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  • 3901.
    Wireklint-Sundström, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Winge, Karin
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    LINDRA-studien2009Konferensbidrag (Refereegranskat)
    Abstract [sv]

    Erfarenheter av att genomföra en forskningsstudie i ambulanssjukvård. LINDRA-studien syftar till att öka ambulanssjuksköterskors möjligheter att bedöma, lindra och behandla bröstsmärta och oro hos patienter som söker ambulanssjukvård. Datainsamlingen startade i maj 2008; Ambulanssjukvården i Göteborg/SU, Skaraborgs sjukhus, Södra Älvsborgs Sjukhus och Halmstad (öster). Våren 2009 gjordes en utökning; Norra Älvsborgs Sjukhus och Uddevalla sjukhus, Kungälvs Sjukhus och Halmstad (väster). Det innebär att ca 500 ambulanssjuksköterskor ingår i studien, som i övrigt involverar 60 ambulanser och en båt i Västsverige. Hittills har knappt 600 patienter deltagit, som när studien är klar sommaren 2010 omfattar ca 1800 patienter. Preliminära resultat beräknas kunna presenteras under slutet av 2010. I hälso- och sjukvården ska forsknings- och utvecklingsarbete (FoU) ingå som en naturlig del (HSL, 1982:763). Däremot saknas tradition och rutin för FoU inom ambulanssjukvård. LINDRA-studiens genomförande har gett oss en rad erfarenheter av möjligheter och svårigheter att bedriva prehospital forskning. Vi kommer att berätta om hur ambulanssjukvård och forskning går att kombinera.

  • 3902.
    Wismén, Snezhana
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ambulanspersonalens förmåga att identifiera patienter med bacteriaemi eller sepsis med fokus på överlevnad de första 30 dagarna: En kvantitativ studie2018Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Bakgrund: Bacteriaemi eller sepsis är ett vanligt förekommande tillstånd som kännetecknas av ett snabbt och diffust insjuknande inom akuta verksamheter. Tillståndet kräver en snabb handläggning, vilket innebär tidig identifiering med en snabb insättning av behandling för att undvika det livshotande tillståndet som kan leda till en dödlig utgång. Detta kräver att vårdpersonalen tidigt ska kunna kartlägga och behandla patienter där det föreligger allvarliga infektioner som sepsis.

    Syftet: med studien är att belysa den kliniska presentationen hos patienter med svåra infektioner som här definieras som att patienten antingen fick slutdiagnosen sepsis eller uppvisade en positiv blododling i prehospital miljö i relation till utfall. Dessutom belyses ambulanspersonalens förmåga att upptäcka tillståndet redan prehospitalt i relation till utfall.

    Metod: En retroperspektiv registergranskning med en kvantitativ ansats. Utfall definieras som död inom de första 30 dagarna.

    Resultat: Totalt deltog 854 patienter i studien. Bland dem dog 20% under de första 30 dagarna. Insjuknandet föreföll ofta att vara ospecifikt. Av de patienter som dog inom 30 dagar var luftvägarna den vanligaste organpåverkan och bland dem som överlevde 30 dagar var infektion i urinvägar den vanligaste orsaken. Det förelåg ingen könsskillnad med avseende på prognos. Tid från larm till start av antibiotikabehandling var kortare bland dem som dog   De som dog var i genomsnitt äldre.  De patienter som dog hade också en lägre grad av vakenhet, ett lägre blodtryck, en lägre syresättning, och en lägre kroppstemperatur samt högre andningsfrekvens jämfört med de som överlevde.  Bara i ca 15% av fallen noterade ambulanspersonalen en misstanke om sepsis och en sådan misstanke var lika ovanligt i båda grupperna.

    Diskussion: Bland patienter med slutdiagnosen sepsis eller bakterieami så är risken att dö under de första 30 dagarna hög. Det föreligger redan i den prehospitala miljön påtagliga skillnader mellan de patienter som kommer att överleva och de som kommer att dö med avseende på patientkaraktäristik, etiologi och vitalparametrar. Denna kunskap kanske i framtiden skulle kunna utnyttjas på ett mera systematiskt sätt eventuellt med hjälp av ett datorstöd. Men andelen fall där ambulanspersonalen misstänker sepsis är alltjämt för låg. En ökad utbildning och förbättrade beslutsstöd kan möjligen förbättra denna siffra.

  • 3903. Wnent, Jan
    et al.
    Masterson, Siobhán
    Gräsner, Jan-Thorsten
    Böttiger, Bernd W
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Koster, Ruud W
    Rosell Ortiz, Fernando
    Tjelmeland, Ingvild
    Maurer, Holger
    Bossaert, Leo
    EuReCa ONE - 27 Nations, ONE Europe, ONE Registry: a prospective observational analysis over one month in 27 resuscitation registries in Europe - the EuReCa ONE study protocol.2015Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, nr 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is substantial variation in the incidence, likelihood of attempted resuscitation and outcomes from out-of-hospital cardiac arrest (OHCA) across Europe. A European, multi-centre study provides the opportunity to uncover differences throughout Europe and may help find explanations for these differences. Results may also have potential to support the development of quality benchmarking between European Emergency Medical Services (EMS).

    METHODS/DESIGN: This prospective European study involves 27 different countries. It provides a common Utstein-based dataset, data collection tool and a common data collection period for all participants. Study research questions will address the following: OHCA incidence in different European regions; incidence of cardiopulmonary resuscitation (CPR); initial presenting rhythm in patients where bystanders or EMS start CPR or any other resuscitation intervention; proportion of patients with any return of spontaneous circulation (ROSC); patient status at the end of pre-hospital treatment i.e. ROSC at handover to hospital, ongoing CPR, dead; proportion of patients still alive 30 days after OHCA; proportion of patients discharged alive from hospital. All patients who suffered an OHCA during October 2014 and were attended and/or treated by an EMS and documented in one of the participating registries will be included in the study. Each National Coordinator is responsible for data collection and quality control in his/her country and will transfer unprocessed anonymised data via secure electronic transfer. Descriptive analysis will be performed at European, national and registry level. For endpoints like ROSC, admission or survival, multivariate logistic regression analysis will be performed.

    DISCUSSION: Documenting differences in epidemiology, treatment and outcome in out-of-hospital cardiac arrest throughout Europe is a first step in finding explanations for these differences. Study results might also support the development of quality benchmarking between Emergency Medical Services (EMS) which in turn will facilitate initiatives to improve OHCA outcome in Europe.

    TRIAL REGISTRATION: The EuReCa ONE Study is registered by ClinicalTrials.gov National Coordinator T02236819 ).

  • 3904. Woods, S
    et al.
    Sandman, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Continental Philosophy and Nursing Ethics2002Ingår i: Ethics In Nursing Education, Research And Management. Perspectives from Europe / [ed] W Tadd, Palgrave , 2002, s. 14-34Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 3905. Wramsten Wilmar, Maria
    et al.
    Ahlborg, Gunnar
    Jacobsson, Christian
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Healthcare managers in negative media focus: a qualitative study of personification processes and their consequences2014Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, nr 8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Over the last decade healthcare management and managers have increasingly been in focus in public debate. The purpose of the present study was to gain a deeper understanding of how prolonged, unfavorable media focus can influence both the individual as a person and his or her managerial practice in the healthcare organization. Methods In-depth interviews (n = 49) with 24 managers and their superiors, or subordinate human resources/information professionals, and partners were analyzed using a grounded theory approach.Results The conceptual model explains how perceived uncertainties related to the managerial role influence personification and its negative consequences. The role ambiguities comprised challenges regarding the separation of individual identity from the professional function, the interaction with intra-organizational support and political play, and the understanding and acceptance of roles in society. A higher degree of uncertainty in role ambiguity increased both personification and the personal reaction to intense media pressure. Three types of reactions were related to the feeling of being infringed: avoidance and narrow-mindedness; being hard on self, on subordinates, and/or family members; and resignation and dejection. The results are discussed so as to elucidate the importance of support from others within the organization when under media scrutiny. Conclusions The degree of personification seems to determine the personal consequences as well as the consequences for their managerial practice. Organizational support for managers appearing in the media would probably be beneficial for both the manager and the organization.

  • 3906.
    Wramsten Wilmar, Maria
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jacobsson, Christian
    Ahlborg, Gunnar
    Health care managers handling negative media focus: Individual and Organizational quagmire increases personification processes and personal consequences2012Konferensbidrag (Refereegranskat)
  • 3907.
    Wramsten Wilmar, Maria
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Dellve, Lotta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jacobsson, Christian
    Ahlborg, Gunnar
    Health care managers handling negative media focus: Individual and Organizational quagmire increases personification processes and personal consequences2012Konferensbidrag (Refereegranskat)
  • 3908.
    Wulcan, Ann-Charlotte
    et al.
    Northern Älvsborg County Hospital, NU-Hospital Group.
    Nilsson, Christina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Midwives’ counselling of women at specialised fear of childbirth clinics: A qualitative study2019Ingår i: Sexual and Reproductive Healthcare, ISSN 1877-5756, Vol. 19, s. 24-30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective

    Fear of childbirth is a well-known problem affecting women’s wellbeing and health. The prevalence of intense fear varies across countries from 4.8 to 14.8%. During the past 25 years in Sweden women with intense fear of childbirth have been offered counselling at specialised clinics staffed by midwives. Although the counselling demonstrates positive results, the training, education, supervision and organisation differ between clinics. It is still unclear which approaches and practices are the most beneficial. The aim was to explore and describe the counselling of women with intense fear of childbirth from the viewpoint of midwives who provide counselling in specialised fear of childbirth clinics in one region of Sweden.

    Methods

    A qualitative study of 13 midwives using focus group interviews and inductive content analysis.

    Results

    The midwives’ counselling of women with intense fear of childbirth is described as ‘striving to create a safe place for exploring fear of childbirth’, comprising the following categories: Providing a reliable relationship; Investigating previous and present fears; and A strong dedication to the women.

    Conclusion

    Although there are no guidelines for the counselling the midwives described similar frameworks. Some approaches were general, while others were specific and related to the individual woman’s parity. The midwives achieved professional and personal development through counselling experiences. The findings add to the existing literature on counselling and can be used to inform the development of midwife-led interventions for women with intense fear of childbirth and previous traumatic births, as well as for the formal education of midwives.

  • 3909.
    Wüstenhagen, Eva-Britt
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Att förebygga och lindra konfusion: En litteraturstudie2012Självständigt arbete på avancerad nivå (magisterexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    Konfusion kan drabba vem som helst, men risken ökar med stigande ålder. Det är en störning av medvetande och kognitiva funktioner. Utlösande faktorer kan vara medicinska tillstånd som allvarlig sjukdom, infektioner, metabola rubbningar, dehydrering eller läkemedel. Konfusion ökar risken för skador och komplikationer, försvårar vårdandet, förlänger vårdtiden samt innebär ett lidande för patienter och anhöriga. Syftet är att identifiera omvårdnadsaktiviteter som kan förebygga och lindra konfusion hos patienter som vårdas på sjukhus. Metoden är en litteraturstudie. Sökning har skett i Cinahl och Medline. Sökord har varit ”acute confusion”, delirium, nursing och ”confusion nursing”. 15 artiklar har analyserats. Nio har en kvantitativ ansats och sex har en kvalitativ ansats. Resultatet sammanfattas i tre teman och nio subteman. Ett tema är vikten av beredskap. Denna består i att identifiera riskfaktorer, eliminera riskfaktorer samt identifiera tidiga tecken på konfusion. Det andra temat är anpassning av miljön. En säker miljö för patienterna bör eftersträvas eftersom de ofta utsätter sig själva för fara. Både en stimulerande miljö och en begriplig miljö lindrar konfusion. Det tredje temat handlar om att patienten med konfusion är i behov av ett äkta möte med vårdaren. Patienten känner sig ofta ensam med sina märkliga upplevelser och vårdaren bör ta sig tid att försöka förstå. Vidare kan patienten behöva känna bekräftelse. Slutligen bör patienten få stöd i att bearbeta sina upplevelser. I diskussionen framkommer vikten av att sjuksköterskan tillägnar sig kunskap för att förebygga och lindra konfusion. God omvårdnad är konfusionsförebyggande och kan förhindra onödigt lidande, komplikationer och därmed ökade kostnader.

  • 3910. Yamasaki, Y
    et al.
    Helou, K
    Watanabw, TK
    Sjöling, Å
    Suzuki, M
    Okuno, S
    Ono, T
    Takagi, T
    Nakamura, Y
    Ståhl, Fredrik
    Tanigami, A
    Mouse Chromosome 19 and Distal Rat Chromosome 1: a Chromosome Segment Conserved in Evolution2001Ingår i: Hereditas, ISSN 0018-0661, E-ISSN 1601-5223, Vol. 134, nr 1, s. 23-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Through a combination of radiation hybrid mapping and studies by FISH and zoo-FISH we have made a comparative investigation of the distal portion of rat chromosome 1 (RNO1) and the entire mouse chromosome 19(MMU19). It was found that homologous segments of RNO1 and MMU19 are similar in banding morphology and in length as determined by several different methods, and that the gene order of the 46 genes studied appears to be conserved across the homologous segments in the two species. High-resolution zoo-FISH techniques showed that MMU19 probes highlight only a continuous segment on RNO1 (Iq43-qter), with no detectable signals on other rat chromosomes. We conclude that these data suggest the evolutionary conservation of a chromosomal segment from a common rodent ancestor. This segment now constitutes the entire MMU19 and a large segment distally on RNO1q in the mouse and rat, respectively.

  • 3911. Youcel, A
    et al.
    Bardaji Ruiz, A
    Axelsson, C
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Chest Injuries during resuscitation following the current guidelines: First results of the Recapta Study2014Konferensbidrag (Refereegranskat)
  • 3912. Yusuf, S
    et al.
    Estrada-Yamamoto, M
    Reyes, CP
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjalmarson, Å
    Factors of Importance for QRS Complex Recovery after Acute Myocardial Infarction1982Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 211, nr 3, s. 157-162Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The regression of the ECG signs of myocardial infarction has been studied in 101 patients. A significant increase in R wave amplitude and decrease in Q wave depth on the standard ECG was observed over three months. In 21% of the patients, Q waves disappeared completely. In inferior infarction, these changes were more apparent in the lateral V leads than in the inferior limb leads. Patients with intraventricular conduction defects were excluded. Two factors associated with the Q and R wave changes have been identified. Lower heart rates appeared to facilitate the recovery of R waves, and smaller infarcts, as assessed by peak LDH, showed greater ECG recovery. This study raises the interesting possibility that modification of the heart rate may affect favourably the healing process after an acute myocardial infarction.

  • 3913.
    Zabihi, Mehri
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Esmaili, Parichehr
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Den vuxna patientens upplevelser kring vad som främjar och hindrar egenvård hos patienter med diabetes typ 2: En litteraturstudie2019Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Diabetes typ 2 medför oftast förhöjda blodsockernivåer och om sjukdomen inte behandlas kan allvarliga komplikationer uppstå. Egenvård är mycket betydelsefullt för att bibehålla en jämn blodsockernivå. Livsstilsförändringar kan behöva göras vilket kan vara en stor utmaning för patienten. Sjuksköterskan har ett ansvar i att fungera som stöd samt ge god kunskap och försöka motivera patienter till god egenvård och därmed förebygga komplikationer. Även anhöriga utgör ett viktigt stöd och har en roll till att bidra till patientens förmåga att utföra egenvård.

    Syftet med studien är att beskriva den vuxna patientens upplevelser kring vad som främjar och hindrar egenvård hos patienter med diabetes typ 2. En litteraturstudie gjordes och 15 artiklar analyserades med hjälp av Fribergs modell. Resultatet visade både hindrande och främjande faktorer som påverkar egenvård. Faktorerna bestod av familj och sociala nätverk, kunskap, motivation och sjuksköterskans roll. I diskussionen diskuteras familj och sjuksköterskans stöd samt kunskap och motivation och det påvisas hur en fungerande egenvård främjas av dessa faktorer. Sjuksköterskans ansvarsroll för att patienten ska kunna göra livsstilsförändringar som krävs för patientens sjukdom och därmed bidra till en hållbar utveckling i vården, synliggörs.

  • 3914.
    Zamani, Akram
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Superabsorbent Polymers from the Cell Wall of Zygomycetes Fungi2010Doktorsavhandling, monografi (Övrigt vetenskapligt)
    Abstract [en]

    The present thesis presents new renewable, antimicrobial and biodegradable superabsorbent polymers (SAPs), produced from the cell wall of zygomycetes fungi. The cell wall was characterized and chitosan, being one of the most important ingredients, was extracted, purified, and converted to SAP for use in disposable personal care products designed for absorption of different body fluids. The cell wall of zygomycetes fungi was characterized by subsequent hydrolysis with sulfuric and nitrous acids and analyses of the products. The main ingredients of the cell wall were found to be polyphosphates (4-20%) and copolymers of glucosamine and N-acetyl glucosamine, i.e. chitin and chitosan (45-85%). The proportion of each of these components was significantly affected by the fungal strain and also the cultivation conditions. Moreover, dual functions of dilute sulfuric acid in relation to chitosan, i.e. dissolution at high temperatures and precipitation at lowered temperatures, were discovered and thus used as a basis for development of a new method for extraction and purification of the fungal chitosan. Treatment of the cell wall with dilute sulfuric acid at room temperature resulted in considerable dissolution of the cell wall polyphosphates, while chitosan and chitin remained intact in the cell wall residue. Further treatment of this cell wall residue, with fresh acid at 120°C, resulted in dissolution of chitosan and its separation from the remaining chitin/chitosan of the cell wall skeleton which was not soluble in hot acid. Finally, the purified fungal chitosan (0.34 g/g cell wall) was recovered by precipitation at lowered temperatures and pH 8-10. The purity and the yield of fungal chitosan in the new method were significantly higher than that were obtained in the traditional acetic acid extraction method. As a reference to pure chitosan, SAP from shellfish chitosan, was produced by conversion of this biopolymer into water soluble carboxymethyl chitosan (CMCS), gelation of CMCS with glutaraldehyde in aqueous solutions (1-2%), and drying the resultant gel. Effects of carboxymethylation, gelation and drying conditions on the water binding capacity (WBC) of the final products, were investigated. Finally, choosing the best condition, a biological superabsorbent was produced from zygomycetes chitosan. The CMCS-based SAPs were able to absorb up to 200 g water/g SAP. The WBC of the best SAP in urine and saline solutions was 40 and 32 g/g respectively, which is comparable to the WBC of commercially acceptable SAPs under identical conditions (34-57 and 30-37 g/g respectively).

  • 3915.
    Zamani, Akram
    et al.
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Jeihanipour, Azam
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Edebo, Lars
    Niklasson, Claes
    Taherzadeh, Mohammad J.
    Högskolan i Borås, Institutionen Ingenjörshögskolan.
    Determination of glucosamine and N-acetyl glucosamine in fungal cell walls2008Ingår i: Journal of Agricultural and Food Chemistry, ISSN 0021-8561, E-ISSN 1520-5118, Vol. 56, nr 18, s. 8314-8318Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A new method was developed to determine glucosamine (GlcN) and N-acetyl glucosamine (GlcNAc) in materials containing chitin and chitosan, such as fungal cell walls. It is based on two steps of hydrolysis with (i) concentrated sulfuric acid at low temperature and (ii) dilute sulfuric acid at high temperature, followed by one-step degradation with nitrous acid. In this process, chitin and chitosan are converted into anhydromannose and acetic acid. Anhydromannose represents the sum of GlcN and GlcNAc, whereas acetic acid is a marker for GlcNAc only. The method showed recovery of 90.1% of chitin and 85.7-92.4% of chitosan from commercial preparations. Furthermore, alkali insoluble material (AIM) from biomass of three strains of zygomycetes, Rhizopus oryzae, Mucor indicus, and Rhizomucor pusillus, was analyzed by this method. The glucosamine contents of AIM from R. oryzae and M. indicus were almost constant (41.7 +/- 2.2% and 42.0 +/- 1.7%, respectively), while in R. pusillus, it decreased from 40.0 to 30.0% during cultivation from 1 to 6 days. The GlcNAc content of AIM from R. oryzae and R. pusillus increased from 24.9 to 31.0% and from 36.3 to 50.8%, respectively, in 6 days, while it remained almost constant during the cultivation of M. indicus (23.5 +/- 0.8%).

  • 3916. Zedigh, C
    et al.
    Alho, A
    Hammar, E
    Karlsson, Thomas
    Kellerth, T
    Svensson, L
    Grimbrandt, E
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Aspects on the intensity and the relief of pain in the prehospital phase of acute coronary syndrome: experiences from a randomized clinical trial2010Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 21, nr 2, s. 113-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The primary aim of this study was to evaluate the pain relief and tolerability of two pain-relieving strategies in the prehospital phase of presumed acute coronary syndrome (ACS), and the secondary aim was to assess the relationship between the intensity and relief of pain and heart rate, blood pressure, and ST deviation. Patients with chest pain judged as caused by ACS were randomized (open) to either metoprolol 5 mg intravenously (i.v.) three times at 2-min intervals (n = 84; metoprolol group) or morphine 5 mg i.v. followed by metoprolol 5 mg three times i.v (n = 80; morphine group). Pain was assessed on a 10-grade scale before randomization and 10, 20, and 30 min thereafter. The mean pain score decreased from 6.5 at randomization to 2.8 30 min later, with no significant difference between groups. The percentages with complete pain relief (pain score <=1) after 10, 20, and 30 min were 11, 16, and 21%, respectively, with no difference between groups. Hypotension was less frequent in the metoprolol group compared with the morphine group (0 vs. 6.3%; P=0.03), as was nausea/vomiting (7.2 vs. 24.0%; P=0.004). At randomization intensity of pain was associated with degree of ST elevation (P=0.009). The degree of pain relief over 30 min was associated with decrease in heart rate (P=0.03) and decrease in ST elevation (P=0.01). In conclusion, in the prehospital phase of presumed ACS, neither a pain-relieving strategy including an anti-ischemic agent alone nor an analgesic plus anti-ischemic strategy in combination resulted in complete pain relief. Fewer side effects were found with the former strategy. Other pain-relieving strategies need to be evaluated.

  • 3917.
    Zhang, Yanru
    et al.
    University of Shanghai for Science and Technology.
    Jiménez-Herrera, María
    Universitat Rovira I Virgili.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Cheng, Yunzhang
    University of Shanghai for Science and Technology.
    Not Bad: Passive Leg Raising in Cardiopulmonary Resuscitation-A New Modeling Study2017Ingår i: Frontiers in Physiology, ISSN 1664-042X, E-ISSN 1664-042X, Vol. 7, s. 665-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To evaluate, using a simulated haemodynamic circulation model, whether passive leg raising (PLR) is able to improve the effect during cardiopulmonary resuscitation (CPR); to expose the possible reasons why PLR works or not.

    Materials and Methods: We adapted a circulatory model for CPR with PLR. First we compared cardiac output (CO), coronary perfusion pressure (CPP), blood flow to heart (Qheart), and blood flow to neck and brain (Qhead) of standard chest compression-only CPR with and without PLR; second we simulated the effects of PLR in different situations, by varying the thoracic pump factor (TPF) from 0 to 1; third we simulated the effects when the legs are lifted to the different heights. Finally, we compared our results with those obtained from a published clinical study.

    Results: According to the simulation model, (1) When TPF is in the interval (0,1), CPP, CO, Qheart, and Qhead are improved with PLR, among them with half-thoracic/half-cardiac pump effect (TPF is 0.5), CPP, CO, Qhead, and Qheart increase the most (by 14, 14, 15, and 17%). (2) When TPF is 1 (pure thoracic pump, with an emphysema or extremely thick thorax), PLR has almost no effect on CPP, CO, and Qheart (-1, 2, and 0%), whereas Qhead is increased by 9%; (3) Regardless of whether there is a cardiac or thoracic pump effect, PLR is able to increase Qhead by 9-15%. (4) When the legs are lifted to 30 degrees to the ground, the volume transferred from legs to upper body is 36% of the initial volume in legs; when the legs are lifted to 45 degrees , the volume transferred is 43%; when the legs are lifted to 60 degrees , the volume transferred is 47%; when the legs are lifted to 90 degrees , the volume transferred is 50%.

    Conclusion: Generally PLR is able to achieve improved cerebral perfusion and coronary perfusion. In some extreme situations, it has no effect on cardiac output and coronary perfusion, but still improves cerebral perfusion. PLR could be a beneficial supplement to CPR, and it is not necessary to lift the legs too high above the ground.

  • 3918.
    Zijlstra, Jolande A
    et al.
    Department of Cardiology, Academic Medical Center.
    Koster, Rudolph W
    Department of Cardiology, Academic Medical Center.
    Blom, Marieke T
    Department of Cardiology, Academic Medical Center.
    Lippert, Freddy K
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Svensson, Leif
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Kramer-Johansen, Jo
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology, Oslo University Hospital.
    Ringh, Mattias
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet.
    Palsgaard Møller, Thea
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Tan, Hanno L
    Department of Cardiology, Academic Medical Center.
    Beesems, Stefanie G
    Department of Cardiology, Academic Medical Center.
    Hulleman, Michiel
    Department of Cardiology, Academic Medical Center.
    Claesson, Andreas
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Folke, Fredrik
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Olasveengen, Theresa Mariero
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology.
    Wissenberg, Mads
    Department of Cardiology, Copenhagen University Hospital Gentofte.
    Hansen, Carolina Malta
    Department of Cardiology, Copenhagen University Hospital Gentofte.
    Viereck, Soren
    Emergency Medical Services Copenhagen, University of Copenhagen.
    Hollenberg, Jacob
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet.
    Different defibrillation strategies in survivors after out-of-hospital cardiac arrest.2018Ingår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 104, nr 23, s. 1929-1936Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival.

    METHODS: We performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded.

    RESULTS: A total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm.

    CONCLUSION: Survivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.

  • 3919.
    Ädel, Hans
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Orkar anestesisjuksköterskor arbeta fram till pensionsåldern?2009Självständigt arbete på avancerad nivå (magisterexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    På frågan om vad verksamhetscheferna har för åsikt om hur de skulle kunna förhindra långtidssjukskrivningar, förtidspension eller sjukpension på sin avdelning så tar många i likhet med ambulanscheferna upp fysisk träning och ergonomi som områden där de lägger stor vikt. Ingen nämner handledning eller stödjande samtal som metoder man arbetar med. Ser man till resultatet på vad den vanligaste orsaken till långtidssjukskrivningarna är, nämligen muskel – skelettskador, så kan fysisk träning och ergonomi vara riktiga metoder. Stämmer dessutom arbetsgivarnas bedömning att skadorna uppkommit till stor del på fritiden så är arbetsplatsen och dess belastning inte skyldiga till långtidssjukskrivningarna. Men det finns skäl att tro att denna bild inte riktigt är sann.

  • 3920.
    Ågren, Helena
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Patienters upplevelser av information i samband med hjärtinfarkt under vårdtiden på sjukhus2008Självständigt arbete på grundnivå (kandidatexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    Hjärtinfarkt är en allvarlig sjukdom, ofta förknippad med oro och ångest hos den drabbade. Patienter kan hamna i en akut kris till följd av sjukdomen och det plötsliga insjuknandet. Ett tydligt samband finns mellan livsstil, utvecklandet av och risken för återinsjuknande i sjukdomen. Patientinformation utgör en viktig del i vården och rehabiliteringen av hjärtinfarktpatienten. Informationens liksom vårdandets yttersta mål är att vägleda patienten mot en högre grad av hälsa och välbefinnande samt att lindra eller förhindra lidande. Vårdtiden för en okomplicerad hjärtinfarkt beräknas till 3-6 dagar. Under vårdtiden ska patienten hinna landa i sin nya situation och samtidigt hinna ta till sig given information. Patientinformation faller till stor del inom sjuksköterskans ansvarsområde. Syftet med denna litteraturstudie är att beskriva patienters upplevelser av information i samband med hjärtinfarkt, under vårdtiden på sjukhus. Sju kvalitativa artiklar har granskats utifrån Evans modell. Kvalitativ forskning syftar till att skapa förståelse för ett fenomen genom att likheter och olikheter identifieras ur informanternas levda erfarenheter. Analysen resulterade i fem teman, två av temana innehåller subteman: Upplevelser av alltför generell information, Svårigheter att ta till sig information, subteman: Tidpunktens betydelse vid information, Betydelsen av rätt mängd information, Upplevelser av informationens innehåll och information som anses viktig, subteman: Medicinsk information, Livsstilsråd, Metoder och hjälpmedel som tydliggör informationen, Det pedagogiska mötets betydelse vid information. Alla temana går in i varandra och måste alla samverka för att nå resultat. Upplevelser av generell information och behov av individuellt anpassad information löper som en röd tråd genom hela resultatet. Det bästa sättet att tillhandahålla individuell information enligt patienterna i resultatet var i det enskilda pedagogiska möte, mellan vårdare och patient, där patientens livsvärld bejakas i den stunden hon eller han fick information.

  • 3921. Ågård, A
    et al.
    Bentley, L
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Experiences and concerns among patients being treated for atypical chest pain2005Ingår i: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 16, nr 5, s. 339-344Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Many patients who are discharged from the hospital without receiving a clear-cut diagnosis of their chest pain continue to consume health care because of disabling physical and psychological symptoms. By identifying their experiences and concerns following hospitalization, an empirical basis for discussions on ways of improving the care of these particular patients will be obtained. Methods A qualitative analysis of semi-structured interviews with 38 patients with a diagnosis of unspecified chest pain was carried out. Results Two-thirds of the respondents had unanswered questions and concerns that had not been addressed. They found it difficult to understand why they had not undergone more tests. They requested an explanation for their chest pain, at the very least, or were worried about the future. Some respondents accepted the fact that they had not been given a sufficient amount of time and information. They referred to the stressful working situation of the physicians, the view that their admission could be regarded as unnecessary or that physicians at the hospital could not be expected to do more than exclude serious diseases. Conclusions Health professionals should address their patients' questions and fears properly and provide them with the most probable explanation for their symptoms. When taking the harmlessness of their symptoms or the situation of their caregivers into account, patients may find it inappropriate to impose further demands on care.

  • 3922. Ågård, A
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Castrén, M
    Jonsson, L
    Sandman, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Guidance for ambulance personnel on decisions and situations related to out-of-hospital CPR2012Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, nr 1, s. 27-31Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ethical guidelines on out-of-hospital cardio-pulmonary resuscitation (CPR) are designed to provide substantial guidance for the people who have to make decisions and deal with situations in the real world. The crucial question is whether it is possible to formulate practical guidelines that will make things somewhat easier for ambulance personnel. The aims of this article are to address the ethical aspects related to out-of-hospital CPR, primarily to decisions on not starting or terminating resuscitation attempts, using the views and experience of ambulance personnel as a starting point, and to summarise the key points in a practice guideline on the subject.

  • 3923. Ågård, A
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Hermerén, G
    Obtaining informed consent from patients in the early phase of acute myocardial infarction: physicians’ experiences and attitudes2004Ingår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 90, nr 2, s. 208-210Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is possible to question whether patients suffering from the early phase of an acute myocardial infarction (AMI) are able to give free and informed consent and whether or not it is ethically defensible to include them—those patients suffering from more severe symptoms, in particular—in research projects. In fact, it has been shown that a reasonable number of patients who have given their consent in this situation are only able to recall very little of the information they received about the study and that only a minority read through the consent form before signing it. The aim of this study is to determine how physicians, who have been involved in including patients in intervention trials in the early phase of their AMIs, experienced the informed consent procedures. In our view, data obtained from those people who are actually confronted by the research subjects and who are responsible for carrying out the consent procedure should also be taken into account, when the most appropriate ways of including these patients in studies are discussed. To our knowledge no survey of physicians relating to this issue has previously been undertaken.

  • 3924. Ågård, A
    et al.
    Hermerén, G
    Herlitz, Johan
    [external].
    Informed consent: Are there ethically justified conditions for exceptions?2002Ingår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 87, nr 2, s. 105-106Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    Abstract [en]

    Are good clinical practice and informed consent inseparable? This depends, to some extent at least, on what is meant by “inseparable”. Does this refer to a logical relation, on the assumption that “good clinical practice” by definition includes informed consent, to an empirical generalisation about current medical practice, or a normative statement about how it ought to be? Different arguments pro and contra are relevant depending on whether the statement is interpreted as a logical statement, an empirical generalisation, or as a normative statement.We do not dispute the moral ground for the requirement of informed consent in general,1 and we agree with the statement that “the clinical duty to obtain proper informed consent is now widely believed to be an essential component of good clinical practice”. Neither do we dispute that improved training in communication skills and more time for doctors to communicate with their patients would be a good thing—and probably make more patients participate in the decision process.2What we wished to do in our paper3 was to discuss whether there might not be situations in which exceptions from the general requirement of informed consent would be acceptable. We hope that such a debate could help to define stringent and precise conditions when such exceptions could be morally and legally acceptable. One general assumption we share is the idea that such an exception is reasonable, if insisting on the requirement of informed consent causes more harm than good. In its turn, this presupposes a discussion of criteria of harm and benefit and who should decide about the relative magnitude of harm and benefit. Verification after the event by the patients in question could in certain situations be worth investigating. If there is a verification by the patients concerned, in the sense that they afterwards confirm that they think that an exception from the general requirement was ethically justified, then the concept of an exception from the general main rule is supported by referring to what the patients themselves want. If autonomy is taken seriously, references to what the patients say they want cannot be dismissed lightly.Our ambition with the study published3 was not to suggest any radical changes regarding the informed consent procedure when a patient is suffering from an acute myocardial infarction and is a potential research subject, nor to draw any general conclusions from the results obtained. Instead, we wanted to elucidate the possible problems and disadvantages associated with the process of obtaining informed consent in this particular situation. Primarily we wanted to stimulate the debate on the following two issues:1. Does a patient in the midst of a life crisis have to put his/her signature on a consent form in order to be included in an intervention trial?2. Are there ethically justified alternatives to informed consent when a researcher wants to include a patient in a study, who is not capable of giving a free and informed consent in research?We stated: “All possible measures to increase the autonomy of the patients under the prevailing circumstances should be carried out”. Thus, we do not suggest that all patients with acute myocardial infarction should be treated as incompetent. However, what we have tried to do in our study is to bring forth and highlight empirical evidence, which seems to show that in this particular situation some patients do not have the capacity to give a true informed consent for study participation.Professor Doyal adds another argument, to the effect that even if the patients afterwards do not remember anything, this does not reduce the moral importance of relevant information disclosure. The main question is what is meant by “relevant information disclosure”, and who decides what this is. Suppose (a) that it is left to the patient to decide what is relevant information disclosure, (b) that additional information does not change the decision of the patient, and (c) they do not want this additional information, which conclusion should be drawn from this?We claim that it is time to adjust the informed consent procedure to the patients' capacity in this particular situation. Moreover, the patient should be spared the “actual demand” of signing the consent form in the early phase of an acute myocardial infarction.

  • 3925. Ågård, A
    et al.
    Hermerén, G
    Herlitz, Johan
    [external].
    Patients' experiences of intervention trials treatment of myocardial infarction: is it time to adjust the informed consent procedure to the patient's capacity?2001Ingår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 86, nr 6, s. 632-637Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE—To investigate how patients included in trials on treatment in the early phase of acute myocardial infarction experience the consent procedure. DESIGN—A combined qualitative and quantitative interview concerning the patients' knowledge of the trial, their feelings about being asked to participate, and their attitudes towards the consent procedure. SETTING—Tertiary referral centre. PATIENTS—31 patients who had given written informed consent for their participation in randomised intervention trials of acute myocardial infarction. RESULTS—The patients interviewed had only fragmentary knowledge about the trial they were involved in. Most considered that reading and signing a consent form was an unwanted or unnecessary procedure. Instead, they would have preferred to have been given concise verbal information about the study. Most were willing to allow a physician to decide for them in the event of their being too ill to be asked about their participation. CONCLUSIONS—Patients who are asked to participate in intervention trials in the early phase of acute myocardial infarction often appear to lack sufficient knowledge to reach an autonomous choice. There were problems and disadvantages associated with the process of obtaining written informed consent in this particular situation, especially regarding the need for the patient to sign a consent form during the acute phase of the disease.

  • 3926. Ågård, A
    et al.
    Hermerén, G
    Herlitz, Johan
    [external].
    Should cardiopulmonary resuscitation be performed on patients with congestive heart failure? The role of the patient in the decision-making process2000Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 248, nr 4, s. 279-286Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: There is an ongoing debate about patients' involvement in the decision of whether or not to start, cardiopulmonary resuscitation (CPR) in the case of cardiac arrest. The objective here is to analyse on what grounds patients with heart failure, who run a relatively high risk of suffering cardiac arrest, form their attitudes towards CPR and to what extent they want to be involved in making decisions concerning CPR. DESIGN: This study employs a combined qualitative and quantitative interview concerning patients' knowledge about CPR, their experiences and preferences regarding involvement in making decisions concerning CPR, and their willingness to undergo CPR. SETTING: The study was performed at the Department of Cardiology, Sahlgrens University Hospital, Gothenburg. SUBJECTS: The subjects involved were 40 patients with various stages of chronic heart failure. RESULTS: Many of the interviewees lacked fundamental knowledge of CPR. The majority of the patients opted for CPR no matter how small their chances of survival were. The issue had not earlier engaged their thoughts, even less been discussed with physicians. The patients relied on the physician's ability to judge if CPR was to be regarded as a potentially beneficial intervention or as an unmotivated one. Nevertheless, the patients welcomed the opportunity to take part in the decision-making process. CONCLUSION: In order to make ethically justified decisions, physicians should consider bringing up the question of CPR with patients suffering from heart failure at the point in time where the progressive disease gives rise to more severe symptoms, corresponding to NYHA classes IIIb-IV. In earlier stages of the disease, one can assume that the patient will opt for CPR unless he or she demonstrates a negative attitude towards life.

  • 3927. Ågård, A
    et al.
    Hermerén, G
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    When is a patient with heart failure adequately informed? A study of patients' knowledge of and attitudes toward medical information2004Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 33, nr 4, s. 219-226Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The primary aim was to explore patients' knowledge of heart failure and their attitudes toward medical information (prognostic information in particular) and to assess different patient-related factors that might hamper the improvement of patients' knowledge. Moreover, taking the data obtained into account, we analyzed ethical aspects of information disclosure to patients with heart failure. SETTING: The study was performed at Sahlgren's University Hospital in Gothenburg, Sweden. DESIGN: The study was a qualitative analysis of semistructured interviews. PATIENTS: The sample included 40 patients with various stages of chronic heart failure. RESULTS: Many patients had only a limited understanding of their disease, but they still claimed that they were satisfied with the information they received. Some of them seemed to accept, to be indifferent to, or to be unaware of their low level of knowledge. The majority did not request prognostic information. CONCLUSION: We argue that patients with heart failure are adequately informed when they have reached the level of knowledge that enables them to be managed as effectively and securely as possible while being satisfied with the information provided. To give adequate information, health care providers should determine the patients' level of knowledge and explore why those patients who have a limited understanding do not assimilate or request information.

  • 3928.
    Ågård, Anders
    et al.
    Sahlgrenska University Hospital.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sallin, Karl
    Uppsala University.
    Engström, Ingemar
    Örebro University.
    Ethical controversies when formulating new national guidelines on cardiopulmonary resuscitation in Sweden2017Ingår i: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Delegation for Medical Ethics within the Swedish Society of Medicine has taken the initiative to create national ethical guidelines on cardiopulmonary resuscitation. The reasons behind this initiative were indications of differences in the way decisions about cardiopulmonary resuscitation were made and documented and requests expressed by health- care professionals for new national ethical guidelines. During the process of creating the guidelines, a number of work- shops were held with representatives from the delegation and clinical experts from various branches of medicine. Several versions of the working document were sent to consultation bodies with requests for comments. We therefore believe that the final guidelines are well supported by the medical profession in Sweden. The purpose of this article is to present ethical issues on which it was difficult to reach consensus due to divergent opinions expressed by the people and organisations involved. The arguments for and against a particular point of view or wording in the text are presented. The main controversies were related to the following six issues; Determining whether or not cardiopulmonary resus- citation is beneficial for the patient – The presence of close loved ones during cardiopulmonary resuscitation – Performing cardiopulmonary resuscitation for the benefit of people other than the patient – Ambulance personnel’s mandate to decide not to initiate and to terminate cardiopulmonary resuscitation outside hospital – Limiting the length and content of cardiopulmonary resuscitation – Whether or not to specify a week of gestation before which cardio- pulmonary resuscitation should not be started. 

  • 3929.
    Åhlström, Linda
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Dellve, Lotta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. 1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    Implementation of lean and the 3-year-trends of sick-leave among health care workers in different hospital care context2015Konferensbidrag (Refereegranskat)
  • 3930.
    Åhsberg, Cecilia
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Johansson, Jenny
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Förstagångspappors upplevelser av förlossningen2009Självständigt arbete på avancerad nivå (magisterexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    Som barnmorska är det viktigt att tänka på hela familjen under förlossningen. Det blir naturligt stort fokus på kvinnan eftersom det är hon som bär på barnet och hon som föder det. Från att det på 60- talet var ovanligt att de blivande papporna var med på förlossningen är det idag konstigt om de inte är med. Syfte med studien är att beskriva mäns upplevelser av att vara med vid sitt första barns födelse. Studien har sin grund i metoden fenomenologi med livsvärldsansats. Det innebär att försöka förstå hur papporna upplever förlossningen. Intervjuer genomfördes med åtta förstagångs pappor 24 till 48 timmar efter förlossningen. Resultatet tydliggörs i fem bärande teman. De är att vara bra förberedd inför förlossningen, att känna sig utsatt i den okända situationen, att få en förändrad självbild under förlossningen, att få trygghet och bekräftelse av barnmorskan, att få vara med om det fantastiska och omtumlande mötet med barnet. Essensen visar att männen strävar mot att vara ett gott stöd för kvinnan på bekostnad av sina egna behov. Männen behöver bli sedda och bekräftade under förlossningen i sin nya papparoll.

  • 3931. Årestedt, Kristofer
    et al.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Israelsson, Johan
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Psychometric properties of the Hospital Anxiety and Depressionscale in sudden cardiac arrest survivors2015Konferensbidrag (Refereegranskat)
  • 3932.
    Årestedt, Kristoffer
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Allert, Camilla
    Blekinge Institute of Technology.
    Djucanovic, Ingrid
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Agerström, Jens
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Liselott
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Health Related Quality of Life Among In-Hospital Cardiac Arrest Survivors in Working Age2018Konferensbidrag (Refereegranskat)
  • 3933.
    Ödman, Elise
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Magni, Maria
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Att leva med en obotlig sjukdom.Att leva med en obotlig sjukdom.2012Självständigt arbete på grundnivå (kandidatexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    HIV är en av de största epidemierna i världen och i Sverige lever ca 5300 personer med HIV idag. HIV är en långvarig sjukdom där behandlingen består av bromsmediciner. Över hela världen är HIV förknippat med fördomar. Att drabbas av HIV innebär stora påfrestningar och omvälvningar i livet. Många upplever en känsla av skam, stigma och diskriminering vilket kan leda till ett lidande. Vårdpersonal behöver kunskap om HIV-sjukdomen och hur den upplevs av personer. Det kan hjälpa vårdpersonalen i vården av och i mötet med HIV-smittade personer. Syftet är att beskriva personers upplevelser av att få diagnosen HIV och hur det är att leva med sjukdomen. Uppsatsen är en litteraturstudie baserat på vårdvetenskapliga artiklar med kvalitativ inriktning. En litteratursökning i vårdvetenskapliga databaser gjordes vilket resulterade i tio artiklar som kvalitetsgranskades och analyserades. Likheter och skillnader i studiernas resultat identifierades och utmynnade i två huvudteman och åtta subteman. Upplevelser i samband med diagnos beskriver olika reaktioner i samband med att personerna får sin diagnos och känslan av att vara annorlunda. Att leva sitt liv med HIV beskriver hur personerna lever vidare, betydelsen av omgivningens stöd och upplevelser av möten i vården. Det mest framträdande i resultatet är livsförändring, stigmatisering, andlighet och upplevelser av möten i vården, vilka tas upp i diskussionen. Där betonas också vikten av att vårdpersonalen individanpassar vården, utgår ifrån ett livsvärldsperspektiv och att han/hon bemöter individen med respekt och värdighet.

  • 3934. Öresland, Stina
    et al.
    Määttä, Sylvia
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Norberg, Astrid
    Lützén, Kim
    Patients as 'Safeguard' and Nurses as 'Substitute' in Home Health Care2009Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 16, nr 2, s. 219-230Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    One aim of this study was to explore the role, or subject position, patients take in the care they receive from nurses in their own home. Another was to examine the subject position that patients say the nurses take when giving care to them in their own home. Ten interviews were analysed and interpreted according to a discourse analytical method. The findings show that patients constructed their subject position as ‘safeguard’, and the nurses’ subject position as ‘substitute’ for themselves. These subject positions provided the opportunities, and the obstacles, for the patients’ possibilities to receive care in their home. The subject positions described have ethical repercussions and illuminate that the patients put great demands on tailored care.

  • 3935. Öresland, Stina
    et al.
    Määttä, Sylvia
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Norberg, Astrid
    Winther Jörgensen, Marianne
    Lützén, Kim
    Nurses as guests or professionals in home health care2008Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, nr 3, s. 371-383Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to explore and interpret the diverse subject of positions, or roles, that nurses construct when caring for patients in their own home. Ten interviews were analysed and interpreted using discourse analysis. The findings show that these nurses working in home care constructed two positions: `guest' and `professional'. They had to make a choice between these positions because it was impossible to be both at the same time. An ethics of care and an ethics of justice were present in these positions, both of which create diverse ethical appeals, that is, implicit demands to perform according to a guest or to a professional norm.

  • 3936.
    Östman, Malin
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bäck-Pettersson, Siv
    Sandvik, Ann-Helén
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Continuity of care as experienced by next of kin in patients with chronic heart failure2019Konferensbidrag (Refereegranskat)
  • 3937.
    Östman, Malin
    et al.
    Göteborgs Universitet.
    Jakobsson Ung, Eva
    Göteborgs Universitet.
    Falk, Kristin
    Göteborgs Universitet.
    Continuity means "preserving a consistent whole" - A grounded theory study.2015Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 10, artikel-id 29872Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Living with a chronic disease like chronic heart failure (CHF) results in disruptions, losses, and setbacks in the participants' daily lives that affect health and well-being. By using grounded theory method, we illuminate whether persons with CHF experience discontinuity in life and, if so, what helps them to preserve and strengthen continuity in their daily lives. Thirteen individual interviews and one group interview with five participants, aged 62 to 88 years, were carried out. Through data collection and data analysis, we constructed three concepts that make up a model illustrating the participants' experiences in daily life in relation to corporeality, temporality, and identity: experiences of discontinuity, recapturing approaches, and reconciliation. The first concept, experiences of discontinuity, was constructed from the following categories: the alienated body, the disrupted time, and the threatened self. The second concept, recapturing approaches, consists of categories with continuity creative constructions: repossessing the body, maintaining a façade, seizing the day, restoring the balance of time, and preserving self. These actions are intended to overcome problems and master changes in order to maintain balance in daily life through constructions that recreate normality and predictability. The third concept, reconciliation, was constructed from three categories: feel normal, set to adjust, and be positioned. These categories describe how the participants minimize their experiences of discontinuity by recapturing approaches in order to reconcile with various changes and maintain continuity in daily life. Our findings provide a fresh perspective on continuity that may contribute to the development of significant interventions in continuity of care for persons with CHF. However, continuity requires that healthcare systems support each patient's ability to manage change, reorientation, and adjustment to the new situation in order to make it easier for the patient to create and continue living their daily lives as they desire.

  • 3938.
    Östman, Malin
    et al.
    Göteborgs Universitet.
    Ung, Eva Jakobsson
    Göteborgs Universitet.
    Falk, Kristin
    Göteborgs Universitet.
    Health-care encounters create both discontinuity and continuity in daily life when living with chronic heart failure - A grounded theory study.2015Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 10, nr 1, artikel-id 27775Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Living with chronic heart failure (CHF) often involves lifelong contact with health care, more or less frequently, depending on fluctuating health-generating disruptions in everyday life. To reduce the influence on continuity in life, health-care professionals should preferably focus on supporting patients in managing their daily lives, based on their perspective. The aim of this study was to describe how the interaction in health-care encounters contributes to either continuity or discontinuity in the daily life for persons with CHF. Interviews with 18 participants were carried out, using the grounded theory method, through data collection and analysis. Two core concepts were constructed from data which reveal a model that illuminates the characteristics of the encounters, the actions of health-care professionals and the normative discourse. Patient-centred agenda consists of the categories: "Experiencing a subordinate approach," "Objectifying during the encounter" and "Expected to be compliant." This describes how health-care professionals enhance discontinuity in daily life by using a paternalistic approach in the encounter. Person-centred agenda consists of the categories: "Experiencing an empowering approach," "Person-centredness during the encounter" and "Expected to be capable." It describes how participants perceive that health-care professionals enable them to deal with everyday life which enhances continuity. The findings highlight the importance of health-care professionals' attitudes and communication in encounters with patients. Health care must be designed to support and promote patients' own strategic thinking by strengthening their self-image to enhance continuity in everyday life. The experience of discontinuity is based on the prevailing health-care culture which focuses on disease and medical treatment and regards it as superior to the illness experience in an everyday life context. We therefore strongly suggest a paradigm shift in the health-care organisation and culture in order to support the patients in their efforts to live a meaningful, rich life, in spite of the chronic illness CHF.

  • 3939.
    Čengić, Dalila
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Palosaari, Pirjo
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Distriktssköterskans erfarenheter av läkemedelsgenomgångar hos äldre patienter inom hemsjukvård och särskilda boenden2015Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Många äldre patienter har idag flera sjukdomar och många läkemedel eftersom detta är den vanligaste behandlingsformen. Med antal läkemedel ökar risken för läkemedelsbiverkningar samt sämre livskvalitet och välbefinnande för patienten. Läkemedelsgenomgångar är till för att se över vilka läkemedel patienten använder och varför dessa läkemedel är ordinerade. Även nyttan och risker för läkemedelsbiverkningar ses över.

    Syftet är att undersöka distriktssköterskans erfarenheter av läkemedelsgenomgångar hos äldre patienter inom den kommunala hälso- och sjukvården. För att uppnå syftet i denna studie har författarna använt sig av kvalitativ metod med induktiv ansats. Datainsamlingen genomfördes med halvstrukturerade intervjuer med sju distriktssköterskor och tre sjuksköterskor inom olika stadsdelar i en stad i Västra Götaland. Studien visar att distriktssköterskans erfarenheter av läkemedelsgenomgångar inom hemsjukvård och särskilda boenden är att det finns brister och hinder som kan påverka patientsäkerheten. Studien visar också att distriktssköterskor känner stort ansvar när det kommer till patientens läkemedelsanvändning, livskvalitet och välmående. Vidare saknas det ordentliga riktlinjer och ansvarsuppdelning vid läkemedelsgenomgångar. Studien visar även att ökad läkemedelsanvändning kan påverka miljö negativt samt att läkemedelsbiverkningar innebär onödiga kostnader för samhället och onödigt lidande för patienten.

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