Publications by authors named "Asta Bye"

55 Publications

Refeeding syndrome occurs among older adults regardless of refeeding rates: A systematic review.

Nutr Res 2021 Jul 21;91:1-12. Epub 2021 May 21.

Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo 0130, Norway; Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo 0424, Norway. Electronic address:

Refeeding syndrome is a life-threatening clinical disorder that can occur when treating malnutrition. The aim was to examine the current knowledge of refeeding syndrome in patients ≥ 65 + years with special focus on the incidence of hypophosphatemia (HP) in relation to refeeding rate (kcal/kg/day), number of days until the lowest level of phosphate occurs (day of nadir), refeeding rates and adverse events, and death. Specifically, we hypothesized that higher energy provision would cause a higher incidence of HP. A search was conducted in the available databases. Two cohort studies, 1 case control, and a total of 12 case series/case reports, which accounted for 19 individual patient cases, were eligible. The incidence of HP (<0.5 mmol/L) was 15% and 25% in the 2 cohort studies and 4% in the case control study. The mean day of nadir was between days 2 and 3 in the cohort studies, day 11 in the case control study, and day 3 in the cases series/case reports. Importantly, a rapid drop in phosphate occurred receiving both 30 kcal/kg/day and 8 to 10 kcal/kg/day. The cohort studies reported high death rates-26% and 23%-using both 10 and 20 kcal/kg/day, respectively. Adverse events were noted in most all case series/case reports. Clinicians should be aware that HP may occur in up to 25% of older hospitalized adults, and importantly, it occurs even when refeeding cautiously. Hence, electrolytes should be closely monitored, especially between days 2 and 4, which is when the day of nadir occurs most frequently.
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http://dx.doi.org/10.1016/j.nutres.2021.05.004DOI Listing
July 2021

A comparison of two different refeeding protocols and its effect on hand grip strength and refeeding syndrome: a randomized controlled clinical trial.

Eur Geriatr Med 2021 Jun 4. Epub 2021 Jun 4.

Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

Purpose: Optimal refeeding protocols in older malnourished hospital patients remain unclear. We aimed to compare the effect of two different refeeding protocols; an assertive and a cautious protocol, on HGS, mortality and refeeding syndrome (RFS), in patients ≥ 65 years METHODS: Patients admitted under medical or surgical category and at risk of RFS, were randomized to either an enteral nutrition (EN) refeeding protocol of 20 kcal/kg/day, reaching energy goals within 3 days (intervention group), or a protocol of 10 kcal/kg/day, reaching goals within 7 days (control group). Primary outcome was the difference in hand grip strength (HGS) at 3 months follow-up, in an intention to treat analysis. RFS (phosphate < 0.65 mmol/L) during the hospital stay and mortality rates at 3 months were secondary outcomes.

Results: A total of 85 patients were enrolled, with mean (SD) age of 79.8(7.4) and 54.1% female, 41 in the intervention group and 44 in the control group. HGS was similar at 3 months with mean change of 0.42 kg (95% CI - 2.52 to 3.36, p = 0.78). Serum phosphate < 0.65 mmol/L was seen in 17.1% in the intervention group and 9.3% in the control group, p = 0.29. There was no difference in mortality rates (39% vs 34.1%, p = 0.64). An indication of more respiratory distress was found in the intervention group, 53.6% vs 30.2%, p = 0.029.

Conclusion: A more assertive refeeding protocol providing 20 kcal/kg/day did not result in improved HGS measured 3 months after discharge compared with a cautious refeeding (10 kcal/kg/day) protocol. No difference in incidence of mortality or RFS was found.

Trial Registration: ClinicalTrials.gov Protocol Record 2017/FO148295, Registered: 21st of February, 2017.
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http://dx.doi.org/10.1007/s41999-021-00520-5DOI Listing
June 2021

Mortality and microbial diversity after allogeneic hematopoietic stem cell transplantation: secondary analysis of a randomized nutritional intervention trial.

Sci Rep 2021 Jun 2;11(1):11593. Epub 2021 Jun 2.

Department of Haematology, Oslo University Hospital, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.

Gut mucosal barrier injury is common following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and associated with poor clinical outcomes. Diet is critical for microbial diversity, but whether nutritional support affects microbiota and outcome after allo-HSCT is unknown. We present a secondary analysis of a randomized controlled nutritional intervention trial during allo-HSCT. We investigated if the intervention influenced gut microbiota, short-chain fatty acids (SCFAs), and markers of gut barrier functions, and if these parameters were associated with clinical outcomes. Fecal specimens were available from 47 recipients, and subjected to 16S rRNA gene sequencing. We found no significant differences between the intervention group and controls in investigated parameters. We observed a major depletion of microbiota, SCFAs, and altered markers of gut barrier function from baseline to 3 weeks post-transplant. One-year mortality was significantly higher in patients with lower diversity at 3 weeks post-HSCT, but not related to diversity at baseline. The relative abundance of Blautia genus at 3 weeks was higher in survivors. Fecal propionic acid was associated with survival. Markers of gut barrier functions were less strongly associated with clinical outcomes. Possibly, other strategies than dietary intervention are needed to prevent negative effects of gut microbiota and clinical outcomes after allo-HSCT.ClinicalTrials.gov (NCT01181076).
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http://dx.doi.org/10.1038/s41598-021-90976-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172574PMC
June 2021

Patient Flow or the Patient's Journey? Exploring Health Care Providers' Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People.

Qual Health Res 2021 May 19:10497323211003861. Epub 2021 May 19.

Oslo Metropolitan University, Oslo, Norway.

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers' understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers' experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient's journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.
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http://dx.doi.org/10.1177/10497323211003861DOI Listing
May 2021

Effect of nutritional and physical exercise intervention on hospital readmission for patients aged 65 or older: a systematic review and meta-analysis of randomized controlled trials.

Int J Behav Nutr Phys Act 2021 05 10;18(1):62. Epub 2021 May 10.

Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

Background: Unplanned readmission may result in consequences for both the individual and society. The transition of patients from hospital to postdischarge settings often represents a discontinuity of care and is considered crucial in the prevention of avoidable readmissions. In older patients, physical decline and malnutrition are considered risk factors for readmission. The purpose of the study was to determine the effects of nutritional and physical exercise interventions alone or in combination after hospital admission on the risk of hospital readmission among older people.

Methods: A systematic review and meta-analysis of randomized controlled studies was conducted. The search involved seven databases (Medline, AMED, the Cochrane Library, CINAHL, Embase (Ovid), Food Science Source and Web of Science) and was conducted in November 2018. An update of this search was performed in March 2020. Studies involving older adults (65 years and above) investigating the effect of nutritional and/or physical exercise interventions on hospital readmission were included.

Results: A total of 11 randomized controlled studies (five nutritional, five physical exercise and one combined intervention) were included and assessed for quality using the updated Cochrane Risk of Bias Tool. Nutritional interventions resulted in a significant reduction in readmissions (RR 0.84; 95% CI 0.70-1.00, p = 0.049), while physical exercise interventions did not reduce readmissions (RR 1.05; 95% CI 0.84-1.31, p-value = 0.662).

Conclusions: This meta-analysis suggests that nutrition support aiming to optimize energy intake according to patients' needs may reduce the risk of being readmitted to the hospital for people aged 65 years or older.
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http://dx.doi.org/10.1186/s12966-021-01123-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112053PMC
May 2021

Crossing knowledge boundaries: health care providers' perceptions and experiences of what is important to achieve more person-centered patient pathways for older people.

BMC Health Serv Res 2021 Apr 7;21(1):310. Epub 2021 Apr 7.

Department of Physiotherapy, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway.

Background: Improving the transitional care of older people, especially hospital-to-home transitions, is a salient concern worldwide. Current research in the field highlights person-centered care as crucial; however, how to implement and enact this ideal in practice and thus achieve more person-centered patient pathways remains unclear. The aim of this study was to explore health care providers' (HCPs') perceptions and experiences of what is important to achieve more person-centered patient pathways for older people.

Methods: This was a qualitative study. We performed individual semistructured interviews with 20 HCPs who participated in a Norwegian quality improvement collaborative. In addition, participant observation of 22 meetings in the quality improvement collaborative was performed.

Results: A thematic analysis resulted in five themes which outline central elements of the HCPs' perceptions and experiences relevant to achieving more person-centered patient pathways: 1) Finding common ground through the mapping of the patient journey; 2) the importance of understanding the whole patient pathway; 3) the significance of getting to know the older patient; 4) the key role of home care providers in the patient pathway; and 5) ambiguity toward checklists and practice implementation.

Conclusions: The findings can assist stakeholders in understanding factors important to practicing person-centered transitional care for older people. Through collaborative knowledge sharing the participants developed a more shared understanding of how to achieve person-centered patient pathways. The importance of assuming a shared responsibility and a more holistic understanding of the patient pathway by merging different ways of knowing was highlighted. Checklists incorporating the What matters to you? question and the mapping of the patient journey were important tools enabling the crossing of knowledge boundaries both between HCPs and between HCPs and the older patients. Home care providers were perceived to have important knowledge relevant to providing more person-centered patient pathways implying a central role for them as knowledge brokers during the patient's journey. The study draws attention to the benefits of focusing on the older patients' way of knowing the patient pathway as well as to placing what matters to the older patient at the heart of transitional care.
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http://dx.doi.org/10.1186/s12913-021-06312-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028726PMC
April 2021

Power Comparisons and Clinical Meaning of Outcome Measures in Assessing Treatment Effect in Cancer Cachexia: Secondary Analysis From a Randomized Pilot Multimodal Intervention Trial.

Front Nutr 2020 14;7:602775. Epub 2021 Jan 14.

Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.

New clinical trials in cancer cachexia are essential, and outcome measures with high responsiveness to detect meaningful changes are crucial. This secondary analysis from a multimodal intervention trial estimates sensitivity to change and between treatment effect sizes (ESs) of outcome measures associated with body composition, physical function, metabolism, and trial intervention. The study was a multicenter, open-label, randomized pilot study investigating the feasibility of a 6-week multimodal intervention [exercise, non-steroidal anti-inflammatory drugs, and oral nutritional supplements containing polyunsaturated fatty acids (-3 PUFAs)] vs. standard cancer care in non-operable non-small-cell lung cancer and advanced pancreatic cancer. Body composition measures from computerized tomography scans and circulating biomarkers were analyzed. Forty-six patients were randomized, and the analysis included 22 and 18 patients in the treatment and control groups, respectively. The between-group ESs were high for body weight (ES = 1.2, < 0.001), small for body composition and physical function [handgrip strength (HGS)] measures (ES < 0.25), moderate to high for n-3 PUFAs and 25-hydroxyvitamin D (25-OH vitamin D) (ES range 0.64-1.37, < 0.05 for all), and moderate for serum C-reactive protein (ES = 0.53, = 0.12). Analysis within the multimodal treatment group showed high sensitivity to change for adiponectin (ES = 0.86, = 0.001) and n-3 PUFAs (ES > 0.8, < 0.05 for all) and moderate for 25-OH vitamin D (ES = 0.49, = 0.03). In the control group, a moderate sensitivity to change for body weight (ES = -0.84, = 0.002) and muscle mass (ES = -0.67, = 0.016) and a high sensitivity to change for plasma levels of 25-OH vitamin D (ES = -0.88, = 0.002) were found. Demonstrating high sensitivity to change and between treatment ES and body composition measures, body weight still stands out as a clinical and relevant outcome measure in cancer cachexia. Body composition and physical function measures clearly are important to address but demand large sample sizes to detect treatment group differences. ClinicalTrials.gov identifier: NCT01419145.
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http://dx.doi.org/10.3389/fnut.2020.602775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874039PMC
January 2021

Community-living older people's interpretation of the Norwegian version of older people's quality of life (OPQOL) questionnaire.

Health Soc Care Community 2021 Jan 13. Epub 2021 Jan 13.

Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway.

The aim of this study is to investigate how community-living older people interpret the Norwegian version of Older People's Quality of Life (OPQOL) questionnaire. The original OPQOL questionnaire was translated based on guidelines for cross-cultural translation. The Three-Step Test-Interview instrument was adopted to investigate how community-living older people interpreted the questionnaire. Data were collected from 14 participants (72-89 years). The questionnaire was filled in under observation. Semi-structured interviews were then conducted to clarify the observational data and elicit the participants' experiences and opinions. Lastly, data were analysed using a hermeneutic interpretation approach. Our findings indicate that most of the participants managed to complete the OPQOL questionnaire without problems. The data analysis resulted in four primary themes: relevance & applicability, formulation, consistency & accuracy and subjectivity. The questionnaire covered all aspects related to the participants' quality of life. However, statements related to religion were found to be irrelevant to their quality of life. Most of the participants thought that religion, philosophy and culture should be separate rather than included in the same statement. The participants missed the option of 'not applicable' when the statements were irrelevant to them. The statements are formulated in both positive and negative ways, which was sometimes confusing to them. The participants perceived phases such as "around me" "local," and "things" as ambiguous, and thus they raised concerns about whether the OPQOL questionnaire could capture consistent data regarding their quality of life. The results of this study pinpoint the issues that community-living older people faced when interpreting and answering the Norwegian version of OPQOL questionnaire. These issues were mostly caused by sociocultural differences. Our work provides an overview of the changes that must be made in the questionnaire in order to address these sociocultural differences while using the OPQOL questionnaire in the Norwegian context.
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http://dx.doi.org/10.1111/hsc.13273DOI Listing
January 2021

The tension between carrying a burden and feeling like a burden: a qualitative study of informal caregivers' and care recipients' experiences after patient discharge from hospital.

Int J Qual Stud Health Well-being 2021 Dec;16(1):1855751

Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University , Oslo, Norway.

: The number of people aged 80 and above is projected to triple over the next 30 years. Expanding public expenditure on long-term care servicesHas made policies encouraged informal caregiving. Burden of care describes challenges connected to informal caregiving. Dependent patients report feelings of being a burden. Few studies have focused on both the experience of caregiver burden and recipients' feelings of burden. This study explore the experiences of old patients and informal caregivers in the first 30 days after the patient's discharge. : Aphenomenological approach was used to explore the subjective experiences of the participants . Semi-structured individual interviews were analysed thematically. : The reults reflect imbalance regarding care needs relative to time, social roles, physical and emotional states, and formal care resources. Four themes emerged from the interviews: 1) Bridging the gap, 2) Family is family, 3) Never enough, and 4) Stress and distress. : The participants face strains within their roles. The care situation has potential to be burdensome. To secure healthcare quality for old patients, the informal carer's role needs to be recognized. Informal care based on altruism and reciprocity seems to be positive, whereas informal care based on family norms might have a negative impact.
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http://dx.doi.org/10.1080/17482631.2020.1855751DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758041PMC
December 2021

Exercise and Nutrition Interventions in Patients with Head and Neck Cancer during Curative Treatment: A Systematic Review and Meta-Analysis.

Nutrients 2020 Oct 22;12(11). Epub 2020 Oct 22.

Center for Crisis Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Norway.

The aim of this meta-analysis was to examine the effects of nutritional and physical exercise interventions and interventions combining these interventions during radiotherapy treatment for patients with head and neck cancer on body composition, objectively measured physical function and nutritional status. Systematic electronic searches were conducted in MEDLINE (PubMed interface), EMBASE (Ovid interface), CINAHL (EBSCO interface) and Cochrane Library (Wiley interface). We identified 13 randomized controlled trials (RCTs) that included 858 patients. For body composition, using only nutrition as intervention, a significant difference between treatment and control group were observed (SMD 0.42 (95CI 0.23-0.62), < 0.001). Only pilot RCTs investigated combination treatment and no significant difference between the treatment and control groups were found (SMD 0.21 (95CI -0.16-0.58), = 0.259). For physical function, a significant difference between treatment and control group with a better outcome for the treatment group were observed (SMD 0.78 (95CI 0.51-1.04), < 0.001). No effects on nutritional status were found. This meta-analysis found significantly positive effects of nutrition and physical exercise interventions alone in favor of the treatment groups. No effects in studies with combined interventions were observed. Future full-scaled RCTs combining nutrition and physical exercise is warranted.
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http://dx.doi.org/10.3390/nu12113233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690392PMC
October 2020

A qualitative study of old patients' experiences of the quality of the health services in hospital and 30 days after hospitalization.

BMC Health Serv Res 2020 May 20;20(1):446. Epub 2020 May 20.

Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

Background: The number of people aged 80 years and above is projected to triple over the next 30 years. People in this age group normally have at least two chronic conditions. The impact of multimorbidity is often significantly greater than expected from the sum of the effects of each condition. The World Health Organization has indicated that healthcare systems must prepare for a change in the focus of clinical care for older people. The World Health Organization (WHO) defines healthcare quality as care that is effective, efficient, integrated, patient centered, equitable and safe. The degree to which healthcare quality can be defined as acceptable is determined by services' ability to meet the needs of users and adapt to patients' expectations and perceptions.

Method: We took a phenomenological perspective to explore older patients' subjective experiences and conducted semistructured individual interviews. Eighteen patients (aged from 82 to 100 years) were interviewed twice after discharge from hospital. The interview transcriptions were analyzed thematically.

Results: The patients found their meetings with the health service to be complex and demanding. They reported attempting to restore a sense of security and meaning in everyday life, balancing their own needs against external requirements. Five overarching themes emerged from the interviews: hospital stay and the person behind the diagnosis, poor communication and coordination, life after discharge, relationship with their next of kin, and organizational and systemic determinants.

Conclusion: According to the WHO, to deliver quality healthcare, services must include all six of the dimensions listed above. Our findings show that they do not. Healthcare focused on measurable values and biomedical inquiries. Few opportunities for participation, scant information and suboptimal care coordination left the patients with a feeling of being in limbo, where they struggled to find balance in their everyday life. Further work must be done to ensure that integrated services are provided without a financial burden, centered on the needs and rights of older people.
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http://dx.doi.org/10.1186/s12913-020-05303-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238652PMC
May 2020

It takes two to tango: carers' reflections on their participation and the participation of people with dementia in the James Lind Alliance process.

BMC Geriatr 2020 05 14;20(1):175. Epub 2020 May 14.

Faculty of Health Sciences, OsloMet - Metropolitan University, 0130, Oslo, Norway.

Background: Worldwide, patient and public involvement (PPI) in health research has grown steadily in recent decades. The James Lind Alliance (JLA) is one approach to PPI that brings patients, carers and clinicians together to identify priorities for future research in a Priority Setting Partnership (PSP). Our study aim was to describe the reflections of informal carers of people with dementia on the possibility of participating in the JLA's PSP process, for both themselves and the recipients of their care. In addition, we wanted to explore barriers to and facilitators of their participation.

Methods: We conducted four focus groups with 36 carers of people with dementia. Thematic analysis was applied to analyse the data.

Results: An overarching theme emerged from the participants' reflections: "Creating empowering teams where all voices are heard". The overarching theme incorporates the participants' suggestions about the importance of equivalence in power, mutual agreement with and understanding of the goals, adequate support, openness about each partner's tasks and the bonds needed between the partners to sustain the enterprise, and expectations of positive outcomes. From the overarching theme, two main themes emerged: "Interaction of human factors, the PSP process and the environment" and "The power of position and knowledge". The overall results indicated that carers are willing to participate in PSP processes and that they thought it important for people with dementia to participate in PSP processes as well, even if some might need extra support to do so. The carers also identified the need for research topics that influence their everyday lives, policy development and healthcare services.

Conclusions: Both carers and the people with dementia for whom they care are able to contribute to the PSP process when given sufficient support. The involvement of these groups is important for setting healthcare research agendas, developing research projects that increase awareness and knowledge about their circumstances and improving health professionals', researchers' and policymakers' understanding of and insight into their unique situations.
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http://dx.doi.org/10.1186/s12877-020-01570-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227228PMC
May 2020

Physical rehabilitation in patients with head and neck cancer: Impact on health-related quality of life and suitability of a post-treatment program.

Laryngoscope Investig Otolaryngol 2020 Apr 17;5(2):330-338. Epub 2020 Mar 17.

Department of Public Health and Nursing, Faculty of Medicine and Health Sciences Norwegian University of Science and Technology (NTNU) Trondheim Norway.

Objective: Physical rehabilitation programs hold the potential to mitigate deterioration in health-related quality of life (HRQoL) in patients with head and neck cancer. The objective was to assess development in relevant domains of HRQoL following a physical exercise and nutrition intervention administrated during or after treatment.

Methods: In a pilot study, 41 patients were randomized to resistance training and oral nutritional supplements during (EN-DUR, n = 20) or after (EN-AF, n = 21) radiotherapy. Global health status/QoL (GHS) and physical functioning (PF) were measured by the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire at baseline, week 6, and week 14. Differences between the groups were assessed by analysis of covariance. A difference of ≥10 points in GHS and PF was interpreted as clinically relevant.

Results: No statistically significant differences were detected between the groups; however, clinically relevant changes and differences in GHS and PF were observed. From baseline to week 6, GHS decreased 9 points in the EN-DUR group and 23 points in the EN-AF group and PF decreased 13 points and 21 points, respectively. From week 6 to week 14, GHS increased 14 points in the EN-DUR group and 26 points EN-AF group and PF did not change (0 points) in the EN-DUR group and increased 16 points in the EN-AF group.

Conclusion: The findings from the present pilot study are promising and indicate that a physical rehabilitation program may have a positive impact on HRQoL during treatment and enhance recovery after treatment. A definitive randomized trial is warranted.

Level Of Evidence: 1b-Individual randomized controlled trial.
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http://dx.doi.org/10.1002/lio2.368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178444PMC
April 2020

What matters when asking, "what matters to you?" - perceptions and experiences of health care providers on involving older people in transitional care.

BMC Health Serv Res 2020 Apr 16;20(1):317. Epub 2020 Apr 16.

Department of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway.

Background: Transitional care for older chronically ill people is an important area for healthcare quality improvement. A central goal is to involve older people more in transitional care and make care more patient-centered. Recently, asking, "What matters to you?" (WMTY) has become a popular way of approaching the implementation of patient-centered care. The aim of this study was to explore health care providers' perceptions and experiences regarding the question of WMTY in the context of improving transitional care for older, chronically ill persons.

Methods: The data comprise semi-structured individual interviews with 20 health care providers (HCPs) who took part in a Norwegian quality improvement collaborative, three key informant interviews, and observations of meetings in the quality improvement collaborative. We used a thematic analysis approach.

Results: Three interrelated themes emerged from the analysis: WMTY is a complex process that needs to be framed competently; framing WMTY as a functional approach; and framing WMTY as a relational approach. There was a tension between the functional and the relational approach. This tension seemed to be based in different understandings of the purpose of asking the WMTY question and the responsibility that comes with asking it.

Conclusions: WMTY may appear as a simple question, but using it in everyday practice is a complex process, which requires professional competence. When seen in terms of a patient-centered goal process, the challenge of competently eliciting older people's personal goals and transferring these goals into professional action becomes evident. An important factor seems to be how HCPs regard the limits of their responsibility in relation to giving care within the larger frame of the patient's life project. Factors in the organizational and political context also seem to influence substantially how HCPs approach older patients with the WMTY question.
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http://dx.doi.org/10.1186/s12913-020-05150-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164237PMC
April 2020

Associations between health-related quality of life, body mass index, health status and sociodemographic variables in geriatric patients and non-hospitalized older people: A comparative cross-sectional study.

Nutr Health 2020 Jun 16;26(2):141-150. Epub 2020 Apr 16.

Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Norway.

Background: Data on health-related quality of life (HRQoL) in geriatric patients and non-hospitalized older people are lacking, and the associations among HRQoL, body mass index (BMI) and health status are not sufficiently investigated in these groups.

Aim: This study aims to describe and compare HRQoL in a sample of geriatric patients and non-hospitalized people >70 years. It further aims to investigate the associations between HRQoL, BMI, health status and sociodemographic variables in geriatric patients and non-hospitalized people >70 years.

Methods: This cross-sectional study included 107 geriatric patients and 328 non-hospitalized older people. HRQoL was measured with the 36-Item Short Form Survey (SF-36) and BMI was divided into three classes: underweight (<22 kg/m), normal weight (22-27 kg/m) and overweight (>27 kg/m).

Results: All SF-36 scores were lower for the geriatric patients than for the non-hospitalized people ( < .001). Underweight (BMI <22 kg/m) was registered for 43.9% of the geriatric patients and for 13.7% of the non-hospitalized people. No significant associations were found between the SF-36 subscale scores and underweight, but overweight was associated with lower scores on physical functioning (: -8.7) and vitality (: -6.8) compared to those with normal BMI ( < .05). The participants with rheumatic diseases, pulmonary diseases, hypertension and digestive diseases had significantly lower scores on most SF-36 scales reflecting physical health.

Conclusion: HRQoL is substantially lower in geriatric patients than in non-hospitalized older people. The negative effects of both overweight and morbidity on HRQoL indicate that it is important to monitor weight and disease symptoms to promote HRQoL in older people, whether hospitalized or non-hospitalized.
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http://dx.doi.org/10.1177/0260106020909047DOI Listing
June 2020

Older patients' and their family caregivers' perceptions of food, meals and nutritional care in the transition between hospital and home care: a qualitative study.

BMC Nutr 2020 18;6:11. Epub 2020 Mar 18.

2Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.

Background: Older people have varying degrees of unmet nutritional needs following discharge from hospital. Inadequate involvement of the older person and his or her family caregivers in care and care planning, and inadequate support of self-management in the discharge process and follow-up care at home, negatively affects the quality of care. Research on older patients' and their family caregivers' experiences with nutritional care in hospital and home care and in the transition between these settings is limited. Thus, the aim of this study was to explore older patients' and their family caregivers' perceptions regarding the food, meals and nutritional care provided in the transition between hospital and home care services, focusing on the first 30 days at home. The overall aim of this study is to produce knowledge that can inform policy and clinical practice about how to optimise the care provided to older persons that are malnourished or at risk of malnutrition.

Methods: Using a qualitative interpretive descriptive design, we carried out face-to-face semi-structured interviews with 15 older patients, with documented risk of malnutrition or malnourishment (Mini Nutritional Assessment [MNA]), two and five weeks after hospital discharge. In addition, we interviewed nine family caregivers once during this five week period. The questions focused on perceptions of food, meals and nutritional care in hospital and home care and in the transition between these settings. We analysed the data thematically.

Results: Four overarching themes emerged from the material: 1) the need for a comprehensive approach to nutritional care, 2) non-individualised nutritional care at home, 3) lack of mutual comprehension and shared decision making and 4) the role of family caregivers.

Conclusion: The organisation of nutritional care and food provision to older people, depending on care, lack consideration for the individual's values, needs and preferences. Older patients' and their family caregivers' needs and preferences should guide how nutritional care is provided.
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http://dx.doi.org/10.1186/s40795-020-00335-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079473PMC
March 2020

Informal caregivers' views on the quality of healthcare services provided to older patients aged 80 or more in the hospital and 30 days after discharge.

BMC Geriatr 2020 03 12;20(1):97. Epub 2020 Mar 12.

Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

Background: In the European Union (EU), informal caregivers provide 60% of all care. Informal caregiving ranges from assistance with daily activities and provision of direct care to helping care recipients to navigate within complex healthcare and social services systems. While recent caregiver surveys document the impact of informal caregivers, systematic reviews show that they have unmet needs. Because of the political desire to reduce the length of hospital stays, older patients are discharged from the hospital 'quicker and sicker' than before. The transition between different levels of the healthcare system and the period after hospital discharge is critical for elderly patients. Caregivers' perspectives on the quality of older patients' care journeys between levels of the healthcare system may provide valuable information for healthcare providers and policymakers. This study aims to explore older patient's informal caregivers' views on healthcare quality in the hospital and in the first 30 days after hospitalisation.

Method: We conducted semi-structured individual interviews with 12 participants to explore and describe informal caregivers' subjective experiences of providing care to older relatives. The interviews were then transcribed and analysed thematically.

Results: The analysis yielded the overarching theme 'Informal caregivers - a health service alliance - quality contributor', which was divided into four main themes: 'Fast in, fast out', 'Scant information', 'Disclaimer of responsibility' and 'A struggle to secure professional care'. The healthcare system seemed to pay little attention to ensuring mutual understandings between those involved in discharge, treatment and coordination. The participants experienced that the healthcare providers' main focus was on the patients' diseases, although the health services are supposed to view patients holistically.

Conclusion: Based on the information given by informal caregivers, health services must take into account each person's needs and preferences. To deliver quality healthcare, better coordination between inter-professional care teams and the persons they serve is necessary. Health professionals must strengthen the involvement of caregivers in transitions between care and healthcare. Future work should evaluate targeted strategies for formal caregivers to cooperate, support and empower family members as informal caregivers.
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http://dx.doi.org/10.1186/s12877-020-1488-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068939PMC
March 2020

Long-term follow-up with a smartphone application improves exercise capacity post cardiac rehabilitation: A randomized controlled trial.

Eur J Prev Cardiol 2020 11 28;27(16):1782-1792. Epub 2020 Feb 28.

Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Norway.

Background: Mobile health interventions, especially smartphone applications (apps), have been proposed as promising interventions for supporting adherence to healthy behaviour in patients post cardiac rehabilitation (CR). The overall aim of the study was to examine the effect of individualized follow-up with an app for one year on peak oxygen uptake (VO) in patients completing CR.

Design: The study was designed as a single-blinded multicentre randomized controlled trial.

Methods: The intervention group (IG) received individualized follow-up enabled with an app for one year, while the control group (CG) received usual care. The primary outcome was difference in VO. Secondary outcomes included exercise performance (time to exhaustion, peak incline (%) and peak velocity (km/h)), bodyweight, resting blood pressure, lipid profile, triglycerides, exercise habits, health-related quality of life, health status and self-perceived goal achievement.

Results: In total, 113 patients completing CR (73.4% with coronary artery disease, 16.8% after valve surgery and 9.8% with other heart diseases) were randomly allocated to the IG or CG. Intention to treat analyses showed a statistically significant difference in VO between the groups at follow-up of 2.2 ml/kg/min, 95% confidence interval 0.9-3.5 ( < 0.001). Statistically significant differences were also observed in exercise performance, exercise habits and in self-perceived goal achievement.

Conclusions: Individualized follow-up for one year with an app significantly improved VO, exercise performance and exercise habits, as well as self-perceived goal achievement, compared with a CG in patients post-CR. There were no statistically significant differences between the groups at follow-up in the other outcome measures evaluated.
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http://dx.doi.org/10.1177/2047487320905717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564298PMC
November 2020

Deterioration in Muscle Mass and Physical Function Differs According to Weight Loss History in Cancer Cachexia.

Cancers (Basel) 2019 Dec 3;11(12). Epub 2019 Dec 3.

Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7491 Trondheim, Norway.

Background: Muscle mass and physical function (PF) are common co-primary endpoints in cancer cachexia trials, but there is a lack of data on how these outcomes interact over time. The aim of this secondary analysis of data from a trial investigating multimodal intervention for cancer cachexia (ClinicalTrials.gov: NCT01419145) is to explore whether changes in muscle mass and PF are associated with weight loss and cachexia status at baseline.

Methods: Secondary analysis was conducted using data from a phase II randomized controlled trial including 46 patients with stage III-IV non-small cell lung cancer (n = 26) or inoperable pancreatic cancer (n = 20) due to commence chemotherapy. Cachexia status at baseline was classified according to international consensus. Muscle mass (assessed using computed tomography (CT)) and PF outcomes, i.e., Karnofsky performance status (KPS), self-reported PF (self-PF), handgrip strength (HGS), 6-minute walk test (6MWT), and physical activity (PA), were measured at baseline and after six weeks.

Results: When compared according to cachexia status at baseline, patients with no/pre-cachexia had a mean loss of muscle mass (-5.3 cm, = 0.020) but no statistically significant change in PF outcomes. Patients with cachexia also lost muscle mass but to a lesser extent (-2.8 cm, = 0.146), but demonstrated a statistically significant decline in PF; KPS (-3.8 points, = 0.030), self-PF (-8.8 points, = 0.027), and HGS (-2.7 kg, = 0.026).

Conclusions: Weight loss history and cachexia status at baseline are of importance if one aims to detect changes in PF outcomes in cancer cachexia trials. To improve the use of co-primary endpoints that include PF in future trials, outcomes that have the potential to detect change relative to weight loss should be investigated further.
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http://dx.doi.org/10.3390/cancers11121925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966581PMC
December 2019

Effects of individualized follow-up with a smartphone-application after cardiac rehabilitation: protocol of a randomized controlled trial.

BMC Sports Sci Med Rehabil 2019 21;11:34. Epub 2019 Nov 21.

1Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PB 4, St. Olavs plass, 0130 Oslo, Norway.

Background: Cardiac rehabilitation (CR) programs are evidence-based and widely recommended. However, benefits from CR are likely lost among individuals who discontinue their regular exercise routines and healthy habits. One possible approach to enhance adherence to lifestyle advice after completion of CR, may be individualized follow-up enabled by a smartphone application (app).

Methods: A protocol of a single-blinded, pragmatic randomized controlled trial. The study will take place in the eastern part of Norway, and will include heart patients who have completed CR. Participants will be recruited from two CR centers. Based on power calculation, 113 participants will be included. The intervention group will receive individualized follow-up through an app on a weekly basis throughout a year. The app will be set up with the participant's own goals, and the follow-up will be based on these individual goals. The control group will receive usual care, including general advice regarding physical activity, exercise and diet. The participants will be assessed at baseline (at completion of CR) and 12 months after baseline. Primary outcome of the study will be peak oxygen uptake. Secondary outcomes include exercise performance, quality of life, health status, health literacy, self-perceived goal achievement, exercise habits, body weight, blood pressure as well as lipids and triglycerides.

Discussion: To our knowledge, this will be the first study to examine the effects of individualized follow-up with an app for one year, in patients completing CR. Hence, it is reasonable to assume that the study may be groundbreaking. Due to the large sample size and the theoretically based intervention, the study has the potential to generate new knowledge that may improve the design of future technology-based follow-up interventions of patients that have completed rehabilitation.

Trial Registration: ClinicalTrials.gov. NCT03174106. First registration, 19/05/2017.
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http://dx.doi.org/10.1186/s13102-019-0148-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873676PMC
November 2019

Healthcare professionals' experiences of providing individualized nutritional care for Older People in hospital and home care: a qualitative study.

BMC Geriatr 2019 11 20;19(1):317. Epub 2019 Nov 20.

Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.

Background: Recent studies indicate inadequate nutritional care practices in healthcare institutions and identify several barriers to perform individualized nutritional care to older persons. Organisation of care can become rigid and standardised, thus failing to be respectful of and responsive to each person's needs and preferences. There is limited research exploring health professionals' views on how structure of care allows them to individualize nutritional care to older persons. In this study we aim to explore how healthcare professionals' experience providing individualised nutritional care within the organisational frames of acute geriatric hospital care and home care.

Methods: Semi-structured interviews with 23 healthcare professionals from hospital acute geriatric care and home care. Interviews were analyzed using thematic analysis.

Results: Two main themes and six sub-themes emerged from the material. Theme 1: 'Meeting patients with complex nutritional problems' with the sub-themes: 'It is much more complex than just not eating' and 'seeing nutrition as a part of the whole'. Theme 2: 'The structure of the nutritional care', with the sub-themes: 'Nutritional routines: Much ado, but for what?', 'lack of time to individualize nutritional care', 'lack of interdisciplinary collaboration in nutritional care' and 'meeting challenging situations with limited resources in home care'.

Conclusions: The healthcare professionals described having a high focus on and priority of nutritional care when caring for older persons. They did however find it challenging to practice individualized nutritional care due to the complexity of the patients' nutritional problems and constraints in the way nutritional care was organised. By describing the challenges the healthcare professionals face when trying to individualize the nutritional care, this study may provide important knowledge to health professionals and policy makers on how to decrease the gap between older patients' preferences for care and nutritional care practice.
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http://dx.doi.org/10.1186/s12877-019-1339-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6865038PMC
November 2019

Experiences of elderly patients regarding participation in their hospital discharge: a qualitative metasummary.

BMJ Open 2019 11 3;9(11):e025789. Epub 2019 Nov 3.

Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.

Background: Ageing patients are discharged from the hospital 'quicker and sicker' than before, and hospital discharge is a critical step in patient care. Older patients form a particularly vulnerable group due to multimorbidity and frailty. Patient participation in healthcare is influenced by government policy and an important part of quality improvement of care. There is need for greater insights into the complexity of patient participation for older patients in discharge processes based on aggregated knowledge.

Objective: The aim of this study was to review reported evidence concerning the experiences of older patients aged 65 years and above regarding their participation in the hospital discharge process.

Methods: We conducted a qualitative metasummary. Systematic searches of Medline, Embase, Cinahl, PsycINFO and SocINDEX were conducted. Data from 18 studies were included, based on specific selection criteria. All studies explored older patients' experience of participation during the discharge process in hospital, but varied when it came to type of discharge and diagnosis. The data were categorised into themes by using thematic analysis.

Results: Our analysis indicated that participation in the discharge process varied among elderly patients. Five themes were identified: (1) complexity of the patients state of health, (2) management and hospital routines, (3) the norm and preference of returning home, (4) challenges of mutual communication and asymmetric relationships and (5) the significance of networks.

Conclusions: Collaboration between different levels in the health systems and user-friendly information between staff, patient and families are crucial. The complexity of patient participation for this patient group should be recognised to enhance user involvement during discharge from hospital. Interventions or follow-up studies of how healthcare professionals can improve their communication skills and address the tension between client-centred goals and organisational priorities are requested. Organisational structure may need to be restructured to ensure the participation of elderly patients.
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http://dx.doi.org/10.1136/bmjopen-2018-025789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858187PMC
November 2019

Nutritional experiences in head and neck cancer patients.

Eur J Cancer Care (Engl) 2019 Nov 30;28(6):e13168. Epub 2019 Sep 30.

General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.

Objective: Extensive research has documented the negative nutritional impact of head neck cancer (HNC) treatment, but few studies have addressed the patients' experiences. The purpose of this study was to describe how patients with HNC experience the nutritional situation and perceive nutritional support from diagnosis to the post-treatment phase.

Methods: Patients with HNC were recruited from a randomised pilot study. Individual interviews were conducted after radiotherapy with 10 participants aged 49 - 70 years and analysed by qualitative content analysis.

Results: Undergoing surgery was experienced as a poor nutritional starting point for the upcoming radiotherapy. During radiotherapy, increasing side effects made the participants customise their meals to improve food intake. About halfway through radiotherapy, virtually no food intake was experienced and hospital admissions and initiations of tube-feeding occurred in this period. Oral nutritional supplements were recommended for all, but eventually became unbearable to ingest. When radiotherapy was finally completed, the participants felt discouraged about the persistent side effects preventing them from resume eating. The participants missed tailored information about development of side effects and involvement of a dietitian when reflecting on the treatment-period.

Conclusion: The comprehensive nutritional problems experienced by patients with HNC require early nutritional assessments and improved individually tailored nutritional support.
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http://dx.doi.org/10.1111/ecc.13168DOI Listing
November 2019

The Dramaturgical Act of Positioning Within Family Meetings: Negotiation of Patients' Participation in Intermediate Care Services.

Qual Health Res 2020 05 16;30(6):811-824. Epub 2019 Sep 16.

Oslo Metropolitan University, Oslo, Norway.

Family meetings are a cornerstone in intermediate care (IC) and a powerful tool in achieving patient participation. Staff in IC are nevertheless uncertain about how to run these meetings. This study explores the negotiation of patient participation in 14 family meetings by observing the interactions between patients, relatives, and staff. Using Goffman's dramaturgical theory, supplemented by positioning theory, we illustrate, through four cases, how the participants negotiate their opinions by enacting positions like performer, director, audience, and nonperson. Patient participation takes place when the family meetings are characterized by respect and empathy, when the staff restore and elicit patients' and relatives' preferences, and there exist real alternative outcomes of the meetings. The emphasis should be on meeting structure, group composition, and preparation of the patient team. The findings are valuable for staff, patient organizations, and policy makers responsible for program development and tools to optimize patient participation within family meetings.
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http://dx.doi.org/10.1177/1049732319873054DOI Listing
May 2020

Patient interpretation of the Patient-Generated Subjective Global Assessment (PG-SGA) Short Form.

Patient Prefer Adherence 2019 16;13:1391-1400. Epub 2019 Aug 16.

Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.

Background: The Patient-Generated Subjective Global Assessment (PG-SGA) is a patient-reported instrument for assessment of nutrition status in patients with cancer. Despite thorough validation of PG-SGA, little has been reported about the way patients perceive, interpret, and respond to PG-SGA. The aim of this study was to investigate how patients interpret the patient-generated part of the PG-SGA, called PG-SGA Short Form.

Methods: Purposive sampling was used to identify participants that had experienced weight loss and/or reduced dietary intake and/or had a low body mass index. Data were collected from 23 patients by combining observations of patients filling in the PG-SGA Short Form, think-aloud technique and structured interviews, and analyzed qualitatively using systematic text condensation.

Results: Most of the participants managed to complete the PG-SGA Short Form without problems. However, participant-related and questionnaire-related sources of misinterpretation were identified, possibly causing misinterpretations or wrong/missing answers. Participants either read too fast and skipped words, or they struggled to find response options that were suitable for covering their entire situation perfectly. The word "normal" was perceived ambiguous, and the word "only" limited the participants' possibility to accurately describe their food intake. Long recall periods in the questions and two-pieced response options made it difficult for patients to select only one option.

Conclusion: The results of this study provide a unique patient perspective of using the PG-SGA Short Form and valuable input for future use and revisions of the form. The identified sources of misunderstanding could be used to develop a standardized instruction manual for patients and health care personnel using the PG-SGA Short Form.
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http://dx.doi.org/10.2147/PPA.S204188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701615PMC
August 2019

Striking a balance: Health care providers' experiences with home-based, patient-centered care for older people-A meta-synthesis of qualitative studies.

Patient Educ Couns 2019 11 21;102(11):1991-2000. Epub 2019 May 21.

Department of Physiotherapy, OsloMet- Oslo Metropolitan University, Oslo, Norway.

Objective: The aim of this article was to synthesize research findings about health care providers' experiences of patient-centered care in the home setting.

Methods: This is a meta-synthesis of qualitative findings using the analytical method of meta-ethnography developed by Noblit and Hare. We performed a systematic literature search in seven databases and assessed potential studies against eligibility criteria and quality. Subsequently, 10 primary studies were included for analysis.

Results: The core theme "being a balance artist" emerged from the synthesis, incorporating the participants' experiences when faced with conflicting and competing responsibilities and needs. Two subthemes-"balancing the older clients' needs against organizational demands" and "balancing the older clients' needs against professional standards"-further elaborated on this core theme.

Conclusion: Health care providers' experiences indicate that organizational factors play a crucial role in shaping the conditions for patient-centered care for older people in the home setting.

Practice Implications: To motivate and facilitate health care providers to move to a more patient-centered practice, it is important to expand the values of patient-centered care beyond the clinical encounter into the organization.
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http://dx.doi.org/10.1016/j.pec.2019.05.017DOI Listing
November 2019

Health-care professionals' experiences of patient participation among older patients in intermediate care-At the intersection between profession, market and bureaucracy.

Health Expect 2019 10 24;22(5):921-930. Epub 2019 May 24.

Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

Background: Patient participation is a key concern in health care. Nevertheless, older patients often do not feel involved in their rehabilitation process. Research states that when organizational conditions exert pressure on the work situation, care as a mere technical activity seems to be prioritized by the health-care staff, at the expense of patient involvement.

Objective: The aim of this article is to explore how health-care professionals experience patient participation in IC services, and explain how they perform their clinical work balancing between the patient's needs, available resources and regulatory constraints.

Design: Using a framework of professional work and institutional logics, underpinned by critical realism, we conducted semi-structured interviews with 18 health-care professionals from three IC institutions.

Results: IC appears as an important service in the patient pathway for older people with a great potential for patient participation. However, health care staff may experience constraints that prohibit them from using professional discretion, which is perceived as a threat to patient participation. Further, they may adopt routines that simplify their interactions with patients. Our results call for more emphasis on an individualized rehabilitation process and a recognition that psychological and social aspects are critical for patient participation in IC.

Conclusion: Patients interact in the face of conflicting institutional priorities or protocols. The study adds important knowledge about the practice of patient participation in IC from a front-line provider perspective. Underlying mechanisms are identified to understand and recommend how to facilitate patient participation at different levels in narrowing the gap between policy and clinical work in IC.
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http://dx.doi.org/10.1111/hex.12896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803410PMC
October 2019

Feasibility of a Mobile Phone App to Promote Adherence to a Heart-Healthy Lifestyle: Single-Arm Study.

JMIR Form Res 2019 Apr 19;3(2):e12679. Epub 2019 Apr 19.

Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

Background: Long-term maintenance of preventive activities is fundamental for achieving improved outcomes in cardiac rehabilitation (CR). Despite this, it has been shown to be a major challenge for many patients to follow recommendations and thereby adhere to a heart-healthy lifestyle. Mobile phone apps have been emphasized as potential tools to promote preventive activities after attendance in a CR program. Before commencing a trial to assess the potential effect of using an app to promote long-term adherence to preventive activities after attendance in CR, a study to assess if it is feasible to use an app is warranted.

Objective: The goal of the research is to assess if it is feasible to use a mobile phone app for promoting and monitoring patients' adherence to a heart-healthy lifestyle after CR.

Methods: The study included an experimental, pre-post single-arm trial lasting for 12 weeks. All patients received access to an app aimed to guide individuals to change or maintain a heart-healthy lifestyle. During the study period, patients received weekly, individualized monitoring through the app, based on their own goals. Feasibility outcomes assessed were recruitment rate, adherence to the app, resource requirements, and efficacy regarding capability to detect a change in quality of life, health status, and perceived goal achievement as well as evaluating ceiling and floor effect in these outcomes. Criteria for success were preset to be able to evaluate whether the app was feasible to use in a potential future RCT.

Results: In total, 71% (17/24) of the patients who completed CR were eligible for a potential RCT as well as for this study. All 14 patients included in the study used the app to promote preventive activities throughout the study. Satisfaction with the technology was high, and the patients found the technology-based follow-up intervention both useful and motivational. Ceiling effect was present in more than 20% of the patients in several domains of the questionnaires evaluating quality of life (36-Item Short Form Health Survey and COOP/WONCA functional health assessments) and health status (EQ-5D). Overall self-rated health status (EuroQol Visual Analog Scale) and perceived goal achievement were found to be outcomes able to detect a change.

Conclusions: Individual follow-up through an app after attendance in CR is feasible. All patients used the app for preventive activities and found the app both useful and motivating. Several points of guidance from the patients in the study have been adopted and incorporated into the final design of the RCT now in the field.
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http://dx.doi.org/10.2196/12679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528433PMC
April 2019

Older persons' experiences of adapting to daily life at home after hospital discharge: a qualitative metasummary.

BMC Health Serv Res 2019 Apr 11;19(1):224. Epub 2019 Apr 11.

Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.

Background: Researchers have shown that hospitalisation can decrease older persons' ability to manage life at home after hospital discharge. Inadequate practices of discharge can be associated with adverse outcomes and an increased risk of readmission. This review systematically summarises qualitative findings portraying older persons' experiences adapting to daily life at home after hospital discharge.

Methods: A metasummary of qualitative findings using Sandelowski and Barroso's method. Data from 13 studies are included, following specific selection criteria, and categorised into four main themes.

Results: Four main themes emerged from the material: (1) Experiencing an insecure and unsafe transition, (2) settling into a new situation at home, (3) what would I do without my informal caregiver? and (4) experience of a paternalistic medical model.

Conclusions: The results emphasise the importance of assessment and planning, information and education, preparation of the home environment, the involvement of the older person and caregivers and supporting self-management in the discharge and follow-up care processes at home. Better communication between older persons, hospital providers and home care providers is needed to improve the coordination of care and facilitate recovery at home. The organisational structure may need to be redefined and reorganised to secure continuity of care and the wellbeing of older persons in transitional care situations.
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http://dx.doi.org/10.1186/s12913-019-4035-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460679PMC
April 2019
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