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Martinsson L, Brännström M, Andersson S. Symptom assessment in the dying: family members versus healthcare professionals. BMJ Support Palliat Care 2024:spcare-2023-004382. [PMID: 37973205 DOI: 10.1136/spcare-2023-004382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/03/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Symptom management and support of the family members (FMs) are considered essential aspects of palliative care. During end of life, patients are often not able to self-report symptoms. There is little knowledge in the literature of how healthcare professionals (HCPs) assess symptoms compared with FMs. The objective was to compare the assessment of symptoms and symptom relief during the final week of life between what was reported by FMs and what was reported by HCPs. METHODS Data from the Swedish Register of Palliative Care from 2021 and 2022 were used to compare congruity of the assessments by the FMs and by HCPs regarding occurrence and relief of three symptoms (pain, anxiety and confusion), using Cohen's kappa. RESULTS A total of 1131 patients were included. The agreement between FMs and HCPs was poor for occurrence of pain and confusion (kappa 0.25 and 0.16), but fair for occurrence of anxiety (kappa 0.30). When agreeing on a symptom being present, agreement on relief of that symptom was poor (kappa 0.04 for pain, 0.10 for anxiety and 0.01 for confusion). The trend was that HCPs more often rated occurrence of pain and anxiety, less often occurrence of confusion and more often complete symptom relief compared with the FMs. CONCLUSIONS The views of FMs and HCPs of the patients' symptoms differ in the end-of-life context, but both report important information and their symptom assessments should be considered both together and individually. More communication between HCPs and FMs could probably bridge some of these differences.
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Affiliation(s)
- Lisa Martinsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | - Sofia Andersson
- Department of Nursing, Campus Skellefteå, Umeå University, Umeå, Sweden
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Grönlund CF, Isaksson U, Brännström M. Moral distress thermometer: Swedish translation, cultural adaptation and validation. Nurs Ethics 2023:9697330231197707. [PMID: 37755115 DOI: 10.1177/09697330231197707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND Moral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time. AIM The aim of this study was to translate the MDT and adapt it to the Swedish cultural context. RESEARCH DESIGN The first part of this study concerns the translation of MDT to the Swedish context, and the second part the psychometric testing of the Swedish version. PARTICIPANTS AND RESEARCH CONTEXT 89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch's ANOVA, Games-Howell post-hoc test and Pearson's correlation analysis were done. ETHICAL CONSIDERATIONS The study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration. RESULTS The translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress. CONCLUSION The MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context.
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Fischer-Grönlund C, Brännström M, Isaksson U. Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). BMC Med Ethics 2023; 24:35. [PMID: 37254086 DOI: 10.1186/s12910-023-00916-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/17/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Moral distress has been described as moral constraints and uncertainty connected with guilty feelings of being unable to give care in accordance with one's values for good care. Various instruments to measure moral distress have been developed. The instrument measure of moral distress for healthcare professionals (MMD-HP) was developed to capture the experience and frequency of moral distress among various healthcare professionals. The MMD-HP has been translated and culturally adapted into the Swedish language and context; however, the translation has not been validated. Therefore, this study aimed to evaluate the validity and reliability of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). METHODS Eighty-nine staff from various professions at a hospital in northern Sweden participated in the study. A confirmatory factor analysis was performed to check for consistency with the original version of the MMD-HP. To evaluate internal consistency, Cronbach's alpha was calculated for each domain and for the scale as a whole. RESULTS The scale as a whole showed a Cronbach's alpha of 0.96, with a range between 0.84 and 0.90 between the different subscales. A confirmatory factor analysis based on the original four-factor structure showed good fit indices with a χ2/df of 0.67, CFI at 1.00, TLI at 1.02 and NFI at 0.97. RMSEA was at 0.00, and SRMR was at 0.08. A comparison of the total score between three equally large groups of years of experience at the present workplace showed no significant differences (F = 0.09, df = 2, p = 0.912). CONCLUSIONS We found that the Swedish version of the MMD-HP has shown validity and reliability for use in a Swedish context for measuring moral distress among health personnel.
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Affiliation(s)
| | - Margareta Brännström
- Department of Nursing, Umeå University, Campus Skellefteå, 93187, Skellefteå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, Linnaeus v 9, 90736, Umeå, Sweden
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Jeon H, Choi Y, Brännström M, Akin JW, Curry TE, Jo M. Cortisol/glucocorticoid receptor: a critical mediator of the ovulatory process and luteinization in human periovulatory follicles. Hum Reprod 2023; 38:671-685. [PMID: 36752644 PMCID: PMC10068287 DOI: 10.1093/humrep/dead017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/03/2023] [Indexed: 02/09/2023] Open
Abstract
STUDY QUESTION Do cortisol/glucocorticoid receptors play an active role in the human ovary during ovulation and early luteinization? SUMMARY ANSWER The ovulatory hCG stimulation-induced glucocorticoid receptor signaling plays a crucial role in regulating steroidogenesis and ovulatory cascade in human periovulatory follicles. WHAT IS KNOWN ALREADY Previous studies reported an increase in cortisol levels in the human follicular fluid after the LH surge or ovulatory hCG administration. However, little is known about the role of cortisol/glucocorticoid receptors in the ovulatory process and luteinization in humans. STUDY DESIGN, SIZE, DURATION This study was an experimental prospective clinical and laboratory-based study. An in vivo experimental study was accomplished utilizing the dominant ovarian follicles from 38 premenopausal women undergoing laparoscopic sterilization. An in vitro experimental study was completed using the primary human granulosa/lutein cells (hGLC) from 26 premenopausal women undergoing IVF. PARTICIPANTS/MATERIALS, SETTING, METHODS This study was conducted in a private fertility clinic and academic medical centers. Dominant ovarian follicles were collected before the LH surge and at defined times after hCG administration from women undergoing laparoscopic sterilization. Primary hGLC were collected from women undergoing IVF. hGLC were treated without or with hCG in the absence or presence of RU486 (20 µM; dual antagonist for progesterone receptor and glucocorticoid receptor) or CORT125281 (50 µM; selective glucocorticoid receptor antagonist) for 12 or 36 h. The expression of genes involved in glucocorticoid receptor signaling, steroidogenesis, and ovulatory cascade was studied with RT-quantitative PCR and western blotting. The production of cortisol, corticosterone, and progesterone was assessed by hormone assay kits. MAIN RESULTS AND THE ROLE OF CHANCE hCG administration upregulated the expression of hydroxysteroid 11-beta dehydrogenase 1 (HSD11B1), nuclear receptor subfamily 3 group C member 1 (NR3C1), FKBP prolyl isomerase 5 (FKBP5), and FKBP prolyl isomerase 4 (FKBP4) in human ovulatory follicles and in hGLC (P < 0.05). RU486 and CORT125281 reduced hCG-induced increases in progesterone and cortisol production in hGLC. The expression of genes involved in glucocorticoid receptor signaling, steroidogenesis, and the key ovulatory process was reduced by RU486 and/or CORT125281 in hGLC. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION The role of cortisol/glucocorticoid receptors demonstrated using the hGLC model may not fully reflect their physiological roles in vivo. WIDER IMPLICATIONS OF THE FINDINGS Successful ovulation and luteinization are essential for female fertility. Women with dysregulated cortisol levels often suffer from anovulatory infertility. Deciphering the functional role of glucocorticoid receptor signaling in human periovulatory follicles enhances our knowledge of basic ovarian physiology and may provide therapeutic insights into treating infertility in women. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by P01HD71875 (to M.J., T.E.C., and M.B.) and R01HD096077 (to M.J.) from the Foundation for the National Institutes of Health and the BTPSRF of the University of Kentucky Markey Cancer Center (P30CA177558). The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- H Jeon
- Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, KY, USA
- Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Y Choi
- Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - M Brännström
- Department of Obstetrics and Gynecology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Stockholm IVF, Stockholm, Sweden
| | - J W Akin
- Bluegrass Fertility Center, Lexington, KY, USA
| | - T E Curry
- Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - M Jo
- Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, KY, USA
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Hedman M, Doolan-Noble F, Stokes T, Brännström M. Doctors' experiences of providing care in rural hospitals in Southern New Zealand: a qualitative study. BMJ Open 2022; 12:e062968. [PMID: 36600351 PMCID: PMC9730364 DOI: 10.1136/bmjopen-2022-062968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore rural hospital doctors' experiences of providing care in New Zealand rural hospitals. DESIGN The study had a qualitative design, using qualitative content analysis. SETTING The study was conducted in South Island, New Zealand, and included nine different rural hospitals. RESPONDENTS Semistructured interviews were conducted with 16 rural hospital doctors. RESULTS Three themes were identified: 'Applying a holistic perspective in the care', 'striving to maintain patient safety in sparsely populated areas' and 'cooperating in different teams around the patient'. Rural hospital care more than general hospital care was seen as offering a holistic perspective on patient care based on closeness to their home and family, the generalist perspective of care and personal continuity. The presentation of acute life-threatening low-frequency conditions at rural hospitals were associated with feelings of concern due to limited access to ambulance transportation and lack of experience.Overall, however, patient safety in rural hospitals was considered equal or better than in general hospitals. Doctors emphasised the central role of rural hospitals in the healthcare pathways of rural patients, and the advantages and disadvantages with small non-hierarchical multidisciplinary teams caring for patients. Collaboration with hospital specialists was generally perceived as good, although there was a sense that urban colleagues do not understand the additional medical and practical assessments needed in rural compared with the urban context. CONCLUSIONS This study provides an understanding of how rural hospital doctors value the holistic generalist perspective of rural hospital care, and of how they perceive the quality and safety of that care. The long distances to general hospital care for acute cases were considered concerning.
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Affiliation(s)
- Mante Hedman
- Public Health and Clinical Medicine, Umea University, Umeå, Sweden
| | - Fiona Doolan-Noble
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
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Van der Kolk WL, Van der Zee AGJ, Slomovitz BM, Baldwin PJW, Van Doorn HC, De Hullu JA, Van der Velden J, Gaarenstroom KN, Slangen BFM, Kjolhede P, Brännström M, Vergote I, Holland CM, Coleman R, Van Dorst EBL, Van Driel WJ, Nunns D, Widschwendter M, Nugent D, DiSilvestro PA, Mannel RS, Tjiong MY, Boll D, Cibula D, Covens A, Provencher D, Runnebaum IB, Monk BJ, Zanagnolo V, Tamussino K, Oonk MHM. Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe. Gynecol Oncol 2022; 167:3-10. [PMID: 36085090 DOI: 10.1016/j.ygyno.2022.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN. METHODS We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up. RESULTS Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was diagnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor ≥30 mm. Bilateral radiotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence. CONCLUSION The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases.
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Affiliation(s)
- W L Van der Kolk
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A G J Van der Zee
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - B M Slomovitz
- Mount Sinai Medical Center, Miami Beach, FL, United States of America
| | - P J W Baldwin
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - H C Van Doorn
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A De Hullu
- Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - B F M Slangen
- Maastricht University Medical Center+, Maastricht, the Netherlands
| | | | - M Brännström
- Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - I Vergote
- Leuven Cancer Institute, Leuven, Belgium
| | - C M Holland
- Manchester University NHS Foundation Trust-St Marys Hospital, Manchester, United Kingdom
| | - R Coleman
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | | | - W J Van Driel
- Center of Gynecological Oncology Amsterdam, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - D Nunns
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - M Widschwendter
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, University Innsbruck, Austria
| | - D Nugent
- Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, United Kingdom
| | - P A DiSilvestro
- Women and Infants Hospital of Rhode Island, Providence, RI, United States of America
| | - R S Mannel
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States of America
| | - M Y Tjiong
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - D Boll
- Catharina Ziekenhuis Eindhoven, the Netherlands
| | - D Cibula
- First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - A Covens
- University of Toronto, Toronto, Ontario, Canada
| | - D Provencher
- CHUM, Université de Montréal, Montréal, Quebec, Canada
| | - I B Runnebaum
- Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - B J Monk
- St Josephs Hospital and Medical Center, Phoenix, AZ, United States of America
| | - V Zanagnolo
- Department of Obstetrics and Gynaecology, European Cancer Institute, Milan, Italy
| | | | - M H M Oonk
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Grönlund CF, Brännström M. Postgraduate nursing students' experiences of practicing ethical communication. Nurs Ethics 2022; 29:1709-1720. [PMID: 35773019 DOI: 10.1177/09697330221109943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ethics communication has been described as a pedagogical form, promoting development of ethical competence among nursing students. The 'one to five method' was developed by this research group as a tool for facilitating ethical communication in groups among healthcare professionals but has not yet been evaluated. AIM To explore post-graduate nursing students' experiences of practicing ethical communication in groups. RESEARCH DESIGN The study design is qualitative. PARTICIPANTS AND RESEARCH CONTEXT The study comprised 12 nursing students on a post-graduate course for Registered Nurses focusing on palliative care. After education the students engaged as participants and facilitators in ethics communication in groups, with support from the 'one to five method'. Data were derived from the students written reflections and subjected to thematic analysis. ETHICAL CONSIDERATIONS The study was performed in accordance with the ethical standards in the 2013 Helsinki Declaration and approved by the Ethics Committee of the Medical Faculty at Umeå University. RESULTS An overall theme was identified, 'being supported to achieve a democratic dialogue concerning ethical problems' and five themes, related to each step of the 'one to five method'. The themes concerned: putting the experience of an ethical dilemma into words; being confirmed by shared emotions; defining the value conflict using ethical principles; expressing virtues of empathy and raised awareness; jointly finding various action approaches. DISCUSSION Regular ethics communication in groups encourages nursing students to actively seek understanding and clarification of ethically difficult situations. CONCLUSIONS The results indicate that ethics communication in groups could be a way of developing virtues during education. Interventions using the 'one to five method' need to be further studied among student groups from other healthcare contexts.
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Granat L, Andersson S, Hadziabdic E, Brännström M, Sandgren A. Translation, adaptation, and validation of the Self-efficacy in Palliative Care scale (SEPC) for use in Swedish healthcare settings. Palliat Care 2022; 21:48. [PMID: 35410328 PMCID: PMC8995693 DOI: 10.1186/s12904-022-00940-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 04/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background One challenge for healthcare professionals when delivering palliative care can be their lack of confidence. The Self-efficacy in Palliative Care Scale (SEPC) is considered a valid and reliable assessment scale to evaluate confidence when delivering palliative care. Currently, there is not a reliable instrument aimed to measure healthcare professionals’ confidence in palliative care in Swedish. Therefore, this study aimed to translate, culturally adapt, and validate the SEPC-scale for use in a Swedish healthcare context. Methods This study applied the World Health Organization’s (WHO) guidelines for translating and adapting instruments, using forward and back-translation, an expert panel, and cognitive interviews. Swedish experts in palliative care (n = 6) assessed the Swedish version of the SEPC-scale based on its relevance, understandability, clarity, and sensitivity on a Likert scale. Methods involved calculation of content validity index (CVI) with modified kappa statistics and cognitive interviewing with healthcare professionals (n = 10) according to the “think-aloud” method. Results Calculation of I-CVI (Item-CVI) showed that the Swedish SEPC-scale was considered relevant but needed some modifications to improve its understandability and clarity. The experts recognized an absence of precision in some items that affected clarity and understanding. Likewise, the healthcare professionals highlighted some challenges with understandability and clarity. They indicated that the scale was relevant, but a few items needed adjustment to fit a broader range of healthcare professionals. Items that referred to death and dying could be sensitive but were considered relevant. Conclusions The SEPC-scale is considered valid for use in Swedish healthcare practice, for a broad range of healthcare professionals, and for diagnoses other than cancer. This study shows that cultural adaptation is necessary for establishing relevance and enabling acceptance to various healthcare professionals and contexts in the target country.
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Affiliation(s)
- Lisa Granat
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, 351 95, Växjö, Sweden.
| | - Sofia Andersson
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, 351 95, Växjö, Sweden
| | - Emina Hadziabdic
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, 351 95, Växjö, Sweden
| | | | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, 351 95, Växjö, Sweden
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Öhlén J, Böling S, HamdanAlshehri H, Brännström M, Henoch I, Hessman E, Nilsson S, Ozanne A. Strategies for knowledge translation of a palliative approach outside specialized palliative care services: a scoping review. Palliat Care 2022; 21:39. [PMID: 35317795 PMCID: PMC8939083 DOI: 10.1186/s12904-022-00929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Research suggests palliative care to be translated and integrated in non-specialized palliative care services throughout the palliative care continuum across populations and settings. A need has been identified to build on the existing research literature in order to design strong knowledge translation strategies that can be evaluated in future research. The aim was to map strategies for knowledge translation of a palliative approach to care into non-specialized palliative care services for adult patients. The objectives were to explore the primary research activities, the specific type of knowledge translation strategies used, the research designs and study settings for such evaluations along with the major results thereof, and to identify major research gaps in this area. Methods A scoping review was performed to map the volume and characteristics of research literature (project registered in PROSPERO #2018 CRD42018100663). The ten-year period 2010 to 2019 was searched in six major databases for original articles published in English in which the knowledge translation of a palliative approach for adult patients was evaluated in non-specialized palliative healthcare settings, and all type of empirical data-based research designs. We excluded non-English, non-empirical articles, non-evaluation of knowledge translations, specialized palliative care settings, and other types of publications (i.e. non-original articles). Results Most of the 183 included articles focused on patients with cancer who were dying in hospitals and in high income countries. Only 13 articles focused on early palliative care. A palette of different strategies was used to implement palliative care in non-specialist palliative settings; no strategy was identified as outstanding. The majority of the articles had unspecified essential components of the research designs. Conclusion Previous suggestions for utilization of implementation science for knowledge translation of a palliative approach to care into non-specialized palliative care services are confirmed, and established knowledge translation theories can strengthen the field. To advance this specific field of knowledge, meticulously detailed reporting of studies is required as related to research designs, clarifications of contextual influences and mechanisms at work. Specific systematic reviews and meta-syntheses in the field are merited. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00929-0.
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Affiliation(s)
- Joakim Öhlén
- University of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences and Centre for Person-Centred Care, and Palliative Centre at the Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
| | - Susanna Böling
- University of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden.
| | - Hanan HamdanAlshehri
- University of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden.,Princess Nourah, Bint Abdulrahman University, Medical-Surgical Department of Nursing College, Riyadh, Saudi Arabia
| | | | - Ingela Henoch
- University of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden
| | - Eva Hessman
- University of Gothenburg, Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Nilsson
- University of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care (GPCC), Gothenburg, Sweden
| | - Anneli Ozanne
- University of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Crona Guterstam Y, Bister J, Strunz B, Dumitrescu B, Haij Bhattarai K, Özenci V, Brännström M, Ivarsson M, Gidlöf S, Björkström N. 330 Human endometrial mait cells are transiently tissue resident and respond to neisseria gonorrhoeae. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fischer-Grönlund C, Brännström M. The Swedish translation and cultural adaptation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). BMC Med Ethics 2021; 22:151. [PMID: 34772400 PMCID: PMC8588668 DOI: 10.1186/s12910-021-00722-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Moral distress has been described as an emotionally draining condition caused by being prevented from providing care according to one's convictions. Studies have described the impact of moral distress on healthcare professionals, their situations and experiences. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team. The aim of this project was to translate and make a cultural adaption of the MMD -HP to the Swedish context. METHODS The questionnaire comprises 27 items, rated according to frequency and intensity on a five-point Likert scale (0-4). The procedure for translating MMD-HP followed WHO guidelines (2020). These entailed a forward translation from English to Swedish, a back translation, expert panel validation, pretesting and cognitive face-to-face interviews with 10 healthcare professionals from various professions and healthcare contexts. RESULTS The Swedish version of MMD-HP corresponds essentially to the concept of the original version. Parts of some items' had to be adjusted or removed in order to make the item relevant and comprehensible in a Swedish context. Overall, the cognitive interviewees recognized the content of the items which generally seemed relevant and comprehensible. CONCLUSION The Swedish version of MMD-HP could be a useful tool for measuring moral distress among healthcare professionals in a Swedish healthcare context.
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Abstract
Purpose Informal carers have an important role in society through their care and support of their long-term ill relatives. Providing informal care is challenging and can lead to caregiver burden; moreover, many support needs of the carers are not met, leading to confusion, disappointment and frustration. We conducted an interview study to clarify the meaning of support given and received by informal carers to relatives with chronic obstructive pulmonary disease or chronic heart failure. Methods We purposively selected and recruited informants via participants in another study, thereby conducting interviews over the phone from June 2016 to May 2017. In total, we conducted 14 interviews with 12 informants. All interviews were transcribed verbatim and the content was analysed using a phenomenological hermeneutical approach. Result and conclusion Our comprehensive understanding of the meaning of support for these carers is twofold: it is a self-evident struggle for the good life of their relatives and that they want to be carers in partnership. The healthcare system must recognize the efforts of carers and include them in the strategic planning and operational stages of care and treatment for people with long-term illness.
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Affiliation(s)
- Elin Blanck
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Research and Development Primary Health Care, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Psychiatric Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margareta Brännström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Nursing, Umeå University, Campus Skellefteå, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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13
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Andersson S, Martinsson L, Fürst CJ, Brännström M. End-of-life discussions in residential care homes improves symptom control: a national register study. BMJ Support Palliat Care 2021:bmjspcare-2021-002983. [PMID: 34162583 DOI: 10.1136/bmjspcare-2021-002983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In Europe, residential care homes (RCHs) rather than hospitals are the most common care facilities for the older adult and the place where most deaths occur in this age group. There is a lack of knowledge regarding end-of-life (EOL) discussions and how they correlate with symptoms and symptom relief. OBJECTIVE The aim was to examine the correlation between EOL discussions and symptom occurrence, symptom relief and prescriptions or PRN drugs against symptoms for care home residents. METHODS All expected deaths at RCHs from 1 October 2015 to 31 December 2016 and registered in the Swedish Register of Palliative Care were included. Univariate and multivariate logistic regression were used to compare the RCH residents, or their family members, who had received documented EOL discussions with a physician (the EOL discussion group) and the non-EOL discussion group. RESULTS The EOL discussion group (n=17 071) had a higher prevalence of pain, nausea, anxiety, death rattles and shortness of breath reported, compared with the non-EOL discussion group (n=4164). Those with symptoms were more often completely relieved and had more often been prescribed PRN drugs against that symptom in the EOL discussion group. All differences remained significant when adjusting for age, time living in unit and cause of death. CONCLUSION The results indicate that EOL discussions are correlated with higher prevalence of symptoms, but also with better symptom relief and prescription of symptom drugs PRN when symptomatic. A possible explanation for this is that the EOL discussion can work as an opportunity to discuss symptoms and treatment for symptom relief.
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Affiliation(s)
| | - Lisa Martinsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Carl Johan Fürst
- The Institute for Palliative Care, Lund University and Skåne Regional Council, Lund, Sweden
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14
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Årestedt K, Brännström M, Evangelista LS, Strömberg A, Alvariza A. Palliative key aspects are of importance for symptom relief during the last week of life in patients with heart failure. ESC Heart Fail 2021; 8:2202-2209. [PMID: 33754461 PMCID: PMC8120384 DOI: 10.1002/ehf2.13312] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 01/05/2023] Open
Abstract
AIMS This study aimed to describe symptom prevalence of pain, shortness of breath, anxiety, and nausea and to identify factors associated with symptom relief in patients with heart failure during their last week of life. METHODS AND RESULTS This nationwide study used data from the Swedish Register of Palliative Care and the Swedish Causes of Death Certificate Register. The sample included 4215 patients with heart failure as the underlying cause of death. Descriptive statistics and logistic regression were used to analyse data. Pain was the most prevalent symptom (64.0%), followed by anxiety (45.1%), shortness of breath (28.8%), and nausea (11.4%). Pain was the most often totally relieved (77.5%), followed by anxiety (68.4%), nausea (54.7%), and shortness of breath (37.1%). Key aspects of palliative care such as documented palliative care in the patient record, individual medication prescriptions by injection, symptom assessment with validated scales, documented end-of-life discussions with patients and/or family members, and external consultation were significantly associated with symptom relief. Relief of pain, shortness of breath, anxiety, and nausea were significantly better managed in nursing homes and hospice/inpatient palliative care compared with care in hospitals. CONCLUSIONS The results show that key aspects of palliative care during the last week of life are significantly associated with symptom relief. Increased access to palliative care could provide a way to improve care during the last week of life for patients with heart failure. Home-based settings provided more symptom relief than hospitals, which may indicate that the latter focuses on treatments and saving lives rather than promoting life before death.
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Affiliation(s)
- Kristofer Årestedt
- Faculty of Health and Life SciencesLinnaeus UniversityKalmarSE‐39182Sweden
- The Research SectionKalmar County CouncilKalmarSweden
| | | | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences and Department of CardiologyLinköping UniversityLinköpingSweden
- Department of CardiologyLinköping UniversityLinköpingSweden
| | - Anette Alvariza
- Department of Health Care Sciences & Palliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
- Capio Palliative CareDalen HospitalStockholmSweden
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15
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Zakerkish F, Soriano MJ, Novella-Mestre E, Brännström M, Díaz-García C. Differential effects of the immunosuppressive calcineurin inhibitors cyclosporine-A and tacrolimus on ovulation in a murine model. Hum Reprod Open 2021; 2021:hoab012. [PMID: 33997300 PMCID: PMC8111498 DOI: 10.1093/hropen/hoab012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/22/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Do therapeutic levels of cyclosporine-A and tacrolimus affect ovulation in a rat gonadotrophin-induced ovulation model? SUMMARY ANSWER Cyclosporine-A, but not tacrolimus, decreases ovulation rate when administered for 5 days before induced ovulation. WHAT IS KNOWN ALREADY The mainstays of immunosuppression in solid organ transplantation, to prevent rejection, are the calcineurin inhibitors cyclosporine-A or tacrolimus. These drugs could potentially affect fertility in transplanted patients. Since ovulation is an inflammation-like process with pivotal roles for several immune cells and modulators, it is possible that the calcineurin inhibitors, with broad effects on the immune system, could interfere with this sensitive, biological process. STUDY DESIGN, SIZE, DURATION Experimental design at university-based animal facilities. A total of 45 immature Sprague–Dawley rats were used. The study was carried out over 3 months. PARTICIPANTS/MATERIALS, SETTING, METHODS Immature Sprague–Dawley rats (n = 45) were randomly assigned to receive equivalent doses of tacrolimus (0.5 mg/kg/day; TAC), cyclosporine-A (10 mg/kg/day; CyA) or vehicle (Control). Ovarian hyperstimulation was induced with 10 IU of equine chorionic gonadotrophin, and ovulation was triggered with 10 IU of hCG. Oocytes were retrieved from the oviducts and ovulation rates were calculated. Various subpopulations of white blood cells were counted in peripheral blood and ovarian tissue samples. MAIN RESULTS AND THE ROLE OF CHANCE Animals in the CyA group showed a lower ovulation rate when compared to the TAC and Control groups (CyA: mean 9 oocytes (range 0–22); TAC: 21 oocytes (8–41); Control: 22 oocytes (6–39); P = 0.03). Regarding counts of the white blood cell subpopulations and resident neutrophils in the ovary, no significant differences were observed between the groups. LIMITATIONS, REASONS FOR CAUTION Although the ovulation process is highly conserved within species, the differences between rodents and humans may limit the external translatability of the study. WIDER IMPLICATIONS OF THE FINDINGS These findings suggest that tacrolimus should be the preferred calcineurin inhibitor of choice in transplanted patients who are aiming for pregnancy. STUDY FUNDING/COMPETING INTEREST(S) Swedish Research Council and ALF of Sahlgrenska Academy, Sweden. Rio Hortega Grant from the Instituto de Salud Carlos III, Spain (CM09/00063). There are no conflicts of interest.
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Affiliation(s)
- F Zakerkish
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M J Soriano
- Reproductive Medicine Research Group, IIS La Fe, Valencia, Spain
| | - E Novella-Mestre
- Reproductive Medicine Research Group, IIS La Fe, Valencia, Spain
| | - M Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - C Díaz-García
- Reproductive Medicine Research Group, IIS La Fe, Valencia, Spain
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16
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Hedman M, Boman K, Brännström M, Wennberg P. Clinical profile of rural community hospital inpatients in Sweden - a register study. Scand J Prim Health Care 2021; 39:92-100. [PMID: 33569976 PMCID: PMC7971215 DOI: 10.1080/02813432.2021.1882086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Patients in Sweden's rural community hospitals have not been clinically characterised. We compared characteristics of patients in general practitioner-led community hospitals in northern Sweden with those admitted to general hospitals. DESIGN Retrospective register study. SETTING Community and general hospitals in Västerbotten and Norrbotten counties, Sweden. PATIENTS Patients enrolled at community hospitals and hospitalised in community and general hospitals between 1 January 2010 and 31 December 2014. OUTCOME MEASURES Age, sex, number of admissions, main, secondary and total number of diagnoses. RESULTS We recorded 16,133 admissions to community hospitals and 60,704 admissions to general hospitals. Mean age was 76.8 and 61.2 years for community and general hospital patients (p < .001). Women were more likely than men to be admitted to a community hospital after age adjustment (odds ratio (OR): 1.11; 95% confidence interval (CI): 1.09-1.17). The most common diagnoses in community hospital were heart failure (6%) and pneumonia (5%). Patients with these diagnoses were more likely to be admitted to a community than a general hospital (OR: 2.36; 95% CI: 2.15-2.59; vs. OR: 3.32: 95% CI: 2.77-3.98, respectively, adjusted for age and sex). In both community and general hospitals, doctors assigned more diagnoses to men than to women (both p<.001). CONCLUSIONS Patients at community hospitals were predominantly older and women, while men were assigned more diagnoses. The most common diagnoses were heart failure and pneumonia. Our observed differences should be further explored to define the optimal care for patients in community and general hospitals.Key pointsThe patient characteristics at Swedish general practitioner-led rural community hospitals have not yet been reported. This study characterises inpatients in community hospitals compared to those referred to general hospitals.• Patients at community hospitals were predominantly older, with various medical conditions that would have led to a referral to general hospitals elsewhere in Sweden. • Compared to men, women were more likely to be admitted to community hospitals than to general hospitals, even after adjustment for age. To the best of our knowledge, this pattern has not been reported in other countries with community hospitals. • In both community hospitals and general hospitals, doctors assigned more diagnoses to men than to women.
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Affiliation(s)
- Mante Hedman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- CONTACT Mante Hedman Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kurt Boman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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17
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Fischer-Grönlund C, Brännström M, Zingmark K. The 'one to five' method - A tool for ethical communication in groups among healthcare professionals. Nurse Educ Pract 2021; 51:102998. [PMID: 33639607 DOI: 10.1016/j.nepr.2021.102998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
Healthcare professionals have expressed a wish for facilitated inter-professional communications about ethical difficulties experienced in clinical practice. The introduction of an easily accessible method for facilitating ethical communication in groups may promote its implementation in everyday clinical practice. The aim of this paper was to draw on previous studies and available knowledge in order to develop and describe a method that enables systematic implementation of inter-professional ethical communication in groups. The 'one-to-five method' for facilitated ethical communication in groups is theoretically inspired by Habermas's theory of communicative actions and base on previous studies that accords with the Helsinki Declaration (2013). The 'one to five method' supports guidance of ethical communication in five steps: telling the story about the situation; reflections and dialogue concerning the emotions involved; formulation of the problem/dilemma; analysis of the situation and the dilemma; and searching for a choice of action or approach. It offers an easily accessible method for teaching healthcare professionals how to facilitate ethics communication groups. Educating facilitators closely connected to clinical work may lead to ethical dialogue becoming a natural part of clinical practice for healthcare professionals.
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Affiliation(s)
| | | | - Karin Zingmark
- Department of Health Science, Division of Nursing, Luleå University of Technology, Sweden.
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18
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Tiemann TT, Padma AM, Sehic E, Bäckdahl H, Oltean M, Song MJ, Brännström M, Hellström M. Towards uterus tissue engineering: a comparative study of sheep uterus decellularisation. Mol Hum Reprod 2021; 26:167-178. [PMID: 31980817 PMCID: PMC7103571 DOI: 10.1093/molehr/gaaa009] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/06/2019] [Indexed: 02/06/2023] Open
Abstract
Uterus tissue engineering may dismantle limitations in current uterus transplantation protocols. A uterine biomaterial populated with patient-derived cells could potentially serve as a graft to circumvent complicated surgery of live donors, immunosuppressive medication and rejection episodes. Repeated uterine bioengineering studies on rodents have shown promising results using decellularised scaffolds to restore fertility in a partially impaired uterus and now mandate experiments on larger and more human-like animal models. The aim of the presented studies was therefore to establish adequate protocols for scaffold generation and prepare for future in vivo sheep uterus bioengineering experiments. Three decellularisation protocols were developed using vascular perfusion through the uterine artery of whole sheep uteri obtained from slaughterhouse material. Decellularisation solutions used were based on 0.5% sodium dodecyl sulphate (Protocol 1) or 2% sodium deoxycholate (Protocol 2) or with a sequential perfusion of 2% sodium deoxycholate and 1% Triton X-100 (Protocol 3). The scaffolds were examined by histology, extracellular matrix quantification, evaluation of mechanical properties and the ability to support foetal sheep stem cells after recellularisation. We showed that a sheep uterus can successfully be decellularised while maintaining a high integrity of the extracellular components. Uteri perfused with sodium deoxycholate (Protocol 2) were the most favourable treatment in our study based on quantifications. However, all scaffolds supported stem cells for 2 weeks in vitro and showed no cytotoxicity signs. Cells continued to express markers for proliferation and maintained their undifferentiated phenotype. Hence, this study reports three valuable decellularisation protocols for future in vivo sheep uterus bioengineering experiments.
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Affiliation(s)
- T T Tiemann
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden.,Dept. of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden.,Dept. of Gynecology and Obstetrics, University Hospital of Heidelberg, 69120 Heidelberg, Germany
| | - A M Padma
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden.,Dept. of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden
| | - E Sehic
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden.,Dept. of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden
| | - H Bäckdahl
- Bioscience and Materials-Medical Device Technology, RISE Research Institutes of Sweden, PO Box 857, 50115 Borås, Sweden
| | - M Oltean
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden.,Dept. of Transplantation Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30 Sweden
| | - M J Song
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden.,Dept. of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden.,Division of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - M Brännström
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden.,Dept. of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden.,Stockholm IVF-EUGIN, Hammarby allé 93, 120 63 Stockholm, Sweden
| | - M Hellström
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden.,Dept. of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden
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19
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Holmlund L, Brännström M, Lindmark K, Sandberg C, Hellström Ängerud K. Health-related quality of life in patients with heart failure eligible for treatment with sacubitril-valsartan. Nurs Open 2020; 7:556-562. [PMID: 32089852 PMCID: PMC7024611 DOI: 10.1002/nop2.420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/07/2019] [Accepted: 11/01/2019] [Indexed: 12/11/2022] Open
Abstract
Aim To describe and compare self‐reported health‐related quality of life between younger and older patients with severe heart failure eligible for treatment with sacubitril–valsartan and to explore the association between health‐related quality of life and age, NYHA classification, systolic blood pressure and NT‐proBNP level. Design Cross‐sectional study. Methods A total of 59 patients, eligible for treatment with sacubitril–valsartan were consecutively included and divided into a younger (≤75 years) and older group (>75 years). Health‐related quality of life was assessed using the Kansas City Cardiomyopathy Questionnaire and the EuroQol 5‐dimensions. Data were collected between June 2016 and January 2018. The STROBE checklist was used. Results There were no differences in overall health‐related quality of life between the age groups. The older patients reported lower scores in two domains measured with the Kansas City Cardiomyopathy Questionnaire, namely self‐efficacy (67.0 SD 22.1 vs. 78.8 SD 19.7) and physical limitation (75.6 SD 19.0 vs. 86.3 SD 14.4). Higher NYHA class was independently associated with lower Kansas City Cardiomyopathy Questionnaire Overall Summary Score.
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Affiliation(s)
| | | | - Krister Lindmark
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Camilla Sandberg
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
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20
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Forslund M, Landin-Wilhelmsen K, Trimpou P, Schmidt J, Brännström M, Dahlgren E. Type 2 diabetes mellitus in women with polycystic ovary syndrome during a 24-year period: importance of obesity and abdominal fat distribution. Hum Reprod Open 2020; 2020:hoz042. [PMID: 31976382 PMCID: PMC6964225 DOI: 10.1093/hropen/hoz042] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/10/2019] [Indexed: 12/16/2022] Open
Abstract
STUDY QUESTION What are the predictive factors for later development of type 2 diabetes (T2DM) in women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Obesity and abdominal fat distribution in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24 years later when lifestyle factors were similar to controls. WHAT IS KNOWN ALREADY Women with PCOS have an increased prevalence of T2DM. STUDY DESIGN SIZE DURATION A longitudinal and cross-sectional study was performed. Women with PCOS were examined in 1992 and in 2016. Randomly selected, age-matched women from the general population served as controls. PARTICIPANTS/MATERIALS SETTING METHODS Women with PCOS (n = 27), attending an outpatient clinical at a tertiary care centre for infertility or hirsutism were diagnosed in 1992 (mean age 30 years) and re-examined in 2016 (mean age 52 years). Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease (WHO MONICA-GOT) 2008, aged 38-68 years, served as controls (n = 94), and they were previously examined in 1995. At both at baseline and at follow-up, women had blood samples taken, underwent a clinical examination and completed structured questionnaires, and the women with PCOS also underwent a glucose clamp test at baseline. MAIN RESULTS AND THE ROLE OF CHANCE None of women with PCOS had T2DM at baseline. At the 24-year follow-up, 19% of women with PCOS had T2DM versus 1% of controls (P < 0.01). All women with PCOS who developed T2DM were obese and had waist-hip ratio (WHR) >0.85 at baseline. No difference was seen between women with PCOS and controls regarding use of high-fat diet, Mediterranean diet or amount of physical activity at follow-up at peri/postmenopausal age. However, women with PCOS had a lower usage of a high-sugar diet as compared to controls (P = 0.01). The mean increases in BMI and WHR per year were similar in women with PCOS and controls during the follow-up period. LIMITATIONS REASONS FOR CAUTION The small sample size of women with PCOS and the fact that they were recruited due to infertility or hirsutism make generalization to women with milder forms of PCOS uncertain. WIDER IMPLICATIONS OF THE FINDINGS Obesity and abdominal fat distribution, but not hyperandrogenism per se, in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24 years later when peri/postmenopausal. Lifestyle factors were similar to controls at that time. STUDY FUNDING/COMPETING INTERESTS The study was financed by grants from the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement (ALFGBG-718611), the Gothenburg Medical Association GLS 694291 and 780821, the Swedish Heart Lung Foundation and Hjalmar Svensson Foundation. The authors have no conflict of interest.
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Affiliation(s)
- M Forslund
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, 413 45 Gothenburg, Sweden
| | - K Landin-Wilhelmsen
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.,Section for Endocrinology, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden
| | - P Trimpou
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.,Section for Endocrinology, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden
| | - J Schmidt
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - M Brännström
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, 413 45 Gothenburg, Sweden
| | - E Dahlgren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, 413 45 Gothenburg, Sweden
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21
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Nilsson S, Ohlen J, Hessman E, Brännström M. Paediatric palliative care: a systematic review. BMJ Support Palliat Care 2019; 10:157-163. [PMID: 31836595 DOI: 10.1136/bmjspcare-2019-001934] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To review literature relating to evidence, context and facilitation to describe knowledge translation in paediatric palliative care. Paediatric palliative care requires competences including both paediatric specialists as well as services that are developed for this purpose, and there is a need to facilitate paediatric palliative care knowledge translation. Promoting Action on Research Implementation in the Health Services (PARiHS) is a framework for knowledge translation, which highlights the relationships between evidence, context and facilitation. PARiHS framework has been revised and updated in a new version called i-PARiHS. METHODS The electronic databases AgeLine, CINAHL, The Cochrane Library, PsycINFO, PubMed and Scopus were searched. Papers included were limited to English and Swedish publications and restricted to publications dated between 1993 and August 2019. All types of observational and experimental studies using any research design were included. RESULTS AND CONCLUSIONS Thirty-eight articles were included and there was a common vision about how and when palliative care should be offered to children. The i-PARiHS was used as a lens to describe the knowledge translation in paediatric palliative care. Symptom relief was the most commonly described evidence-based strategy, and the hospital environment was the most commonly described context. Different types of education were the most commonly used strategies to facilitate knowledge translation. The results mainly focused on increasing knowledge of palliative care in paediatric care. To sum up, the results report strategies to achieve knowledge translation of paediatric palliative care, and these can be interpreted as a guideline for how this process can be facilitated. TRIAL REGISTRATION NUMBER CRD42018100663.
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Affiliation(s)
- Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .,University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Ohlen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital Västra Götaland, Gothenburg, Sweden
| | - Eva Hessman
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Brännström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Nursing, Umeå University, Campus Skellefteå, Umeå, Sweden
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Andersson S, Lindqvist O, Fürst CJ, Brännström M. Family members' experiences of care of the dying in residential care homes where the Liverpool Care Pathway was used. Int J Palliat Nurs 2019; 24:194-202. [PMID: 29703112 DOI: 10.12968/ijpn.2018.24.4.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Residential care homes (RCHs) are increasingly becoming a common place of death for older people. AIM The aim of this study was to describe family members' experiences of care of the dying in RCHs where the Liverpool care pathway for the dying patient was used. METHODS This study had a descriptive qualitative study design. Fifteen (n=15) individual interviews were analysed using qualitative content analysis. RESULTS The analysis resulted in three themes: being confident in a familiar and warm atmosphere, being involved vs not being involved in end-of-life (EoL) care, and being consoled by witnessing the health professional's endeavour to relieve suffering. SIGNIFICANCE OF RESULTS The results indicated that taking part in a care plan seems to increase family members' feelings of involvement in EoL care. This study also highlights the family members' needs for increased possibilities for EoL discussions with the GP.
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Affiliation(s)
- Sofia Andersson
- Registered Nurse, PhD student, Department of Nursing, Umeå University, Umeå, Sweden
| | - Olav Lindqvist
- Registered Nurse, Senior lecturer, Department of Nursing, Umeå University; Department of Learning, Informatics, Management and Ethics/Division of Innovative Care, Karolinska Institutet, Stockholm, Sweden
| | - Carl-Johan Fürst
- Professor, The Institute for Palliative Care, Faculty of Medicine, Department of Clinical Science, Lund University and Region Skåne, Lund, Sweden
| | - Margareta Brännström
- Registered Nurse, Associate Professor, Senior lecturer, Department of Nursing, Umeå; The Arctic Research Centre, Umeå University; Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University
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23
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Brucker SY, Taran FA, Rall K, Schöller D, Dahm-Kâhler P, Kvarnström N, Järvholm S, Nadalin S, Königsrainer A, Wallwiener D, Brännström M. Experiences of a multistep process with medical and psychological interventions for patients with congenital uterine aplasia to achieve motherhood: the Gothenburg-Tübingen collaboration. Facts Views Vis Obgyn 2019; 11:121-126. [PMID: 31824633 PMCID: PMC6897517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Congenital uterine aplasia, also known as Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) is a condition associated to a non-functional uterus in the presence of functional ovaries. In a setting where surrogacy is illegal (or not accepted) and adoption is the only alternative, neovaginoplasty and subsequent uterus transplantation (UTx) can provide a route to motherhood for women with MRKHS. This review article describes a multistep process by which patients with MRKHS can achieve motherhood with their own biological child. This process involving a careful clinical diagnosis, psychological counselling, assessment of eligibility for neovagina creation and UTx, the surgical treatment, fertility treatment, and long-term follow-up was developed at the Tübingen University Hospital and in close collaboration with Sahlgrenska Academy, University of Gothenburg, Sweden, where the basic experimental and clinical groundwork for UTx was laid and the first-ever UTx procedure was performed.
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Affiliation(s)
- SY Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - F-A Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - K Rall
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - D Schöller
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - P Dahm-Kâhler
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - N Kvarnström
- Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - S Järvholm
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - S Nadalin
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - D Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - M Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden,Stockholm IVF, Stockholm, Sweden
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24
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Brännström M, Fischer Grönlund C, Zingmark K, Söderberg A. Meeting in a ‘free-zone’: Clinical ethical support in integrated heart-failure and palliative care. Eur J Cardiovasc Nurs 2019; 18:577-583. [DOI: 10.1177/1474515119851621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Integrating heart-failure and palliative care combines expertise from two cultures, life-saving cardiology and palliative care, and involves ethically difficult situations that have to be considered from various perspectives. We found no studies describing experiences of clinical ethical support (CES) in integrated cardiology and palliative care teams. Objective: Our aim is to describe experiences of CES among professionals after a period of three years working in a multidisciplinary team in integrated heart-failure and palliative homecare. Method: The study design was descriptive qualitative, comprising interviews with seven professionals from one integrated heart-failure and palliative care team who received CES over a three-year period. The interview data were subjected to qualitative content analysis. Results: The CES was found to offer possibilities for meeting in an ethical ‘free-zone’ where the participants could relate to each other beyond their various professional roles and specialties. The trust within the team seemed to increase and the participants were confident enough to express their points of view. Together they developed an integrated understanding, and acquired more knowledge and a comprehensive view of the ethically difficult situation of concern. The CES sessions were considered a means of becoming better prepared to deal with ethical care issues and developing action strategies to apply in practice, from shared standpoints. Conclusion: Participating in CES was experienced as meeting in an ethical ‘free-zone’ and seemed to be a means of facilitating integration of palliative and heart-failure care.
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Affiliation(s)
- Margareta Brännström
- Department of Nursing, Umeå University, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Karin Zingmark
- Department of Health Science, Division of Nursing, Luleå University of Technology & Norrbotten County Council, Sweden
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25
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Ericsson M, Ängerud KH, Brännström M, Lawesson SS, Strömberg A, Thylén I. Interaction between tele-nurses and callers with an evolving myocardial infarction: Consequences for level of directed care. Eur J Cardiovasc Nurs 2019; 18:545-553. [PMID: 31067981 DOI: 10.1177/1474515119848195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rapid contact with emergency medical services is imperative to save the lives of acute myocardial infarction patients. However, many patients turn to a telehealth advisory nurse instead, where the delivery of urgent and safe care largely depends on how the interaction in the call is established. PURPOSE The purpose of this study was to explore the interaction between tele-nurses and callers with an evolving myocardial infarction after contacting a national telehealth advisory service number as their first medical contact. METHOD Twenty men and 10 women (aged 46-89 years) were included. Authentic calls were analysed using inductive content analysis. FINDINGS One overall category, Movement towards directed level of care, labelled the whole interaction between the tele-nurse and the caller. Four categories conceptualised the different interactions: a distinct, reasoning, indecisive or irrational interaction. The interactions described how tele-nurses and callers assessed and elaborated on symptoms, context and actions. The interaction was pivotal for progress in the dialogue and affected the achievement of mutual understanding in the communicative process. An indecisive or irrational interaction could increase the risk of failing to recommend or call for acute care. CONCLUSION The interaction in the communication could either lead or mislead the level of care directed in the call. This study adds new perspectives to the communicative process in the acute setting in order to identify a myocardial infarction and the level of urgency from both individuals experiencing myocardial infarction and professionals in the health system.
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Affiliation(s)
- Maria Ericsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Karin H Ängerud
- Heart Centre, Umeå University, Sweden.,Department of Nursing, Umeå University, Sweden
| | | | - Sofia S Lawesson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingela Thylén
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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26
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Pusa S, Dorell Å, Erlingsson C, Antonsson H, Brännström M, Sundin K. Nurses' perceptions about a web-based learning intervention concerning supportive family conversations in home health care. J Clin Nurs 2019; 28:1314-1326. [PMID: 30554435 PMCID: PMC7328792 DOI: 10.1111/jocn.14745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/27/2018] [Accepted: 12/05/2018] [Indexed: 11/25/2022]
Abstract
Aims and objectives To describe the perceptions that municipal primary healthcare nurses and municipal registered nurses had about a web‐based learning intervention concerning supportive family health conversations in municipal home health care. Background Even though family health conversations are well grounded in theory with several reported benefits for patients and families, most working nurses have little or no training in practising family systems nursing including family health conversations. Continued learning is necessary for nurses, where web‐based learning may be one answer of updating the professional skills and knowledge of nurses regarding supporting families. Design The study used a descriptive design and followed the “Consolidated criteria for reporting qualitative research” (COREQ) checklist. Methods Twenty‐one nurses participated in an educational intervention that consisted of web‐based learning and two face‐to‐face seminars about family systems nursing including family health conversations. The nurses were interviewed after completion, and the audio‐recorded interviews were transcribed verbatim and analysed using qualitative content analysis. Results The findings consist of nurses’ perceptions regarding the disposition of instruction, the prerequisites for learning and a changed approach when working with families. The findings are further reflected on through Illeris’ theory concerning learning triangle. Conclusions The findings are encouraging for educating nurses in family health conversations at their workplace, with the purpose of supporting patients and families. However, it is important to be aware of the different dimensions of learning, in addition to the appraisal of social aspects and organisational circumstances when educating nurses as they influence the utilisation of the knowledge. Relevance to clinical practice This web‐based learning intervention seems to be suitable for educating nurses in family health conversations and could be an appropriate step towards implementing these conversations in home health care with the purpose of supporting families.
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Affiliation(s)
- Susanna Pusa
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Åsa Dorell
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Christen Erlingsson
- Department of Health and Caring Sciences, Linnaes University, Kalmar, Sweden
| | | | - Margareta Brännström
- Department of Nursing, Umeå University, Umeå, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Sundin
- Department of Nursing, Umeå University, Umeå, Sweden
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27
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Andersson S, Årestedt K, Lindqvist O, Fürst CJ, Brännström M. Factors Associated With Symptom Relief in End-of-Life Care in Residential Care Homes: A National Register-Based Study. J Pain Symptom Manage 2018; 55:1304-1312. [PMID: 29305321 DOI: 10.1016/j.jpainsymman.2017.12.489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 12/13/2022]
Abstract
CONTEXT Residential care homes (RCHs) are a common place of death. Previous studies have reported a high prevalence of symptoms such as pain and shortness of breath among residents in the last week of life. OBJECTIVES The aim of the study was to explore the presence of symptoms and symptom relief and identify factors associated with symptom relief of pain, nausea, anxiety, and shortness of breath among RCH residents in end-of-life care. METHODS The data consisted of all expected deaths at RCHs registered in the Swedish Register of Palliative Care (N = 22,855). Univariate and multiple logistic regression analyses were conducted. RESULTS Pain was reported as the most frequent symptom of the four symptoms (68.8%) and the one that most often had been totally relieved (84.7%) by care professionals. Factors associated with relief from at least one symptom were gender; age; time in the RCH; use of a validated pain or symptom assessment scale; documented end-of-life discussions with physicians for both the residents and family members; consultations with other units; diseases other than cancer as cause of death; presence of ulcers; assessment of oral health; and prescribed pro re nata injections for pain, nausea, and anxiety. CONCLUSION Our results indicate that use of a validated pain assessment scale, assessment of oral health, and prescribed pro re nata injections for pain, nausea, and anxiety might offer a way to improve symptom relief. These clinical tools and medications should be implemented in the care of the dying in RCHs, and controlled trials should be undertaken to prove the effect.
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Affiliation(s)
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden; Kalmar County Hospital, Kalmar, Sweden
| | - Olav Lindqvist
- Department of Nursing, Umeå University, Umeå, Sweden; Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden
| | - Carl-Johan Fürst
- Department of Clinical Science, Faculty of Medicine, The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Margareta Brännström
- Department of Nursing, Umeå University, Campus Skellefteå, Umeå, Sweden; The Arctic Research Centre, Umeå University, Umeå, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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28
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Hägglund L, Boman K, Brännström M. A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older. Nurs Open 2018; 5:176-185. [PMID: 29599993 PMCID: PMC5867290 DOI: 10.1002/nop2.127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/29/2017] [Indexed: 01/25/2023] Open
Abstract
Aims and objectives This study aimed to evaluate Tai Chi group training among patients with chronic heart failure (CHF) aged 70 years and older. Background Physical activity is recommended for CHF treatment. Tai Chi is found to be beneficial to different patient groups, although few studies focus on older patients with CHF. Design A mixed methods study. Participants were randomly assigned to Tai Chi training twice a week for 16 weeks (N = 25) or control (N = 20). Quantitative data were collected at baseline, at the end of the training period and 6 months after training, assessing self‐rated fatigue and quality of life, natriuretic peptides and physical performance. Individual qualitative interviews were conducted with participants (N = 10) in the Tai Chi training group. Results No statistical differences between the Tai Chi training group and the control group in quality of life or natriuretic peptides was found. After 16 weeks, the training group tended to rate more reduced activity and the control group rated more mental fatigue. Participants in the training group rated increased general fatigue at follow‐up compared with baseline. Qualitative interviews showed that Tai Chi training was experienced as a new, feasible and meaningful activity. The importance of the leader and the group was emphasized. Improvements in balance were mentioned and there was no physical discomfort. Conclusion Tai Chi was experienced as a feasible and meaningful form of physical exercise for patients with CHF aged over 70 years despite lack of achieved health improvement. Further investigations, using feasibility and meaningfulness as outcome variables seems to be useful.
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Affiliation(s)
| | - Kurt Boman
- Department of Medicine-Geriatric Skellefteå County Hospital Skellefteå Sweden.,Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
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29
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Årestedt K, Alvariza A, Boman K, Öhlén J, Goliath I, Håkanson C, Fürst CJ, Brännström M. Symptom Relief and Palliative Care during the Last Week of Life among Patients with Heart Failure: A National Register Study. J Palliat Med 2018; 21:361-367. [DOI: 10.1089/jpm.2017.0125] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences and Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalens Hospital, Stockholm, Sweden
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå, Sweden
- Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Joakim Öhlén
- Centre for Person-Centred Care and Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ida Goliath
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Håkanson
- Department of Health Care Sciences and Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Carl Johan Fürst
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
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30
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Brännström M, Niederbach C, Rödin AC. Experiences of surviving a cardiac arrest after therapeutic hypothermia treatment. An interview study. Int Emerg Nurs 2018; 36:34-38. [DOI: 10.1016/j.ienj.2017.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 08/29/2017] [Accepted: 09/09/2017] [Indexed: 11/25/2022]
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31
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Tan HK, Tan BK, Tan LK, Olofsson JI, Dahm-Kähler P, Brännström M. Authors' reply re: Starting a Uterus transplantation service: Notes from a small island. BJOG 2017; 125:516. [PMID: 29226565 DOI: 10.1111/1471-0528.15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
- H K Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - B K Tan
- Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - L K Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - J I Olofsson
- Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.,Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - P Dahm-Kähler
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - M Brännström
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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32
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Boman K, Olofsson M, Bergman ACR, Brännström M. Anaemia, but not iron deficiency, is associated with clinical symptoms and quality of life in patients with severe heart failure and palliative home care: A substudy of the PREFER trial. Eur J Intern Med 2017; 46:35-40. [PMID: 28899603 DOI: 10.1016/j.ejim.2017.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/23/2017] [Accepted: 08/30/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND To explore the relationships between anaemia or iron deficiency (ID) and symptoms, quality of life (QoL), morbidity, and mortality. METHODS A post-hoc, non-prespecified, explorative substudy of the prospective randomized PREFER trial. One centre study of outpatients with severe HF and palliative need managed with advanced home care. Associations between anaemia, ID, and the Edmonton Symptom Assessment Scale (ESAS), Euro QoL (EQ-5D), Kansas City Cardiomyopathy Questions (KCCQ) were examined only at baseline but at 6months for morbidity and mortality. RESULTS Seventy-two patients (51 males, 21 females), aged 79.2±9.1years. Thirty-nine patients (54%) had anaemia and 34 had ID (47%). Anaemia was correlated to depression (r=0.37; p=0.001), anxiety (r=0.25; p=0.04), and reduced well-being (r=0.26; p=0.03) in the ESAS; mobility (r=0.33; p=0.005), pain/discomfort (r=0.27; p=0.02), and visual analogue scale of health state (r=-0.28; p=0.02) in the EQ-5D; and physical limitation (r=-0.27; p=0.02), symptom stability; (r=-0.43; p<0.001); (r=-0.25; p=0.033), social limitation;(r=-0.26; p=0.03), overall summary score; (r=-0.24, p=0.046) and clinical summary score; (r=-0.27; p=0.02) in the KCCQ. ID did not correlate to any assessment item. Anaemia was univariably associated with any hospitalization (OR: 3.0; CI: 1.05-8.50, p=0.04), but not to mortality. ID was not significantly associated with any hospitalization or mortality. CONCLUSION Anaemia, but not ID, was associated although weakly with symptoms and QoL in patients with advanced HF and palliative home care.
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Affiliation(s)
- Kurt Boman
- Research Unit, Department of Medicine, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Mona Olofsson
- Research Unit, Department of Medicine, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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33
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Tan HK, Tan BK, Tan LK, Olofsson JI, Dahm-Kähler P, Brännström M. Starting a uterus transplantation service: notes from a small island. BJOG 2017; 125:404-406. [DOI: 10.1111/1471-0528.14968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- H-K Tan
- Department of Obstetrics and Gynaecology; Singapore General Hospital; Singapore Singapore
| | - B-K Tan
- Department of Plastic, Reconstructive & Aesthetic Surgery; Singapore General Hospital; Singapore Singapore
| | - L-K Tan
- Department of Obstetrics and Gynaecology; Singapore General Hospital; Singapore Singapore
| | - JI Olofsson
- Reproductive Medicine; Karolinska University Hospital; Stockholm Sweden
- Division of Obstetrics and Gynecology; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - P Dahm-Kähler
- Department of Obstetrics and Gynecology; Sahlgrenska Academy; University of Gothenburg; Göteborg Sweden
| | - M Brännström
- Department of Obstetrics and Gynecology; Sahlgrenska Academy; University of Gothenburg; Göteborg Sweden
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34
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Talabani N, Ängerud KH, Boman K, Brännström M. Patients' experiences of person-centred integrated heart failure care and palliative care at home: an interview study. BMJ Support Palliat Care 2017; 10:e9. [PMID: 28689185 DOI: 10.1136/bmjspcare-2016-001226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 05/27/2017] [Accepted: 05/31/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Patients with severe heart failure (HF) suffer from a high symptom burden and high mortality. European and Swedish guidelines for HF care recommend palliative care for these patients. Different models for integrated palliative care and HF care have been described in the literature. No studies were found that qualitatively evaluated these models. The purpose of this study is to describe patients' experiences of a new model of person-centred integrated HF and palliative care at home. METHOD Interviews were conducted with 12 patients with severe HF (New York Heart Association class IIIâ€"IV) and included in the research project of Palliative advanced home caRE and heart FailurE caRe (PREFER). Qualitative content analysis was used for data analysis. RESULTS Two themes and a total of five categories were identified. The first theme was feeling secure and safe through receiving care at home with the categories: having access to readily available care at home, being followed up continuously and having trust in the team members' ability to help. The second theme was being acknowledged as both a person and a patient, with the following two categories: being met as a person, participating in decisions about one's care and receiving help for symptoms of both HF and comorbidities. CONCLUSIONS: Person-centred integrated HF and palliative care provides a secure environment and holistic care for patients with severe HF. This approach is a way to improve the care management in this population. TRIAL REGISTRATION NUMBER NCT01304381; Results.
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Affiliation(s)
- Naghada Talabani
- Department of Cardiology M82, Karolinska University Hospital, Stockholm, Sweden
| | | | - Kurt Boman
- Research Unit Skellefteå, Department of Medicine, Umeå University, Skellefteå, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Margareta Brännström
- Department of Nursing, Umeå University, Umeå, Sweden.,The Arctic Research Centre, Umeå University, Umeå, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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35
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Andersson S, Lindqvist O, Fürst CJ, Brännström M. Care professional's experiences about using Liverpool Care Pathway in end-of-life care in residential care homes. Scand J Caring Sci 2017; 32:299-308. [DOI: 10.1111/scs.12462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/05/2017] [Indexed: 12/13/2022]
Affiliation(s)
| | - Olav Lindqvist
- Department of Nursing; Umeå University; Umeå Sweden
- Department of Learning, Informatics, Management and Ethics/MMC; Karolinska Institutet; Stockholm Sweden
| | - Carl-Johan Fürst
- The Institute for Palliative Care; Lund University and Region Skåne; Lund Sweden
| | - Margareta Brännström
- Department of Nursing; Umeå University; Skellefteå Sweden
- The Arctic Research Centre; Umeå University; Umeå Sweden
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Mölne J, Broecker V, Ekberg J, Nilsson O, Dahm-Kähler P, Brännström M. Monitoring of Human Uterus Transplantation With Cervical Biopsies: A Provisional Scoring System for Rejection. Am J Transplant 2017; 17:1628-1636. [PMID: 27868389 DOI: 10.1111/ajt.14135] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 01/25/2023]
Abstract
Until now, absolute uterine factor infertility has been the major untreatable form of female infertility. Uterus transplantation has recently proven to be the first successful treatment for absolute uterine factor infertility, with demonstration of live births. In this study, live donation uterus transplantation was performed in nine women. In total, 163 cervical biopsies (149 protocol, 14 follow-up) were taken to detect histopathological signs of rejection. Based on experience from animal experiments, we used a three-grade scoring system to evaluate biopsies systematically. Nine episodes of rejection were diagnosed in five patients: grade 1 in six episodes, grade 2 in two episodes, and grade 3 in one episode. Treatment decisions were based on histopathology, and all rejection episodes were reversed after treatment. The biopsies were reviewed retrospectively, and immunohistochemistry was performed to characterize the inflammatory infiltrates. A borderline category was introduced to avoid overtreatment of patients. Based on our review of all biopsies, we put forward a simple grading system for monitoring of rejection and to guide immunosuppressive treatment in uterus transplantation.
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Affiliation(s)
- J Mölne
- Department of Pathology and Genetics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - V Broecker
- Department of Pathology and Genetics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Ekberg
- Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - O Nilsson
- Department of Pathology and Genetics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Dahm-Kähler
- Department of Obstetrics & Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Brännström
- Department of Obstetrics & Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Stockholm IVF, Gothenburg, Sweden
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Ängerud KH, Boman K, Brännström M. Areas for quality improvements in heart failure care: quality of care from the family members' perspective. Scand J Caring Sci 2017; 32:346-353. [PMID: 28543624 DOI: 10.1111/scs.12468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care. OBJECTIVE To describe family members' perceptions of quality of HF care in an outpatient setting. METHODS A cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV. RESULTS Family members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members. CONCLUSION Family members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care.
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Affiliation(s)
| | - Kurt Boman
- Research Unit Skellefteå, Department of Medicine, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Margareta Brännström
- Department of Nursing, Umeå University, Umeå, Sweden.,The Arctic Research Centre, Umeå University, Umeå, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Norberg EB, Löfgren B, Boman K, Wennberg P, Brännström M. A client-centred programme focusing energy conservation for people with heart failure. Scand J Occup Ther 2017; 24:455-467. [PMID: 28052703 DOI: 10.1080/11038128.2016.1272631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The purpose of this study was to describe clients and occupational therapists (OTs) experiences of a home-based programme focusing energy conservation strategies (ECS) for clients with chronic heart failure (CHF). METHODS The programme, based on occupational therapy intervention process model (OTIPM), was led by two OTs in primary health care. Five clients' self-reported activities of daily living (ADL), fatigue, depression, goal achievements and use of ECS. Furthermore, both clients and OTs were individually interviewed. RESULTS The clients reported mild depression, severe fatigue and both increased and decreased independence in ADL. Most goals were achieved, and multiple ECS were used. Clients perceived that they worked collaboratively with the OTs and gained professional support to enhance daily activities. The OTs experienced knowledge and structure and found benefits from the programme, but doubted the possibility of using it in clinical practice. CONCLUSIONS This study, despite having few participants, indicates that both the OTs and the clients experienced that the specialized programme gave structure to the OTs work, provided knowledge about CHF and valuable energy conservation strategies. The programme supported the OTs in working in a more comprehensive client-centred way. However, its feasibility needs to be further evaluated.
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Affiliation(s)
- Eva-Britt Norberg
- a Department of Community Medicine and Rehabilitation , Occupational Therapy, Umeå University, Umeå , Sweden
| | - Britta Löfgren
- a Department of Community Medicine and Rehabilitation , Occupational Therapy, Umeå University, Umeå , Sweden
| | - Kurt Boman
- b Department of Public Health and Clinical Medicine , Research Unit, Medcine Skellefteå, Umeå University , Skellefteå , Sweden
| | - Patrik Wennberg
- c Department of Public Health and Clinical Medicine , Family Medicine, Umeå University , Umeå , Sweden
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Brännström M, Ekman I, Norberg A, Boman K, Strandberg G. Living with Severe Chronic Heart Failure in Palliative Advanced Home Care. Eur J Cardiovasc Nurs 2016; 5:295-302. [PMID: 16546447 DOI: 10.1016/j.ejcnurse.2006.01.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 01/31/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Living with severe chronic heart failure (CHF) in palliative care has been little studied. AIM The aim of this study is to illuminate meaning of living with severe CHF in palliative advanced home care through patients' narratives. METHODS Narrative interviews were conducted with 4 patients, tape-recorded and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. RESULTS Meaning of living with severe CHF in palliative advanced home care emerged as 'knocking on death's door' although surviving. The course of the illness forces one to live a 'roller coaster life,' with an ongoing oscillation between ups and downs. Making it through the downs breeds a kind of confidence in one's ability to survive and the will to live is strong. Being offered a safety belt in the 'roller coaster' by the palliative advanced home care team evokes feelings of security. CONCLUSIONS Meaning of living with severe CHF in palliative advanced home care is on one hand, being aware of one's imminent death, on the other hand, making it through the downs i.e. surviving life-threatening conditions, breed confidence in also surviving the current down. Being constructively dependent on palliative advanced home care facilitates everyday life at home.
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Ängerud KH, Boman K, Ekman I, Brännström M. Areas for quality improvements in heart failure care: quality of care from the patient's perspective. Scand J Caring Sci 2016; 31:830-838. [DOI: 10.1111/scs.12404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Karin H. Ängerud
- Department of Nursing; Umeå University; Umeå Sweden
- The Arctic Research Centre; Umeå University; Umeå Sweden
| | - Kurt Boman
- Research Unit Skellefteå; Department of Medicine; Umeå University; Umeå Sweden
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences; University of Gothenburg; Gothenburg Sweden
- Centre for Person-Centred Care; University of Gothenburg (GPCC); Gothenburg Sweden
| | - Margareta Brännström
- Department of Nursing; Umeå University; Umeå Sweden
- The Arctic Research Centre; Umeå University; Umeå Sweden
- Centre for Person-Centred Care; University of Gothenburg (GPCC); Gothenburg Sweden
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Brännström M, Brulin C, Norberg A, Boman K, Strandberg G. Being a Palliative Nurse for Persons with Severe Congestive Heart Failure in Advanced Homecare. Eur J Cardiovasc Nurs 2016; 4:314-23. [PMID: 15946901 DOI: 10.1016/j.ejcnurse.2005.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 04/01/2005] [Accepted: 04/11/2005] [Indexed: 10/25/2022]
Abstract
Advanced homecare for persons with congestive heart failure is a ‘new’ challenge for palliative nurses. The aim of this study is to illuminate the meaning of being a palliative nurse for persons with severe congestive heart failure in advanced homecare. Narrative interviews with 11 nurses were conducted, tape-recorded, and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. One meaning of being a palliative nurse is being firmly rooted and guided by the values of palliative culture. Being adaptable to the patient's way of life carries great weight. On one hand nurses live out this value, facilitating for the patients to live their everydaylife as good as possible. Being a facilitator is revealed as difficult, challenging, but overall positive. On the other hand nurses get into a tight corner when values of palliative culture clash and do not correspond with the nurses interpretation of what is good for the person with congestive heart failure. Being in such a tight corner is revealed as frustrating and giving rise to feelings of inadequacy. Thus, it seems important to reflect critical on the values of palliative culture.
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Akouri R, Brännström M. Human uterus transplantation with live births; Outcome of the first clinical trials. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1571398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Andersson S, Lindqvist O, Fürst CJ, Brännström M. End-of-life care in residential care homes: a retrospective study of the perspectives of family members using the VOICES questionnaire. Scand J Caring Sci 2016; 31:72-84. [DOI: 10.1111/scs.12317] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/16/2015] [Indexed: 12/14/2022]
Affiliation(s)
| | - Olav Lindqvist
- Department of Nursing; Umeå University; Umeå Sweden
- Department of Learning, Informatics, Management and Ethics/MMC; Karolinska Institutet; Stockholm Sweden
| | - Carl-Johan Fürst
- The Institute for Palliative Care; Lund University and Region; Skåne Lund Sweden
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Sahlen KG, Boman K, Brännström M. A cost-effectiveness study of person-centered integrated heart failure and palliative home care: Based on a randomized controlled trial. Palliat Med 2016; 30:296-302. [PMID: 26603186 DOI: 10.1177/0269216315618544] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion. AIM To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care. DESIGN A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients' responses to the EQ-5D quality of life instrument. SETTING/PARTICIPANTS Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital. RESULTS EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs. CONCLUSION The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.
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Affiliation(s)
- Klas-Göran Sahlen
- Department of Nursing, Umeå University, Umeå, Sweden Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden The Arctic Research Centre, Umeå University, Umeå, Sweden
| | - Kurt Boman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden Research Unit, Department of Medicine, Umeå University, Skellefteå, Sweden
| | - Margareta Brännström
- Department of Nursing, Umeå University, Umeå, Sweden The Arctic Research Centre, Umeå University, Umeå, Sweden
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45
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Markgren R, Brännström M, Lundgren C, Boman K. Impacts of person-centred integrated chronic heart failure and palliative home care on pharmacological heart failure treatment: a substudy of a randomised trial. BMJ Support Palliat Care 2016; 9:e10. [DOI: 10.1136/bmjspcare-2015-000894] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 11/02/2015] [Accepted: 12/17/2015] [Indexed: 11/04/2022]
Abstract
ObjectivePatients with chronic heart failure (CHF) may be insufficiently treated pharmacologically. Recently, we presented a person-centred integrated Palliative advanced homecaRE and heart FailurE caRe (PREFER) strategy and compared it with usual care (control). Patients managed according to PREFER had improved health-related quality of life and markedly reduced hospitalisations compared with the control group. We hypothesised that these improvements may have been partly due to better drug treatments within the PREFER strategy. Thus, our aim in this study was to explore the management of drug treatments in the PREFER group compared with the control group.MethodsDoses and numbers of drugs and the number of patients receiving the target doses based on current guidelines were measured and compared between the groups at the start and finish of the study.ResultsThe percentages of ACE inhibitors (ACEIs) or mineralocorticoid receptor antagonists (MRAs) increased, while loop diuretics decreased in the PREFER arm during the study, although the differences were not significant. Beta-receptor blockers (BBs) decreased somewhat in both groups. The number of patients treated with MRAs differed the most between groups, and increased from 10 (28%) to 15 (48%) in the PREFER arm compared with 13 (35%) vs 13 (39%) in the control group. The change in patients receiving full target doses (+8 vs. +1) of the ACEIs/angiotensin receptor blockers, BBs and MRAs were significantly higher (p=0009) in the PREFER arm than in the control arm.ConclusionsPerson-centred integrated care of patients with severe CHF was associated with increased evidence-based drug treatments, especially MRAs.Clinical trial numberNCT01304381.
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Brännström M, Fürst CJ, Tishelman C, Petzold M, Lindqvist O. Effectiveness of the Liverpool care pathway for the dying in residential care homes: An exploratory, controlled before-and-after study. Palliat Med 2016; 30:54-63. [PMID: 25986540 DOI: 10.1177/0269216315588007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical pathways aim to ensure that individuals receive appropriate evidence-based care and interventions, with the Liverpool Care Pathway for the Dying Patient focusing on end of life. However, controlled studies of the Liverpool Care Pathway for the Dying Patient, particularly outside of cancer settings, are lacking. AIM To compare the effects of the Liverpool Care Pathway for the Dying Patient and usual care on patients' symptom distress and well-being during the last days of life, in residential care homes. DESIGN Exploratory, controlled before-and-after study. During a 15-month baseline, usual care was carried out in two areas. During the following 15-months, usual care continued in the control area, while residential care home staff implemented Liverpool Care Pathway for the Dying Patient use in the intervention area. The intervention was evaluated by family members completing retrospective symptom assessments after the patient's death, using the Edmonton Symptom Assessment System and Views of Informal Carers - Evaluation of Services. SETTINGS/PARTICIPANTS Patients who died at all 19 residential care homes in one municipality in Sweden. RESULTS Shortness of breath (estimate = -2.46; 95% confidence interval = -4.43 to -0.49) and nausea (estimate = -1.83; 95% confidence interval = -3.12 to -0.54) were significantly reduced in Edmonton Symptom Assessment System in patients in the intervention compared to the control area. A statistically significant improvement in shortness of breath was also found on the Views of Informal Carers - Evaluation of Services item (estimate = -0.47; 95% confidence interval = -0.85 to -0.08). CONCLUSION When implemented with adequate staff training and support, the Liverpool Care Pathway for the Dying Patient may be a useful tool for providing end-of-life care of elderly people at the end of life in non-cancer settings.
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Affiliation(s)
| | - Carl Johan Fürst
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Carol Tishelman
- Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Max Petzold
- Akademistatistik - Centre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olav Lindqvist
- Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Department of Nursing, Umeå University, Umeå, Sweden
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Morken NH, Diaz-Garcia C, Reisaeter AV, Foss A, Leivestad T, Geiran O, Hervás D, Brännström M. Obstetric and neonatal outcome of pregnancies fathered by males on immunosuppression after solid organ transplantation. Am J Transplant 2015; 15:1666-73. [PMID: 25868657 DOI: 10.1111/ajt.13159] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 12/03/2014] [Accepted: 12/14/2014] [Indexed: 01/25/2023]
Abstract
Immunosuppressive drugs may influence spermatogenesis, but little is known about outcome of pregnancies fathered by transplanted males. We estimated risk of adverse outcomes in pregnancies (with data after the first trimester) fathered by males that had undergone organ transplantation and were treated with immunosuppression. A population-based study, linking data from the Norwegian transplant registry and the Medical Birth Registry of Norway during 1967-2009 was designed. All Norwegian men undergoing solid organ transplantation were included. Odds ratios for major malformations, preeclampsia, preterm delivery (<37 weeks) and small-for-gestational-age were obtained using logistic regression. A total of 2463 transplanted males, fathering babies of 4614 deliveries before and 474 deliveries after transplantation were identified. The risk of preeclampsia was increased (AOR: 7.4, 95% CI: 1.1-51.4,) after transplantation compared to prior to transplantation. No increased risk was found for congenital malformations or other outcomes when compared with pregnancies before transplantation or with the general population (2 511 506 births). Our results indicate an increased risk of preeclampsia mediated through the transplanted and immunosuppressed father. Importantly, no increased risk was found for other adverse obstetric outcomes or malformations, which may reassure male transplant recipients planning to father children.
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Affiliation(s)
- N-H Morken
- Department of Clinical Sciences, University of Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - C Diaz-Garcia
- Department of Gynecology and Obstetrics, La Fe University Hospital and Instituto de Investigación Sanitaria La Fe, University of Valencia, Spain
| | | | - A Foss
- Department of Transplantation Medicine, Rikshospitalet, Oslo University Hospital, Norway
| | | | - O Geiran
- Institute of Clinical Medicine, University of Oslo, Norway.,Department of Cardio-Thoracic Surgery, Rikshospitalet, Oslo University Hospital, Norway
| | - D Hervás
- Biostatistics Unit, Instituto de Investigación Sanitaria La Fe, University of Valencia, Spain
| | - M Brännström
- Department of Obstetrics & Gynecology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Nord-Ljungquist H, Brännström M, Bohm K. Communication and protocol compliance and their relation to the quality of cardiopulmonary resuscitation (CPR): A mixed-methods study of simulated telephone-assisted CPR. Int Emerg Nurs 2014; 23:254-9. [PMID: 25680743 DOI: 10.1016/j.ienj.2014.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/15/2014] [Accepted: 12/21/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND In the event of a cardiac arrest, emergency medical dispatchers (EMDs) play a critical role by providing telephone-assisted cardiopulmonary resuscitation (T-CPR) to laypersons. The aim of our investigation was to describe compliance with the T-CPR protocol, the performance of the laypersons in a simulated T-CPR situation, and the communication between laypersons and EMDs during these actions. METHODS We conducted a retrospective observational study by analysing 20 recorded video and audio files. In a simulation, EMDs provided laypersons with instructions following T-CPR protocols. These were then analysed using a mixed method with convergent parallel design. RESULTS If the EMDs complied with the T-CPR protocol, the laypersons performed the correct procedures in 71% of the actions. The single most challenging instruction of the T-CPR protocol, for both EMDs and laypersons, was airway control. Mean values for compression depth and frequency did not reach established guideline goals for CPR. CONCLUSION Proper application of T-CPR protocols by EMDs resulted in better performance by laypersons in CPR. The most problematic task for EMDs as well for laypersons was airway management. The study results did not establish that the quality of communication between EMDs and laypersons performing CPR in a cardiac arrest situation led to statistically different outcomes, as measured by the quality and effectiveness of the CPR delivered.
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Affiliation(s)
| | - Margareta Brännström
- Strategic Research Program in Health Care Sciences (SFO-V), 'Bridging Research, Practice for Better Health', Department of Nursing, Umeå University, Umeå, Sweden
| | - Katarina Bohm
- Department of Clinical Science, Education, Karolinska Institutet, Södersjukhuset, Sweden
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Brännström M, Ekman I, Boman K, Strandberg G. Narratives of a man with severe chronic heart failure and his wife in palliative advanced home care over a 4.5-year period. Contemp Nurse 2014. [DOI: 10.5172/conu.2007.27.1.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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Hellström M, El-Akouri R, Sihlbom C, Olsson B, Lengqvist J, Bäckdahl H, Johansson B, Olausson M, Sumitran-Holgersson S, Brännström M. Towards the development of a bioengineered uterus: comparison of different protocols for rat uterus decellularization. Acta Biomater 2014; 10:5034-5042. [PMID: 25169258 DOI: 10.1016/j.actbio.2014.08.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/17/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Abstract
Uterus transplantation (UTx) may be the only possible curative treatment for absolute uterine factor infertility, which affects 1 in every 500 females of fertile age. We recently presented the 6-month results from the first clinical UTx trial, describing nine live-donor procedures. This routine involves complicated surgery and requires potentially harmful immune suppression to prevent rejection. However, tissue engineering applications using biomaterials and stem cells may replace the need for a live donor, and could prevent the required immunosuppressive treatment. To investigate the basic aspects of this, we developed a novel whole-uterus scaffold design for uterus tissue engineering experiments in the rat. Decellularization was achieved by perfusion of detergents and ionic solutions. The remaining matrix and its biochemical and mechanical properties were quantitatively compared from using three different protocols. The constructs were further compared with native uterus tissue composition. Perfusion with Triton X-100/dimethyl sulfoxide/H2O led to a compact, weaker scaffold that showed evidence of a compromised matrix organization. Sodium deoxycholate/dH2O perfusion gave rise to a porous scaffold that structurally and mechanically resembled native uterus better. An innovative combination of two proteomic analyses revealed higher fibronectin and versican content in these porous scaffolds, which may explain the improved scaffold organization. Together with other important protocol-dependent differences, our results can contribute to the development of improved decellularization protocols for assorted organs. Furthermore, our study shows the first available data on decellularized whole uterus, and creates new opportunities for numerous in vitro and in vivo whole-uterus tissue engineering applications.
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