Visual functioning and health-related quality of life in diabetic patients about to undergo anti-vascular endothelial growth factor treatment for sight-threatening macular edema

Purpose To examine patient-reported outcome (PRO) in a selected group of Swedish patients about to receive anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME). Material and methods In this cross-sectional study, 59 patients with diabetes mellitus, who regularly visited the outpatient eye-clinics, were included. Sociodemographic and clinical data were collected and the patients completed PRO measures before starting anti-VEGF treatment. PRO measures assessed eye-specific outcomes (NEI-VFQ-25) and generic health-related quality of life (SF-36). Results The participants consisted of 30 men and 29 women (mean age, 68.5 years); 54 (92 %) patients had type 2 diabetes; Five (9%) patients had moderate or severe visual impairment; 28 (47 %) were classified as having mild visual impairment. Some of the patients reported overall problems in their daily lives, such as with social relationships, as well as problems with impaired sight as a result of reduced distance vision. Conclusions Further studies are needed to investigate PRO factors related to low perceived general health in this patient population. It is important to increase our understanding of such underlying mechanisms to promote improvements in the quality of patient care.

Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

Methods and background characteristics of the TOHNN study : a population-based study of oral health conditions in northern Norway

OBJECTIVES: The aim of the Tromstannen - Oral Health in Northern Norway (TOHNN) study was to investigate oral health and dental-related diseases in an adult population. This article provides an overview of the background of the study and a description of the sample characteristics and methods employed in data collection. STUDY DESIGN: Cross-sectional population-based study including a questionnaire and clinical dental examination. METHODS: A randomly selected sample of 2,909 individuals (20-79 years old) drawn from the population register was invited to participate in the study. The data were collected between October 2013 and November 2014 in Troms County in northern Norway. The questionnaire focused on oral health-related behaviours and attitudes, oral health-related quality of life, sense of coherence, dental anxiety and symptoms from the temporomandibular joint. The dental examinations, including radiographs, were conducted by 11 dental teams in 5 dental offices. The examination comprised of registration of dental caries, full mouth periodontal status, temporomandibular disorders, mucosal lesions and height and weight. The participants were grouped by age (20-34, 35-49, 50-64 and 65-79) and ethnicity (Norwegian, Sámi, other European and other world). RESULTS: From the original sample of 2,909 individuals, 1,986 (68.3%) people participated, of whom 1,019 (51.3%) were women. The highest attendance rate was among women 20-34 years old (80.3%) and the lowest in the oldest age group of women (55.4%). There was no difference in response rate between rural and urban areas. There was a positive correlation between population size and household gross income (p < 0.001) and education level (p < 0.001). The majority of Sámi resided in smaller municipalities. In larger cities, most participants used private dental health care services, whereas, in rural areas, most participants used the public dental health care service. CONCLUSION: The TOHNN study has the potential to generate new knowledge on a wide range of oral health conditions beneficial to the population in Troms County. Due to the high participation rate, generalization both nationally and to the circumpolar area ought to be possible.

Symtom som påverkar den hälsorelaterade livskvaliteten hos svårt leversjuka patienter : En litteraturöversikt

Syfte: Syftet med studien var att beskriva vilka symtom som påverkade den hälsorelaterade livskvaliteten hos svårt leversjuka patienter samt beskriva hur symtomen påverkade patientens hälsorelaterade livskvalitet. Metod: Vetenskapliga artiklar söktes i databaserna Cinahl, Ovid Medline, Pubmed och PsycINFO. 15 vetenskapliga artiklar godkändes efter kvalitetsgranskning och låg till grund för resultatet. Resultat: I litteraturstudien framkom att patienternas hälsorelaterade livskvalitet påverkades av trötthet, hjärnpåverkan orsakat av sviktande leverfunktion, vätskeansamling i kroppen, klåda, smärta, muskelkramper, symtom från mag-tarmkanalen, benskörhet samt torrhet i ögon och mun. Symtomen påverkade i olika grad den psykiska-, fysiska- och sociala hälsorelaterad livskvaliteten. Psykiskt upplevde patienterna bristande energi och motivation, försämrad sömn, koncentrationssvårigheter, försämrad självkänsla, osäkerhet, frustration, skuld, otillräcklighet, rädsla, oro, ångest, depression och självmordstankar. De fysiska följderna innebar utmattning, andnöd, ökad smärtupplevelse och begränsad förmåga till fysisk aktivitet. Besvären innebar problem att hantera relationer, gav begränsningar i det yrkesverksamma livet, inskränkning i sociala aktiviteter samt svårigheter att klara av det dagliga livet. Slutsatser: Många symtom påverkade den svårt leversjuka patientens hälsorelaterade livskvalitet. Symtomen gav patienten problem att klara av olika vardagssituationer. Den genomförda litteraturstudien ger sjuksköterskan kunskap för att kunna tolka och bedöma de symtom som patienten beskriver.  

Faktorer av betydelse för livskvalitet efter stroke ur ett patientperspektiv : en systematisk litteraturstudie

Stroke är en allvarlig sjukdom som betraktas som den främsta orsaken till funktionsnedsätt-ning i vuxen ålder och kräver flest vårddagar på sjukhus. Syftet med denna studie var att analysera vilka faktorer som har betydelse för en persons livskvalitet efter genomgången stroke samt möjligheter för hälso- och sjukvårdspersonal att underlätta för strokepatienten att återfå sin livskvalitet. Studien genomfördes som en sammanställning av litteraturen med induktiv ansats där författarna granskade fyra studier med kvalitativ design och nio studier med kvantitativ design. Utmaningarna efter stroke är många för den som insjuknat. Livskvalitet påverkas inte enbart av de fysiska funktionsnedsättningar som stroke medför utan även av psykiska och sociala faktorer som till exempel depression, ångest, brist på socialt umgänge och fritidsaktiviteter. Kunskap, motivation och stöd var avgörande faktorer under återhämtningen och påverkade patientens följsamhet till rehabiliteringen. Studiens resultat visade att KUNSKAP om sjuk-domen, rehabiliteringen och de resurser som fanns att tillgå under den krävande återhämtningsprocessen var en viktig faktor för att strokepatienter skulle uppleva meningsfullhet med tillvaron och på så sätt uppleva livskvalitet. Kunskap ökade i sin tur MOTIVATIONEN vilket bidrog till att patienter valde att fortsätta vilja och orka återfå förlorade funktioner. För att detta skulle vara möjligt måste personer som drabbats av stroke erhålla STÖD i form av hjälp från familj och vänner samt olika insatser från hälso- och sjukvården.

Vuxna personers upplevelse av hälsorelaterad livskvalité efter en gastric bypass operation : –En litteraturöversikt

Bakgrund: Fetma och övervikt har blivit vanligare den senaste tiden och är idag ett stort hälsoproblem över hela världen. Många har svårt att gå ner i vikt på egen hand vilket har gjort att kirurgi har blivit allt vanligare de senaste åren. Gastric bypass är idag den vanligaste kirurgiska metoden för viktminskning och har visat goda resultat. Däremot kan den hälsorelaterade livskvalitén påverkas då operationen innebär en stor livsstilsförändring. Syfte: Syftet med denna studie var att beskriva vuxna personers upplevelse av hälsorelaterad livskvalité efter en gastric bypass operation. Metod: En litteraturöversikt med 11 kvantitativa och 3 kvalitativa vetenskapliga artiklar som ligger till grund för hur vuxna personer upplever sin hälsorelaterade livskvalité efter en gastric bypass operation. Resultat: Hälsorelaterad livskvalité (HRQOL) har visat en förbättring i samtliga studier efter en gastric bypass operation. HRQOL har haft sin topp efter 1 månad i samtliga skalor utifrån SF-36 frågeformulär. Slutsats: Den stora livsstilsförändringen som personer går igenom efter en gastric bypass operationen har visat förbättringar i HRQOL på både lång och kort sikt. Bidragande faktorer som kan påverka den förbättrade hälsorelaterade livskvalitén kan bland annat vara uppfyllda förväntningar av operationen och fysisk aktivitet.

Patient-reported outcomes and visual acuity after 12 months of anti-VEGF-treatment for sight-threatening diabetic macular edema in a real world setting

Aims To examine objective visual acuity measured with ETDRS, retinal thickness (OCT), patient reported outcome and describe levels of glycated hemoglobin and its association with the effects on visual acuity in patients treated with anti-VEGF for visual impairment due to diabetic macular edema (DME) during 12 months in a real world setting. Methods In this cross-sectional study, 58 patients (29 females and 29 males; mean age, 68 years) with type 1 and type 2 diabetes diagnosed with DME were included. Medical data and two questionnaires were collected; an eye-specific (NEI VFQ-25) and a generic health-related quality of life questionnaire (SF-36) were used. Results The total patient group had significantly improved visual acuity and reduced retinal thickness at 4 months and remains at 12 months follow up. Thirty patients had significantly improved visual acuity, and 27 patients had no improved visual acuity at 12 months. The patients with improved visual acuity had significantly improved scores for NEI VFQ-25 subscales including general health, general vision, near activities, distance activities, and composite score, but no significant changes in scores were found in the group without improvements in visual acuity. Conclusions Our study revealed that anti-VEGF treatment improved visual acuity and central retinal thickness as well as patient-reported outcome in real world 12 months after treatment start.

Communication in Smoking Cessation and Self-management : a study at Nurse-led COPD-clinics in Primary Health Care

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol

Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment. Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment. Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family. Trial registration: Current controlled trials: ISRCTN22444034