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- Blomberg, Karin, 1970-, et al.
(author)
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Symptoms and self-care strategies during and six months after radiotherapy for prostate cancer : Scoping the perspectives of patients, professionals and literature
- 2016
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In: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 21, s. 139-145
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Journal article (peer-reviewed)abstract
- Purpose: Under-diagnosed and uncontrolled symptoms in patients with prostate cancer during radiotherapy can have a negative impact on the individual's quality of life. An opportunity for patients to report their symptoms systematically, communicate these symptoms to cancer nurses and to receive self-care advice via an application in an Information and Communication Technology-platform could overcome this risk. The content in the application must precisely capture symptoms that are significant to both patients and health care professionals. Therefore, the aim of the study was to map and describe symptoms and self-care strategies identified by patients with prostate cancer undergoing radiotherapy, by health care professionals caring for these patients, and in the literature.Methods: The study combines data from interviews with patients (n ¼ 8) and health care professionals (n ¼ 10) and a scoping review of the literature (n ¼ 26) focusing on the period during and up to 6 months after radiotherapy.Results: There was a concordance between the patients, health care professionals, and the literature on symptoms during and after radiotherapy. Urinary symptoms, bowel problems, pain, sexual problems, fatigue, anxiety, depression, cognitive impairment and irregular symptoms were commonly described during the initial treatment period. Self-care strategies were rarely described in all three of the sources.Conclusions: The results show which symptoms to regularly assess using an Information and Communication Technology-platform for patients with newly-diagnosed prostate cancer during radiotherapy. The next step is to evaluate the efficacy of using the platform and the accuracy of the selected symptoms and self-care advice included in a smartphone application.
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| 4. |
- Fernström, Erik, et al.
(author)
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Cerebrospinal fluid markers of extracellular matrix remodelling, synaptic plasticity and neuroinflammation before and after cranial radiotherapy
- 2018
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In: Journal of Internal Medicine. - : Wiley. - 0954-6820. ; 284:2, s. 211-225
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Journal article (peer-reviewed)abstract
- Background Advances in the treatment of brain tumours have increased the number of long-term survivors, but at the cost of side effects following cranial radiotherapy ranging from neurocognitive deficits to outright tissue necrosis. At present, there are no tools reflecting the molecular mechanisms underlying such side effects, and thus no means to evaluate interventional effects after cranial radiotherapy. Therefore, fluid biomarkers are of great clinical interest. Objective Cerebrospinal fluid (CSF) levels of proteins involved in inflammatory signalling, synaptic plasticity and extracellular matrix (ECM) integrity were investigated following radiotherapy to the brain. Methods Patients with small-cell lung cancer (SCLC) eligible for prophylactic cranial irradiation (PCI) were asked to participate in the study. PCI was prescribed either as 2 Gy/fraction to a total dose of 30 Gy (limited disease) or 4 Gy/fraction to 20 Gy (extensive disease). CSF was collected by lumbar puncture at baseline, 3 months and 1 year following PCI. Protein concentrations were measured using immunobased assays or mass spectrometry. Results The inflammatory markers IL-15, IL-16 and MCP-1/CCL2 were elevated in CSF 3 months following PCI compared to baseline. The plasticity marker GAP-43 was elevated 3 months following PCI, and the same trend was seen for SNAP-25, but not for SYT1. The investigated ECM proteins, brevican and neurocan, showed a decline following PCI. There was a strong correlation between the progressive decline of soluble APP and brevican levels. Conclusion To our knowledge, this is the first time ECM-related proteins have been shown to be affected by cranial radiotherapy in patients with cancer. These findings may help us to get a better understanding of the mechanisms behind side effects following radiotherapy.
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- Heimann, Emilia, et al.
(author)
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Branched short-chain fatty acids modulate glucose and lipid metabolism in primary adipocytes
- 2016
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In: Adipocyte. - : Informa UK Limited. - 2162-3945 .- 2162-397X. ; 5:4, s. 359-368
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Journal article (peer-reviewed)abstract
- Short-chain fatty acids (SCFAs), e.g. acetic acid, propionic acid and butyric acid, generated through colonic fermentation of dietary fibers, have been shown to reach the systemic circulation at micromolar concentrations. Moreover, SCFAs have been conferred anti-obesity properties in both animal models and human subjects. Branched SCFAs (BSCFAs), e.g., isobutyric and isovaleric acid, are generated by fermentation of branched amino acids, generated from undigested protein reaching colon. However, BSCFAs have been sparsely investigated when referring to effects on energy metabolism. Here we primarily investigate the effects of isobutyric acid and isovaleric acid on glucose and lipid metabolism in primary rat and human adipocytes. BSCFAs inhibited both cAMP-mediated lipolysis and insulin-stimulated de novo lipogenesis at 10 mM, whereas isobutyric acid potentiated insulin-stimulated glucose uptake by all concentrations (1, 3 and 10 mM) in rat adipocytes. For human adipocytes, only SCFAs inhibited lipolysis at 10 mM. In both in vitro models, BSCFAs and SCFAs reduced phosphorylation of hormone sensitive lipase, a rate limiting enzyme in lipolysis. In addition, BSCFAs and SCFAs, in contrast to insulin, inhibited lipolysis in the presence of wortmannin, a phosphatidylinositide 3-kinase inhibitor and OPC3911, a phosphodiesterase 3 inhibitor in rat adipocytes. Furthermore, BSCFAs and SCFAs reduced insulin-mediated phosphorylation of protein kinase B. To conclude, BSCFAs have effects on adipocyte lipid and glucose metabolism that can contribute to improved insulin sensitivity in individuals with disturbed metabolism.
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- Hälleberg Nyman, Maria, 1968-, et al.
(author)
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Identifying the knowledge to translate : the example of urinary incontinence in older people
- 2015
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In: Nordic Conference on Implementation of Evidence-Based Practice.
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Conference paper (peer-reviewed)abstract
- Background: While urinary incontinence (UI) is a common and worrying issue among older people, promoting the use of evidence to prevent UI onset has rarely been studied. An earlier study that was conducted in nursing homes suggests that UI can be better assessed and managed, but the prevention of UI onset requires attention to the issue by staff within acute care settings. Aim: To report on the internal facilitators’ (IF) transition, identifying the 'know-do gap' between evidence and practice in UI prevention in orthopaedic care.Methods: The Onset PrevenTion of Incontinence in Orthopaedic Nursing and rehabilitation (OPTION) pilot was carried out in two Swedish orthopaedic units of different size and location. The pilot project included a programme to support nursing and rehab staff to facilitate knowledge translation (KT). Five IFs were interviewed at baseline, and one and three months after the intervention was completed, and non-participant observations were performed during the KT-intervention. Interviews and observations were triangulated, depicting when and how the IFs identified the present, local UI practice, the evidence on UI, and the know-do gap in preventing UI onset in older patients undergoing hip surgery.Results: Preliminary results indicate that before the study, neither the IFs nor their fellows at the units were aware that they could prevent UI onset. Rather, through mapping their context and matching the evidence provided by the dialogue with the experts in the KTintervention, the IFs became aware of which practice was evidence based and which evidence to implement, and how to facilitate KT and promote evidence use.Conclusion: The OPTION pilot indicates that KT can be promoted by tailored implementation strategies and tailoring evidence, supported by IFs awareness and understanding of the local know-do gap, and strategies to overcome barriers and promote use of evidence.
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- Hälleberg Nyman, Maria, 1968-, et al.
(author)
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Patients' Perspective on Participation in Care With or Without the Support of a Smartphone App During Radiotherapy for Prostate Cancer : Qualitative Study
- 2017
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In: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 5:7
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Journal article (peer-reviewed)abstract
- BACKGROUND: Patients with prostate cancer are often cared for as outpatients during radiotherapy, which can be an aggravating circumstance for patient participation. There is a need to evaluate whether an interactive smartphone app could enable participation in care, specifically during treatment for prostate cancer. The interactive app (Interaktor) used in this study is developed in codesign with patients and health care professionals; it includes daily reports of symptoms, a risk assessment model, evidence-based self-care advice, along with the provision of immediate access to clinicians.OBJECTIVE: The aim of this study was to explore how patients with prostate cancer perceived their participation with or without the support of the smartphone app during radiotherapy.METHODS: A total of 28 prostate cancer patients receiving adjuvant radiotherapy were interviewed about their perceived participation in their own care. All the patients interviewed in this study participated in an intervention study where the control group received standard care that comprised having access to a contact nurse to turn to with any concerns during their treatment. In addition to standard care, the patients in the intervention group received the app downloaded in a smartphone. The patients' age ranged between 57 and 77 years; 17 patients used the smartphone app. The interviews were analyzed with directed qualitative content analysis.RESULTS: The four dimensions of patient participation, which include mutual participation, fight for participation, requirement for participation, and participation in getting basic needs satisfied, were confirmed as valid perspectives in the interviews with the patients with prostate cancer, irrespective of whether they used the smartphone app. However, the patients who had used the smartphone app described it as a facilitating factor, especially for mutual participation.CONCLUSIONS: Using innovative ways to communicate with patients, such as an interactive app for symptom management with contact with health care in real time, can successfully help achieve increased patient participation in care.
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| 8. |
- Hälleberg Nyman, Maria, 1968-, et al.
(author)
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Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care : A process evaluation of an implementation intervention in the orthopaedic context
- 2019
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In: Journal of Evaluation In Clinical Practice. - : Wiley-Blackwell Publishing Inc.. - 1356-1294 .- 1365-2753. ; 25:2, s. 282-289
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Journal article (peer-reviewed)abstract
- RATIONALE, AIMS, AND OBJECTIVES: The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery.METHODS: A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed.RESULTS: Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit.CONCLUSION: To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.
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| 9. |
- Hälleberg Nyman, Maria, 1968-, et al.
(author)
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Urinary incontinence and its management in patients aged 65 and older in orthopaedic care : what nursing and rehabilitation staff know and do
- 2017
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In: Journal of Clinical Nursing. - West Sussex, United Kingdom : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 26:21-22, s. 3345-3353
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Journal article (peer-reviewed)abstract
- Aims and objectives: To describe what nursing and rehabilitation staff know and do with regards to urinary incontinence and risk of urinary incontinence in patients 65 years or older undergoing hip surgery.Background: Urinary incontinence is a common but often neglected issue for older people. Despite the existence of evidence-based guidelines on how to assess, manage and prevent UI, there are indications that these guidelines are not applied in hospital care.Design: A qualitative study with descriptive design was conducted in two orthopaedic units.Methods: 46 interviews and 36 observations of care were conducted from January to October 2014 and analysed with qualitative content analysis.Results: Enrolled nurses performed most of the care related to bladder function, with focus on urinary catheterisation and preventing urinary tract infection and urinary retention. Registered nurses' role in urinary matters mainly comprised documentation, while the rehabilitation staff focused on making it possible for the patient to be independent in toileting. The nursing staff considered urinary incontinence a common condition for older people and that it was convenient for the patients to have an indwelling catheter or incontinence pad/pant, although they acknowledged some of the risks associated with these procedures.Conclusions: Urinary incontinence is not a priority in orthopaedic care, and urinary incontinence guidelines are not applied. Further, attitudes and actions are mainly characterised by a lack of urinary incontinence knowledge and the nursing and rehabilitation staff do not take a team approach to preventing and managing UI.Relevance and clinical practive: An increased focus on knowledge on urinary incontinence and evidence-based guidelines is needed. To secure evidence-based practice, the team of nursing and rehabilitation staff and managers must be aligned and work actively together, also including the patient in the team.
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