| 1. |
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| 2. |
- Brandberg, M, et al.
(author)
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A comparative study of simple and interference reaction times in men and women
- 2018
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In: Conference program The 13th Nordic Meeting in Neuropsychology Stockholm, 2018.
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Conference paper (other academic/artistic)abstract
- Introduction: studies on reaction time (RT) indicate faster reactions for men than women. However, when comparing samples across decades, this difference seems to decrease. The aim of this study was to explore reaction times in a large contemporary sample of adult males and females (age range = 15-82). Methods: simple reaction time and interference reaction time (a go/no go reaction task) were measured with the Vienna Reaction Apparatus (Wiener Reaktionstest, Schuhfried), RT, version S1 and S2 for simple reaction time and version S3 and S4 for interference reaction time. Results Men responded faster on the interference reaction task, S3 (M=441,57, SD=80,86) than women (M=461,53, SD=91,53). This difference was significant,t(3,7) = p<0,001 and represent a small sized effect, d= .21. There were no significant differences regarding simple reaction time (S1 and S2) or on the other interference task (S4). In regards to intraindividual variability there was a significant difference, t(3.1), p=.002, d=.21, with less variability in males (M=65.99) as compared to females (M=70,45) on S3. Conclusions: when comparing groups, men performed slightly faster on one of the interference tasks. However, there were no significant differences on the other measures. This result is consistent with previous studies indicating a decrease in differences on reaction times, comparing men and women. Grant support: Skaraborg Research and Development Council, Research Fund at Skaraborg Hospital and The Swedish Stroke Association.
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| 3. |
- Brandberg, Martin, 1972, et al.
(author)
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A comparative study on simple and interference reaction times in women and men.
- 2018
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In: Conference program, The 13th Nordic Meeting in Neuropsychology, Stockholm, 2018.
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Conference paper (other academic/artistic)abstract
- Introduction: studies on reaction time (RT) indicate faster reactions for men than women. However, when comparing samples across decades, this difference seems to decrease. The aim of this study was to explore reaction times in a large contemporary sample of adult males and females (age range = 15-82). Methods: Simple reaction time and interference reaction time (a go/no go reaction task) were measured with the Vienna Reaction Apparatus (Wiener Reaktionstest, Schuhfried), RT, version S1 and S2 for simple reaction time and version S3 and S4 for interference reaction time. Results: men responded faster on the interference reaction task, S3 (M=441,57, SD=80,86) than women (M=461,53, SD=91,53). This difference was significant, t(3,7) = p<0,001 and represent a small sized effect, d = .21. There were no significant differences regarding simple reaction time (S1 and S2) or on the other interference task (S4). In regards to intraindividual variability there was a significant difference, t(3.1), p =.002, d =.21, with less variability in males (M =65.99) as compared to females (M=70,45) on S3. Conclusions: when comparing groups, men performed slightly faster on one of the interference tasks. However, there were no significant differences on the other measures. This result is consistent with previous studies indicating a decrease in differences on reaction times, comparing men and women.
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| 4. |
- Browall, Maria, et al.
(author)
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Patient-reported stressful events and coping strategies in post-menopausal women with breast cancer
- 2016
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In: European Journal of Cancer Care. - : Hindawi Limited. - 0961-5423 .- 1365-2354. ; 25:2, s. 324-333
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Journal article (peer-reviewed)abstract
- The objective of this paper was to explore what stressful events post-menopausal women with primary or recurrent breast cancer experience, how bothersome these events were and which coping strategies these women used. Data were collected from 131 patients diagnosed with primary or recurrent breast cancer. The Daily Coping Assessment was used. Thematic analysis was applied to form themes of stressful events. Six types of stressful events were extracted. The most frequently experienced events for women with primary cancer and those with recurrent cancer were distressing bodily symptoms'. The most bothersome event among primary cancer was everyday concerns' and in the recurrent group, distressing psychological reactions'. The most commonly used strategies were acceptance', distraction' and relaxation'. This study shows that women in different parts of the cancer trajectory differ in what they perceive to be stressful events when reporting them in their own words in a diary. The differences have an impact on the subsequent coping strategies they used.
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| 5. |
- Falk, Hanna, 1977, et al.
(author)
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Differences in Symptom Distress Based on Gender and Palliative Care Designation Among Hospitalized Patients.
- 2016
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In: Journal of Nursing Scholarship. - : Wiley. - 1527-6546 .- 1547-5069. ; 48:6, s. 569-576
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Journal article (peer-reviewed)abstract
- PURPOSE: To explore patient-reported symptom distress in relation to documentation of symptoms and palliative care designation in hospital inpatients.DESIGN: This cross-sectional study analyzed data from 710 inpatients at two large hospitals in Sweden using the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Chart reviews focused on nurses' and physicians' symptom documentation and palliative turning point.METHODS: Descriptive statistics were calculated for all variables and provided summaries about the sample. Patients were grouped according to gender, age, palliative care designation, and symptom documentation. The t test and chi-square test were used to calculate whether symptom distress varied between groups. A two-way analysis of variance was conducted for multiple comparisons to explore the impact of gender and age on mean symptom distress.FINDINGS: Females reported higher levels of symptom distress than did males related to pain, fatigue, and nausea. When comparing symptom distress between males and females with documentation pertaining to symptoms, there were significant differences implying that females had to report higher levels of symptom distress than males in order to have their symptoms documented.CONCLUSIONS: Females need to report higher levels of symptom distress than do males for healthcare professionals to identify and document their symptoms. It can be hypothesized that females are not receiving the same attention and symptom alleviation as men. If so, this highlights a serious inequality in care that requires further exploration.CLINICAL RELEVANCE: Considering that common reasons why people seek health care are troublesome symptoms of illness, and that the clinical and demographic characteristics of inpatients are changing towards more advanced ages with serious illnesses, inadequate symptom assessment and management are a serious threat to the care quality.
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| 6. |
- Friberg, Febe, 1950, et al.
(author)
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Exploration of dynamics in a complex person-centred intervention process based on health professionals' perspectives
- 2018
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 18:1
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Journal article (peer-reviewed)abstract
- Background: The assessment and evaluation of practical and sustainable development of health care has become a major focus of investigation in health services research. A key challenge for researchers as well as decision-makers in health care is to understand mechanisms influencing how complex interventions work and become embedded in practice, which is significant for both evaluation and later implementation. In this study, we explored nurses' and surgeons' perspectives on performing and participating in a complex multi-centre person-centred intervention process that aimed to support patients diagnosed with colorectal cancer to feel prepared for surgery, discharge and recovery. Method: Data consisted of retrospective interviews with 20 professionals after the intervention, supplemented with prospective conversational data and field notes from workshops and follow-up meetings (n = 51). The data were analysed to construct patterns in line with interpretive description. Results: Although the participants highly valued components of the intervention, the results reveal influencing mechanisms underlying the functioning of the intervention, including multiple objectives, unclear mandates and competing professional logics. The results also reveal variations in processing the intervention focused on differences in using and talking about intervention components. Conclusions: The study indicates there are significant areas of ambiguity in understanding how theory-based complex clinical interventions work and in how interventions are socially constructed and co-created by professionals' experiences, assumptions about own professional practice, contextual conditions and the researchers' intentions. This process evaluation reveals insights into reasons for success or failure and contextual aspects associated with variations in outcomes. Thus, there is a need for further interpretive inquiry, and not only descriptive studies, of the multifaceted characters of complex clinical interventions and how the intervention components are actually shaped in constantly shifting contexts.
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| 7. |
- Fridh, Isabell, 1954, et al.
(author)
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Extensive human suffering : a point prevalence survey of patients' most distressing concerns during inpatient care
- 2015
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 29, s. 444-453
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Journal article (peer-reviewed)abstract
- AIM: To explore patients' most distressing concerns during a hospital stay.BACKGROUND: The characteristics of hospitalised patients have changed. Care is provided at a higher age, lengths of stay have fallen and the nursing workload is increasing. It is presumed that hospitalised patients are more seriously ill and have more palliative needs than previously. Studies show that inpatients suffer from more distress than similar outpatients although there is a lack of overall knowledge about inpatients' distress and major concerns, regardless of age, diagnosis or care setting.METHODS: This study was part of a point prevalence survey (PPS) concerning symptom prevalence. Of the 710 patients who participated in the PPS, 678 (95%) answered an open-ended question in a questionnaire: What is your main concern or what is most distressing or troublesome for you at present? Using a life-world approach, the text was analysed qualitatively and patients' concerns were interpreted in two main dimensions, an intersubjective dimension and a temporal dimension.FINDINGS: The patients reported extensive suffering due to illness, symptoms and failing health. Patients were concerned about family members, existential issues and the future. Three aspects of the patients' most distressing concerns were interpreted: The suffering self, The suffering person in close relations and The suffering person in a threatening world.CONCLUSION: Hospitalised patients are affected by severe illness, distressing symptoms and existential quandaries, revealing extensive human suffering in the midst of the demanding activities that take place during an ordinary day in a hospital. To support patients and alleviate suffering, hospital staff need to be more sensitive to patients' most distressing concerns. This presupposes a hospital environment in which the value system supports caring and comforting behaviour.
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| 8. |
- Gustavsson, Susanne, 1966, et al.
(author)
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Using an adapted approach to the Kano model to identify patient needs
- 2016
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In: The TQM Journal. - 1754-2731. ; 28:1
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Journal article (peer-reviewed)abstract
- Purpose – The purpose of this paper is to study how an account of multiple patient roles when using the Kano model in healthcare improvements can support identification of a wide range of patients’ needs. Design/methodology/approach – The study presented in this paper was part of a longitudinal action research study. The empirical material was collected by various methods (interviews, a focus group, participative observations, and a survey) over a two-month period within the Children’s and Women’s Healthcare department in a Swedish hospital. The respondents included the management team, healthcare professionals, patients, and the patients’ partners. Findings – The study shows that incorporating a view of multiple patient roles into application of the Kano model, and using input on customer needs obtained from patients, relatives, and healthcare professionals, helps to identify a wide range of patients’ needs. Originality/value – The view on patients within healthcare is being transformed from one based on servility to that of patients as customers. This paper elaborates on a hands-on way of applying the Kano model based on a view of multiple patient roles as a means to support this new patient view. The application builds on input from various groups (such as patients and healthcare professionals), and, by using input from various stakeholders. This approach appears to overcome a gap, identified in earlier research, of either relying solely on patients, or solely on healthcare professionals, when identifying patients’ need. Rather input from several groups – patients, relatives, and professionals – are suggested to be used in combination.
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| 9. |
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| 10. |
- Hadimeri, Ursula
(author)
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Factors affecting the physical characteristics of arterio-venous fistula in patients with renal failure
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Background and PurposeA patent access is vital for a dialysis patient. The arterio-venous fistula (AVF), the most important access for haemodialysis (HD), is frequently affected by extensive complications such as stenosis and occlusions.Study I: To investigate whether the dimensions of AVFs used for performing haemodialysis were affected by the original disease.Study II: To investigate if the diameter of the distal radiocephalic fistula could influence left ventricular variables in stable haemodialysis patients.Study III: To investigate whether a single Far Infrared (FIR) light treatment could alter blood velocity, AVF diameter or inflammatory markers.Study IV: To evaluate in what extent the renal diagnosis and radiological interventions affected the dysfunction of AVF and results of percutaneous transluminal angioplasty (PTA).Materials and methodsStudy I: The lumen diameter of the AVF was studied by ultrasound in 19 patients with autosomal dominant polycystic kidney disease (ADPKD) and in 19 control patients. The monitoring was performed along the forearm part of the vein, the maximal diameter was measured. The diameters of the two needle insertion sites were also measured.Study II: Nineteen patients were investigated with echocardiography, using M-mode recordings and measurements in the 2D image. Ultrasound and doppler ultrasound were performed. Transsonic measurements were performed after the ultrasound investigation. Measurements of the diameter of the AVF were performed in four locations. Heart variables were analysed regarding left ventricular (LV) criteria.Study III: Thirty patients with native AVF in the forearm were included. Each patient was his/her own control. Ultrasound examinations of the AVF diameter and blood flow velocity were performed before and after a single Far Infrared light (FIR) treatment.Study IV: 522 radiological investigations and endovascular treatments between January 1, 2006 and December 31, 2014 were analysed in 174 patients, retrospectively. All investigations had been performed due to clinical suspicion of impaired AVF function. All stenoses were evaluated and the number, degree, length, location and relation to anastomosis were recorded. After PTA the remaining stenoses were evaluated again and complications were recorded.ResultsStudy I: The diameter of the AVF at the maximal site in patients with ADPKD was significantly wider than that for the control patients.Study II: A larger AVF mean and maximal diameter worsened left ventricular characteristics.Study III: A single FIR treatment resulted in a significant increase in blood velocity over the AV fistula from a mean of 2.1±1.0 m/s to 2.3±1.0 m/s. The diameter of the arterialized vein became wider, i.e. 0.72±0.02 to 0.80±0.02 cm. The increase in fistula blood velocity correlated positively with baseline serum-urate and the increase in venous diameter correlated positively with the baseline plasma orosomucoid concentration.Study IV: The degree of AVF stenosis before PTA correlated significantly with the degree of remaining stenosis after intervention. Arterial stenosis was significantly more frequent among patients with diabetic nephropathy and interstitial nephritis. A shorter life span between PTAs was related to diabetic nephropathy.ConclusionsStudy I: The receiving veins of AVF in patients with ADPKD have an abnormality that causes a greater than normal dilatation in response to the arterialization.Study II: The maximal diameter of the distal AVF seems to be a sensitive marker of LV impairment in stable haemodialysis patients.Study III: A single FIR treatment increased AVF blood velocity and vein diameter. Thus, one FIR treatment can help maturation of AVF in the early postoperative course.Study IV: Repeated PTA was performed significantly more often in patients with diabetic nephropathy. Clinically significant stenosis should be dilated as soon as possible. Occlusion of the AVF should be thrombolyzed and/or dilated when diagnosed.
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| 11. |
- Henoch, Ingela, 1956, et al.
(author)
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Palliative Care Research : A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 2012
- 2016
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In: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 30:1, s. 5-25
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Research review (peer-reviewed)abstract
- Background: In 2007, a literature review was undertaken of palliative care research from Sweden during the 1970s-2006, paving the way for a follow-up study to explore the recent developments. The aim was to systematically examine palliative care research from Sweden between 2007 and 2012, with special attention to methods, designs and research foci.Methods: A literature review was undertaken. The databases Academic search elite, Age line, Ahmed, Cinahl, PsychInfo, PubMed, Scopus, Soc abstracts, Web of science and Libris were reviewed for Swedish palliative care research studies published from 2007 to 2012, applying the search criteria 'palliative care OR palliative medicine OR end-of-life care OR terminal care OR hospice care OR dying OR death'.Results: A total of 263 papers met the inclusion criteria, indicating an increased volume of research compared to the 133 articles identified in the previous review. Common study foci were symptom assessment and management, experiences of illness and care planning. Targeting non-cancer-specific populations and utilisation of population-based register studies were identified as new features. There was continued domination of cross-sectional, qualitative and mono-disciplinary studies, not including ethnic minority groups, nonverbally communicable people or children <18 years of age.Conclusions: The trend is that Swedish palliative care research has expanded in volume from 2007 to 2012 compared to during the 1970s to 2006, with increasing participation of non-cancer-specific populations. A domination of qualitative approaches and small, cross-sectional studies with few interventions is still characteristic. Still more strategies are needed to expand the knowledge development of palliative care to respond to demographical, epidemiological, therapeutic and healthcare structure changes.
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| 12. |
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| 13. |
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| 14. |
- Håkanson, Cecilia, 1968-, et al.
(author)
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Providing Palliative Care in a Swedish Support Home for People Who Are Homeless
- 2016
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In: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 26:9, s. 1252-1262
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Journal article (peer-reviewed)abstract
- Despite high frequencies of multiple, life-limiting conditions relating to palliative care needs, people who are homeless are one of the most underserved and rarely encountered groups in palliative care settings. Instead, they often die in care places where palliative competence is not available. In this qualitative single-case study, we explored the conditions and practices of palliative care from the perspective of staff at a Swedish support home for homeless people. Interpretive description guided the research process, and data were generated from repeated reflective conversations with staff in groups, individually, and in pairs. The findings disclose a person-centered approach to palliative care, grounded in the understanding of the person’s health/illness and health literacy, and how this is related to and determinant on life as a homeless individual. Four patterns shape this approach: building trustful and family-like relationships, re-dignifying the person, re-considering communication about illness and dying, and re-defining flexible and pragmatic care solutions.
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| 15. |
- Johansson, Yvonne A., 1956-, et al.
(author)
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Assessment of cognitive function and delirium - Lack of clinical routines
- 2018
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Conference paper (peer-reviewed)abstract
- Introduction: Cognitive impairment and delirium are often unidentified in hospitalized patients. Despite the fact that 40 % of all cases of delirium might be prevented, national guidelines are missing in Sweden. Study aim was to examine the routines about assessing cognitive function and delirium in a university hospital and a county hospital in Sweden.Methods: A web based questionnaire was developed and distributed to 58 managers. The questionnaire addressed routines for identifying cognitive impairment and delirium in clinical practice, for instance which assessment tools, and which terms were used.Results: The response rate was 43 % (25/58) equally distributed for nurses and physicians managers (43 and 44 %). Study findings showed that structured assessment of cognitive function and delirium were missing. Twelve managers (48 %) had established routines for assessment of cognitive function and seven (28 %) for assessment of delirium. It was unclear how the assessments were performed. Most common was free descriptions based on varying questions. Assessment tools and the term delirium were rarely used. Conclusion: Established routines of assessing cognitive function and delirium are missing. Validated rapid clinical assessment tools for cognitive function and delirium are needed as well as consensus to use the term “delirium”.
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| 16. |
- Johansson, Yvonne A, 1956-, et al.
(author)
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Core values - A strategy to achieve person-centered care
- 2018
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In: 26TH INTERNATIONAL CONFERENCE ON HEALTH PROMOTING HOSPITALS AND HEALTH SERVICES. Health promotion strategies to achieve reorientation of health services: evidence-based policies and practices. Bologna, Italy | June 6-8, 2018.
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Conference paper (other academic/artistic)
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| 17. |
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| 18. |
- Johansson, Yvonne A, 1956-, et al.
(author)
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Delirium in older hospitalized patients—signs and actions : a retrospective patient record review
- 2018
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In: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 18:1, s. 1-11
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Research review (peer-reviewed)abstract
- BackgroundDelirium is common in older hospitalized patients, and is associated with negative consequences for the patients, next of kin, healthcare professionals and healthcare costs. It is important to understand its clinical features, as almost 40% of all cases in hospitals may be preventable. Yet, delirium in hospitalized patients is often unrecognized and untreated. Few studies describe thoroughly how delirium manifests itself in older hospitalized patients and what actions healthcare professionals take in relation to these signs. Therefore, the aim of this study was to describe signs of delirium in older hospitalized patients and action taken by healthcare professionals, as reported in patient records.MethodsPatient records from patients aged ≥65 (n = 286) were retrospectively reviewed for signs of delirium, which was found in 78 patient records (27%). Additionally, these records were reviewed for action taken by healthcare professionals in relation to the patients’ signs of delirium. The identified text was analyzed with qualitative content analysis in two steps.ResultsHealthcare professionals responded only in part to older hospitalized patients’ needs of care in relation to their signs of delirium. The patients displayed various signs of delirium that led to a reduced ability to participate in their own care and to keep themselves free from harm. Healthcare professionals met these signs with a variation of actions and the care was adapted, deficient and beyond the usual care. A systematic and holistic perspective in the care of older hospitalized patients with signs of delirium was missing.ConclusionImproved knowledge about delirium in hospitals is needed in order to reduce human suffering, healthcare utilization and costs. It is important to enable older hospitalized patients with signs of delirium to participate in their own care and to protect them from harm. Delirium has to be seen as a preventable adverse event in all hospitals units. To improve the prevention and management of older hospitalized patients with signs of delirium, person-centered care and patient safety may be important issues.
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| 19. |
- Johansson, Yvonne A, 1956-, et al.
(author)
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Hospital transition to person-centered care - a culture journey in practice
- 2017
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In: 30th World Congress on Advanced Nursing Practice September 04-06, 2017 | Edinburgh, Scotland. ; , s. 1-
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Conference paper (peer-reviewed)abstract
- This action research project started in 2015 with the aim to achieve an overall sustainable hospital transition to person-centered care. In the first wave of change towards an overall hospital transition to person-centered care, hospital managers were invited to work-shops and discussions. Eight hospital units were nominated as pilot units. Specific acilitators/change leaders were educated in the philosophy of person-centered care. A learning network was created including the project managers, project unit managers and facilitators/change leaders. Based on the theory of person-centered care, and the importance of focusing soft skills and learning skills and not just technical skills, as well as experiences and reflections during this action research project, a general model for transition to person-centered care was developed. Steps included in the model: 1) Introduction; 2) V alues linked to person-centered care; 3) Multidisciplinary teams including/involving patients and/or next of kin; 4) Communication skills, and in-depth knowledge about person-centered care, 5) Practical application of the person-centered approach into clinical practice.
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| 20. |
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| 21. |
- Kenne Sarenmalm, Elisabeth, et al.
(author)
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Mindfulness and its efficacy for psychological and biological responses in women with breast cancer
- 2017
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In: Cancer Medicine. - : Wiley. - 2045-7634. ; 6:5, s. 1108-1122
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Journal article (peer-reviewed)abstract
- Many breast cancer survivors have to deal with a variety of psychological and physiological sequelae including impaired immune responses. The primary purpose of this randomized controlled trial was to determine the efficacy of a mindfulness-based stress reduction (MBSR) intervention for mood disorders in women with breast cancer. Secondary outcomes were symptom experience, health status, coping capacity, mindfulness, posttraumatic growth, and immune status. This RTC assigned 166 women with breast cancer to one of three groups: MBSR (8 weekly group sessions of MBSR), active controls (self-instructing MBSR) and non-MBSR. The primary outcome measure was the Hospital Anxiety and Depression Scale. Secondary outcome measures were: Memorial Symptom Assessment Scale, SF-36, Sense of Coherence, Five Facets of Mindfulness Questionnaire, and Posttraumatic Growth Index. Blood samples were analyzed using flow cytometry for NK-cell activity (FANKIA) and lymphocyte phenotyping; concentrations of cytokines were determined in sera using commercial high sensitivity IL-6 and IL-8 ELISA (enzyme-linked immunosorbent assay) kits. Results provide evidence for beneficial effects of MBSR on psychological and biological responses. Women in the MBSR group experienced significant improvements in depression scores, with a mean pre-MBSR HAD-score of 4.3 and post-MBSR score of 3.3 (P = 0.001), and compared to non-MBSR (P = 0.015). Significant improvements on scores for distress, symptom burden, and mental health were also observed. Furthermore, MBSR facilitated coping capacity as well as mindfulness and posttraumatic growth. Significant benefits in immune response within the MBSR group and between groups were observed. MBSR have potential for alleviating depression, symptom experience, and for enhancing coping capacity, mindfulness and posttraumatic growth, which may improve breast cancer survivorship. MBSR also led to beneficial effect on immune function; the clinical implications of this finding merit further research.
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| 22. |
- Kenne Sarenmalm, Elisabeth, 1956, et al.
(author)
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Swedish Version of the Distress Thermometer: Validity Evidence in Patients With Colorectal Cancer.
- 2018
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In: Journal of the National Comprehensive Cancer Network : JNCCN. - : Harborside Press, LLC. - 1540-1413 .- 1540-1405. ; 16:8, s. 959-966
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Journal article (peer-reviewed)abstract
- Background: The objective of this study was to validate the NCCN Distress Thermometer (DT), including the accompanying Problem List (PL), in a Swedish population of patients diagnosed with colorectal cancer (CRC). Methods: A total of 488 patients diagnosed with CRC completed the DT/PL and EORTC core quality-of-life questionnaire (QLQ-C30) before surgery. Construct validity of the PL was analyzed using a confirmatory factor analysis. Internal consistency reliability (ICR) was tested using Cronbach's alpha coefficient. Correlations between the reported PL areas and QLQ-C30 function scales were used to explore convergent validity. Discriminant validity was examined by evaluating associations between the DT and QLQ-C30 measures of overall health-related quality of life (HRQoL). Results: Findings showed that the Swedish translation of the DT/PL is consistent with the original English version. The DT has good ICR, with the total number of reported problems significantly correlating with DT scores (r=0.67; P<.001). Analysis of convergent validity indicated that the PL areas significantly correlated with QLQ-C30 function scales, with emotional problems showing the highest correlation (r=0.76; P<.001), and item-level correlation analyses showed significant correlations between symptoms. There was also good discriminant validity between the DT and the QLQ-C30 in terms of HRQoL, including overall health status (r=-0.49; P<.001) and overall quality of life (r=-0.57; P<.001). Furthermore, there was good discriminant validity between the DT and QLQ-C30 regarding poor, moderate, and excellent HRQoL. Conclusions: These findings provide validity evidence regarding the DT, including the PL. Findings also show that the DT has good potential for screening distress-related practical, family, emotional, and physical problems during the cancer trajectory in Swedish-speaking patients. Additionally, the DT seems to be an effective screening tool to detect patients with poor, moderate, and excellent HRQoL.
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| 23. |
- Nyqvist, Jenny, et al.
(author)
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Metachronous and synchronous occurrence of 5 primary malignancies in a female patient between 1997 and 2013 : A case report with germline and somatic genetic analysis
- 2017
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In: Case Reports in Oncology. - : S. Karger AG. - 1662-6575. ; 10:3, s. 1006-1012
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Journal article (peer-reviewed)abstract
- The number of patients with multiple primary malignancies has been increasing steadily in recent years. In the present study, we describe a unique case of an 81-year-old woman with 5 metachronous and synchronous primary malignant neoplasms. The patient was first diagnosed with an endometrium adenocarcinoma in 1997 and a colon adenocarcinoma in 2002. Eleven years after her colon surgery, in 2013, the patient presented with 3 other primary malignancies within a 4-month time span: An invasive malignant melanoma on the lower leg, an invasive mucinous breast carcinoma in the right breast, and a pleomorphic spindle cell sarcoma on the left upper arm. Subsequent routine medical checkups in 2013-2017 revealed no metastases of the primary malignancies. The patient mentioned a familial aggregation of malignant tumors, including 2 sisters with breast cancer and a brother with lung cancer. Interestingly, next-generation sequencing analysis of the patient's blood sample detected no mutations in the BRCA1, BRCA2, TP53, PTEN, CDH1, PALB2, RAD51C, RAD51D, MLH1, MSH2, MSH6, PMS2, EPCAM, APC, MUTYH, STK11, BMPR1A, SMAD4, PTEN, POLE, POLD1, GREM1, and GALNT12 genes. Therefore, whole genome sequencing is warranted to identify cancer-related genetic alterations in this patient with quintuple primary malignancies.
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| 24. |
- Pettersson, Monica, 1963, et al.
(author)
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Prepared for surgery : Communication in nurses preoperative consultations with patients undergoing surgery for colorectal cancer after a person-centred intervention
- 2018
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In: Journal of Clinical Nursing. - : Blackwell Publishing. - 0962-1067 .- 1365-2702. ; 27:13-14, s. 2904-2916
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Journal article (peer-reviewed)abstract
- Aims and objectivesTo describe preoperative communication after a person‐centred intervention in nurses' consultations with patients undergoing surgery for colorectal cancer.BackgroundPatients all over the world scheduled for surgery are referred to preoperative consultations with healthcare professionals. The goal is to assess the risk of perioperative complications, improving quality of care and enabling patients to be prepared for surgery and recovery. A person‐centred intervention was developed, which consisted of an interactive written patient education material and person‐centred communication.DesignAn explorative quantitative and qualitative study based on 18 audio‐taped transcriptions.MethodsEighteen patients preoperative nursing consultations at three Swedish hospitals were analysed quantitatively regarding structure: words, time, phases, questions, discursive space, and qualitatively: topics and how the person‐centred communication appeared in the consultations.ResultsThe median time for consultations was 27 min (range 13–64 min). The nurses used two‐thirds of the discursive space in the consultations with the patients. The patient education material was used as a support to structure the consultation and discuss sensitive and difficult issues. Seven topics were discussed during the consultation. Two different approaches to communication were identified: Talking with the patient versus Talking to the patient. Talking with the patient (seen as person‐centred communication) was defined as: listening to the narrative and confirming each other, raising difficult topics, seeing each other as persons, building on strengths and resources, preparing for surgery and asking open questions.ConclusionWays of communicating influence how the preoperative consultation develops. Talking with the patient could be seen as person‐centred communication in the preoperative care, and when using this approach, the intervention purpose of person‐centred communication was met.Relevance to clinical practiceEducation in person‐centred communication is important for nurses to improve their skills in performing preoperative consultations.
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| 25. |
- Wennberg, Pär, 1972-, et al.
(author)
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Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures - effects on cognition
- 2019
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In: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 19:1
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Journal article (peer-reviewed)abstract
- Background Impaired cognition is a major risk factor for perioperative delirium. It is essential to provide good pain control in patients with hip fractures and especially important in patients with severely impaired cognitive status, as they receive less pain medication, have poorer mobility, poorer quality of life and higher mortality than patients with intact cognition. The purpose of this study was to examine the association between preoperative pain management with nerve blocks and cognitive status in patients with hip fractures during the perioperative period. Methods One hundred and twenty-seven patients with hip fractures participating in a double-blind, randomised, controlled trial were included in this study. At hospital admission, a low-dose fascia iliaca compartment block (FICB) was administered as a supplement to regular analgesia. Cognitive status was registered on arrival at hospital before FICB and on the first postoperative day using the Short Portable Mental Status Questionnaire. Results Changes in cognitive status from arrival at hospital to the first postoperative day showed a positive, albeit not significant, trend in favour of the intervention group. The results also showed that patients with no or a moderate cognitive impairment received 50% more prehospital pain medication than patients with a severe cognitive impairment. FICB was well tolerated in patients with hip fractures. Conclusion Fascia iliaca compartment block given to patients with hip fractures did not affect cognitive status in this study. Patients with a cognitive impairment may receive inadequate pain relief after hip fracture and this discrimination needs to be addressed in further studies.
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| 26. |
- Wennberg, Pär, 1972-
(author)
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Pain management in older persons with hip fractures
- 2019
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis was to evaluate the preoperative management of pain from the perspectives of a literature overview, emergency medical service pain management, an intervention with a fascia iliaca compartment block and the association between cognitive status and the treatment of pain. Paper 1 is an integrative review of the literature on emergency care in patients with hip fractures or suspected hip fractures. Pain is a major problem for patients suffering a hip fracture when waiting for surgery and it is challenging for health care to provide sufficient pain relief. Listening to the patient’s narrative and the mandatory use of pain scales and pain documentation are necessary to deepen our understanding of individual patients’ needs. Paper 2 is a prospective observational study that explored the prehospital pain levels in 1,426 patients with suspected hip fractures. Furthermore, this study evaluated prehospital pain management. At the site of the injury, patients with hip fractures are often in substantial pain. Seventy-five per cent of the patients received pain relief from the emergency medical service (EMS) care providers and the pain relief was often effective. Several of the patients that did not receive prehospital pain relief had moderate to severe pain. Paper 3 is a randomised placebo-controlled double-blind trial (RCT) of 127 patients waiting for surgery. This RCT evaluated the effect of fascia iliaca compartment blocks (FICB) in relation to pain and medical pain relief, when added to regular preoperative analgesia. FICB improved pain relief when compared with regular analgesia alone (p=0.002). Paper 4 examined whether preoperative pain management with FICB could have an effect on cognitive status in the same 127 patients that were included in Paper 3. No impact on cognitive impairment was proven in this study. Patients with severe cognitive impairment received significantly lower doses of prehospital morphine than patients with higher cognitive status. Prehospital and hospital pain management need to improve. Pain management is especially challenging in persons with cognitive impairment.
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| 27. |
- Wennberg, Pär, 1972-, et al.
(author)
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Pre-operative pain management with nerve block in patients with hip fractures : a randomized, controlled trial.
- 2019
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In: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier BV. - 1878-1241 .- 1878-1292. ; 33, s. 35-43
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Pain management in patients with hip fractures is a major challenge for emergency care. The objective of this study was to evaluate whether the supplementation of pre-operative analgesia with low-dose fascia iliaca compartment block (FICB) compared with placebo would improve pain relief in patients with hip fractures.METHODS: A double-blind, randomized, controlled trial was conducted on 127 patients. At hospital admission, a low-dose FICB was administered to patients with hip fractures as a supplement to regular pre-operative analgesia. Patients with and without cognitive impairment were included. The instruments used were a visual analogue scale (VAS), a numerical rating scale and a tool for behavior related pain assessment. The primary endpoint was the change in reported pain on movement from hospital admission to two hours after FICB.RESULTS: The intervention group showed improved pain management by mean VAS score for pain on movement compared with the control group (p = 0.002).CONCLUSIONS: Our results support the use of low-dose FICB as a pain-relieving adjuvant to other analgesics when administered to patients with a hip fracture.
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| 28. |
- Öhlén, Joakim, 1958, et al.
(author)
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Preparedness for colorectal cancer surgery and recovery through a person-centred information and communication intervention - A quasi-experimental longitudinal design.
- 2019
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:12
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Journal article (peer-reviewed)abstract
- To meet patients' information and communication needs over time in order to improve their recovery is particularly challenging for patients undergoing cancer surgery. The aim of the study was to evaluate whether an intervention with a person-centred approach to information and communication for patients diagnosed with colorectal cancer undergoing surgery can improve the patients' preparedness for surgery, discharge and recovery during six months following diagnosis and initial treatment. The intervention components involving a novel written interactive patient education material and person-centred communication was based on critical analysis of conventional information and communication for these patients. During 2014-2016, 488 consecutive patients undergoing elective surgery for colorectal cancer were enrolled in a quasi-experimental longitudinal study. In three hospitals, first a conventional care group (n = 250) was recruited, then the intervention was introduced, and finally the intervention group was recruited (n = 238). Patients' trajectories of preparedness for surgery and recovery (Preparedness for Colorectal Cancer Surgery Questionnaire-PCSQ) health related quality of life (EORTC QLQ-C30) and distress (NCCS Distress Thermometer) were evaluated based on self-reported data at five time points, from pre-surgery to 6 months. Length of hospital stay and patients' behavior in seeking health care pre- and post-surgery were extracted from patient records. Longitudinal structural equation models were used to test the hypothesized effects over time. Statistically significant positive effects were detected for two of the four PCSQ domains (patients searching for and making use of information, and making sense of the recovery) and for the role functioning domain of the EORTC QLQ-C30. Patients in the intervention group were also more likely to contact their assigned cancer "contact nurse" (a.k.a. nurse navigator) instead of contacting a nurse on duty at the ward or visiting the emergency department. In conclusion, the overall hypothesis was not confirmed. Further research is recommended on written and oral support tools to facilitate person-centred communication.
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| 29. |
- Öhlén, Joakim, 1958, et al.
(author)
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Systematic Review of Foci, Designs and Methods of Palliative Care Research Conducted in Sweden between 2007 and 2012
- 2015
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In: 14th World Congress of the European Association of Palliative Care. 8-10 maj, 2015. Köpenhamn, Danmark..
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Conference paper (other academic/artistic)abstract
- Background: In order to guide further development of palliative care research, national reviews regarding characteristics of national PC research is suggested. In Sweden, a previous review of national palliative care from the 1970s to 2006 provided a useful source for comparison with research conducted during the subsequent six years. Aim: To systematically examine palliative care research from Sweden between 2007 and 2012, with special attention to research foci, designs and methods. Methods: A systematic review was undertaken. The databases Academic Search Elite, Age Line, Ahmed, Cinahl, PsychInfo, Pub Med, Scopus, Soc abstracts, Web of Science and Libris were reviewed for Swedish palliative care research studies published from 2007 to 2012, applying the same search criteria as used in the previous review. Results: A total of 263 papers met the inclusion criteria, indicating an increased volume of research compared to the 133 articles identified in the previous review. Common study foci were symptom assessment and management, experiences of illness, and care planning. Targeting non-cancer specific populations and utilisation of population-based register studies were identified as new features. There was continued domination of cross-sectional, qualitative and mono-disciplinary studies, not including ethnic minority groups, non- verbally communicable people, or children under 18 years of age. Conclusion: Palliative care research has increased in Sweden, from 2007 to 2012 compared to during the 1970s to 2006, and there is an increased trend for research of non-cancer specific populations. A domination of qualitative approaches and small, cross-sectional studies with few interventions is still characteristic. Still more strategies are needed to expand the knowledge development of palliative care to respond to demographical, epidemiological, therapeutic and health care structure changes.
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