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  • 1.
    Aasa, Ulrika
    et al.
    Umeå universitet.
    Wiitavaara, Birgitta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Personalens hälsa och arbetsmiljö2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, p. 72-79Chapter in book (Other academic)
  • 2.
    Ahmadi, Nader
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Asylsökande barn med uppgivenhetssymtom: kunskapsöversikt och kartläggning2005Report (Other academic)
    Abstract [sv]

    En studie om situationen för sylsökande barn med uppgivenhetssymtom genomförd i två delar: en kunskapsöversikt och en kartläggning.

    Syftet har varit att ge en bild av såväl den internationella och nationella kunskapsnivån som problematikens omfattning och de drabbde barnens psykosociala tillstånd.

  • 3.
    Ahmadi, Nader
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Asylsökande barn med uppgivenhetssymtom: trauma, kultur, asylprocess2006Report (Other academic)
  • 4.
    Ahmadi, Nader
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Hessle, Marie
    Mannikoff, Anna
    Asylsökande barn med uppgivenhetssymtom: ett svenskt fenomen åren 2001-20062006Report (Other academic)
  • 5.
    Andersson, Olga
    et al.
    University of Gävle, Faculty of Health and Occupational Studies.
    Lena, Norlin
    University of Gävle, Faculty of Health and Occupational Studies.
    Patienters egenvårdstrategier vid Irritabel Bowel Syndrome.: En litteraturstudie.2010Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 6.
    Azar , Jonny
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Snickars, Sophie
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Hur ungdomar med cancer hanterar sin sjukdom och vad de har för livskvalitet: en litteraturstudie2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this literature study was to investigate how adolescents with cancer cope with there disease and how it effect their quality of life (QoL). This study was a descriptive literature study were the authors searched for scientific articles in the databases Medline, Cinahl, SweMed+ and PsykInfo. The result is based on fifteen articles. The result showed that social support such as parents and a special friend is important for the adolescents' well-being. The adolescents also described that it felt god to have someone to talk to that was in the same situation. A positive attitude and humour helped the adolescents to cope with their disease. One way to escape from the disease was trying to feel normal, a way of doing that was to wear accessories, modern clothes and pushing their limits. The adolescents spent a lot of time in the hospitals thus made them isolated, which resulted in alienation. Changed body image, fear and alienation are all factors that influence on the adolescents QoL. It was showed that adolescents with cancer had lower QoL than healthy adolescents, but as time pass by their QoL increased. In general the girls hade better QoL than the boys.

  • 7.
    Bengtsson, Inger
    et al.
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg.
    Lissner, Lauren
    The Sahlgrenska School of Public Health and Community Medicine, Public Health Epidemiology Unit (EPI), Gothenburg, Sweden.
    Ljung, Thomas
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Medical science.
    Rosengren, Annika
    Department of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Thelle, Dag
    Institute of Basic Medical Science, Department of Biostatistics, Oslo, Norway.
    Währborg, Peter
    Sahlgrenska Academy at University of Gothenburg.
    The cortisol awakening response and the metabolic syndrome in a population-based sample of middle-aged men and women.2010In: Metabolism: Clinical and Experimental, ISSN 0026-0495, E-ISSN 1532-8600, Vol. 59, no 7, p. 1012-9Article in journal (Refereed)
    Abstract [en]

    The objective was to explore the relationship between the cortisol awakening response (CAR) and the metabolic syndrome (MetS) as defined by the National Cholesterol Education Program criteria. The final study sample consisted of 91 women (14 with MetS) and 84 men (15 with MetS), aged 45 to 70 years, from a general population sample. The only exclusion criteria were no consent, pregnancy, or insufficient cortisol testing. On the day of measurement (weekday), salivary cortisol was sampled at awakening and 15 minutes after awakening. Relative CAR (CAR%) and the MetS were the main variables studied. Results showed that, in women with the MetS, cortisol at awakening was significantly lower (mean, 8.92 vs 12.33 nmol/L; P = .05) and the CAR was significantly higher (91.4% vs 36.5%, P < .001) than in women without the syndrome. Significant difference in the relative CAR was also present between men and women with MetS (38.5% and 91.4%, respectively; P = .02). No difference was seen in the awakening response comparing men with and without the MetS. In a regression model, the response to awakening was dependent on the MetS in women (F1,89 = 13.19, P < .001); but the model was not significant in men. Furthermore, the awakening response was associated with more depressive symptoms in women (F1,80 = 8.12, P = .01) and with weekday/weekend cortisol sampling in men (F1,82 = 4.63, P = .03). The association between the relative CAR and the MetS remained significant but somewhat attenuated after adjusting for depressive symptoms (P = .01). Results indicate a sex difference in the CAR% in the presence of the MetS independent of depressive symptoms, a known correlate of the MetS.

  • 8. Berglund, Eva
    et al.
    Eriksson, Mårten
    University of Gävle, Department of Education and Psychology, Ämnesavdelningen för psykologi.
    Reliability and content validity of a new instrument for assessment of communicative skills and language abilities in young Swedish children2000In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 25, no 4, p. 176-185Article in journal (Refereed)
  • 9.
    Bergström, Emma
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Kärvin, Linnéa
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Att vara ett syskon till en bror eller syster med cancer2017Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Varje år insjuknar ca 320 barn mellan 0-18 år av cancer i Sverige vilket innebär att många syskon kan få en förändrad vardag. Cancer orsakas av att celler i kroppen börjar dela sig okontrollerat samt ökar i storlek, vilket resulterar i en cancertumör. Hur ett syskon reagerar när en bror eller syster får sin cancerdiagnos är beroende på ålder och tidigare erfarenheter. I mötet med ett sjukt barn och dess familj är det viktigt att som sjuksköterska stötta och hantera hela familjens upplevelser i den rådande situationen. Syfte: Syftet med studien var att beskriva syskons upplevelse av att ha en bror eller syster med cancer samt att studera de inkluderade artiklarnas undersökningsgrupp. Metod: En deskriptiv litteraturstudie som inkluderar elva vetenskapliga artiklar som söktes via databasen Medline via PubMed. Artiklarna analyserades med hjälp av Polit och Becks niostegsmodell för ett objektivt urval. Huvudresultat: Syskon som hade en bror eller syster med cancer upplevde många omställningar i livet, både emotionellt, fysiskt och psykiskt. Resultatet visar tre centrala stora upplevelser som syskonen upplevde, ”Känslosamma ögonblick”, “Att rätt information skapar trygghet” samt “Att leva i en förändrad tillvaro”. Undersökningsgrupperna i de inkluderade artiklarna var individer mellan 6-22 år och både pojkar och flickor samt att antalet varierade mellan 6-125 deltagare. Slutsats: Ett syskon till en bror eller syster med cancer upplever många känslor och förändringar samt påverkas av den nya tillvaron som uppstår efter cancerbeskedet. Detta innebär att familjesituationen, relationer och skolan påverkas på olika sätt.  

  • 10.
    Bildtgard, Torbjörn
    et al.
    Stockholms universitet.
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Changing sexual pracitices in intimate relationships in later life - a life course perspective2014In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 54, no Suppl. 2, p. 76-76Article in journal (Other academic)
    Abstract [en]

    In late modernity sex has escaped its reproductive cage and people form pure relationships, based on mutual satisfaction (Giddens). Ironically, although older people are per definition non-reproductive, they have been neglected in studies on sexuality. The aim is to study sexual attitudes and practices among older people in life-course perspective. We present results from 1) a qualitative interview study with 28 63–91 year old Swedes currently dating or in a relationship (married, cohabiting, LAT) initiated 60+ and 2) a quantitative survey including 1225 60–90 year old Swedes (response rate 42%). The interviews revealed a normative change, from condemnation of extra-marital sex in young adulthood to encouragement of sexual relationships but not marriage in later life. Despite restrictive norms, the survey showed a majority (93%) had had their sexual debut before marriage. All informants had experienced the 1960’s sexual liberation and today liberal attitudes seem to encompass later life. Most had had rather active sexual lives. Half or the survey respondents had had ≥4 more sexual partners, and one in five ≥10. Today, an active sex-life was regarded as important for a good relationship. Many informants had interpreted sexual decline as “natural” and age-related, but re-discovered sexuality with their new partner. The survey confirmed relationship length as a better predictor of sexual activity than age. Cohort and period effects will be discussed. It has been argued that sexual practices will become more liberal in the future by cohort replacement. Our data indicates that “the future might already be here”.

  • 11.
    Bildtgård, Torbjörn
    et al.
    Stockholms Universitet.
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Changing Sexual Practices in New Intimate Relationships in Later Life – A Life Course Perspective2014In: 8th International Conference on Cultural Gerontology: Programme and Abstracts, 2014, p. 138-138Conference paper (Other academic)
    Abstract [en]

    It has been argued that in late modernity sex has escaped its reproductive cage and people form pure relationships, based on mutual satisfaction. Ironically, although older people are per definition non-­‐reproductive, they have often been neglected in studies on sexuality. In this paper we present results from 1) a qualitative interview study with a strategic sample of 28 63–91 year old Swedes currently dating or in a heterosexual relationship (married, cohabiting, LAT) initiated 60+ and 2) a quantitative survey including answers from 1225 60–90 year old Swedes. The interviews revealed a clear normative  change,  from  a  cultural  context  that  condemned  extra-­‐marital  sex  in young adulthood  to  a context  encouraging  sexual  relationships  but  not  marriage in later  life.  All  had experienced  the  sexual  liberation  of  the  1960s,  and today, these liberal  attitudes  seem  to encompass later life. Today, an active sex-­‐life is regarded as important for a good relationship and sexual attraction was seen as a precondition for newrelationships. Many informants had interpreted sexual decline in former relationships as “natural ageing”, but re-­‐discovered sexuality with their new partner. In the survey, a majority (93 %) had had their sexual debut before marriage (despite the restrictive norms). Half or the respondents have had ≥ 4 sexual partners, and one in five ≥ 10. Sexual activity correlated negatively with relationship length. It has often been argued that sexual values and practices will become more liberal in the future by cohort replacement. Our data indicates that “the future might already be here”.

  • 12.
    Bildtgård, Torbjörn
    et al.
    Stockholms universitet.
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    New intimate relationships as a resource for independent living in later life2014In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 54, no Suppl. 2, p. 11-11Article in journal (Other academic)
    Abstract [en]

    Despite increased research interest in transitions into new intimate relationships in later life, little focus has been on how transitions affect older people’s social networks. We investigate the impact of entering into new intimate relationships in later life on interdependent lives. Results are based on both qualitative interviews with 28 Swedes (63–91 years) either dating or living in new relationships initiated 60+ (marriage, cohabitation, LAT), and a quantitative survey to 60–90 year old Swedes (n=1225; response rate 42%). A central theoretical frame is Elder’s (1994) principle of interdependent lives. A new relationship usually meant integration into the new partner’s social and filial networks (some problems will be discussed) and a restructuring of the relationship chain so that time and energy is redirected to the new partner. A new partner was described as a resource for living independent lives by the older informants, and as a way of “unburdening” the children. Finally, the qualitative interviews hinted at a hierarchy of dependencies. This was confirmed by the survey. A majority of respondents would primarily turn to their partners for social, emotional and practical support, with children as a distant second and “others” third. An exception was personal hygiene, where partners remained the first choice, but where the social services were preferred to children. This hierarchy was the same in new relationships. The results, partly contradicting previous research findings, are discussed in light of Western individualism generally and Swedish welfare-state and state supported individualism in particular.

  • 13.
    Bildtgård, Torbjörn
    et al.
    Stockholms universitet.
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    The Impact of New Intimate Relationships in Later Life on Intergenerational Exchange2014In: 8th International Conference on Cultural Gerontology: Programme and Abstracts, 2014, p. 167-167Conference paper (Other academic)
    Abstract [en]

    Much social gerontological research has focused on partner loss in later life and how it affects social, emotional and practical exchanges between generations. In this paper we instead ask how a newintimate relationship in later life affects these inter-­‐generational exchanges. The results are based both  on  qualitative  interviews  with  28  Swedes  (63–91  years)  either  dating  or  living  in  new relationships initiated after the age of 60 (marriage, cohabitation, LAT), and a quantitative survey to 60–90 year old Swedes (n=1225). In the interviews we found that the informants described changes in what we conceptualize as the ‘relationship chain’ –a hierarchy in social and care responsibilities–where the new partner stepped in at the very front of the chain. The follow-­‐up survey confirmed a hierarchy of dependencies, where partners tend to come first, followed by children, friends and the state. The interviews further showed that the informants recurrently described their partners as a resource for their own autonomy as well as that of their children and friends. We interpret these findings in light of an individualist culture of independence that characterizes the Nordic countries, aided by a strong welfare state, involving a strong ethic of not being a burden, even to your own children.

  • 14.
    Björk, Ingela
    et al.
    University of Gävle, Faculty of Health and Occupational Studies.
    Leitzig, Andrea
    University of Gävle, Faculty of Health and Occupational Studies.
    Sömnförändringar, sömnpåverkande faktorer samt sömnförbättrande omvårdnadsåtgärder för IVA-patienter: - en litteraturstudie2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Människan tillbringar en tredjedel av sitt liv i sömn det är ett behov vilket hon inte kan vara utan. Patienter som vårdas på IVA drabbas frekvent av sömnstörningar och därmed sömnbrist. Tidigare gjorda studier tyder på att IVA patienter upplever sömnstörningar som ett stort problem. Syfte: Att beskriva sömnförändringar, sömnpåverkande faktorer och sömnförbättrande omvårdnadsåtgärder för IVA-patienter. Metod: Databassökning gjordes och nyckelord har identifierats. Studier som inkluderar vuxna patienter som vårdats på en IVA har valts för denna beskrivande litteraturstudie. Resultat: IVA-patienter drabbas av fragmenterad sömn uppdelad i korta abnorma perioder. Sömnen påverkas av mänsklig intervention, diagnostiska tester samt miljöbetingad ljus och ljud. Minskning av ljud- och ljusnivån samt sammanhängande vilotid utan intervention var de främst undersökta sömnfrämjande omvårdnadsåtgärder i de granskande artiklarna. Slutsats: Alla IVA-patienter upplevde störd sömnrytm. I vilken utsträckning sömnrytm stördes berodde på ålder, sjukdom, erfarenhet av IVA-vård och respiratorvård. Omvårdnadsåtgärder som planerad vilotid, sänkningar av ljud och ljus förbättrade sömnmönstret och skapade möjlighet till förbättrad sömn.

  • 15.
    Brolund, Emelie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Jonsson, Kristin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Hur patienter som drabbats av hjärtinfarkt skattar och upplever sin livskvalitet efter utskrivning från sjukhus: En litteraturstudie2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund

    Att ha drabbats av en hjärtinfarkt kan vara väldigt omvälvande och innebär inte bara att patienter kan få fysiska skador på hjärtmuskulaturen utan även att den psykiska hälsan kan påverkas. Därför är det viktigt att studera hur patienter skattar och upplever att deras livskvalitet har påverkats efter att de drabbats av hjärtinfarkt.

    Syfte

    Syftet med denna litteraturstudie var att beskriva hur patienter som drabbats av hjärtinfarkt skattar och upplever sin livskvalitet efter utskrivning från sjukhus samt vilka datainsamlingsmetoder som använts i artiklarna.

    Metod

    Examensarbetet har gjorts i form av en deskriptiv litteraturstudie utifrån 12 stycken artiklar med kvalitativ och kvantitativ ansats. Artiklarna är hämtade från databaserna Medline och PsycINFO och har granskats av båda författarna.

    Huvudresultat

    Studien visar att livskvaliteten kan förändras hos patienter som drabbats av hjärtinfarkt, och att många kan ha svårt att acceptera och hantera den nya situationen. I föreliggande studie framkom att patienternas brist på energi ligger till grunden för andra problem hos majoriteten av patienterna. Data har samlats in med hjälp av enkäter samt genom semistrukturerade intervjuer.

    Slutsats

    Denna studie visar att patienter som drabbats av hjärtinfarkt behöver tydlig information om deras tillstånd och vad de har att förvänta sig efter hjärtinfarkten för att lättare kunna acceptera och hantera den omvälvande situationen. Informationen och rehabiliteringen bör vara anpassad utifrån varje enskild individ eftersom patienterna många gånger upplever olika typer av problem och då kan behöva olika strategier för att handskas med dessa.

  • 16.
    Browaldh, Nanna
    et al.
    Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Nerfeldt, Pia
    Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Lysdahl, Michael
    Aleris Fysiolog Lab, Sleep Division, Stockholm, Sweden .
    Bring, Johan
    Statisticon AB, Uppsala, Sweden .
    Friberg, Danielle
    Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    SKUP3 randomised controlled trial: polysomnographic results after uvulopalatopharyngoplasty in selected patients with obstructive sleep apnoea2013In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 68, no 9, p. 846-853Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the 6-month efficacy of uvulopalatopharyngoplasty (UPPP) compared with expectancy in selected patients with obstructive sleep apnoea syndrome (OSAS).

    DESIGN: A prospective single-centre randomised controlled trial with two parallel arms stratified by Friedman stage and body mass index (BMI).

    PARTICIPANTS: 65 consecutive patients with moderate to severe OSAS (apnoea-hypopnoea index (AHI) ≥15 events/h sleep), BMI <36 kg/m(2), Epworth sleepiness scale ≥8, Friedman stage I or II.

    INTERVENTION: Surgical treatment with UPPP. The control group underwent UPPP after a delay of 6 months.

    OUTCOMES: Changes in AHI and other polysomnography parameters at baseline compared with the 6-month follow-up.

    RESULTS: All patients (32 in the intervention group and 33 in the control group) completed the trial. The mean (SD) AHI in the intervention group decreased significantly (p<0.001) by 60% from 53.3 (19.7) events/h to 21.1 (16.7) events/h . In the control group the mean AHI decreased by 11% from 52.6 (21.7) events/h to 46.8 (22.8) events/h, with a significant difference between the groups (p<0.001). The mean time in the supine position and the BMI were unchanged in both groups. Subgroup analyses for Friedman stage, BMI group and tonsil size all showed significant reductions in AHI in the intervention group compared with controls. There were no severe complications after surgery.

    CONCLUSIONS: This trial demonstrates the efficacy of UPPP in treating selected patients with OSAS with a mean reduction in AHI of 60% compared with 11% in controls, a highly significant and clinically relevant difference between the groups.

    TRIAL REGISTRATION NUMBER: NCT01659671.

  • 17.
    Bülow, Michaela
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Gvozden, Azra
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Intensivvårdssjuksköterskans upplevelser av att vårda patienter som utfört suecid försök: En kvalitativ intervjustudie2018Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Suicide is a global health problem, according to WHO 800 000 people worldwide commit suicide every year and the suicide attempts are far more. Aim: To describe intensive care nurses’ (ICU nurse) experiences of taking care of patients, at an intensive care unit, who has committed a suicide attempt. Method: A descriptive design with a qualitative approach was used. Semi structured interviews with ten ICU nurses were conducted and analyzed using qualitative content analysis. Results: Five categories were found; To meet patients who has committed a suicide attempt is complicated, To meet relatives of patients who has committed a suicide attempt, To patients who has committed a suicide attempt, psychiatry has meaning, To care for patients who has committed a suicide attempt brings up a lot of emotions, and To experience limitations and possibilities when taking care of patients who has committed a suicide attempt. ICU nurses described the complexity of nursing, communicating and treating patients who have committed a suicide attempt. These patients were described as a recurrent group, who often had an earlier experience of psychiatric care. They described a variety of reactions from relatives and the relatives need for support. ICU nurses experienced a long wait for the psychiatric consultation which contributed to slowing down the planning of the patients’ continued care. ICU nurses referred to suicide as tragic and that it brings up a lot of emotions among them. They also described that they experienced differences in severity of the suicide attempt depending on the use of suicide method and that prejudices existed among colleagues. ICU nurses described they lacked knowledge about mental illness and wished for better cooperation with psychiatric care. Conclusion: ICU nurses described the complexity of nursing, communicating and treating this group of patients due to lack of knowledge and that cooperation with psychiatric care could be improved.

  • 18.
    Candell, Agneta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Dental hygienists’ work environment: motivating, facilitating, but also trying2010In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 8, no 3, p. 204-212Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to describe dental hygienists' experiences of their physical and psychosocial work environment. The study was descriptive in design and used a qualitative approach. Eleven dental hygienists participated in the study and data were collected during spring 2008 using semi-structured interviews. The material was analysed using qualitative content analysis. The results showed that the dental hygienists experienced their work environment as motivating and facilitating, but at the same time as trying. The three categories revealed a theme: Being controlled in a modern environment characterized by good relationships. Motivating factors were the good relationship with co-workers, managers and patients, seeing the results of your work, having your own responsibility and making your own decisions. The new, pleasant and modern clinics, good cooperation between co-workers and varying duties were described as facilitating factors. The trying factors, as described by the dental hygienists, were above all being controlled by time limits or by some elements of the work, such as teamwork. The dental hygienists also felt stress because appointments were too-short. To conclude, the participants described their work environment as trying in several ways, despite the modern clinics and good relationships.

  • 19.
    Christensen, Karin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Holmstedt, Rebecca
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Metabolt syndrom hos neuroleptikabehandlade patienter inom rättspsykiatrisk vård 2010Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 20.
    Dahlström, Örjan
    et al.
    Linköpings universitet, Handikappvetenskap.
    Skagerstrand, Åsa
    Örebro University Hospital, Audiological Research Center.
    Lyxell, Björn
    Linköpings universitet, Handikappvetenskap.
    Thunberg, Per
    Örebro University, Department of Medical Physics.
    Sörqvist, Patrik
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Building, Energy and Environmental Engineering, Environmental psychology.
    Lundin, Margareta
    Örebro University Hospital, Audiological Research Center.
    Johnsrude, Ingrid
    University of Western Ontario, School of Communication Sciences and Disorders.
    Rudner, Mary
    Linköpings universitet, Handikappvetenskap.
    Rönnberg, Jerker
    Linköpings universitet, Handikappvetenskap.
    Möller, Claes
    Örebro University Hospital, Audiological Research Center.
    Cognitive training and effects on speech-in noise performance in normal hearing and hearing impaired individuals2015Conference paper (Other academic)
    Abstract [en]

    Cognitive training might have potential to improve speech understanding under adverse listening conditions. Here, we have examined the effects of a 5-week computer-based cognitive training program on speech-in-noise-performance, in normal hearing (NH) participants and in participants with mild-to-moderate sensorineural hearing loss (HI).

    Two groups, matched on gender and age (45-65 years), of 20 participants each (HI and NH respectively) are recruited. Participants perform four test-sessions; inclusion (t0), five weeks (t1), ten weeks (t2) and six months (t3). Training is performed either between t0 and t1, or between t1 and t2 (using a cross-over design), using the computer-based Cogmed training program, approximately 30-40 minutes per day, five days per week, during five weeks. At each session participants are tested in three different ways: (a) cognitive testing (KIPS, SICSPAN, TRT); (b) auditory performance (pure tone-audiometry (air- and bone-conduction) and speech audiometry (HINT, Swedish SPIN-test (SNR +4dB))); (c) cortical activation (MR sessions where participants performed a speech-in-noise task using Hagerman-sentences with steady-state speech-spectrum noise (SSN) and with two competing talkers). MR imaging is performed on a Philips Achieva 1.5 Tesla scanner using a sparse imaging technique in which stimuli are presented during the silent period between successive scans. Participants listen to auditory stimuli under eight different conditions: clear speech, SSN or two competing talkers (each at 90%, 50% and 0% intelligibility), and silent rest. Pre- and post-training, hearing disability is assessed by the Speech-Spatial-Qualities-Questionnaire.

    The study is on-going and behavioral results as well as results from fMRI will be presented.

  • 21.
    Engstrand, Åsa
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Anestesisjuksköterskors upplevelse av barnanestesi2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    The aim of this study was to describe the anesthesia nurses experiences of pediatric anesthesia in two surgical wards, a general surgery department and a day surgery surgical department at two hospitals in central Sweden. The study had a descriptive design with a qualitative approach, in which ten anesthetic nurses with more or less experience in children's anesthesia participated. Data were collected using semi-structured interview questions and were analyzed using qualitative content analysis. The results were reported based on a theme, three sub themes and nine categories. The theme When skills, tactfulness and interpersonal skills come to a head, with three sub themes Being prepared and ready, Interacts and open for participation   and Emotional tension. The anesthesia nurses who were interviewed described the experiences of children anesthesia as complex and varied situations. They needed to prepare themselves thoroughly, both mentally and practically. Good interactions with the child, parents and health professionals were described as important components for a successful pediatric anesthesia. A successful anesthesia gave a feeling of great satisfaction, while a less successful anesthesia gave a feeling of frustration and failure of the anesthetic nurses. Despite the emotional tension, they felt that pediatric anesthesia was the most fun and challenging they could be involved in their profession.

     

     

     

     

    Keywords: anesthesia nurses, experiences, children's anesthesia, experience, preparation, parents' presence.

  • 22.
    Eriksson, Britt-Mari
    et al.
    University of Gävle, Faculty of Health and Occupational Studies.
    Tinnerholm, Camilla
    University of Gävle, Faculty of Health and Occupational Studies.
    Samsjuklighet med missbruk/beroende inom rättspsykiatrisk vård: en intervjustudie om vårdares erfarenheter2010Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Many psychiatric patients with comorbidity of addiction /dependence are treating in forensic mental health. The patient group is heterogenic with complex and specific health needs. Nursing care staffs are those who spent the most time with these patients. The aim of this study was to describe caregivers' experiences of caring for patients suffering from severe mental disorder with comorbidity of addiction /dependence, in psychiatric care. Ten registered nurses and ten licensed mental nurses who worked at a forensic psychiatric clinic were interviewed, and the material was processed with content analysis. Interviews were conducted with support of a semi-structured interview guide. From the analysis revealed 14 subcategories to form four categories: collaboration, create functional everyday life, persist over time and knowledge / skills. The results showed that nursing care staff´s interaction with patients and other health care professionals gave a holistic approach. Good health care relationships could help patients to break the denial of substance abuse problems. Individualized activities and practical skill training was important in patients' rehabilitation. Nursing process could not be rushed and motivational work was crucial. Clinical experience, life experience, theoretical knowledge combined with a secure and stable personality, were the skills as nursing care staff´s needed to care for these patients. In the area of knowledge abuse/dependence experienced nurses need theoretical completion.

  • 23.
    Eslami, Bahareh
    et al.
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet; Karolinska Institutet.
    Sundin, Örjan
    Mittuniversitetet, Avdelningen för psykologi.
    Khankeh, Hamid Reza
    Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Style of Coping and its Determinants in Adults with Congenital Heart Disease in a Developing Country2014In: Congenital Heart Disease, ISSN 1747-079X, E-ISSN 1747-0803, Vol. 9, no 4, p. 349-360Article in journal (Refereed)
    Abstract [en]

    Objective The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies.

    DesignThe study has a cross-sectional case-control design.

    SettingThe study was conducted in two university-affilliated heart hospitals in Tehran, Iran.

    Patients The participants comprised 347 persons (18–64 years) with and 353 individuals without congenital heart disease, matched by gender and age.

    Outcome Measures Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group.

    Results The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables.

    Conclusions The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.

  • 24. Forinder, Ulla
    Barn med cancer – familj i kris1997In: Komplekst og varieret: en antologi om svensk-dansk psykosocial onkologi / [ed] Helle Ploug Hansen, Carol Tishelman, Lund: Studentlitteratur AB, 1997, 1Chapter in book (Other academic)
  • 25. Forinder, Ulla
    Stödgrupp för unga vuxna - ur ett anhörigperspektiv: ett vårdutvecklingsprojekt hos Cancerfonden 1999-2000 : slutrapport2001Report (Other academic)
    Abstract [sv]

    Rapporten beskriver ett projekt på Huddinge universitetssjukhus med syfte att skaffa kunskap om huruvida en gruppverksamhet är en lämplig stödform för unga anhöriga till cancerpatienter. Man anordnade en verksamhet med en grupp bestående av 5 ungdomar vars föräldrar var svårt och obotligt sjuka i cancer. Vid den åttonde och sista gruppträffen gjordes en utvärdering av gruppen. Samtliga inblandade var i stort sett mycket positiva. De deltagande ungdomarna tyckte att en gruppverksamhet fungerade mycket bra då det överskuggande behovet var att träffa andra som är i samma situation.

  • 26.
    Fritzell, Kaisa
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Stake Nilsson, Kerstin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Jervaeus, Anna
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Hultcrantz, Rolf
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; Breast and Sarcoma Unit, Radiumhemmet, Karolinska University Hospital, Stockholm, Swede.
    The importance of people's values and preferences for colorectal cancer screening participation2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 6, p. 1079-1084Article in journal (Refereed)
    Abstract [en]

    Background: To explore how individuals reason when they make decisions about participating in colorectal cancer(CRC) screening.

    Methods: Individuals randomized colorectal cancer (CRC) screeningto FIT or colonoscopy included in the Screening of Swedish Colons (SCREESCO) program was invited to focus group discussions and individual telephone interviews. The concept of shared decision-making (SDM: information; values/preferences; involvement) was used as a matrixfor the analyses. To validate findings, additional focus group discussions using the nominal group technique were performed.

    Results: Lack of knowledge of CRC and CRC screening was prominent for participants and non-participants, while the results differed between the groups in relation to their values and preferences. The influence of significant others promoted participation while it prevented it among non-participants. Those who participated and those who did not made it clear that there was no need to involve health care professionals when making the decision.

    Conclusions: Based on the results, a display of different ways to spread knowledge and communicate about CRC and CRC-screening could be applied such as, community-based information campaigns, decisions aids, interactive questionnaires, chat-functions and telephone support. The disparity in values and pref-erences between participants and non-participants may be the key to understand why non-participants make theirdecisions not to participate and warrant further exploration.

  • 27.
    Gabrielsson, Göran
    University of Gävle, Department of Caring Sciences and Sociology.
    "Lasta och åk": Akutbilens anestesisjuksköterskors uppfattningar om intubation vid traumatiska skallskador2009Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 28.
    Gizachew, Sirgut
    University of Gävle, Department of Caring Sciences and Sociology.
    Människors upplevelser av att leva med typ 2 diabetes2008Independent thesis Basic level (degree of Bachelor), 15 points / 22,5 hpStudent thesis
  • 29.
    Godskesen, Tove
    et al.
    Uppsala universitet, Centrum för forsknings- och bioetik.
    Kihlbom, Ulrik
    Uppsala universitet, Centrum för forsknings- och bioetik.
    Nordin, Karin
    Uppsala universitet; University of Bergen, Bergen, Norway.
    Silén, Marit
    Uppsala universitet, Vårdvetenskap.
    Nygren, Peter
    Uppsala universitet, Experimentell och klinisk onkologi.
    Differences in trial knowledge and motives for participation among cancer patients in phase 3 clinical trials2015In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 25, no 3, p. 516-523Article in journal (Refereed)
    Abstract [en]

    While participants in clinical oncology trials are essential for the advancement of cancer therapies, factors decisive for patient participation have been described but need further investigation, particularly in the case of phase 3 studies. The aim of this study was to investigate differences in trial knowledge and motives for participation in phase 3 clinical cancer trials in relation to gender, age, education levels and former trial experience. The results of a questionnaire returned from 88 of 96 patients (92%) were analysed using the Mann-Whitney U-test. There were small, barely relevant differences in trial knowledge among patients when stratified by gender, age or education. Participants with former trial experience were less aware about the right to withdraw. Male participants and those aged ≥65 years were significantly more motivated by a feeling of duty, or by the opinions of close ones. Men seem more motivated than women by external factors. With the awareness that elderly and single male participants might be a vulnerable group and participants with former trial experience are less likely to be sufficiently informed, the information consent process should focus more on these patients. We conclude that the informed consent process seems to work well, with good results within most subgroups.

  • 30.
    Gustafsson, Niclas
    et al.
    Ersta-Sköndal College University, Stockholm, Sweden.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Effect of Complex Working Conditions on Nurses Who Exert Coercive Measures in Forensic Psychiatric Care2016In: Journal of Psychosocial Nursing and Mental Health Services, ISSN 0279-3695, E-ISSN 1938-2413, Vol. 54, no 9, p. 37-43Article in journal (Refereed)
    Abstract [en]

    Nurses who exert coercive measures on patients within psychiatric care are emotionally affected. However, research on their working conditions and environment is limited. The purpose of the current study was to describe nurses' experiences and thoughts concerning the exertion of coercive measures in forensic psychiatric care. The investigation was a qualitative interview study using unstructured interviews; data were analyzed with inductive content analysis. Results described participants' thoughts and experiences of coercive measures from four main categories: (a) acting against the patients' will, (b) reasoning about ethical justifications, (c) feelings of compassion, and (d) the need for debriefing. The current study illuminates the working conditions of nurses who exert coercive measures in clinical practice with patients who have a long-term relationship with severe symptomatology. The findings are important to further discuss how nurses and leaders can promote a healthier working environment.

  • 31.
    Gustafsson, Patrik
    et al.
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Crenshaw, Albert G.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Edmunsson, David
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Toolanen, Göran
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Crnalic, Sead
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Muscle oxygenation in Type 1 diabetic and non-diabetic patients with and without chronic compartment syndrome2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 10, article id e0186790Article in journal (Refereed)
    Abstract [en]

    Background. Type 1 diabetic patients and non-diabetic patients were referred for evaluation for chronic exertional compartment syndrome (CECS) based on clinical examination and complaints of activity-related leg pain in the region of the tibialis anterior muscle. Previous studies using near-infrared spectroscopy (NIRS) showed greater deoxygenation during exercise for CECS patients versus healthy controls; however, this comparison has not been done for diabetic CECS patients.

    Methods. We used NIRS to test for differences in oxygenation kinetics for Type 1 diabetic patients diagnosed with (CECS-diabetics, n = 9) versus diabetic patients without (CON-diabetics, n = 10) leg anterior chronic exertional compartment syndrome. Comparisons were also made between non-diabetic CECS patients (n = 11) and healthy controls (CON, n = 10). The experimental protocol consisted of thigh arterial cuff occlusion (AO, 1-minute duration), and treadmill running to reproduce symptoms. NIRS variables generated were resting StO2%, and oxygen recovery following AO. Also, during and following treadmill running the magnitude of deoxygenation and oxygen recovery, respectively, were determined.

    Results. There was no difference in resting StO2%between CECS-diabetics (78.2±12.6%) vs. CONdiabetics (69.1±20.8%), or between CECS (69.3±16.2) vs. CON (75.9±11.2%). However, oxygen recovery following AO was significantly slower for CECS (1.8±0.8%/sec) vs. CON (3.8±1.7%/sec) (P = 0.002); these data were not different between the diabetic groups. StO2%during exercise was lower (greater deoxygenation) for CECS-diabetics (6.3±8.6%) vs. CON-diabetics (40.4±22.0%), and for CECS (11.3±16.8%) vs. CON (34.1±21.2%) (P<0.05 for both). The rate of oxygen recovery post exercise was faster for CECS-diabetics (3.5±2.6%/sec) vs. CON-diabetics (1.4±0.8%/sec) (P = 0.04), and there was a tendency of difference for CECS (3.1±1.4%/sec) vs. CON (1.9±1.3%/sec) (P = 0.05).

    Conclusion. The greater deoxygenation during treadmill running for the CECS-diabetics group (vs. CON-diabetics) is in line with previous studies (and with the present study) that compared non-diabetic CECS patients with healthy controls. Our findings could suggest that NIRS may be useful as a diagnostic tool for assessing Type 1 diabetic patients suspected of CECS.

  • 32.
    Halvorsen, Alexander
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Preoperativ oro hos barn: Anestesisjuksköterskors erfarenhet att bemöta och lindra oro hos barn : intervjustudie2017Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction To prepare a child for anesthesia put the nurses in a complex situation. The child is worried about the unknow that is going to happen and therefore the nurse needs to reduce the child’s level of anxiety and worry. The parents are supposed to comfort the child and together with the nurse they should help the child to manage the difficult situation. Aim: Describe the anesthesia nurses experience in addressing and reducing anxiety in children who are about to undergo anesthesia. Method:A qualitative interview study of 8 nurses with different age and work experience where included and interviewed. Result: Based on the experience of the nurses it showed that the most important thing where to create comfort, use distractions and the ability to use their previous professional experience. To be able to cooperate with the parents, create a relationship with the child as well as excellent preoperative preparation seemed to create comfort in both the child and the parents. The nurses used distracting strategies to transfer the negative anxiety to something more positive.  Since there are no written guidelines of how to comfort children about to undergo anesthesia the nurses had to use and incorporate their previous experience as an anesthesia nurse. The nurses mentioned that it is crucial to be able to sense and evaluate the situation and then act based on the conclusion. The most important thing was to adapt and conform to the need of the child and not rush the process. Conclusion: The study highlighted the experience of the nurse’s preoperative care. The result showed that the nurses experienced difficulty to care for worried children as well as the complex situation they were presented with. Sometimes worried parents made the situation more complex for the anesthesia nurse since they were not able to cooperate and work together. However, the corporation could be improved if the anesthesia nurse and the parent had the same goal and a joint way of handling the situation. The anesthesia nurse were required to have high professional competence, advanced humility as well the ability to make sure that the child  is comfortable and relaxed.

  • 33.
    Hedborg, Kerstin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Medical science.
    Migraine and Stress: An Internet administered Multimodal Behavioral Treatment Intervention2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Migraine is a disabling neurological disorder with high prevalence, the clinical manifestations of which are highly dependent on stress.

    The overall theme of the present thesis was to address aspects of stress in migraine. A multimodal behavioral treatment (MBT) program was developed specifically designed for migraine and focusing on stress as a trigger and an intervention was performed using this Internet-administered program. Migraine symptoms were followed via an Internet administered diary and questionnaires were answered at regular intervals during the 11-month study period.

    The thesis is based on four papers: In Paper I, life events and current stress, personality traits, and gender were studied cross-sectionally in 106 women and 44 men with migraine, who suffered at least two attacks a month at inclusion. Paper II describes a randomized controlled trial of the MBT program performed on 58 women and 25 men recruited from participants of the study described in Paper I. In the MBT study participants were randomized into one control group and two MBT groups, one of which received hand massage as part of the treatment. In Paper III, complete migraine drug use and changes in use and in drug efficacy during the MBT program were studied. In Paper IV, the salivary cortisol levels of MBT participants were evaluated as a biological stress marker.

    The MBT program proved effective in decreasing migraine headache; it was feasible and there was low attrition. Moreover, MBT resulted in decreased migraine drug use and increased drug efficacy, but had no discernible effects on salivary cortisol profiles. No effect of hand massage on migraine headache frequency was seen. Personality trait profiling revealed high scores for the neuroticism factor. Stress susceptibility was the single most aberrant personality trait and correlated highly with the reported level of current stress and with experienced negative life events.

    Gender differences included higher scores for women on trait anxiety, negative life events, depressive mood, anxiety, tension type headache, use of triptans, and efficacy of analgesics, whereas men displayed higher use of analgesics.

    In conclusion, the efficacy and low attrition associated with the present MBT program appears promising and timely with regard to the development of better and more accessible migraine treatment. Stress susceptibility, gender, negative life events and psychosomatic comorbidity are important factors to consider in relation to the care of persons with migraine.

  • 34.
    Hedborg, Kerstin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Omvårdnad vid migrän2015In: Omvårdnad vid neurologiska sjukdomar / [ed] Kristina Gottberg, Lund: Studentlitteratur AB, 2015, 1, , p. 194p. 101-124Chapter in book (Other academic)
    Abstract [sv]

    Migrän är en vanlig neurologisk sjukdom och en viktig orsak till smärta hos befolkningen. Stress anges som den viktigaste utläsande orsaken till migränanfall. Omvårdnad av migrän innebär att se till hela livssituationen hos personen med migrän och kartlägga aspekter som stress och andra faktorer som påverkar sjukdomen.

  • 35.
    Hedborg, Kerstin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Medical science.
    Muhr, Carin
    Uppsala universitet, Medicin.
    Evaluation of Salivary Cortisol in Adult Migraineurs Participating in an Internet-Administered Multimodal Behavioral Treatment Program2011Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To evaluate salivary cortisol as a biological stress marker in migraine and how the different measurements used were affected during the course of a multimodal stress treatment program.

    Methods: Saliva samples were collected at four predetermined time points of the day at inclusion, at mid-treatment, and at treatment conclusion during the course of a controlled Internet-administered multimodal behavioral treatment (MBT) intervention focusing on stress. Seventy-six participants (52 women/24 men) reporting at least two migraine attacks a month at inclusion were enrolled. The following four measurements of salivary cortisol as putative stress markers were used: aberrant Awakening Cortisol Response (ACR; < 50% or > 160% or < 2.5 nmol/L), low daytime profiles (all values <13 nmol/L), a low daytime value(s) (< 2.5 nmol/L; excluding the bedtime value), a high bedtime value (> 6 nmol/L), and a summarizing cortisol “index”. In a multivariate model these outcome measurements were compared to the following parameters: MBT treatment time, headache level, gender, stress susceptibility, negative life events, quality of life, depressive mood, physical activity, and body mass index − chosen as independent parameters related to stress.

    Results: During the course of the MBT study the rate of aberrant relative ACR (< 50% or > 160%) was high with a range of 59 to 83 percent. No differences in aberrant cortisol profiles (ACR and low daytime profile) were detected as a function of: treatment (vs. control), degree of headache improvement, gender, or body mass index. With regard to single cortisol values (day- or bedtime), the number of high bedtime values increased and the number of low daytime values decreased significantly with time for participants in MBT when compared with controls, thus providing ambiguous data on change in stress responses as a function of the intervention. Low daytime profiles correlated with stress susceptibility. Experience of strongly negative life events during childhood and adolescence correlated with low daytime values and a higher cortisol “index”. However, the inverse relationship was found for strongly negative life events that had occurred during adulthood. Increased depressive mood according to MADRS-S scores was significantly associated with aberrant ACR.

    Conclusions: The great variations in salivary cortisol profiles seen here demonstrate the complexity of cortisol regulation and, hence, underscore the difficulty of using measurements of salivary cortisol as stress markers in migraine. Although the intervention showed no consistent effect on cortisol levels, data need to be cautiously interpreted. Cortisol findings relating to stress susceptibility and life events during childhood/adolescence may be of particular interest for further study.

  • 36.
    Hedborg, Kerstin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Medical science.
    Muhr, Carin
    Uppsala Universitet.
    The influence of multimodal behavioral treatment on the consumption of acute migraine drugs: a randomized, controlled study2012In: Cephalalgia, ISSN 0333-1024, E-ISSN 1468-2982, Vol. 32, no 4, p. 297-307Article in journal (Refereed)
    Abstract [en]

    Objectives: To characterize overall drug use in migraine in conjunction with multimodal behavioral treatment (MBT). Methods: Seventy-six adults reporting at least two monthly migraine attacks underwent a randomized, controlled, 24-week MBT intervention. Migraine drugs and symptoms were registered in an Internet-based diary. Results: During 4256 days of baseline registration, 859 drug doses were taken during 655 of the 856 days with migraine headache. Triptans and analgesics constituted 56.7 and 38.3% of all doses with efficacy ratios of 0.41 and 0.20, respectively. Men displayed significantly lower drug efficacy (p = 0.001), and used triptans significantly less (p < 0.001) and analgesics significantly more (p < 0.001) than women. At the end of the MBT, total drug consumption decreased by 22% (p = 0.029), corresponding to 27% fewer days with migraine headache. Drug efficacy increased during MBT from 0.30 to 0.52 (p < 0.001), mainly explained by an increased proportion of mild attacks, which also was the attack category that displayed the largest increase in drug efficacy. Conclusions: Triptans were the most used and efficient drugs. MBT led to decreased and more efficient drug consumption. Men used triptans less frequently.

  • 37.
    Hedström, Mariann
    et al.
    Uppsala University, Department of Public Health and Caring Sciences, Section of Caring Sciences.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala University, Department of Public Health and Caring Sciences.
    Ekman, Anna
    Uppsala University Hospital, Department of medication and patient safety.
    Gillespie, Ulrika
    Uppsala University Hospital, Department of medication and patient safety.
    Mörk, Christina
    Uppsala County Council, Pharmaceutical Committee.
    Hulter Åsberg, Kerstin
    Uppsala University, Department of Neuroscience.
    Development of the PHASE-Proxy scale for rating drug-related signs and symptoms in severe cognitive impairment2018In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 22, no 1, p. 53-60Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The need for assessment of possible drug-related signs and symptoms in older people with severe cognitive impairment has increased. In 2009, the PHASE-20 rating scale for identifying symptoms possibly related to medication was the first such scale to be found valid and reliable for use with elderly people. In this project, the aim was to develop and examine the psychometric properties and clinical utility of PHASE-Proxy, a similar scale for proxy use in assessing elderly people with cognitive impairment.

    METHODS: Three expert groups revised PHASE-20 into a preliminary proxy version, which was then tested for inter-rater reliability, internal consistency, and content validity. Its clinical usefulness was investigated by pharmacist-led medication reviews. Group interviews and a study-specific questionnaire with nursing home staff were used to investigate the feasibility of use.

    RESULTS: The PHASE-Proxy scale had satisfactory levels of inter-rater reliability (Spearman's rank correlation coefficient; rs = 0.8), and acceptable internal consistency (Cronbach's alpha coefficient; α = 0.73). The factor analysis resulted in a logical solution with seven factors, grouped into two dimensions: signs of emotional distress and signs of physical discomfort. The medication reviews, interviews, and questionnaires also found the proxy scale to be clinically useful, and feasible to use.

    CONCLUSION: The PHASE-Proxy scale appears to be a valid instrument that enables proxies to reliably assess nursing home residents who cannot participate in the assessment, to identify possible drug-related signs and symptoms. It also appears to be clinically useful and feasible for use in this population.

  • 38. Hemgren, Barbro
    et al.
    Mamhidir, Anna-Greta
    Sammanfattning av diabeteskurs september 1991 - maj 19921992Report (Other academic)
  • 39.
    Hofsten, Anna
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för medicinsk vetenskap.
    Helander, Ingrid
    Medicinska biblioteket Uppsala universitet.
    Is Gender always reported in Blood Pressure Research?2009Conference paper (Refereed)
  • 40.
    Hultmark, Lisa
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Kans, Frida
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Sjuksköterskans roll och upplevelser vid förberedelser av barn inför perifer venkateter sättning och blodprovstagning: En intervjustudie2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of the study was to describe the nurse´s role and experiences around

    preparation of children in front of peripheral venous catheter (PVC) placement and

    blood draw. The study used a descriptive design with qualitative approach and was

    performed on a pediatric clinic in Sweden. Semi-structured interviews were performed

    with seven nurses of whom the first was a pilot interview, which was included in the

    result. The recruitment of nurses was made by a purposeful sampling, maximum

    variation sampling, with help of the quality coordinator of the pediatric clinic. The

    collected data was analyzed with the manifest qualitative content method. The analyzes

    resulted in the categories “To adept the preparation according to the child and the

    situation to breed a confident relation” and “To give safety and be flexible at

    difficulties”. In the result it emerged that all nurses prepared the children

    with authentic material and information but adapted the preparation by

    the children's age and cognitive development. But in spite the difficulties that can

    emerge the adaption will be expired as something positive. It is important that the nurse

    is flexible since every children and preparation situation is unique. If the nurse manages

    to earn the child’s faith the preparation will be fine and be a positive experience for both

    the children and the nurse.

  • 41.
    Ineland, Lisa
    et al.
    Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
    Jacobsson, Lars
    Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
    Salander Renberg, Ellinor
    Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
    Sjölander, Per
    University of Gävle, Centre for Musculoskeletal Research. Södra Lapplands Forskningsenhet, Vilhelmina, Sweden.
    Attitudes towards mental disorders and psychiatric treatment: changes over time in a Swedish population2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 3, p. 192-197Article in journal (Refereed)
    Abstract [en]

    Over the years a lot of research of attitudes towards mental disorders, towards people with mental illness and towards psychiatric services and treatment have shown a persistent negative attitude. There are, however, few studies on changes over time. The aim of this study was to compare responses to a questionnaire on attitudes towards mental disorders and psychiatric patients and the perception of psychiatric treatment in a community in northern Sweden in 1976 and 2003. In 1976 a random sample of 391 persons 18-70 years of age were asked and in 2003 a new sample of 500 persons from the same community were approached with the same questions. There are considerable changes over time. In 2003, almost 90% agree to the statement that mental illness harms the reputation more than physical illness, compared with 50% in 1976. In 2003, 51% agreed to the statement "Most people with mental disorders commit violent acts more than others" compared with 24% in 1976. There is an apparent ambivalence towards psychiatric treatment. Whilst 88% would advice a person with mental problems to contact a psychiatrist, still 26% would not like themselves to be referred to a psychiatrist. We argue that improving treatment methods is as important as changing attitudes through accurate information.

  • 42.
    Israelsson, Johan
    et al.
    Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Kalmar, Sweden; Kalmar Maritime Academy, Linnaeus University, Kalmar, Sweden; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden .
    Bremer, Anders
    Department of Acute and Prehospital Care and Medical Technology and PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden; Division of Emergency Medical Services, Kalmar County Hospital, Kalmar, Sweden .
    Herlitz, Johan
    Department of Acute and Prehospital Care and Medical Technology and PreHospen – Centre for Prehospital Research, University of Borås, Borås, Sweden.
    Axelsson, Åsa B.
    Institute of Health and Care Sciences, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden.
    Cronberg, Tobias
    Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
    Djärv, Therese
    Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Larsson, Ing-Marie
    Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Lilja, Gisela
    Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
    Sunnerhagen, Katharina S.
    Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Sweden.
    Wallin, Ewa
    Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Ågren, Susanna
    Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiothoracic Surgery, County Council of Östergötland, Linköping, Sweden .
    Åkerman, Eva
    Department of Perioperative Medicine and Intensive Care, Skane University Hospital, Malmö, Sweden; Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Stockholm, Sweden .
    Årestedt, Kristofer
    Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden; Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden; Kalmar County Hospital, Kalmar, Sweden .
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33Article in journal (Refereed)
    Abstract [en]

    AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.

    METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).

    RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.

    CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.

  • 43.
    Jansson, Tove
    et al.
    University of Gävle, Faculty of Engineering and Sustainable Development.
    Saad, Neimo
    University of Gävle, Faculty of Engineering and Sustainable Development.
    "Challenges when implementing standardized and processes within a customer service unit"2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

     

    Abstract

     

     

    Interest in Lean grows and spreads to the public from industrial and service sectors. Lean is currently used in administrative processes and it is called Administration but can administration be Lean? The aim of our study is to develop a useful model for a successful implementation of Lean Administration by using various scientific articles, books and information from the case study.

    The part of the purpose is to: • Identify critical success factors that arise• Identify the challenges arising from the implementation of Lean Administration.We have studied a Division within Distribution at GE Healthcare in Uppsala. The model that we have developed provides challenges and success factors for a successful implementation.

    In order to succeed in implementation, a culture that promotes continuous improvement must exist in the organization. A key success factor is to understand Lean Administrations structure and principles. Having a supportive leadership is a matter of course as well as having a secure and stable environment.

  • 44.
    Johansson, Amanda
    et al.
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Forsgren, Sture
    Department of Integrative Medical Biology, Umeå University, Umeå, Sweden.
    Stenberg, Berndt
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Wilen, Jonna
    Department of Radiation Sciences, Umeå University, Umeå, Sweden.
    Kaiezic, Nebojsa
    University of Gävle, Centre for Musculoskeletal Research.
    Sandstrom, Monica
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    No effect of mobile phone-like RF exposure on patients with atopic dermatitis2008In: Bioelectromagnetics, ISSN 0197-8462, E-ISSN 1521-186X, Vol. 29, no 5, p. 353-362Article in journal (Refereed)
    Abstract [en]

    This study investigates the effect of exposure to a mobile phone-like radiofrequency (RF) electromagnetic field on people with atopic dermatitis (AD). Fifteen subjects with AD were recruited and matched with 15 controls without AD. The subjects were exposed for 30 min to an RF field at 1 W/kg via an indoor base station antenna attached to a 900 MHz GSM mobile phone. Blood samples for ELISA analysis of the concentration of substance P (SP), tumor necrosis factor receptor 1 (TNF RI), and brain derived neurotrophic factor (BDNF) in serum were drawn before and after the provocation (exposure/sham). Baseline heart rate and heart rate variability, local blood flow, and electrodermal activity were also recorded. No significant differences between the subject groups were found for baseline neurophysiological data. The cases displayed a serum concentration of TNF RI significantly higher than the control subjects and a significantly lower serum concentration of BDNF in the baseline condition. For SP there was no difference between groups. However, no effects related to RF exposure condition were encountered for any of the measured substances. As to symptoms, a possible correlation with exposure could not be evaluated, due to too few symptom reports. The result of the study does not support the hypothesis of an effect of mobile phone-like RF exposure on serum levels of SP, TNF RI, and BDNF in persons with AD.

  • 45.
    Johansson, Therese
    et al.
    University of Gävle, Faculty of Health and Occupational Studies.
    Bjur, Jenny
    University of Gävle, Faculty of Health and Occupational Studies.
    Hur sjuksköterskor kan uppmärksamma barns vars föräldrar är alkoholmissbrukare: Litteraturstudie2010Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie var att belysa hur sjuksköterskor kan upptäcka och identifiera signaler hos barn som växer upp i en destruktiv miljö av alkoholmissbruk. Metod som användes för att belysa syftet var beskrivande litteraturstudie. Databaser som användes vid sökningen av valda källor var Medline(PubMed) och Cinahl. Andra sökstrategier var manuellsökning i valda källor. Huvudresultatet visade att barn till föräldrar med tungt alkoholmissbruk framförallt mådde psykiskt dåligt, det tog sig uttryck som depression och utåtagerande beteende. Barns ohälsa i samband med att växa upp i dysfunktionella miljöer relaterat till alkoholmissbruk tog även sig uttryck i återkommande psykosomatiska symtom samt kognitiva brister. Risken för att barn skulle fara illa kopplades även till den känslomässiga miljön som rådde i hemmet. Tecken på ohälsa behövde dock inte vara en följd av en ogynnsam uppväxtmiljö utan kunde härledas till genetiska faktorer. Slutsatsen är, för att kunna identifiera barn som befaras fara illa i sitt hem krävs goda kunskaper om problemets komplexitet. För att utgöra en viktig länk i detta arbete som sjuksköterska krävs förutom kunskap även utarbetade riktlinjer. Virginia Hendersons omvårdnadsteori kan enligt författarna utgöra ett gott stöd i att bedöma varje enskild situation, utifrån dess orsak och verkan baserade tänkande.

     

  • 46.
    Jonsson, Ann-Sofie
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Roos, Peter
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Livskvalitet hos patienter med pankreascancer: -en litteraturstudie2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study was to describe the quality of life in patients with pancreatic cancer and to examine whether there were any factors that could affect patient’s quality of life. Searches were carried out in the databases Academic Search Elite and Medline. The keywords used were pancreatic cancer, quality of life and pancreatic neoplasm. Thirteen research articles were selected for the study results. These articles were reviewed, analyzed and compiled. The results showed that the quality of life was significantly impaired in patients with pancreatic cancer compared with a general population. Patients experienced several disturbing symptoms. Fatigue and pain were among the most prevalent symptoms and these could also be linked to reduced quality of life. Despite various interventions and treatments many of the patients did not experience any kind of improvement in quality of life. Some patients who stabilized their weight experienced better quality of life and survived longer than those who continued to lose weight. One group of patients with local cancer who underwent surgery showed a significantly improved quality of life after treatment. The patients who received radiation therapy with a radioactive drug experienced a significantly improved quality of life. More research is needed to get an understanding of how these groups of patients experience their quality of life and to offer interventions that can provide a better quality of life.

  • 47.
    Kalles, Jessica
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Anestesisjuksköterskors upplevelser av kommunikationen med operationsteamet under operation2017Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Operationsavdelningen klassas som en högriskmiljö, fel eller kommunikationsmisstag kan få allvarliga konsekvenser för patienten. Teamarbete, effektiv och frekvent kommunikation mellan personalen leder till minskade risker för patienten.

    Syfte: Syftet med studien var att beskriva anestesisjuksköterskors upplevelse av kommunikationen med operationsteamet under operation

    Metod: Kvalitativ intervjustudie. Åtta semistrukturerade intervjuer med anestesisjuksköterskor med olika bakgrund och erfarenhet. Innehållet har analyserats utifrån kvalitativ innehållsanalys.

    Huvudresultat: Resultatet resulterade i tre kategorier; perioperativt samarbete, betydelsen av WHO´s checklista och klimatet på operationssalen. Anestesisjuksköterskorna upplevde förbättrad kommunikation när det hade ett fungerade teamarbete och alla strävade åt samma håll och arbetade för patienten. En tydlig och ömsesidig dialog var helt avgörande för att optimera förutsättningarna för anestesisjuksköterskan att göra det bästa för patienten. Sedan införandet av WHO´s checklista upplevde anestesisjuksköterskorna förbättrad kommunikation och ökad delaktighet. De visade sig också att klimatet på operationssalen spelade en avgörande roll för kommunikationen. Tillåtande klimat skapade möjligheter för god kommunikation medan andra faktorer försämrade och försvårade kommunikationen med operationsteamet. 

    Slutsats: Det framkom i studien att kommunikationen förbättrades av teamarbete och att alla strävade åt samma håll och arbetade för patienten. En tydlig dialog mellan alla i operationsteamet var avgörande för att optimera anestesisjuksköterskornas förutsättningar att göra det bästa för patienten. Införandet av WHO´s checklista hade förbättrat kommunikation och klimatet på operationssalen spelade en avgörande roll för kommunikationen. Det framkom också att bristande kommunikation skapade frustration och försämrade anestesisjuksköterskornas förutsättningar att göra det så bra som möjligt för patienten. Att belysa vikten av god kommunikation mellan yrkeskategorierna på operation kan förbättra omvårdnaden och patientsäkerheten.

  • 48.
    Knudsen, Kati
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
    Airway management in anaesthesia care: professional and patient perspectives2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Careful airway management, including tracheal intubation, is important when performing anaesthesia in order to achieve safe tracheal intubation. Aim: To study airway management in anaesthesia care from both the professional and patient perspectives. Methods: 11 RNAs performed three airway tests in 87 patients, monitored in a study-specific questionnaire. The tests usefulness for predicting an easy intubation was analysed (Study I). 68 of 74 anaesthesia departments in Sweden answered a self-reported questionnaire about the presence of airway guidelines (Study II). 20 anaesthesiologists were interviewed; a phenomenographic analysis was performed to describe how anaesthesiologists' understand algorithms for management of the difficult airway (Study III). 13 patients were interviewed; content analysis was performed to describe patients' experiences of being awake fiberoptic intubated (Study IV). Results: The Mallampati classification is a good screening test for predicting easy intubation and intubation can be safely performed by RNAs (Study I). The presence of airway guidelines in Swedish anaesthesia departments is poorly implemented (Study II). Algorithms can be understood as law-like rules, a succinct plan to follow in difficult airway situations, an action plan kept in the back of one's mind while creating flexible and versatile personal algorithms, or as consensus guidelines based on expert opinion in order to be followed in clinical practice (Study III). One theme emerged describing experiences of being awake intubated; feelings of being in a vulnerable situation but cared for in safe hands, described in five categories: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff's competence, professional caring and support, and no hesitation about new awake intubation (Study IV). Conclusions: The Mallampati classification is a good screening test for predicting easy intubation, when the airway assessment is performed in a structured manner by RNAs. The presence of airway guidelines in Swedish anaesthesia departments was poorly implemented and should receive higher priority. Algorithms need to be simple and easy to follow and based on the best available scientific evidence. Tailored information about what to expect, ensuring eye contact, and giving breathing instructions during the procedure may reduce patients' feeling distress.

  • 49.
    Knudsen, Kati
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Nilsson, Ulrica
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Högman, Marieann
    Centre for Research & Development, Uppsala University/Region Gävleborg, 801 88 Gävle, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Pöder, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study2016In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, no 1, article id 71Article in journal (Refereed)
    Abstract [en]

    Background

    Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure.

    Methods

    A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation. A qualitative content analysis extracted theme, categories, and subcategories.

    Results

    From the patient statements, one main theme emerged, feelings of being in a vulnerable situation but cared for in safe hands, which were described in five categories with 15 subcategories. The categories were: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff’s competence, professional caring and support, and no hesitation about new awake intubation. The patients felt they lacked information about what to expect and relied on the professionals’ expertise. Some patients felt overwhelmed by the information they were given and wanted less specific information about the equipment used but more information about how they would be cared for in the operating room. Undergoing awake intubation was an acceptable experience for most patients, whereas others experienced it as being painful and terrifying because they felt they could not breathe or communicate during the procedure itself.

    Conclusions

    Tailored information about what to expect, ensuring eye contact and breathing instruction during the procedure seems to reduce patient distress when undergoing awake fiberoptic intubation. Most of the patients would not hesitate to undergo awake intubation again in the future if needed.

  • 50.
    Knudsen, Kati
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.
    Pöder, Ulrika
    Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.
    Högman, Marieann
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden, and Centre for Research & Development Uppsala University/ County Council of Gävleborg, Gavle, Sweden.
    Larsson, Anders
    Department of surgical sciences, Uppsala University, Anaesthesiology & ICM, Uppsala, Sweden.
    Nilsson, Ulrica
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    A nationwide postal questionnaire survey: The presence of airway guidelines in anaesthesia department in Sweden2014In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, no 25, p. 25-Article in journal (Refereed)
    Abstract [en]

    Background

    In Sweden, airway guidelines aimed toward improving patient safety have been recommended by the Swedish Society of Anaesthesia and Intensive Care Medicine. Adherence to evidence-based airway guidelines is known to be generally poor in Sweden. The aim of this study was to determine whether airway guidelines are present in Swedish anaesthesia departments.

    Methods

    A nationwide postal questionnaire inquiring about the presence of airway guidelines was sent out to directors of Swedish anaesthesia departments (n = 74). The structured questionnaire was based on a review of the Swedish Society of Anaesthesia and Intensive Care voluntary recommendations of guidelines for airway management. Mean, standard deviation, minimum/maximum, percentage (%) and number of general anaesthesia performed per year as frequency (n), were used to describe, each hospital type (university, county, private). For comparison between hospitals type and available written airway guidelines were cross tabulation used and analysed using Pearson’s Chi-Square tests. A p- value of less than 0 .05 was judged significant.

    Results

    In total 68 directors who were responsible for the anaesthesia departments returned the questionnaire, which give a response rate of 92% (n 68 of 74). The presence of guidelines showing an airway algorithm was reported by 68% of the departments; 52% reported having a written patient information card in case of a difficult airway and guidelines for difficult airways, respectively; 43% reported the presence of guidelines for preoperative assessment; 31% had guidelines for Rapid Sequence Intubation; 26% reported criteria for performing an awake intubation; and 21% reported guidelines for awake fibre-optic intubation. A prescription for the registered nurse anaesthetist for performing tracheal intubation was reported by 24%. The most frequently pre-printed preoperative elements in the anaesthesia record form were dental status and head and neck mobility.

    Conclusions

    Despite recommendations from the national anaesthesia society, the presence of airway guidelines in Swedish anaesthesia departments is low. From the perspective of safety for both patients and the anaesthesia staff, airway management guidelines should be considered a higher priority.

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