Patient Perspective

Background: Cardiac Catheterization is a critical health status which requires standardized care policies, as well as it needs qualified and skilled health provider to obtain good outcome of management. This study aimed to assess the knowledge and practice of nurses regarding patient safety after cardiac catheterization. Material: This cross-sectional study was conducted in Punjab Institute of cardiology located in Lahore, Pakistan from 01 st December 2016 to 31 st March, 2017. 171 female nurses through using convenient sampling technique were included in the study. Questionnaire with multiple choice was used to collect data. Likert scale for multiple choose questionnaires regarding knowledge and practice of the nurses were used. Collected data were analyzed using SPSS version 21. Results: Out of 171 participants, all (N = 171) were female, most nurses had job experience of 2-5 years and 6-10 years, they were represented by 34.5% and 31.0% respectively. Mean of total knowledge was found good, when compared to mean of practice which was poor. This showed that nurses have good knowledge about post cardiac catheterization complication. It was found significant value of P < 0.0001 by applying correlation, that showed there was a good association between knowledge and practice (P < 0.05). There was positive association between the knowledge and practice about patient's safety after Cardiac Catheterization among Pakistanis registered nurses. Nurses those have proper knowledge and practice could help in rehabilitation of patients.

Bakgrund: Mötet med patienter från andra kulturer blir allt vanligare inom hälso-och sjukvården på grund av det mångkulturella samhället. Detta ställde krav på sjukvården då patientens syn på hälsa och sjukdom kan skilja sig från majoritetsbefolkningens. Kommunikation var viktigt i omvårdnaden och språkbarriärer kunde uppstå mellan sjuksköterskor och patienter när de inte talade samma språk. Leiningers transkulturella omvårdnadsteori omfattar hur hälsa och omvårdnad påverkas av kulturtillhörighet. Syfte: Syftet var att belysa sjuksköterskors erfarenhet av att vårda patienter med utländsk bakgrund som inte talar samma språk som vårdgivande sjuksköterska. Metod: En litteraturöversikt baserad på femton kvalitativa artiklar, en kvantitativ artikel och en med mixad metod. Resultat: Sammanställningen av datamaterialet resulterade i tre teman med två tillhörande subteman. Det första temat var Kommunikationshinder, det andra temat var Transkulturell omvårdnad och det tredje temat var Vårdrelation. Diskussion: Kommunikationen mellan sjuksköterskor och patienter påverkades av språkbarriärer och behövde därför förebyggas. Sjuksköterskor måste betrakta alla patienter som unik individer och vårda dem utifrån rådande behov. Att vårda alla patienter på lika villkor oavsett etnisk bakgrund var viktigt. Slutsats: Det behövs utbildning för sjuksköterskor i kulturell kompetens, och även i hur språkbarriären kunde hanteras, krävdes. Detta skulle möjliggöra en tillfredsställande transkulturell omvårdnad. Ytterligare forskning krävdes inom området för att säkra vårdkvaliteten och patientsäkerheten för dessa patienter.

The ways in which we interact with healthcare institutions and contribute to understandings of health and illness are influenced by uneven and often invisible power relations in the social world. One of the key mechanisms that dictate how healthcare interacts in the sociopolitical arena is the distribution of epistemic power. This chapter offers an in-depth examination of the unique epistemic injustices that arise in the medical context, within both somatic and psychiatric

Background The drive for non-medical prescribing has progressed quickly since the late 1990s and involves a range of healthcare professionals including pharmacists. As part of a commissioned research project, this qualitative element of a larger case study focused on the views of patients of pharmacist prescribers. Objective The aim of this study was to explore patients' perspectives of pharmacists as prescribers. Methods Three pharmacists working as independent prescribers in the clinical areas of (i) hypertension, (ii) cardiovascular/diabetes management, (iii) anticoagulation were recruited to three case studies of pharmacist prescribing in Northern Ireland. One hundred and five patients were invited to participate in focus groups after they had been prescribed for by the pharmacist. Focus groups took place between November 2010 and March 2011 (ethical/governance approvals granted) were audio taped, transcribed verbatim, read independently by two authors and analysed using constant comparative analysis. Thirty-four patients agreed to participate across seven focus groups. Analysis revealed the emergence of one overarching theme: team approach to patient care. A number of subthemes related to the role of the pharmacist, the role of the doctor and patient benefits. There was an overwhelming lack of awareness of pharmacist prescribing. Patients discussed the importance of a multidisciplinary approach to their care and recognized limitations of the current model of prescribing. Patients were positive about pharmacist prescribing and felt that a team approach to their care was the ideal model especially when treating those with more complex conditions. Despite positive attitudes, there was a general lack of awareness of this new mode of practice.

SUMMARY This work consists of a review of the medical records of 142 horses that visited the Equine dermatology clinic, at the University Animal Hospital, UDS, at Ultuna, Uppsala, Sweden, between January 2007 and June 2010. The study answers certain main questions like clinical signs responsible for the visit, the most common diagnoses, their diagnostic procedures, treatment modalities and finally, the outcome of treatment. Among 50 diagnoses, four were predominant followed by additional 46 diagnoses, each presenting by few or, in many cases, only one horse. The most common dermatological problem diagnosed was Equine Sarcoid representing 18,3 % of the cases (26/142), which probably reflects the initiation of a Sarcoid treatment-trial in 2007, that resulted in an accumulation of sarcoid horses in the clinic .The second most common diagnosis was Atopy 12 % (17/142) followed by Allergy with skin affection 9,2 % (13/142) and Acute superficial pyodermia 4,9 % (7/142). If the horses were ...

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and nonpharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.

Purpose Sexual well-being and sexual functioning are understudied in patients born with ARM. The aim of this exploratory study was to investigate sexual history, main fears, and problems encountered during sexual relationships. Methods Before participating in a sexual education intervention, 21 adolescents or young adults (12 males; mean 28.8; SD 10.6) born with ARM, answered a ten-item questionnaire specifically developed to evaluate sexual well-being. Percentages and Chi-square were calculated. Results 52.4% were married/had a partner. The majority (71%) declared that had sexual relationships. Mean age of the first sexual relationship was 18.8 (2.7) and 22.7 (3.8) for males and females, respectively. Females reported both more fear and experience of pain during sexual intercourse, compared to males. Main experienced problems and fears for male patients were loss of feces and premature ejaculation, followed by the fear of lack of erection and managing contraception. Main experienced problems and fears in females were loss of feces, pain, lack of desire, and lack of lubrication. In only few cases, patients asked for advices to a pediatric surgeon or to an adult surgeon specialized in ARM. Conclusions Adult and adolescent patients may benefit of andrological/gynecological evaluation, psychological support, and sexual counseling to improve their sexual well-being.

Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we take care of them? Research on human suffering after a major catastrophe, using an ethics of care perspective, is scarce. People suffering from disasters are often called to be in distress and their emotional difficulties 'medicalised'. This brings them often into a situation of long term use of medication, and one can wonder if medication is of help to them in the long run. In our paper, we will explore another moral perspective, focusing on the importance of the victims' narrative and their lived experiences. We will use Paul Ricoeur's phenomenological reflections from 'Suffering is not the same as pain' for conceptualizing human suffering and how to apply it to victims of disaster. Ricoeur suggests that suffering is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Above all, the perspective of care and listening could offer an opportunity to reconcile people from their loss and suffering.

Background and objective. The aim of this study was to describe what factors of the healthcare environment are perceived as being important to patients in oncology care. Design. A qualitative design was adopted using focus group interviews. Setting and participants. The sample was 11 patients with different cancer diagnoses in an oncology ward at a university hospital in west Sweden. Results. Analysis of the patients' perceptions of the environment indicated a complex entity comprising several aspects. These came together in a structure consisting of three main categories: safety, partnership with the staff, and physical space. The care environment is perceived as a complex entity, made up of several physical and psychosocial aspects, where the physical factors are subordinated by the psychosocial factors. It is clearly demonstrated that the patients' primary desire was a psychosocial environment where they were seen as a unique person; the patients wanted opportunities for good encounters with staff, fellow patients, and family members, supported by a good physical environment; and the patients valued highly a place to withdraw and rest. Conclusions. This study presents those attributes that are valued by cancer patients as crucial and important for the support of their well-being and functioning. The results show that physical aspects were subordinate to psychosocial factors, which emerged strongly as being the most important in a caring environment.

Patients with a non-English language preference (NELP) require services in a language different from that spoken by English-speaking healthcare practitioners. National guidelines advocate professional interpreting services, but little is known about patients' perspectives and factors that secure interpreting for them. A total of 1,120 NELP patients in Melbourne were surveyed from 2016 to 2020 in their preferred language. Patients report high awareness and utilisation of free interpreting services, predominantly initiated by healthcare staff rather than themselves. This points to cultural competence among healthcare staff as crucial for them to identify the need for interpreters. Alongside this, some patients rely on family members for linguistic mediation. This may result from patients not (self-)reporting their NELP or from contextual considerations. Amongst the latter are patients' privacy concerns and a lack of understanding that interpreters are bound to observe ethical principles such as confidentiality and impartiality. These responses underscore the need for explicit explanations from healthcare providers and interpreters to patients about their roles and the protocols they observe.

Sexualiteten är en del av varje människas identitet och har varierande innebörd för den enskilda individen. Förmågan att älska och att känna sig älskad är en viktig förutsättning för god hälsa. Den som drabbas av cancer får ofta sexuella problem och det är flera orsaker ...

ObjectiveTelemedicine has been promoted as an economical and effective way to enhance patient care, but its acceptance among patients in low-income and middle-income countries is poorly understood. This study is aimed to explore the experiences and perspectives of people with type 2 diabetes mellitus that used telemedicine to manage their condition.DesignIn-depth and focus group interviews were conducted with participants who have engaged in telemedicine. Questions included were participants’ perception on the programme being used, satisfaction as well as engagement with the telemedicine programme. All interviews and focus groups were audio-recorded and transcribed verbatim. Data were analysed using a thematic approach.Participants and settingPeople with type 2 diabetes (n=48) who participated in a randomised controlled study which examined the use of telemedicine for diabetes management were recruited from 11 primary care clinics located within the Klang Valley.ResultsTwelve focus ...

This study aimed to assess whether complementing atraumatic restorative treatment (ART) with oral health educational strategies (OHES) improves the perception of oral health-related quality of life (OHRQoL) and clinical oral outcomes. A controlled clinical trial included 93 six- to eight-year-old students from five public schools of Piracicaba, Saltinho, and Charqueada municipalities (State of São Paulo, Brazil) divided into 3 groups (31 children each) which received: OHES (caries-free), ART (dental caries), and ART plus OHES (dental caries). OHRQoL (CPQ8-10-ISF:16), dental caries, biofilm control, and gingivitis were assessed before and 1 month after interventions by one calibrated examiner. OHES consisted of an educational interactive activity performed once a week for four weeks. Data were analyzed using mixed model ANOVA, Chi-square, and Sign tests. After 1 month of follow-up, improvement in gingivitis status, OHRQoL total score, and Functional Limitations, Emotional Well-Being ...

ObjectivesWe hypothesise that patients have a positive sentiment regarding biological/targeted synthetic disease modifying anti-rheumatic drugs (b/tsDMARDs) and a negative sentiment towards conventional synthetic agents (csDMARDs). We analysed discussions on social media platforms regarding DMARDs to understand the collective sentiment expressed towards these medications.MethodsTreato analytics were used to download all available posts on social media about DMARDs in the context of rheumatoid arthritis. Strict filters ensured that user generated content was downloaded. The sentiment (positive or negative) expressed in these posts was analysed for each DMARD using sentiment analysis. We also analysed the reason(s) for this sentiment for each DMARD, looking specifically at efficacy and side effects.ResultsComputer algorithms analysed millions of social media posts and included 54 742 posts about DMARDs. We found that both classes had an overall positive sentiment. The ratio of positiv...

To cite: Strand V, de Vlam K, covarrubias-cobos Ja, et al. tofacitinib or adalimumab versus placebo: patientreported outcomes from OPal Broaden-a phase iii study of active psoriatic arthritis in patients with an inadequate response to conventional synthetic disease-modifying antirheumatic drugs. RMD Open 2019;5:e000806.

Background and aims While predictors of survival in older people have been examined in depth in a large number of studies, a literature search revealed no cross-national comparative prospective cohort studies on this issue. This study investigated survival and its predictors from age 75 to 85 among three local Nordic populations using survival data on national cohorts as background information. Methods The data were derived from national registers and from samples of 75-year old living in Denmark, Sweden, and Finland. The subjects were invited to take part in interviews and examinations focusing on different domains of health, functional capacity, and physical and social activities. Results The proportion of survivors to age 75 was markedly smaller among the Finnish men and women than Danish or Swedish subjects. In the local population no marked differences in survival from age 75 to 85 were observed between the groups of men, while women survived longer than men and longer in Göteborg than in Glostrup or Jyväskylä. Univariate models revealed 12 predictors of survival. In the multivariate models, the significant predictors among men related to physical fitness, whereas among women they pertained to social activities and morbidity. Conclusions Despite great differences in the proportions of survivors to age 75, and excepting the survival advantage of women, only minor differences were present in the subjects' further survival to age 85. In the univariate analyses, many of the factors predictive of survival from age 75 to 85 were the same in the examined populations, whereas in the multivariate analyses differences between the sexes emerged.

Objectives: To evaluate the effect of individually tailored programs on perceived autonomy in institutionalized physically disabled older people and to describe participants' activity wishes and content of the programs. Method: This blinded randomized trial with follow-up included a total of nine nursing homes and 50 nursing home residents who were randomized into either a control group or an intervention group. Perceived autonomy was measured at baseline (T1), after 12 weeks (T2) of intervention and after 24 weeks (T3) Wishes for daily activities was identified at T1. Weekly reports of individual programs were drawn up. Results: Both groups perceived autonomy as average at baseline and increased their mean score at T2 to high

Bakgrund Antalet kirurgiska ingrepp förväntas öka, och därmed ökar även den totala risken för komplikationer. Världshälsoorganisationen, World Health Organization, WHO, har tagit fram en Checklista att använda i samband med kirurgiska ingrepp för att minska komplikationer och öka patientsäkerheten. Syftet med föreliggande studie är att undersöka operationssjuksköterskors erfarenheter av Checklistan. Metod En pilotstudie genomfördes och fem operationssjuksköterskor intervjuades. Intervjuerna transkriberades ordagrant och en manifest kvalitativ innehållsanalys gjordes med induktiv ansats. Resultatet visar att det fanns hinder vid användning av Checklistan, det fanns en ovana vid de nya rutiner som Checklistan innebär, arbetslagets attityder påverkar användningen och att vissa i operationsteamet visade oförståelse för Checklistans syfte. Osäkerhet rådde bland operationssjuksköterskorna för när Checklistans olika faser skulle utföras samt vem som ska initiera Checklistan. Användning av Checklistan medförde trygghet för så väl patient som personal, liksom en ökad handlingsberedskap för operationssjuksköterskan. Presentation av personalen på operationssalen ansågs vara positiv för ny personal, och negativ då detta tar tid och innebär upprepning. Slutsats WHO:s Checklista är ett bra verktyg för att öka kommunikationen och därmed öka patientsäkerheten. Det fanns ett behov av att anpassa Checklistan till den egna kliniken.

Bakgrund Antalet kirurgiska ingrepp förväntas öka, och därmed ökar även den totala risken för komplikationer. Världshälsoorganisationen, World Health Organization, WHO, har tagit fram en Checklista att använda i samband med kirurgiska ingrepp för att minska komplikationer och öka patientsäkerheten. Syftet med föreliggande studie är att undersöka operationssjuksköterskors erfarenheter av Checklistan. Metod En pilotstudie genomfördes och fem operationssjuksköterskor intervjuades. Intervjuerna transkriberades ordagrant och en manifest kvalitativ innehållsanalys gjordes med induktiv ansats. Resultatet visar att det fanns hinder vid användning av Checklistan, det fanns en ovana vid de nya rutiner som Checklistan innebär, arbetslagets attityder påverkar användningen och att vissa i operationsteamet visade oförståelse för Checklistans syfte. Osäkerhet rådde bland operationssjuksköterskorna för när Checklistans olika faser skulle utföras samt vem som ska initiera Checklistan. Användning av Checklistan medförde trygghet för så väl patient som personal, liksom en ökad handlingsberedskap för operationssjuksköterskan. Presentation av personalen på operationssalen ansågs vara positiv för ny personal, och negativ då detta tar tid och innebär upprepning. Slutsats WHO:s Checklista är ett bra verktyg för att öka kommunikationen och därmed öka patientsäkerheten. Det fanns ett behov av att anpassa Checklistan till den egna kliniken.

Bakgrund: I Sverige diagnostiseras omkring 20 kvinnor dagligen med en brostcancerdiagnos. Detta resulterar i att varje ar far 9000 kvinnor en brostcancerdiagnos. Hur en kvinna upplever att diagnostiseras med brostcancer ar hogst individuellt och upplevelsen kan endast beskrivas av personen sjalv. Olika personer erfar och tolkar saker och ting som hander i det dagliga livet olika beroende pa tidigare erfarenheter och handelser i livet. Fa studier har undersokt hur kvinnor med brostcancer upplever perioden mellan diagnos och behandling. Sjukskoterskan har ett ansvar att bedoma patienters behov av stod efter en diagnos. Det ar darfor av betydelse att studera kvinnors upplevelse efter diagnos fram till att behandlingen startar. Syfte: Syftet med studien var att belysa kvinnors upplevelse efter diagnosen brostcancer fram till behandlingen startar. Metod: Kvalitativ litteraturstudie baserad pa tre patografier. Resultatet har analyserat med inspiration av Graneheim och Lundmans tolkning av...

Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we take care of them? Research on human suffering after a major catastrophe, using an ethics of care perspective, is scarce. People suffering from disasters are often called to be in distress and their emotional difficulties 'medicalised'. This brings them often into a situation of long term use of medication, and one can wonder if medication is of help to them in the long run. In our paper, we will explore another moral perspective, focusing on the importance of the victims' narrative and their lived experiences. We will use Paul Ricoeur's phenomenological reflections from 'Suffering is not the same as pain' for conceptualizing human suffering and how to apply it to victims of disaster. Ricoeur suggests that suffering is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Above all, the perspective of care and listening could offer an opportunity to reconcile people from their loss and suffering.

The public health nurse often constitutes the final link in the chain of care from somatic care in hospitals, to continued care in patient's homes. In order to guarantee patient safety and quality of care, it is important that the final report accompanying the patient home contains nursing information that is regarded as relevant for the continued home care. The nursing report written when the patient is discharged from the hospital should contain a short description over the patients immediate care need. The aim of this study was to describe the public health nurses perceptions of the relevance and the usefulness of nursing reports in continued home care with focus on palliative patients, and to compare their perceptions with the actual content in nursing reports accompanying the patient when discharged from the closed somatic care. Method used was content analyze in analysing 16 functional reports, documented by nurses at a surgery ward specializing in abdominal surgery in a large hospital in the Gothenburg region. In addition five public health nurses in the Gothenburg region were interviewed, and the interviews were analysed using content analysis approach. The last and final part consisted of a comparison between the nursing reports and the result of interviews in order to assess similarities and differences. The result of this study showed that the nursing reports can be improved in several aspects to guarantee palliative patients continued good palliative care in there home environment. The reports should describe the patients health problems and symptoms on the basis of the patients experience. They should also contain a description of which information the patient and relatives has been given regarding the disease and the course of the prognoses. Medical terminology and internal shortenings in the nursing report should decrease at the time as the use of language of nursing theory and nursing process should increase.

ObjectiveTelemedicine has been promoted as an economical and effective way to enhance patient care, but its acceptance among patients in low-income and middle-income countries is poorly understood. This study is aimed to explore the experiences and perspectives of people with type 2 diabetes mellitus that used telemedicine to manage their condition.DesignIn-depth and focus group interviews were conducted with participants who have engaged in telemedicine. Questions included were participants’ perception on the programme being used, satisfaction as well as engagement with the telemedicine programme. All interviews and focus groups were audio-recorded and transcribed verbatim. Data were analysed using a thematic approach.Participants and settingPeople with type 2 diabetes (n=48) who participated in a randomised controlled study which examined the use of telemedicine for diabetes management were recruited from 11 primary care clinics located within the Klang Valley.ResultsTwelve focus ...

Although opioid maintenance treatment lowers mortality and has proven efficacy in reducing opioid use, it is not an option for every person with an opioid addiction. Studies of the experiences of those who have overcome their addiction without pharmaceuticals are rare, but vital to understanding the quitting process and how it can be facilitated. This study investigated what persons with a previous heroin addiction perceived as helpful when overcoming their addiction without the use of pharmaceuticals, and what they consider important for health services to consider. Eleven adults with former heroin addiction participated. Most described the leaving process as prolonged and including many attempts. Experiences such as being worn out and numb, life-threatening overdoses, personal losses or a growing feeling of missing important stages in life fueled the decision process. Envisioning a future without drugs was described as an important component. To maintain the decision to refrain from heroin use the possibility to gain a new social context was crucial. Results imply that health care professionals should be proactive by seizing the moment of opportunity for change (e.g., after an overdose), and should be empathetic and never give up on a person. Those concerned with care, welfare and other support or control systems in society must cooperate to offer more personalized support.

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Although opioid maintenance treatment lowers mortality and has proven efficacy in reducing opioid use, it is not an option for every person with an opioid addiction. Studies of the experiences of those who have overcome their addiction without pharmaceuticals are rare, but vital to understanding the quitting process and how it can be facilitated. This study investigated what persons with a previous heroin addiction perceived as helpful when overcoming their addiction without the use of pharmaceuticals, and what they consider important for health services to consider. Eleven adults with former heroin addiction participated. Most described the leaving process as prolonged and including many attempts. Experiences such as being worn out and numb, life-threatening overdoses, personal losses or a growing feeling of missing important stages in life fueled the decision process. Envisioning a future without drugs was described as an important component. To maintain the decision to refrain from heroin use the possibility to gain a new social context was crucial. Results imply that health care professionals should be proactive by seizing the moment of opportunity for change (e.g., after an overdose), and should be empathetic and never give up on a person. Those concerned with care, welfare and other support or control systems in society must cooperate to offer more personalized support.

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and nonpharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.

Background: Despite increasing calls for patient and public involvement in healthcare quality improvement, the question of how patient evaluations can contribute to physician learning and performance assessment has received scant attention. The objective of this study was to explore, amid calls for patient involvement in quality assurance, patients' perspectives on their role in the evaluation of physician performance and to support physicians' learning and decision making on professional competence.

Bakgrund: De flesta människor har närstående i någon form. Dessa närstående kan utgöras av den egna familjen, men även bestå av andra människor såsom kollegor, vänner och gamla bekanta. Kontakten med patienten innebär ofta en nära kontakt med patientens närstående vilket kan ses som en resurs eller ett hinder i vården av patienten. Författarna är av uppfattningen att sjuksköterskans upplevelse av de närstående kommer att vara styrande i hur hon hanterar de närstående och utför sitt arbete. Syfte: Syftet är att beskriva sjuksköterskans upplevelser av patientens närstående i vård kontexter där patienten kan ha svårt att föra sin egen talan. Metod: Litteraturöversikt som bygger på nio vetenskapliga artiklar. Teoretisk ansats är hämtad från Aaron Antonovsky. Antonovskys teori och idéer om känslan av sammanhang är relevant för och kan bidra till förståelsen av sjuksköterskans upplevelse av patientens närstående. Resultat: I resultatet framkommer sjuksköterskans upplevelse av närstående från perspektiven resurs och hinder. Idealet är en god relation och de fördelar detta innebär för de inblandade. Vissa risker finns dock vid för stor emotionell inblandning med närstående. Sjuksköterskan måste känna att hon har den utbildning och erfarenhet som krävs för att kunna bemästra situationen. Diskussion: I metoddiskussionen diskuteras val av sökord och tillvägagångssätt. Resultatet utmynnade i två teman, upplevelser kring närstående som resurs och upplevelser kring närstående som hinder. Dessa teman diskuteras i resultatdiskussionen. I resultatdiskussion diskuteras även sjuksköterskans upplevelser av närstående utifrån Antonovskys teori om KASAM, eller känsla av sammanhang.

Elicitation techniques in connection with semi-structured interviews are scantily used, but reported to be beneficial to research. We developed and tested a new visual technique to be utilized in the latter part of semi-structured interviews. It has proved to be feasible and beneficial to use, and it could possibly be used by others. This way of extending the interviews generates more data in a visual form, as well as in a verbal form, by supporting the participants in remembering nearly forgotten parts of their experiences and in expressing emotions associated with those significant experiences. As a contribution to qualitative research, our study showed that the visual data, created by the participants, also contributed to getting the elaborated narratives.

Hörberg, Ulrica (2008). Att vårdas eller fostras. Det rättspsykiatriska vårdandet och traditionens grepp. (To be the subject of care or the object of correction. Forensic psychiatric care and the power of tradition). Acta Wexionensia No 133/2008.

Att uppleva förändringar i relationer _______________________________________ Påverkan på familjelivet _______________________________________________________________ Behovet av stöd ______________________________________________________________________ När sjukvården brister ___________________________________________________ Att uppleva avsaknad på information och förberedelse _______________________________________ Att inte känna sig sedd _______________________________________________________________ Att uppleva ett ökat ansvar _______________________________________________ Att uppleva stress och oro _____________________________________________________________ Att uppleva ständig närvaro ____________________________________________________________ Behovet av avlastning ________________________________________________________________

Att uppleva förändringar i relationer _______________________________________ Påverkan på familjelivet _______________________________________________________________ Behovet av stöd ______________________________________________________________________ När sjukvården brister ___________________________________________________ Att uppleva avsaknad på information och förberedelse _______________________________________ Att inte känna sig sedd _______________________________________________________________ Att uppleva ett ökat ansvar _______________________________________________ Att uppleva stress och oro _____________________________________________________________ Att uppleva ständig närvaro ____________________________________________________________ Behovet av avlastning ________________________________________________________________

Background: Ensuring patient involvement in health technology assessments (HTAs) and clinical practice guidelines (CPGs) is important. However, the goals and methods of such involvement are not always clear. Objectives: The aim of this study was to 1) discover ways to involve patients in HTA and CPG processes, 2) describe challenges, and 3) find ways of informing patients about HTAs and CPGs in Finland. Methods: As part of a one-day seminar targeted at representatives of patient organizations (POs), 3, 1-h focus group discussions were held (n ¼ 20, with 14 PO representatives). PO representatives included real patients and health care professionals working in the organizations. The discussions were tape-recorded, transcribed, and thematically analyzed. Results: Focus group participants highlighted the importance of gathering patient views from a group of patients, rather than individuals. Surveys through POs were the most frequently mentioned means of gathering patients' views. PO representatives reported interest in cooperating in HTA and CPG processes. The most often mentioned challenges were finding appropriate representatives for the target group and conveying information about HTAs and CPGs to patients. Multichannel communication was seen as essential. Furthermore the information should be readable, comprehensible, tailored, reliable, reusable, complementary, and timely. Conclusions: Possible strategies to involve patients in HTA and CPG processes were incorporating patient representatives in the CPG and HTA groups, offering timely possibility to participate, and ensuring reporting with clear and unambiguous language. The main identified challenge was finding appropriate representatives of the target group. The role of POs was seen as important particularly when informing the patients.

Background: Cardiovascular disease has been found in young people because of the unhealthy lifestyle that is lived by many younger people. Packed activities, social life, and students' assiduity affect their lifestyle. Each student lives a different lifestyle depending on their motivation, therefore it's necessary to do research in order to investigate students' lifestyles, consist of smoking behavior, eating behavior, and physical activity, using the Protection Motivation Theory, which consists of perceived vulnerability and severity of cardiovascular disease, response efficacy, and self-efficacy of healthy behavior. This research aimed to ascertain students' healthy lifestyle as protection against cardiovascular disease. Methods: The research was done using the qualitative method with a phenomenology approach. The data were gathered by doing comprehensive interviews with 14 informants in a purposive way with maximum variation sampling, at four universities in Yogyakarta Province. The research was conducted from May to July 2015. Results: The results indicated that students have yet lived healthily due to some common habits such as smoking, unhealthy diet, lack of exercise, and other discoveries such as coffee and alcohol consumption. The attempt of protection against cardiovascular disease wasn't habitually done yet by students because of their young age and their customary thought that cardiovascular disease mostly happens to elderly people. Students haven't been aware yet that they are not resistant to cardiovascular disease. One of the reasons was how insufficient the student's awareness was when it comes to cardiovascular disease. Their perception of the disease severity was adequate due to the fact that they have seen directly the consequences that were caused by cardiovascular disease. The students' response efficacy and self-efficacy in doing a healthy lifestyle were also considered low because the access to make a healthy lifestyle was still less. Conclusion: The student's awareness of the cardiovascular disease was still low. Among the four parts of Protection Motivation Theory, the part on severity perception was quite decent due to the fact that they had seen directly the consequences that were caused by cardiovascular disease. Each university needs to provide health care services in order to promote a healthy lifestyle, particularly among students.

Background: Older persons with cognitive impairment (CI) risk social isolation. Strong evidence shows that perceived loneliness, or inadequate social networks, triggers and increases health problems. How homecare systems address social participation remains unknown; anecdotal data suggests there are significant gaps. This study's objective was to identify and describe how the assessors of homecare needs document social participation among persons with CI and how their documentation corresponds with the services actually provided to meet social needs. The research questions were: How and what kinds of social participation needs are documented on need assessment forms? What types of homecare services (with a social focus) are documented and approved? How are specified needs in social participation profiles addressed by a homecare service? Methods: Descriptive data from need assessment forms and their attached care plans for all applicants aged 65+ were collected during a 2 month period from a large homecare agency serving a municipality in Sweden. Persons with documented CI (n = 43) in the group were identified. Qualitative data analysis was conducted to examine the research questions. Results: Social participation factors were not documented consistently. The relationship between recognition of limitations to social participation and approval of service eligibility was not consistent. Social participation was designated by references to social status, sometimes by social network size, and occasionally by limitations to social participation. The range of approved homecare services (with social focus) covered services such as day care center visits or companionship. Three profiles of social participation were identified: clients with, (a) no participation limitations; (b) potential limitations; and (c) marked limitations. Conclusion: Given the known health harms from social isolation and the high risk of isolation among older persons with CI, this novel study's documentation of inadequate and inconsistent information in homecare social need assessments and services is sobering. The findings suggest a pressing need for initiatives to formulate best practices and standards to ensure alignment of care service systems to the health needs of the growing group of aging individuals with CI.

Rheumatoid arthritis (RA) has bene associated with atherosclerosis and cardiovascular (CV) disease. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) is suitable to detect synovial and vascular inflammation. Tofacitinib has been used to effectively treat RA.We wished to assess the effects of tofacitinib treatment on synovitis and vascular inflammation simultaneously by 18FDG-PET/CT.Thirty RA patients with active disease were treated with either 5 mg bid or 10 mg bid tofacitinib and evaluated at baseline and after 6 and 12 months. We determined DAS28, CRP, IgM rheumatoid factor (RF) and anti-cyclic citrullinated peptide (aCCP) levels. All patients underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in order to determine vascular and synovial inflammation in five aortic segments and five articular regions, respectively. In the joints, mean (SUVmean) and maximum standard uptake values (SUVmax), while in the...

Bakgrund: 2015 beviljades 100 000 uppehållstillstånd i Sverige. Människor från olika delar av världen har olika behov och olika sätt att tänka. Ett mångkulturellt samhälle kan leda till att sjuksköterskor och patienter kan uppleva utmaningar relaterade till deras olika kulturella bakgrund. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av utmaningar i omvårdnaden av patienter med en annan kulturell bakgrund. Metod: För att uppnå studiens syfte har uppsatsförfattarna valt att göra en litteraturstudie. 8 kvalitativa artiklar som alla har granskats och analyserats har använts. Resultat: Det kan uppkomma utmaningar i transkulturell omvårdnad. Sjuksköterskor identifierade tvärkulturell kommunikation, närståendes betydelse och behov, annorlunda uttryck vid svåra situationer, annorlunda inställning kulturella förväntningar på omvårdnad och behov av ökad kulturell kompetens i professionen som särskilt utmanande. Slutsats Utmaningarna i den transkulturella omvårdnaden är betydande men inte oöverkomliga. Sjuksköterskor upplever att en ökad kunskap inom området är av stor vikt för att tillgodose kompetent transkulturell omvårdnad.

The number of clinical trials for Duchenne muscular dystrophy is increasing. Many trials require muscle biopsies, which involve an invasive surgical procedure. Little is known about short-and long-term impacts of muscle biopsies as perceived by patients and caregivers. Therefore a survey was held among patients and their caregivers who participated in trials involving muscle biopsies, in seven countries. Seventy-eight responses were received. Analysis revealed that many patients and parents had significant anxiety before the biopsy. The main concern of caregivers was the required general anaesthesia. In most cases biopsies caused pain and temporarily hampered daily activities. The main long-term impact was scarring, although large variation in size was reported. Seventy-nine percent of caregivers were little bothered and 21% were moderately or severely bothered by the scar. Willingness to consider another biopsy in future protocols was higher for open-label studies than for placebo-controlled trials. Caregivers stressed the importance of knowing the results of biopsy analyses; only a minority actually received this information. Recommendations are made on the informed consent procedure regarding risks and consequences of muscle biopsies, and communication of results. Furthermore, efforts should be made to minimise the impact of biopsies through pain management and by considering plastic surgery.

To assess the effect of sildenafil, a phosphodiesterase type 5 inhibitor, on digital ulcer (DU) healing in systemic sclerosis (SSc). Randomised, placebo-controlled study in patients with SSc to assess the effect of sildenafil 20 mg or placebo, three times daily for 12 weeks, on ischaemic DU healing. The primary end point was the time to healing for each DU. Time to healing was compared between groups using Cox models for clustered data (two-sided tests, p=0.05). Intention-to-treat analysis involved 83 patients with a total of 192 DUs (89 in the sildenafil group and 103 in the placebo group). The HR for DU healing was 1.33 (0.88 to 2.00) (p=0.18) and 1.27 (0.85 to 1.89) (p=0.25) when adjusted for the number of DUs at entry, in favour of sildenafil. In the per protocol population, the HRs were 1.49 (0.98 to 2.28) (p=0.06) and 1.43 (0.93 to 2.19) p=0.10. The mean number of DUs per patient was lower in the sildenafil group compared with the placebo group at week (W) 8 (1.23±1.61 vs 1.79...

Background (Instrumental) activities of daily living ((I)ADL) questionnaires are often used as a measure of functioning for different purposes. Depending on the purpose, a measurement of functioning that includes subjective patient perspectives can be relevant. However, it is unclear to what extent (I)ADL instruments capture self-perceived functioning. Objective Explore what functioning means to older persons after a hip fracture and assess the extent to which (I)ADL instruments align with self-perceived functioning. Design Qualitative interview study with framework analysis. Setting Prospective cohort study on recovery after a hip fracture among older persons in a hospital in a large city in the west of the Netherlands. Subjects Eighteen home-dwelling older persons (≥70 years) who had a hip fracture 6–12 months ago. Methods Telephone interviews about functioning before and after the hip fracture were coded and analysed using the framework method. Results The activities mentioned by...

Increased patient engagement and the use of new types of data, such as patient-generated health data (PGHD) is shifting how work is performed in relation to healthcare. This change enables healthcare professionals to delegate parts of work previously conducted by them to patients. There is a consensus regarding the need for nurses and physicians to work seamlessly together to make healthcare flow, but the role and responsibility of patients are less researched. In this paper, we aim to fill that gap by focusing on the shift of work from healthcare professionals to patients from the perspective of i) patients and ii) healthcare professionals. We use infrastructuring as a lens to understand the design of everyday work and actions from both perspectives. The main contribution is an analysis of, and insights into, how the work of patients can support healthcare professionals along with a conceptualization of how infrastructuring processes within and outside of healthcare are interconnected.