Push or pull? : The relationship between quality of care and use of complementary and alternative medicine among patients with lung cancer in Sweden

Little is known about relationships between quality of care (QoC) and use of complementary and alternative medicine (CAM) among patients with lung cancer (LC). Purpose: This study examines CAM-use among patients with LC in Sweden, associations between QoC and CAM-use among these patients, and reported aspects of LC-care perceived as particularly positive and negative by patients, as well as suggestions for improving QoC. Methods: Survey data from 94 patient members of the Swedish LC patient organization about CAM-use and QoC as measured by the instrument “Quality from the patient’s perspective” were analyzed. Results: Fifty (53%) LC-patients used CAM, with 40 of the CAM-users reporting that CAM helped them. The most common CAMs used were dietary supplements and natural remedies, followed by prayer. Significantly more patients reported using prayer and meditation for cure than was the case for other types of CAM used. Less than half the CAM-users reported having spoken with staff from the biomedical health care system about their CAM-use. Patients provided numerous suggestions for improving LC-care in a variety of areas, aiming at a more effective and cohesive care trajectory. No differences in QoC were found between CAM-users and non-CAM-users, but differences in CAM-use i.e. type of CAM, reasons for using CAM, and CAM-provider consulted could be associated with different experiences of care. Conclusions: It is important to recognize that CAM-users are not a homogeneous group but might seek different types of CAMs and CAM-providers in different situations depending on experiences of care.

Kraftutveckling för manuella trädfällningsredskap : Force development for manual tree felling tools

The objective with this study has been to build general models of the mechanics in tree felling with chain-saw and to compare felling torque for different tools. The theoretical models are completed and validated with a comparative study. The study includes a great number of felling tools of which some are used with different methods. Felling torque was measured using a naturally like measuring arrangement where a tree is cut at about 3.7 m height and then anchored with a dynamometer to a tree opposite to the felling direction. Notch and felling cut was made as ordinary with exception that the hinge was made extra thin to reduce bending resistance. The tree was consequently not felled during the trials and several combinations of felling tools and individuals could be used on the same tree.The results show big differences between tools, methods and persons. The differences were, however, not general, but could vary depending on conditions (first of all tree diameters). Tools and methods that push or pull on the stem are little affected by the size of the tree, while tools that press on the stump are very much dependent of a large stump-diameter. Hand force asserted on a simple pole is consequently a powerful tool on small trees. For trees of medium size there are several alternative methods with different sizes and brands of felling levers and wedges. Larger and more ungainly tools and methods like tree pusher, winch, etc. develop very high felling torque on all tree sizes. On large trees also the felling wedge and especially the use of several wedges together develop very high felling torque.