| 1. |
- Bylund, Ami, et al.
(author)
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Assessment of family functioning : evaluation of the General Functioning Scale in a Swedish Bariatric Sample
- 2016
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 30:3, s. 614-622
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Journal article (peer-reviewed)abstract
- BackgroundThe General Functioning Scale (GFS) was developed to assess self-perceived overall family functioning. The scale has satisfactory psychometric properties, is internationally recognised and has been used in different contexts. However, no validated Swedish version is available. Healthy family functioning can support patients and help them adhere to treatment regimens. Moreover, it maintains the physical and emotional health and that of the family as a unit. Yet, there is limited information regarding family functioning postgastric bypass surgery. Thus, it is important to use validated instruments to understand family functioning in bariatric contexts. AimTo evaluate aspects of reliability and validity in GFS in a Swedish bariatric sample, focusing on factor structure. MethodThe Swedish version of the GFS (S-GFS) was administered on two occasions to 163 participants who had undergone gastric bypass surgery 6-8 weeks prior to testing. Internal consistency, temporal stability and construct validity were assessed. ResultsData were positively skewed. The S-GFS showed good internal consistency (ordinal = 0.92) with a sufficient overall mean interitem correlation (0.500) and adequate temporal stability (intraclass correlation coefficient = 0.833). After modifying response alternatives, confirmatory factor analysis indicated acceptable fit for a one-factor model. ConclusionThe scale is a promising tool for assessing family functioning in bariatric settings. The S-GFS showed satisfactory reliability - consistent with prior research - and acceptable validity in the study sample. This study contributes to the limited research on the scale's validity. However, the S-GFS needs to be evaluated in different cultural and clinical contexts, focusing on various aspects of validity and responsiveness (sensitivity to detect significant change over time) in different samples.
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| 2. |
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| 3. |
- Bylund, Ami, et al.
(author)
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Creating a New Sense of We-ness : Family Functioning in Relation to Gastric Bypass Surgery
- 2013
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In: BARIATRIC SURGICAL PRACTICE AND PATIENT CARE. - : Mary Ann Liebert Inc. - 2168-023X .- 2168-0248. ; 8:4, s. 152-160
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Journal article (peer-reviewed)abstract
- Background: Gastric bypass surgery (GBP) is the most common treatment for morbid obesity (body mass index 35). To date, the person with obesity has been the main focus in bariatric nursing and research, although the person coexists within their family. Aim: The aim of this study was to describe family functioning in relation to GBP. Methods: Open ended questions were used. Nine families were interviewed on two occasions within 2 weeks 3 months after surgery. The interviews were transcribed and analyzed according to a hermeneutic method. Main Findings: An ongoing process of alterations related to family functioning was identified. Before, GBP families experienced distance and disengagement. Immediately after GBP, there were changes within relationships. Families experienced a period of difficulty, in interactions, while adapting to the lifestyle changes and altered positions. After 3 months, families experienced enhanced closeness in inter-relations within the family and increased social interactions as a whole family with friends and relatives. Conclusions: To better support families and enhance family functioning, bariatric nursing care needs to shift focus from an individual to a family perspective. Further studies are needed to gain a longitudinal perspective and improve understanding of family functioning after GBP.
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| 4. |
- Bylund, Ami, et al.
(author)
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Stabilizing family life after gastric bypass surgery
- 2017
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In: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 12:1
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Journal article (peer-reviewed)abstract
- Weight-loss surgery requires lifelong lifestyle modifications for the maintenance of weight loss and health effects, and can affect both the individual and family. Earlier research indicates that the quality of social relationships has positive and negative influences on wellbeing and health. There is little research on family-life after a member has undergone gastric bypass (GBP) against obesity. Thus, this study aimed to develop a classic grounded theory about families with a member treated with GBP against obesity. The study design used classic grounded theory and included data from 16 interviews. Families’ shared a main concern of unexpected changes after GBP, resulting in the theory Stabilizing family life, explained as a social process to decrease uncertainty and find stability and well-being in family interactions. The social process develops differently which entail families: attaining unity, returning to old patterns, or disconnecting to find stability, depending on the discrepancy in expectations and knowledge. This is affected by the overall life situation, life-stage and relationship quality. The theory highlights unexpected change as a potential challenge for the family, as well as how they resolve this. Hence, the theory can be applied in care strategies for families. Identification of families needing support to stabilize family life after GBP requires further research.
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| 5. |
- Bylund, Ami
(author)
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"Wait for us to catch up" : Aspects of family functioning after gastric bypass surgery
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Aim: To investigate aspects of family functioning when a family member has undergone Gastric Bypass surgery (GBP).Methods: Study I explored experiences of family functioning three months after GBP, based on nine family interviews, analyzed using Gadamerian hermeneutics. Using Classic grounded theory, Study II focused on how families resolve their primary concerns after GBP, through interviews with 16 families. Study III evaluated the reliability and validity of the General Functioning Scale (GFS) based on 163 self-reported questionnaires, and used psychometric analyses. Study IV explored associations between family functioning, weight loss, sex and Health Related-Quality of Life (HR-QoL), based on self-reported questionnaires from 153 participants and utilized descriptive statistics and binary logistic regression.Results: Study I revealed a process of three intertwined changes in family functioning three months after GBP: Living in ambiguous relationship, rewriting family patterns and strengthening family cohesion. Study II showed that families shared a main concern of unexpected change after GBP, resulting in the theory Stabilizing family life, explained as a social process to decrease uncertainty and find stability and well-being in family interactions. This resulted in attaining unity, returning to old family patterns or disconnecting. Study III suggested GFS as a promising tool for assessing family functioning in a Swedish bariatric sample, showing satisfactory reliability and validity. Study IV showed associations between family functioning and the mental dimensions of HR-QoL, two years after GBP. Percent weight loss was associated with the physical dimension. Sex showed no associations to HR-QoL.Conclusion: Families experienced unexpected challenges after GBP affecting family functioning. Mutual remodeling of family life to incorporate changes was seen. Families underwent a social process, indicating that families may represent a resource in bariatric nursing care. A family-system nursing perspective as complement to standard care may be beneficial. As family functioning influence HR-QoL identifying available family resources and giving tailored information to support self-care strategies after GBP, may result in sustainable family functioning and individual health. Studies aimed at identify families that may benefit from family-system nursing interventions are suggested for future inquiry.
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| 6. |
- Dahlberg, Karuna, 1979-, et al.
(author)
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An endeavour for change and self-efficacy in transition : patient perspectives on postoperative recovery after bariatric surgery - a qualitative study
- 2022
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In: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 17:1
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Journal article (peer-reviewed)abstract
- PURPOSE: Self-efficacy plays a role in the process of making lifestyle changes. After bariatric surgery, patients must adapt to several lifelong lifestyle changes. The aim of this study was to explore patients' experiences of recovery after bariatric surgery in those reporting low preoperative self-efficacy.METHODS: This qualitative inductive interview study included 18 participants. Individual interviews were conducted approximately one year after the surgery. Data were analysed using thematic analysis.RESULTS: The analysis identified one theme, and five subthemes describing recovery after bariatric surgery. Participants described being at a crossroads before surgery and having to make a change. After surgery, they had to learn to handle their new situation, which included getting to know their new body, handling thoughts about themselves, and managing social relations. To enhance their situation, support and information were essential. Social relations, support, successes, and challenges influenced their self-efficacy, and thoughts about adopting lifestyle changes, maintaining motivation, and handling setbacks.CONCLUSIONS: Recovery one year after bariatric surgery is an ongoing process that involves challenges encountered in lifestyle changes and physical and psychological transformations. Self-efficacy is not static and is influenced during the recovery process. Support and information are essential to enhance patient recovery after bariatric surgery.
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| 7. |
- Dahlberg, Marie, et al.
(author)
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Objectives and outcomes of patient-driven innovations published in peer-reviewed journals : a qualitative analysis of publications included in a scoping review
- 2023
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:6
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Research review (peer-reviewed)abstract
- Objectives: The aim of this study was to gain a deeper understanding of the objectives and outcomes of patient-driven innovations that have been published in the scientific literature, focusing on (A) the unmet needs that patient-driven innovations address and (B) the outcomes for patients and healthcare that have been reported.Methods: We performed an inductive qualitative content analysis of scientific publications that were included in a scoping review of patient-driven innovations, previously published by our research group. The review was limited to English language publications in peer-reviewed journals, published in the years 2008-2020.Results: In total, 83 publications covering 21 patient-driven innovations were included in the analysis. Most of the innovations were developed for use on an individual or community level without healthcare involvement. We created three categories of unmet needs that were addressed by these innovations: access to self-care support tools, open sharing of information and knowledge, and patient agency in self-care and healthcare decisions. Eighteen (22%) publications reported outcomes of patient-driven innovations. We created two categories of outcomes: impact on self-care, and impact on peer interaction and healthcare collaboration.Conclusions: The patient-driven innovations illustrated a diversity of innovative approaches to facilitate patients' and informal caregivers' daily lives, interactions with peers and collaborations with healthcare. As our findings indicate, patients and informal caregivers are central stakeholders in driving healthcare development and research forward to meet the needs that matter to patients and informal caregivers. However, only few studies reported on outcomes of patient-driven innovations. To support wider implementation, more evaluation studies are needed, as well as research into regulatory approval processes, dissemination and governance of patient-driven innovations.
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| 8. |
- Jaensson, Maria, 1967-, et al.
(author)
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An endeavour for change and self-efficacy in transition : a qualitative study
- 2023
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Conference paper (peer-reviewed)abstract
- Introduction: There is a lack of knowledge how people with low self-efficacy experience their postoperative recovery after bariatric surgery. This study’s aim was to explore patients’ experiences of their recovery after bariatric surgery, in those reporting low preoperative self-efficacy. Method: This was a qualitative inductive interview study. Individual interviews with eighteen participants were conducted approximately one year after the surgery. Data was analyzed using thematic analysis by Braun and Clark. Results: The analysis identified one theme and five sub-themes.Participants described they had to learn to handle their new situation that included learning to know their new body, handling thoughts about themselves, and to manage social relations. Social relations, support, successes, and challenges all influenced their self-efficacy. This affected their thoughts about adapting lifestyle changes, keeping the motivation, and handling setbacks Conclusion: Recovery one year after bariatric surgery is still an ongoing process that involves challenges in lifestyle changes and physical and psychological transformations. During the recovery process self-efficacy is not static and in transition. Clinical implications are tailored information and support from health care personnel is needed.
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| 9. |
- Reinius, Maria, et al.
(author)
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Patient-driven innovations reported in peer-reviewed journals : a scoping review
- 2022
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In: BMJ Open. - London : BMJ Publishing Group Ltd. - 2044-6055. ; 12:1
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Research review (peer-reviewed)abstract
- BackgroundAwareness of patients' innovative capabilities is increasing, but there is limited knowledge regarding the extent and nature of patient-driven innovations in the peer-reviewed literature.ObjectivesThe objective of the review was to answer the question: what is the nature and extent of patient-driven innovations published in peer-reviewed scientific journals?Eligibility criteriaWe used a broad definition of innovation to allow for a comprehensive review of different types of innovations and a narrow definition of 'patient driven' to focus on the role of patients and/or family caregivers. The search was limited to years 2008-2020.Sources of evidenceFour electronic databases (Medline (Ovid), Web of Science Core Collection, PsycINFO (Ovid) and Cinahl (Ebsco)) were searched in December 2020 for publications describing patient-driven innovations and complemented with snowball strategies.Charting methodsData from the included articles were extracted and categorised inductively.ResultsA total of 96 articles on 20 patient-driven innovations were included. The number of publications increased over time, with 69% of the articles published between 2016 and 2020. Author affiliations were exclusively in high income countries with 56% of first authors in North America and 36% in European countries. Among the 20 innovations reported, 'Do-It-Yourself Artificial Pancreas System' and the online health network 'PatientsLikeMe', were the subject of half of the articles.ConclusionsPeer-reviewed publications on patient-driven innovations are increasing and we see an important opportunity for researchers and clinicians to support patient innovators' research while being mindful of taking over the work of the innovators themselves.
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| 10. |
- Scott Duncan, Therese, et al.
(author)
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Empowered patients and informal care-givers as partners? : A survey study of healthcare professionals' perceptions
- 2023
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In: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: More knowledge is needed regarding the perceptions of healthcare professionals when encountering empowered patients and informal caregivers in clinical settings. This study aimed to investigate healthcare professionals' attitudes towards and experiences of working with empowered patients and informal caregivers, and perception of workplace support in these situations. METHODS: A multi-centre web survey was conducted using a non-probability sampling of both primary and specialized healthcare professionals across Sweden. A total of 279 healthcare professionals completed the survey. Data was analysed using descriptive statistics and Thematic analysis. RESULTS: Most respondents perceived empowered patients and informal caregivers as positive and had to some extent experience of learning new knowledge and skills from them. However, few respondents stated that these experiences were regularly followed-up at their workplace. Potentially negative consequences such as increased inequality and additional workload were, however, mentioned. Patients' engagement in the development of clinical workplaces was seen as positive by the respondents, but few had own experience of such engagement and considered it difficult to be achieved. CONCLUSION: Overall positive attitudes of healthcare professionals are a fundamental prerequisite to the transition of the healthcare system recognizing empowered patients and informal caregivers as partners.
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| 11. |
- Stenberg, Erik, 1979-, et al.
(author)
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Early complications after laparoscopic gastric bypass surgery : results from the Scandinavian Obesity Surgery Registry
- 2014
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In: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 260:6, s. 1040-1047
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients.BACKGROUND: Bariatric procedures are among the most common surgical procedures today. There is, however, still a need to identify preoperative and intraoperative risk factors for serious complications.METHODS: From the Scandinavian Obesity Surgery Registry database, we identified 26,173 patients undergoing primary laparoscopic gastric bypass operation for morbid obesity between May 1, 2007, and September 30, 2012. Follow-up on day 30 was 95.7%. Preoperative data and data from the operation were analyzed against serious postoperative complications and specific complications.RESULTS: The overall risk of serious postoperative complications was 3.4%. Age (adjusted P = 0.028), other additional operation [odds ratio (OR) = 1.50; confidence interval (CI): 1.04-2.18], intraoperative adverse event (OR = 2.63; 1.89-3.66), and conversion to open surgery (OR = 4.12; CI: 2.47-6.89) were all risk factors for serious postoperative complications. Annual hospital volume affected the rate of serious postoperative complications. If the hospital was in a learning curve at the time of the operation, the risk for serious postoperative complications was higher (OR = 1.45; CI: 1.22-1.71). The 90-day mortality rate was 0.04%.CONCLUSIONS: Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.
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| 12. |
- Sundbom, Magnus, et al.
(author)
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Substantial Decrease in Comorbidity 5 Years After Gastric Bypass: A Population-based Study From the Scandinavian Obesity Surgery Registry.
- 2017
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In: Annals of Surgery. - Philadelphia PA, USA : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 265:6, s. 1166-1171
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Journal article (peer-reviewed)abstract
- Objective: To evaluate effect on comorbid disease and weight loss 5 years after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity in a large nationwide cohort. Background: The number patients having surgical procedures to treat obesity and obesity-related disease are increasing. Yet, population-based, long-term outcome studies are few. Methods: Data on 26,119 individuals [75.8% women, 41.0 years, and body mass index (BMI) 42.8 kg/m2] undergoing primary RYGB between May 1, 2007 and June 30, 2012, were collected from 2 Swedish quality registries: Scandinavian Obesity Surgery Registry and the Prescribed Drug Registry. Weight, remission of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and sleep apnea, and changes in corresponding laboratory data were studied. Five-year follow-up was 100% (9774 eligible individuals) for comorbid diseases. Results: BMI decreased from 42.8 ± 5.5 to 31.2 ± 5.5 kg/m2 at 5 years, corresponding to 27.7% reduction in total body weight. Prevalence of type 2 diabetes mellitus (15.5%–5.9%), hypertension (29.7%–19.5%), dyslipidemia (14.0%–6.8%), and sleep apnea (9.6%–2.6%) was reduced. Greater weight loss was a positive prognostic factor, whereas increasing age or BMI at baseline was a negative prognostic factor for remission. The use of antidepressants increased (24.1%–27.5%). Laboratory status was improved, for example, fasting glucose and glycated hemoglobin decreased from 6.1 to 5.4 mmol/mol and 41.8% to 37.7%, respectively. Conclusions: In this nationwide study, gastric bypass resulted in large improvements in obesity-related comorbid disease and sustained weight loss over a 5-year period. The increased use of antidepressants warrants further investigation. Studies with long-term results after bariatric surgery are surprisingly rare, 1–5 especially in the light of the large number of procedures performed worldwide. In most studies there is a 1 to 2-year follow-up, 6 and at such an early point in time, it is impossible to evaluate the true effect of gastric bypass, because patients have just reached their nadir in weight. Moreover, for this group of patients, the longstanding remission of obesity-related comorbidities, for example, diabetes mellitus, hypertension, dyslipidemia, and sleep apnea, are of utmost importance. The Scandinavian Obesity Surgery Registry (SOReg) was launched in 2007 as a quality registry for the expanding number of bariatric surgeries in Sweden. 7 In 2015, SOReg contained more than 50,000 bariatric procedures (>98% national coverage), with all 43 operating centers reporting to the registry. There has been an expansion of bariatric surgery, with 3300 bariatric procedures performed in 2008, 4800 in 2009, 7800 in 2010, and 8600 in 2011. There has been a slight decrease in procedures, and currently approximately 7000 performed annually, and approximately 95% of the reported procedures have been primary laparoscopic gastric bypass. 8 Perioperative complication rates (eg, 1.2% leaks) and mortality are low (0.04%), the latter validated with the Swedish Population Register. Regular audits are performed by randomly comparing data in SOReg with patient charts at the surgical centers, demonstrating a high validity with less than 2% incorrect values. 7 Furthermore, by cross-linkage with the national Prescribed Drug Registry (PDR), a 100% follow-up of the occurrence of comorbid disease (defined as medical treatment) can be achieved. The present study reports outcome in weight and obesity-related comorbid disease in a nationwide cohort of 26,119 individuals over 5 years after primary Roux-en-Y gastric bypass (RYGB) in Sweden, using the prospective SOReg database with cross-linkage with the PDR.
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