| 1. |
- Bååth, Carina, 1959-, et al.
(author)
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Pressure reducing intervention among persons with pressure ulcers : results from the first three national pressure ulcer prevalence surveys in Sweden
- 2014
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In: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 20:1, s. 58-65
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Journal article (peer-reviewed)abstract
- Rationale, aims and objectivesThe overall aim of this study was to describe preventive interventions among persons with pressure ulcer (PU) in three nationwide PU prevalence surveys in Sweden.MethodsA cross-sectional research design was used; more than 70 000 persons from different hospitals and nursing homes participated in the three prevalence surveys conducted in March 2011, October 2011 and March 2012.The methodology used was that recommended by the European Pressure Ulcers Advisory Panel.ResultsThe overall prevalence of PU categories I–IV in hospitals was 16.6%, 14.4% and 16.1%, respectively. Corresponding figures for nursing homes were 14.5%, 14.2% and 11.8%, respectively. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PU category I.ConclusionsDespite the three prevalence studies that have showed high prevalence of PU the use of preventing interventions is still not on an acceptable level. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PUs, and individual-planned repositioning also increased. However, when persons already have a PU they should all have pressure-reducing preventive interventions to prevent the development of more PUs. Preventing PUs presents a challenge even when facilities have prevention programmes. A PU prevention programme requires an enthusiastic leader who will maintain the team's focus and direction for all staff involved in patient care.
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| 2. |
- Thorngren, Karl-Göran, et al.
(author)
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Influence of age, sex, fracture type and pre-fracture living on rehabilitation pattern after hip fracture in the elderly
- 2005
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In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 27:18-19, s. 1091-1097
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Journal article (peer-reviewed)abstract
- Purpose: To evaluate the influence of background factors on the rehabilitation pattern after a hip fracture in the elderly.Method: Prospective registration based on the Swedish national register for hip fracture patients called RIKSHÖFT/SAHFE (Standardised Audit of Hip Fractures in Europe). The place of living was registered both before fracture and during the following four months period (120 days). Graphs were calculated and drawn based on day-to‐day changes. Also influences of age, sex, fracture type and type of operation were analyzed.Results: The patient's pre-fracture functional capacity as evidence by the place they were able to manage to live before the fracture was the most discriminating factor for the rehabilitation; more than sex, fracture type or type of operation. Age was also a highly discriminating factor with a pronounced influence on the rehabilitation pattern.Conclusions: These background parameters are very important factors when planning the rehabilitation of hip fracture patients. A strategy with individualized planning of the rehabilitation procedure will be highly necessary in the future, in view of the increasing amount of elderly with hip fractures prognosticated during the coming decades. The knowledge about influencing factors here presented will be useful when planning and performing the rehabilitation for this resource-consuming group of patients.
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| 3. |
- Annersten Gershater, Magdalena, et al.
(author)
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Nurse assistants' perception of caring for older persons who are dying in their own home : An interview study.
- 2024
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In: BMC Palliative Care. - : BioMed Central (BMC). - 1472-684X. ; 23:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: As the proportion of older persons in society increases, there is a growing trend towards providing end-of-life care in their homes. Palliative care is a complex and knowledge-demanding form of care, and nurse assistants are those who work closest to the older person at the end-of-life in their own homes. However, nurse assistants sometimes have low educational and insufficient levels of knowledge in palliative care, which can affect the quality of care they provide. Moreover, nurse assistants' experiences are relatively unexplored in this context. The purpose of the study was to illuminate nurse assistants' experiences in caring for dying older persons at home.METHOD: An empirical, qualitative interview study was conducted with 14 nurse assistants with experience of palliative care in homecare. The material was analyzed using thematic content analysis.RESULTS: From the nurse assistant's experiences, one main theme emerged: doing everything possible for the dying older person despite challenges. Moreover, three sub-themes emerged: making a difference at a crucial time, death awakens emotions, and balancing personal and professional relationships. The nurse assistants' saw their role primarily as relieving symptoms but also focusing on next of kin. The following are described as essential parts of their role: carrying out practical nursing tasks, focusing on the physical environment, working alone and seeking help from colleagues due to a physical distance to the other members of the multidisciplinary team. The nurse assistants experienced a lack of support as there was no structured guidance or debriefing available in difficult emotional situations. Furthermore, they disclosed that they were left alone to deal with their feelings.CONCLUSION: This study demonstrates that nurse assistants strive to provide comprehensive care for dying older persons despite facing obstacles from their working conditions and work organization. They lack supervision and education in palliative care, but they rely on their experience-based knowledge to a large extent and provide care according to the four cornerstones of palliative care.
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| 4. |
- Bergman, Jonathan, et al.
(author)
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Bisphosphonates and mortality : confounding in observational studies?
- 2019
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In: Osteoporosis International. - : Springer London. - 0937-941X .- 1433-2965. ; 30:10, s. 1973-1982
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Journal article (peer-reviewed)abstract
- Summary: Numerous observational studies suggest that bisphosphonates reduce mortality. This study showed that bisphosphonate use is associated with lower mortality within days of treatment, although the association was not significant until the second week. Such an early association is consistent with confounding, although an early treatment effect cannot be ruled out.Introduction: The purpose of this study was to examine whether confounding explains why numerous observational studies show that bisphosphonate use is associated with lower mortality. To this end, we examined how soon after treatment initiation a lower mortality rate can be observed. We hypothesized that, due to confounding, the association would be observed immediately.Methods: This was a retrospective cohort study of hip fracture patients discharged from Swedish hospitals between 1 July 2006 and 31 December 2015. The data covered 260,574 hip fracture patients and were obtained from the Swedish Hip Fracture Register and national registers. Of the 260,574 patients, 49,765 met all eligibility criteria and 10,178 were pair matched (bisphosphonate users to controls) using time-dependent propensity scores. The matching variables were age, sex, diagnoses, prescription medications, type of hip fracture, type of surgical procedure, known or suspected dementia, and physical functioning status.Results: Over a median follow-up of 2.8 years, 2922 of the 10,178 matched patients died. The mortality rate was 7.9 deaths per 100 person-years in bisphosphonate users and 9.4 deaths in controls, which corresponded to a 15% lower mortality rate in bisphosphonate users (hazard ratio 0.85, 95% confidence interval 0.79–0.91). The risk of death was lower in bisphosphonate users from day 6 of treatment, although the association was not significant until the second week.Conclusion: Bisphosphonate use was associated with lower mortality within days of treatment initiation. This finding is consistent with confounding, although an early treatment effect cannot be ruled out.
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| 5. |
- Björkman Björkelund, Karin, et al.
(author)
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Factors at admission associated with 4 months outcome in elderly patients with hip fracture.
- 2009
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In: AANA Journal. - 0094-6354. ; 77:1, s. 49-58
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Journal article (peer-reviewed)abstract
- The purpose of this descriptive cohort study was to describe patients with hip fracture on the basis of ASA physical status and to identify preoperative risk factors associated with postoperative outcome up to 4 months after surgery. Data were collected prospectively through the Swedish National Hip Fracture and Anesthetic registers and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Risk factors for a poorer 4-month survival after hip fracture were ASA physical status 3 and 4, more extensive fractures, 85 years or older, male sex, and dependency in living. Mortality within 4 months was significantly associated with ASA physical status 3 and 4, age 85 years or older, male sex, dementia diagnosis, fewer than 8 correct answers on the Short Portable Mental Status Questionnaire, 4 or more prescribed drugs, hemoglobin level less than 100 g/L, creatinine level more than 100 micromol/L, dependency in living, inability to walk alone, and fracture other than undisplaced intracapsular. Elderly patients with hip fracture should be identified immediately at admission regarding risk factors leading to a poorer survival and more complications.
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| 6. |
- Björkman Björkelund, Karin, et al.
(author)
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Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study.
- 2010
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; Apr 7, s. 678-688
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Journal article (peer-reviewed)abstract
- Background: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. Methods: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (>/=65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale. Results: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had >4 prescribed drugs at admission and scored less well in the SPMSQ test. Conclusion: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.
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| 7. |
- Björkman Björkelund, Karin, et al.
(author)
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The influence of perioperative care and treatment on the 4-month outcome in elderly patients with hip fracture.
- 2011
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In: AANA Journal. - 0094-6354. ; 79:1, s. 51-61
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Journal article (peer-reviewed)abstract
- The purpose of this descriptive cohort study was to identify perioperative risk factors associated with postoperative outcome up to 4 months after surgery in elderly patients with hip fracture. Data were collected prospectively through the Swedish National Hip Fracture, the local Acute and Emergency, and Anesthesia registers, and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Perioperative risk factors predicting death within 4 months after surgery were fasting time of 12 or more hours and blood transfusion of 1 U or more. Risk factors predicting postoperative confusion were postoperative oxygen saturation less than 90% and fasting time 12 hours or longer. Risk factors predicting in-hospital complications were transfusion of 1 or more units of blood, preoperative oxygen saturation less than 90%, and fasting time 12 hours or more. Risk factor predicting length of stay longer than 10 days was blood transfusion of 1 U or more. To minimize morbidity and mortality, providers should increase efforts to optimize the patients' oxygen saturation and hemoglobin level and reduce fasting time and waiting time for surgery.
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| 8. |
- Deprez, Julie, 1996-, et al.
(author)
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What are the prognostic factors for the development of incontinence-associated dermatitis (IAD) : a protocol for a systematic review and meta-analysis
- 2023
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:7
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Journal article (peer-reviewed)abstract
- Introduction Incontinence-associated dermatitis (IAD) is irritant contact dermatitis and skin damage associated with prolonged skin contact with urine and/or faeces. Identifying prognostic factors for the development of IAD may improve management, facilitate prevention and inform future research. Methods and analysis This protocol follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Prospective and retrospective observational studies or clinical trials in which prognostic factors associated with the development of IAD are described are eligible. There are no restrictions on study setting, time, language, participant characteristics or geographical regions. Reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports are excluded. MEDLINE, CINAHL, EMBASE and The Cochrane Library will be searched from inception until May 2023. Two independent reviewers will independently evaluate studies. The Quality in Prognostic Studies tool will be used to assess the risk of bias, and the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies-Prognostic Factors checklist will be used for data extraction of the included studies. Separate analyses will be conducted for each identified prognostic factor, with adjusted and unadjusted estimated measures analysed separately. Evidence will be summarised with a meta-analysis when possible, and narratively otherwise. The Q and I 2 statistics will be calculated in order to quantify heterogeneity. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guidance. Ethics and dissemination No ethical approval is needed since all data is already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.
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| 9. |
- Dobožinskas, Paulius, et al.
(author)
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Changes In Care Management After “Fast Track” Protocol Introduction For Hip Fracture Patients
- 2015
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In: Sveikatos mokslai. - : Association of Lithuanian Serials (Publications). - 1392-6373. ; 25:5, s. 126-130
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Journal article (peer-reviewed)abstract
- Background and objective. The introduction of fast track schemes for patients with hip fracture usually results in reductions in length of stay and mortality, and reduces the numbers of complications. The aim of this study was to evaluate the changes in procedure performance, time from admission to surgery and length of stay after introduction of the fast track protocol (FTP). Materials and methods. 235 patients with hip fracture treated before FTP introduction and after the introduction were prospectively investigated. We studied the use of fracture immobilization, analgesics, infusion therapy, blood test sampling and ECG registration during these two periods. Information about the mean/median time period from admission to surgery and length of stay in the hospital (LOS) in the orthopaedic department was recorded. Results. Significant improvements in the use of immobilization, infusion therapy, blood test sampling and ECG recording were observed after FTP introduction. Also significant reductions were observed in both waiting time for surgery and for LOS. Conclusion. Introduction of a FTP improved the use of procedures necessary for hip fracture patient care, while reducing wait to surgery time and LOS.
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| 10. |
- Estev, Bibi, et al.
(author)
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Registered Nurses’ Perceptions of Factors Contributing to Trust-Based Public Management
- 2020
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In: Open Journal of Nursing. - : Scientific Research Publishing. - 2162-5336 .- 2162-5344. ; 10:11, s. 1126-1141
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Journal article (peer-reviewed)abstract
- Aim: The aim of this study was to illuminate registered nurses’ (RNs) perceptions of Trust-Based Public Management (TBPM) in Swedish health care. Design: This study follows a phenomenografic approach guided by Ference Marton’s philosophy. Methods: Semi-structured interviews were used to identify variations in RNs’ perceptions of TBPM. Between February and April 2019, 24 RNs from five Swedish public healthcare departments participated in the study. Results: The results show that none of the participants had previously heard about the work of the Swedish Delegation for TBPM. The study revealed perceptions those politicians and managers were absent from the workplace, that power had been displaced to HR, and that perceptions of trust in the leadership and of working to guidelines varied. Perceptions varied between RNs employed by the municipalities and by the hospitals concerning administration, the time allotted for work, cooperation, and education.
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