, from the neighbourhood level to UN-Habitat. The main methods have been interviews and discussions with actors as well as studies of policy documents, laws and plans. Among government actors, private rental tenure is largely seen as an issue between landlords and tenants. Tanzanian housing policy focuses more on land for housing than on shelter. This means that house-owners who control land have a more important role in urban planning and policies than tenants have. In Tanzania in general and in Mwanza in particular, housing policy focuses on residents’ involvement in upgrading unplanned areas by organising in Community Based Organisations. This means that owners who live for a longer period in an area benefit more from settlement improvements than tenants. Tenants are relatively mobile and do not take for granted that they will stay in the same house for long. This raises the question of tenants’ possibilities to influence as well as their rights as citizens as compared to that of owners. The question of citizens’ rights for dwellers in informal settlements has received increased attention during the last years in international housing policy discussions. There is an evident need to intensify and diversify this discussion.
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| 17. |
- Cadstedt, Jenny, 1976-
(författare)
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Tenants in Tanzania, invisible dwellers?
- 2005
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Ingår i: Global tenant : quarterly magazine for the IUT - International Union of Tenants. - 1400-531X. ; :Augus, s. 4-5:August, s. 4-5
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 18. |
- Carlsson, Marianne, et al.
(författare)
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A five-year follow-up of quality of life in women with breast cancer in anthroposophic and conventional care
- 2006
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Ingår i: Evidence-based Complementary and Alternative Medicine. - : Hindawi Limited. - 1741-427X .- 1741-4288. ; 3:4, s. 523-531
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Tidskriftsartikel (refereegranskat)abstract
- Complementary and alternative medicine is used by many cancer patients in most parts of the world, and its use is increasing. The aim of the present study was to examine, over 5 years, the perceived quality of life/life satisfaction in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment only. Data from admission, after I year and after 5 years are used for the comparisons. On admission to the study the women in anthroposophic care perceived their quality of life to be lower than that of the women in the conventional treatment group, especially for emotional, cognitive and social functioning and overall quality of life. Sixty women who actively chose treatment with anthroposophic medicine and 60 individually matched women treated with conventional medicine participated. Quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire. Twenty-six women within anthroposophic care and 31 women within conventional medicine survived the 5 years. Effect size (ES) estimation favored the anthroposophic group in seven of the subscales mostly measuring emotional functioning. The ES for four of the subscales favored the conventional treatment group, mostly concerning physical functioning. After 5 years there were improvements in overall quality of life and in emotional and social functioning compared to admission for the women in anthroposophic care. The improvements took place between admission and 1 year, but not further on. Only minor improvements were found in the matching group.
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| 19. |
- Carlsson, Marianne, et al.
(författare)
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Coping in women with breast cancer in complementary and conventional care over 5 years measured by the mental adjustment to cancer scale
- 2005
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Ingår i: Journal of Alternative and Complementary Medicine. - : Mary Ann Liebert Inc. - 1075-5535 .- 1557-7708. ; 11:3, s. 441-447
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Many patients with cancer, women more often than men, use complementary and alternative medicine (CAM) and care. Our aim was to examine coping over 5 years (November 1995 to January 1999) in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment. The present study is part of a larger study of the outcome of anthroposophic care for women with breast cancer. Design: A nonrandomized controlled trial design was used with individual matching and repeated measurements on six occasions (at admission, 1 month, 3 months, 6 months, 1 year, and 5 years). The matching was based on the following variables: stage of disease at entry, age, treatment during the 3 months before entering the study, and prognosis. Setting: An anthroposophic hospital and conventional hospitals in Sweden. Subjects: Sixty (60) women treated with anthroposophic medicine and 60 women from an oncology outpatient department participated. Forty-nine (49) women in anthroposophic care and 51 in the outpatient group survived 1 year, 26 women in anthroposophic care and 31 in the outpatient group survived 5 years. Intervention: An anthroposophic care program. Outcome measure: Coping was measured using the Mental Adjustment to Cancer scale. Repeat measures of analysis of variance (ANOVA) were used for within-group comparisons, and effect size (ES) was used for between-group comparisons. Results: The women in anthroposophic care showed more passive and anxious coping on admission, but this decreased over time. In the women in anthroposophic care, there were small ES improvements in fighting spirit and passive, anxious coping at 4 of the measured timepoints compared to admission. Conclusion: The choice of anthroposophic care could be seen as a possible way to cope with emotional distress in this group of women with breast cancer. © Mary Ann Liebert, Inc.
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| 20. |
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Dementia, Design and Technology : Time to get involved.
- 2009
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- The interest for the design of life environments for persons with dementia is growing stronger among architects, engineers, social scientists and those responsible for housing and health care planning. This development is connected to the enlarged group of people that become afflicted by this disease and to the fact that a safe environment is proved to be very important for their well-being as well as for their relatives and carers. Dementia is a progressive syndrome and the risk increases by age. Since there is no cure for this disease what we can do is to improve their life situation. It is often called the disease of the relatives because it deeply effects relations and daily life. It is also a disease that the individual has to live with. Most often the meaning of daily routines and the use of common technical applications and services changes dramatically. Efforts are made to design housing for persons with dementia and systems to support their carers. Technologies and a variety of aids is expected to help in developing efficiency of these services, supporting family carers and providing solutions for independent living and improved quality of life of persons with dementia. So far, persons with dementia have not been involved in most of the design processes. Their voice has been used by their informal or formal carers or dementia experts. As a consequence most solutions available are focusing mainly on safety and needs of the carers while other needs and possibilities are mainly neglected. Published result confirms that the lack of user involvement did not facilitate the use of common applications, nor assistive technologies. The aim of this book is to increase the understanding of subjective needs of people with dementia and the way this understanding can promote and improve their involvement in design processes. We will present examples of design and design interventions where people with dementia are involved and what is required from technology when the user has an illness causing dementia. Because of the fact that approaches to involve people with dementia in design as active users of technology are still quite novel, we will also discuss ethical issues and challenging experiences gathered in our studies. The authors represent on-going design and research in Scandinavia and United Kingdom.
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