Publications by authors named "Bjöörn Fossum"

37 Publications

Social media in the infertile community-using a text analysis tool to identify the topics of discussion on the multitude of infertility blogs.

Womens Health (Lond) 2021 Jan-Dec;17:17455065211063280

Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.

Background: Infertility affects one in six couples. New digital resources exist which enable the study of lived experience of persons with infertility. Blogging represents a forum for sharing narratives and experiences. To provide high quality care for persons with a history of infertility, it is crucial to ascertain what they value as significant in their situation. Blogs with a focus on infertility may provide this information.

Objectives: The aim of this study was to gain insight into which infertility-related issues are discussed on Swedish infertility blogs.

Methods: In total, 70 infertility blogs were identified on the Internet and 25 met the inclusion criteria. A quantitative-qualitative content analysis was performed with the support of the Gavagai Explorer text analysis software.

Results: A total of 4508 postings were retrieved from the blogs, all of which were written by women. The outcome of the analysis resulted into the following topics: (16.8%), (12.5%), (7.1%), (6.6%), (4.2%), (1.4%) and (0.5%). For most topics, there was a balance between positive and negative statements, but the body topic stood out by having more negative than positive sentiment.

Conclusion: By considering the topics expressed in blogs, health care personnel are provided with an opportunity to better understand the situation of individuals affected by infertility.
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http://dx.doi.org/10.1177/17455065211063280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8646758PMC
December 2021

Feeling valued versus abandoned: Voices of persons who have completed a cognitive assessment.

Int J Older People Nurs 2021 Nov 7;16(6):e12403. Epub 2021 Jul 7.

Sophiahemmet University, Stockholm, Sweden.

Aim: To describe older persons' experiences of a cognitive assessment and possible neuropsychiatric symptoms [NPS] related to a neurocognitive diagnosis.

Background: A cognitive assessment in primary care is offered to persons with suspected dementia with subsequent referral to a specialist clinic if required. The assessment process, with the likelihood of receiving a dementia diagnosis, is surrounded by uncertainty with long waiting times. Although NPS are common among persons with cognitive impairment persons are not routinely asked about these symptoms during a cognitive assessment.

Method: Interviews were held with 18 participants who had completed a cognitive assessment. The Neuropsychiatric Inventory [NPI] was incorporated into one of the interview questions enabling participants to self-report NPS, if present. Interview data were analysed using Interpretive Description.

Results: Two main themes were identified: a matter of trust and making sense of a cognitive diagnosis. Experiences of the assessment process ranged from feeling valued to abandoned with variations of trust in the process. A diagnosis of mild cognitive impairment was experienced as an abstract diagnosis devoid of follow-up support. A lack of preparedness for the assessment existed among participants. Some experienced the process as standardised. One half of participants self-reported the presence of one to four NPS, regardless of neurocognitive diagnosis. Irritability and depression were most common NPS identified.

Conclusions: Experiences of a cognitive assessment varied from feeling valued by society to abandoned in the absence of follow-up support. The assessment was viewed as a standardised procedure failing to see the person behind the testing. Diagnosis disclosure conversations were experienced as diffuse with participants unprepared for a dementia diagnosis. The NPI enabled participants to identify and report the presence of NPS which otherwise could go undetected during the cognitive assessment, impacting on the person's well-being and daily life.
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http://dx.doi.org/10.1111/opn.12403DOI Listing
November 2021

Nursing students' expectations of the process of writing a bachelor's thesis in Sweden: A qualitative study.

Nurse Educ Pract 2021 Jul 22;54:103095. Epub 2021 May 22.

Sophiahemmet University, Dept. of Nursing Science, Stockholm, Sweden; Karolinska Institutet, Södersjukhuset, Dept. of Clinical Science and Education, Stockholm, Sweden. Electronic address:

While performing various academic work, such as writing a bachelor's thesis, are known to be challenging for university students, less is known about students' expectations in this regard.

Aim: The aim was to describe students' expectations of the upcoming process of writing a bachelor's thesis.

Design: The study employed an explorative, qualitative approach with a single, written open-ended question design.

Methods: The data were collected consecutively 2013-2016 in class. A total of 93 final-year students volunteered and provided hand-written accounts which were analyzed using qualitative content analysis.

Results: The students' accounts revealed three generic categories of expectations: Gaining professional knowledge and competency, Planning and organizing the work, and Taking stock of personal resources. Writing a bachelor's thesis was a new challenge for most of the students and the answers testify to mixed feelings about the upcoming work and its supervision.

Conclusions: The nursing students' expectations included present and future competencies, skills and abilities. In promoting development of transferable skills and knowledge, educators of future health-care professionals would be well advised to invite students to reflect on and discuss, their expectations prior to writing a bachelor's thesis and similar academic student papers. This study adds to the research on students' studying and learning in nursing education by bringing to the fore students' expectations of academic learning tasks as an important aspect to consider in higher education contexts, both nationally and internationally.
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http://dx.doi.org/10.1016/j.nepr.2021.103095DOI Listing
July 2021

Communication during the initial visit to a CPAP clinic Practitioners' experiences of facilitators and barriers when talking to patients with obstructive sleep apnea.

J Sleep Res 2021 08 13;30(4):e13244. Epub 2020 Dec 13.

Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.

Adherence to continuous positive airway pressure treatment for obstructive sleep apnea tends to be poor. Communication influences adherence but has not previously been investigated from a practitioner perspective, although shared decision-making is known to be of great importance. The aim was to describe how practitioners experience communication with patients with obstructive sleep apnea during the initial visit at a continuous positive airway pressure treatment clinic, with focus on facilitators and barriers related to the 4 Habits Model, a communication model comprised of four types of interrelated skills to make encounters more patient-centred: investing in the beginning; exploring the patient perspective; showing empathy; and investing in the end. A descriptive design with qualitative content analysis was used. A deductive analysis was carried out based on interviews with 24 strategically selected practitioners from seven continuous positive airway pressure treatment clinics. The 4 Habits Model was used as a framework for identifying facilitators and barriers to communication. Investments in the beginning was described as creating contact, showing the agenda and being adaptive, while explore the patient perspective included showing awareness, being explorative and creating a participating climate. Show empathy consisted of showing openness, being confirmative and creating acceptance, while showing a structured follow-up plan, being open minded and invitational and creating motivation to build on were descriptions of invest in the end. Awareness of potential facilitators and barriers for patient-centred communication during the beginning, middle and end of a continuous positive airway pressure treatment consultation can be used to improve contextual conditions and personal communication competences among practitioners working with continuous positive airway pressure treatment initiation.
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http://dx.doi.org/10.1111/jsr.13244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365721PMC
August 2021

The role of social media for persons affected by infertility.

BMC Womens Health 2020 05 24;20(1):112. Epub 2020 May 24.

Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.

Background: Infertility remains a common universal disorder and a whole range of assisted reproductive technologies has been established. Society may fail to recognize the grief caused by infertility, which may lead to those struggling with it hiding their feelings. Previous research points out that infertile persons experience shortcomings in fertility care regarding continuity of care and social support. Social media may provide social and psychological support for infertile persons. Finding others who are going through similar experiences can help in the realization that the person is not alone and that her/his feelings are reasonable. The aim was to explore the roles of social media for persons affected by infertility.

Methods: A cross-sectional, computer-assisted, self-administered online questionnaire, containing both open and closed questions, was used to collect data. The questionnaire was linked to the bulletin board of six closed infertility social forums. Both quantitative and qualitative analysis methods were used. A total of 132 participants completed the questionnaire containing questions about their use of social media dealing with infertility.

Results: Most of the questionnaires were answered by females (97.7%) through Facebook (87%). Over 60% of the respondents had taken part in discussions about infertility in social media, between one and three years and 39% participated more than once a day. Half of the participants devoted one to three hours weekly to the forums and wrote 1-5 postings per week. The forums offered participants information, solidarity, and the opportunity to receive and give support. However, an adverse aspect that was described concerned advice that were not evidence-based. Infertility was experienced as being alienated from social life and being fragmented as a person.

Conclusion: Participating in infertility forums offers persons information about fertility treatments and social support in the process of coping with infertility.
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http://dx.doi.org/10.1186/s12905-020-00964-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245829PMC
May 2020

Embarking on a memory assessment voices of older persons living with memory impairment.

Dementia (London) 2021 Feb 18;20(2):717-733. Epub 2020 Mar 18.

Sophiahemmet University, Sweden; NVS, Karolinska Institutet, Sweden; Red Cross University College, Sweden.

Aim: To describe older persons who had commenced a memory assessment, experiences of living with memory impairment and related symptoms.

Background: Persons with subjective memory impairment are two times more likely to develop dementia over the years than their peers. Older persons seldom seek help from primary health care clinics solely for subjective memory impairment. Of those who seek help, it can take up to 35 months from the person experiencing initial symptoms to referral to a memory clinic. Further research is needed regarding how older persons live with memory impairment with related symptoms before they receive a memory diagnosis.

Method: A qualitative study with 23 participants who had commenced a memory assessment in primary care. Semi-structured interviews were held. During the interviews, the Neuropsychiatric Inventory was completed and discussed with the participants. Interview data were analysed using Interpretive Description.

Results: The results are presented under four themes: Conflicting views about the situation, Unveiling the presence of neuropsychiatric symptoms, Compensating with external and internal strategies to recall and Worrying about self and future. Persons with memory impairment were encouraged by family members or others to seek a memory assessment. Few persons were self-referred as memory impairment was often seen as a part of aging. Polarised viewpoints existed within the families regarding the impact of memory impairment on daily life. The presence of neuropsychiatric symptoms appeared unexplored in the participants seeking a memory assessment. In this study, the majority of participants experienced neuropsychiatric symptoms at the time of contact for a memory assessment.

Conclusions: Memory problems experienced were often viewed by the person as being part of an aging process. The presence of neuropsychiatric symptoms was not acknowledged as being connected to memory impairment. Contextualising 'memory impairment' as a part of a 'cognitive process' may help the person in identifying the presence of neuropsychiatric symptoms.
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http://dx.doi.org/10.1177/1471301220910637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983336PMC
February 2021

[Transcultural encounter empowering the vulnerable patient].

Lakartidningen 2020 01 14;117. Epub 2020 Jan 14.

Sophiahemmet Högskola - Institutionen för omvårdnadsvetenskap Stockholm, Sweden Sophiahemmet Högskola - Institutionen för omvårdnadsvetenskap Stockholm, Sweden.

The Swedish word, 'bemötande', has no direct equivalent in English but refers to contact, treatment and the relationship with a patient. 'Bemötande', in the context of care, concerns amongst other things how the session is conducted and takes place. The experience of a positive 'bemötande' is important for the patient and relatives to be able to feel trust and confidence, as well as to create a well-functioning working alliance. A respectful 'bemötande' is made more difficult by people's need to classify and see individuals as 'us' and 'them'. A positive 'bemötande' can reinforce patients' self-esteem and have an empowering effect. In this article, we discuss positive 'bemötande' in a transcultural psychiatric care context and focus, in particular, upon the vulnerable patient. We also give examples of how an organisation can contribute to good contact with the local community and facilitate the encounter with individual patients.
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January 2020

Leadership in specialist palliative home care teams: A qualitative study.

J Nurs Manag 2020 Jan 23;28(1):102-111. Epub 2019 Dec 23.

Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.

Aim: The aim of this study was to describe team leaders' experiences of facilitators and barriers of leadership in specialist palliative home care teams.

Background: For effective teamwork in specialist palliative care, leadership is crucial; however, defining and agreeing on what leadership comprises may be challenging. In palliative care, teamwork is recognized as imperative for multiprofessional perspectives to meet dying patients' and families' needs.

Methods: Qualitative interviews with 13 team leaders in specialist palliative home care were performed, using the Pettigrew and Whipp framework, and analysed with directed content analysis.

Results: Team leaders' experiences of conditions influencing the organisation and delivery of specialist palliative home care is multifaceted and leaders seem conflicted in their approach to the multiple levels of leadership, vision and responsibilities.

Conclusion: Team leaders in specialist palliative home care described goals of care on differing levels and, for some, fiscal restraints and external pressures influenced their vision and leadership. Team leaders experienced challenges of leadership in relation to organisational issues, feeling burdened by responsibilities, budget restraints and team size.

Implications For Nursing Management: Team leadership is demanding and complex. In specialist palliative home care, affirming values and enabling vision during times of fiscal strain and external pressures, is challenging. For successful leadership that develops both individuals and the health care team, leaders are recommended to adapt the leadership style to the present situation surrounding the team.
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http://dx.doi.org/10.1111/jonm.12902DOI Listing
January 2020

Living with a well-known stranger: Voices of family members to older persons with frontotemporal dementia.

Int J Older People Nurs 2020 Mar 2;15(1):e12264. Epub 2019 Oct 2.

Sophiahemmet University, Stockholm, Sweden.

Aim: To describe family members' experiences of living with persons with neuropsychiatric symptoms (NPS) related to frontotemporal dementia (FTD).

Background: The majority of persons with dementia during the disease trajectory develop NPS. Persons with FTD are likely to develop greater levels of NPS than persons with other types of dementias. Research-based knowledge regarding family members' experiences of living with persons with FTD and NPS is limited.

Methods: Nine family members of persons with FTD were interviewed. Interviews commenced with completion of the Neuropsychiatric Inventory (NPI). Upon completion of the NPI, questions were posed from an interview guide where study participants provided in-depth information about NPS identified. Interview data were analysed using qualitative content analysis.

Results: Interviewed family members highlighted that persons with FTD had developed between four and eight co-existing NPS. Irritability and disinhibition were the most common NPS, with variations in severity, frequency and distress. From the interview data, two themes emerged: Living with a well-known stranger and Coping and overstepping social norms.

Conclusions: Living with a well-known stranger depicted a new co-existence with a loved one with changes in personality and behaviour, which were not inherent to the person or predictable any more. The presence of NPS can threaten the safety of the person with FTD and their family in real world and on social media. Support offered should focus on the person's physical and psychological needs, not on a diagnosis.

Implications For Practice: From a health care perspective it is important to see the person with FTD and their family as unique individuals with specific needs.
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http://dx.doi.org/10.1111/opn.12264DOI Listing
March 2020

Team type, team maturity and team effectiveness in specialist palliative home care: an exploratory questionnaire study.

J Interprof Care 2019 Sep-Oct;33(5):504-511. Epub 2018 Nov 28.

Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College , Stockholm , Sweden.

To meet complex needs in persons and families within specialist palliative care, care team members are expected to work together in performing a comprehensive assessment of patient needs. Team type (how integrated team members work) and team maturity (group development) have been identified as components in team effectiveness and productivity. The aim of the study reported in this paper was to identify team types in specialist palliative care in Sweden, and to explore associations between team type, team maturity and team effectiveness in home care teams. A national web-based survey of team types, based on Thylefors questionnaire, and a survey of healthcare professionals using the Group Development Questionnaire (GDQ-SE3) to assess team developmental phase, effectiveness and productivity were used in an exploratory cross-sectional design. The participants were: Specialist palliative care teams in Sweden registered in the Palliative Care Directory (n = 77), and members of 11 specialist palliative home care teams. Teams comprised physicians, registered nurses, social workers, physiotherapists and/or occupational therapists, full-or part-time. Our national web survey results showed that the 77 investigated teams had existed from 7 to 21 years, were foremost of medium size and functioned as inter- or transprofessional teams. Results from the 61 HCPs, representing 11 teams, indicated that more mature teams tended to work in an integrated manner, rather than in parallel. The effectiveness ratio varied from 52% to 86% in teams. Recommendations arising from our findings include the need for clarification of team goals and professional roles together with prioritizing the development of desirable psychosocial traits and team processes in clinical settings.
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http://dx.doi.org/10.1080/13561820.2018.1551861DOI Listing
February 2020

Actions helping expressed or anticipated needs: Patients with advanced cancer and their family caregivers' experiences of specialist palliative home care teams.

Eur J Cancer Care (Engl) 2018 Nov 9;27(6):e12948. Epub 2018 Oct 9.

Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.

Patients with advanced cancer and family caregivers in palliative care face physical, psychological, social and existential challenges, much of the time home alone. Specialist palliative home care team services can be instrumental for sense of security in an uncertain situation. The aim of this study was to describe patients' and family caregivers' experiences of specialist palliative home care team actions that are identified by the participants as helping or hindering interventions. Six patients and seven family caregivers were interviewed using the enhanced critical incident technique. Ninety-five critical incidents and wish list items were identified. Providing adequate resources, keeping promises and being reliable, and creating partnerships are actions by specialist palliative care teams that patients and family caregivers experienced as helping in meeting expressed or anticipated needs in patients and family caregivers. Being reliable and including patients and family caregivers in partnerships help to continue with daily life, even though death may be close. Unmet needs resulted in experiences of disrespect or violation of personal space/integrity.
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http://dx.doi.org/10.1111/ecc.12948DOI Listing
November 2018

Infertility-related communication and coping strategies among women affected by primary or secondary infertility.

J Clin Nurs 2018 Jan 30;27(1-2):e335-e344. Epub 2017 Aug 30.

Sophiahemmet University, Stockholm, Sweden.

Aim And Objectives: To explore infertility-related communication and coping strategies among women affected by primary or secondary fertility problems.

Background: Infertility is a worldwide problem and is experienced as psychologically stressful. Communication about infertility varies depending on clinical aspects, personal relationships and culture.

Methods: A quantitative cross-sectional study design was used. One hundred and ninety-nine women affected by primary and secondary infertility were recruited from one fertility clinic in Stockholm. A structured self-administered questionnaire was used to collect data. The answers were compared across the two groups using the chi-squared test for independence.

Results: The majority of the women discussed infertility-related subjects with intimate friends and/or relatives and did not discuss the results of examinations and tests with people outside of the family. There were significant differences between the two groups. Twice as many women with secondary infertility acknowledged that they never talk about the causes or results of the tests and examinations with other people, compared with women with primary infertility. Approximately 25% of the women with primary infertility used distraction techniques, such as turning to work, as a coping strategy compared to women with secondary infertility (10%). Some women did not discuss the inability to conceive and reasons why they were childless with their spouses. Twelve percentage of the women reported that they left the room when the subjects of children were being discussed. Approximately 30% of the participants did not ask friends or relatives for advice and a few were not able to discuss how tests and treatments affected them emotionally.

Conclusion: This study indicates that a majority of infertile women discuss about infertility-related subjects with their spouses. However, they are less likely to discuss the reason for infertility and results of tests and examinations with people outside the family.

Relevance To The Clinical Practice: The result of the current study can be useful regarding interventions for women affected by primary or by secondary infertility. The healthcare staff must be alert and attentive to pay attention to these possible challenges. Identification of women at risk of developing emotional problems due to communication difficulties regarding infertility-related issues merits close attention.
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http://dx.doi.org/10.1111/jocn.13953DOI Listing
January 2018

Voices of Spouses Living with Partners with Neuropsychiatric Symptoms Related to Dementia.

Dementia (London) 2019 Apr 6;18(3):903-919. Epub 2017 Apr 6.

Karolinska Institutet, Sweden.

Persons with dementia, who reside in their own homes, are often cared for by family members. The presence of a family career is said to have a protective effect, postponing admissions to residential care. The majority of persons with dementia develop behavioural and personality changes during the disease trajectory also known as neuropsychiatric symptoms. Quality of life for both the person with neuropsychiatric symptoms and their careers are affected, increasing suffering and risk for hospitalisation and admission to long-term residential care. Family careers to persons with dementia have identified behavioural changes as more distressing than cognitive impairment leading to increased burden of care and admissions to residential care. Knowledge gaps exist regarding how family careers living with persons with dementia experience neuropsychiatric symptoms in a community setting. The aim was to describe spouses' experiences of living with partners who have developed neuropsychiatric symptoms related to dementia in a community setting. Semi-structured interviews were carried out with 14 spouses of partners with dementia. The interviews included completion of the neuropsychiatric inventory. Interview data were analysed using a content analysis approach. The results showed that spouses identified in the neuropsychiatric inventory that partners with dementia had on average five to eight co-existing symptoms. Frequency, severity and distress varied. From the narrative data, the theme living on the edge lacking support and time for self, emerged. The findings of this study suggest that support offered to persons with dementia and their spouses should have a person-centred approach meeting individual needs. Safety and welfare of persons with dementia and their spouses residing in their own homes may be jeopardised in the presence of neuropsychiatric symptoms. A greater awareness is required in the community regarding the well-being of these persons.
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http://dx.doi.org/10.1177/1471301217693867DOI Listing
April 2019

Cardiologists' experiences and perceptions of patient involvement and communication related to shared decision-making regarding atrial fibrillation treatment.

Commun Med 2017 ;14(1):39-50

Sodersjukhuset, Sweden.

Objective: To feel involved in decisions about atrial fibrillation (AF) treatment, patients need supportive communication from cardiologists. Shedding light on cardiologists' perceptions of patient involvement in AF care settings is thus of importance. We examine (1) how cardiologists describe patient involvement and communication related to shared decisionmaking regarding AF treatment, and (2) their perceptions of efforts to involve patients in the treatment decisions.

Methods: Ten cardiologists were interviewed in four Swedish hospitals. A qualitative content analysis was performed on the interview data.

Results: Cardiologists' perceptions of patient involvement in treatment decisions are framed in terms of (1) ideology, (2) experience, and (3) responsibility.

Conclusion: By taking into account patients' feelings in the consultations, and by actively encouraging patients to be involved, the cardiologists contributed to patient involvement.

Practice Implications: One key to improving compliance with legislation aimed at increasing patient involvement in treatment decisions could lie in paying attention to physician-patient communication and the conditions for patient involvement in decision-making about treatment.
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http://dx.doi.org/10.1558/cam.30587DOI Listing
November 2018

Use of complementary and alternative medicine in Swedish patients with inflammatory bowel disease: a controlled study.

Eur J Gastroenterol Hepatol 2016 Nov;28(11):1320-8

aDepartment of Neurobiology, Care Sciences and Society, Division of Nursing bDepartment of Clinical Sciences, Danderyd Hospital cCenter for Digestive Diseases, Karolinska University Hospital dDepartment of Medicine, Solna, Karolinska Institutet eDepartment of Clinical Science and Education, Södersjukhuset, Karolinska Institutet fStockholm GastroCenter gSophiahemmet University, Stockholm hInstitute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg iDepartment of Medicine, Geriatrics and Emergency, Sahlgrenska University Hospital/East Hospital, Gothenburg jDepartment of Gastroenterology, Skane University Hospital, Lund kFaculty of Medicine and Health, School of Health and Medical Sciences, Örebro University and Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.

Background: There is an increasing interest in complementary and alternative medicine (CAM) in patients with chronic diseases, including those with inflammatory bowel disease (IBD). Patients may turn to CAM when conventional therapies are inadequate or associated with side effects for symptomatic relief or to regain control over their disease. The objectives were to explore CAM use and perceived effects in IBD patients in comparison with a control group.

Methods: A cross-sectional, multicenter, controlled study was carried out. IBD patients were invited from 12 IBD clinics in Sweden. Controls were selected randomly from a residence registry. A study-specific questionnaire was used for data collection.

Results: Overall, 48.3% of patients with IBD had used some kind of CAM during the past year compared with 53.5% in controls (P=0.025, adjusted for age, sex, geographic residence, and diet). The most frequently used CAM among IBD patients was massage (21.3%), versus controls (31.4%) (adjusted P=0.0003). The second most used CAM was natural products, 18.7% in IBD patients versus 22.3% of the controls (unadjusted P=0.018). In all, 83.1% of the patients experienced positive effects from CAM and 14.4% experienced negative effects.

Conclusion: Overall, 48.3% of Swedish IBD patients used some kind of CAM and controls used CAM significantly more. Natural products were used by one-fifth of the patients and even more by controls. This is notable from a patient safety perspective considering the possible risks of interactions with conventional medication. In all, 40% of the patients reported adverse events from conventional medicine. Patients experienced predominantly positive effects from CAM, and so did controls.
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http://dx.doi.org/10.1097/MEG.0000000000000710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051534PMC
November 2016

Experiences of security and continuity of care: Patients' and families' narratives about the work of specialized palliative home care teams.

Palliat Support Care 2017 04 22;15(2):181-189. Epub 2016 Jul 22.

Sophiahemmet University,Stockholm,Sweden.

Background: Those who are seriously ill and facing death are often living with physical, emotional, social, and spiritual suffering. Teamwork is considered to be necessary to holistically meet the diverse needs of patients in palliative care. Reviews of studies regarding palliative care team outcomes have concluded that teams provide benefits, especially regarding pain and symptom management. Much of the research concerning palliative care teams has been performed from the perspective of the service providers and has less often focused on patients' and families' experiences of care.

Objective: Our aim was to investigate how the team's work is manifested in care episodes narrated by patients and families in specialized palliative home care (SPHC).

Method: A total of 13 interviews were conducted with patients and families receiving specialized home care. Six patients and seven family members were recruited through SPHC team leaders. Interviews were transcribed verbatim and the transcripts qualitatively analyzed into themes.

Results: Two themes were constructed through thematic analysis: (1) security ("They are always available," "I get the help I need quickly"); and (2) continuity of care ("They know me/us, our whole situation and they really care"). Of the 74 care episodes, 50 were descriptions of regularly scheduled visits, while 24 related to acute care visits and/or interventions.

Significance Of Results: Patients' and family members' descriptions of the work of SPHC teams are conceptualized through experiences of security and continuity of care. Experiences of security are fostered through the 24/7 availability of the team, sensitivity and flexibility in meeting patients' and families' needs, and practical adjustments to enable care at home. Experiences of continuity of care are fostered through the team's collective approach, where the individual team member knows the patients and family members, including their whole situation, and cares about the little things in life as well as caring for the family unit.
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http://dx.doi.org/10.1017/S1478951516000547DOI Listing
April 2017

Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents: A Mixed Method Study.

Prehosp Disaster Med 2016 Aug 23;31(4):376-85. Epub 2016 May 23.

6Sophiahemmet University,Stockholm Sweden and Karolinska Institutet,Department of Clinical Sciences,Danderyds sjukhus,Stockholm,Sweden.

Unlabelled: Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs).

Methods: A mixed method design was used. The first part of the study was in the form of a web-survey of attitudes answered by ambulance personnel. The question explored was: Is it likely that systems that are not used in everyday practice will be used during MIs? Two identical web-based surveys were conducted, before and after implementing a new strategy for triage tagging. This strategy consisted of a time-limited triage routine where ambulance services assigned triage category and applied triage tags in day-to-day trauma incidents in order to improve field triage. The second part comprised three focus group interviews (FGIs) in order to provide a deeper insight into the attitudes towards, and experience of, the use of triage tags. Data were analyzed using qualitative content analysis.

Results: The overall finding was the need for daily routine when failure in practice. Analysis of the web-survey revealed three changes: ambulance personnel were more prone to use tags in minor accidents, the sort scoring system was considered to be more valuable, but it also was more time consuming after the intervention. In the analysis of FGIs, four categories emerged that describe the construction of the overall category: perceived usability, daily routine, documentation, and need for organizational strategies.

Conclusion: Triage is part of the foundation of ambulance skills, but even so, ambulance personnel seldom use this in routine practice. They fully understand the benefit of accurate triage decisions, and also that the use of a triage algorithm and color coded tags is intended to make it easier and more secure to perform triage. However, despite the knowledge and understanding of these benefits, sparse incidents and infrequent exercises lead to ambulance personnel's uncertainty concerning the use of triage tagging during a MI and will therefore, most likely, avoid using them. Rådestad M , Lennquist Montán K , Rüter A , Castrén M , Svensson L , Gryth D , Fossum B . Attitudes towards and experience of the use of triage tags in major incidents: a mixed method study. Prehosp Disaster Med. 2016;31(4):376-385.
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http://dx.doi.org/10.1017/S1049023X16000480DOI Listing
August 2016

Patients' experiences of communication and involvement in decision-making about atrial fibrillation treatment in consultations with nurses and physicians.

Scand J Caring Sci 2016 Sep 28;30(3):535-46. Epub 2015 Dec 28.

Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.

Background: Insights in consultations across patient interactions with physicians and nurses are of vital importance for strengthening the patients' involvement in the treatment decision-making process. The experience of involvement and communication in decision-making from the patients' perspective has been sparsely explored.

Objective: To examine how patients describe involvement in and communication about decision-making regarding treatment in consultations with nurses and physicians.

Method: Twenty-two patients with atrial fibrillation (AF), aged 37-90 years, were interviewed directly after their consultations with nurses and physicians in outpatient AF clinics in six Swedish hospitals.

Results: In consultations with nurses, the patients felt involved when obtaining clarifications about AF as a disease and its treatment and when preparing for and building up confidence in decision-making. In consultations with physicians, the patients felt involved when they could cooperate in decision-making, when acquiring knowledge, and when they felt that they were being understood. One shared category was found in consultations with both nurses and physicians, and the patients felt involved when they had a sense of trust and felt secure during and between consultations.

Conclusions: Patients with AF stated that they would need to acquire knowledge and build up confidence and ability in order to be effectively involved in the decision-making about treatment. Despite not being actively involved in decision-making, patients felt involved through experiencing supportive and confirming communication.

Practice Implications: Attention must be given to the relationship with the patient to create the conditions for patient involvement in the consultation. This can be achieved through supportive communication attempting to create a feeling of clarity and building confidence. This will support involvement in decision-making concerning AF treatment and feelings of being understood and of trust in physicians and/or nurses.
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http://dx.doi.org/10.1111/scs.12276DOI Listing
September 2016

Nurses' and patients' communication in smoking cessation at nurse-led COPD clinics in primary health care.

Eur Clin Respir J 2015 7;2:27915. Epub 2015 Aug 7.

Centre for Clinical Research, Dalarna, Falun, Sweden.

Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes.

Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care.

Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations.

Results: Only to a small extent did nurses' evoke patients' reasons for change, stimulate collaboration, and support patients' autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients' communication was mainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation.

Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking.

Practice Implications: To make patients more active, the nurses need more education and continuous training in motivational communication.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653311PMC
http://dx.doi.org/10.3402/ecrj.v2.27915DOI Listing
December 2015

Authors' response (Unbeck and colleagues).

Int J Nurs Stud 2015 Jan;52(1):484-5; discussion 485-6

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January 2015

Experiences of complementary and alternative medicine in patients with inflammatory bowel disease - a qualitative study.

BMC Complement Altern Med 2014 Oct 22;14:407. Epub 2014 Oct 22.

Division of Gastroenterology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, SE-18288 Stockholm, Sweden.

Background: The use of Complementary and Alternative Medicine (CAM) in Inflammatory Bowel Disease (IBD) is increasing. Although CAM often improves patients' well-being, it can also lead to side-effects and interactions with conventional medications. Research on patients with IBD in Sweden who have experiences of CAM is sparse. More studies are needed to enhance awareness of and improve communication about CAM. The aim of this study was to describe experiences of CAM in the healthcare context reported by patients with IBD.

Methods: Fifteen patients with IBD, eight with Crohn's disease (CD) and seven with ulcerative colitis (UC), were recruited. Semi-structured qualitative interviews were conducted and qualitative content analysis was performed.

Results: The analysis revealed the theme Knowledge and communication lead to participation in the area of CAM based on three categories; CAM use, Communication and Self-care. Patients with IBD wanted to be asked about CAM to be able to start a dialogue, as some perceived being treated in a disparaging manner and not taken seriously when raising the subject. Healthcare professionals (HCPs) need to be aware of this in order to meet and understand patient needs. Patients with IBD found it easier to communicate about CAM with the IBD nurses than physicians and dietary changes was one important CAM treatment.

Conclusions: The finding that it was easier to discuss CAM with nurses than physicians emphasizes the important role of the IBD nurse in communication and monitoring patients' CAM use. Patients wanted to be asked about CAM to be able to start a dialogue, as some perceived not taken seriously when raising the subject. Furthermore, HCPs need to understand that many patients with IBD regard dietary changes as an important part of CAM treatment. Further research in these areas is needed.
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http://dx.doi.org/10.1186/1472-6882-14-407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210588PMC
October 2014

Promoting reflection by using contextual activity sampling: a study on students' interprofessional learning.

J Interprof Care 2014 Sep 22;28(5):400-6. Epub 2014 Apr 22.

Karolinska Institutet, Department of Clinical Science and Education , Södersjukhuset, Stockholm , Sweden .

Students' engagement and reflection on learning activities are important during interprofessional clinical practice. The contextual activity sampling system (CASS) is a methodology designed for collecting data on experiences of ongoing activities by frequent distribution of questionnaires via mobile phones. The aim of this study was to investigate if the use of the CASS methodology affected students' experiences of their learning activities, readiness for interprofessional learning, academic emotions and experiences of interprofessional team collaboration. Student teams, consisting of 33 students in total from four different healthcare programs, were randomized into an intervention group that used CASS or into a control group that did not use CASS. Both quantitative (questionnaires) and qualitative (interviews) data were collected. The results showed that students in the intervention group rated teamwork and collaboration significantly higher after than before the course, which was not the case in the control group. On the other hand, the control group reported experiencing more stress than the intervention group. The qualitative data showed that CASS seemed to support reflection and also have a positive impact on students' experiences of ongoing learning activities and interprofessional collaboration. In conclusion, the CASS methodology provides support for students in their understanding of interprofessional teamwork.
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http://dx.doi.org/10.3109/13561820.2014.907777DOI Listing
September 2014

Translation and cultural adaptation of research instruments - guidelines and challenges: an example in FAMCARE-2 for use in Sweden.

Inform Health Soc Care 2015 Jan 6;40(1):67-78. Epub 2014 Jan 6.

Department of Learning, Informatics, Management and Ethics, Karolinska Institutet , Stockholm , Sweden .

Background: Assessing and evaluating health care is important, and an abundance of instruments are developed in different languages. Translating existing, validated instruments is demanding and calls for adherence to protocol. Purpose: The purpose of this study was to translate and culturally adapt the FAMCARE-2 scale for use in Sweden. Methods: Traditional back-translation and the decentering stance were utilized and assessed. Experts in palliative care clinic and research were involved; the FAMCARE-2 instrument was discussed with family caregivers and content validity was assessed by experienced health professionals. Results: Significant discrepancies were not revealed by back-translation. Using the decentering stance gave reliable structure and opportunities for reflection throughout the translation process. Discussion: Translating an existing instrument into a second language requires interpretation and adaptation more than a naive translation. The back-translation process may be enhanced if the decentering stance is adopted.
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http://dx.doi.org/10.3109/17538157.2013.872111DOI Listing
January 2015

Team interactions in specialized palliative care teams: a qualitative study.

J Palliat Med 2013 Sep;16(9):1062-9

1 Department of Clinical Sciences, Karolinska Institutet , Stockholm, Sweden .

Background: Teamwork is a standard of care in palliative care and that is emphasized by leading organizations. When interdisciplinary teams communicate their varied assessments, outcomes may be more than additive due to the synthesis of information. Interprofessionality does not guarantee multidimensionality in health care interventions, however, and that interprofessional teams promote collaboration may be questioned.

Aim: The aim was to explore team interaction among team members in specialized palliative care teams.

Design: Semistructured interviews were conducted with health professionals working in specialized palliative home care teams. The interviews were analyzed by content analysis.

Setting/participants: Participants were recruited from specialized palliative care units in Sweden. The 15 interviewees included 4 men and 11 women. Physcians, nurses, paramedical staff, and social workers were included.

Results: Organizational issues like resources and leadership have a great impact on delivery of care. Competence was mirrored in education, collaboration, approach, and support within the team; while communication was described as key to being a team, resolving conflict, and executing palliative care.

Conclusion: Communication and communication patterns within the team create the feeling of being a team. Team climate and team performance are significantly impacted by knowledge and trust of competence in colleagues, with other professions, and by the available leadership. Proportions of different health professionals in the team have an impact on the focus and delivery of care. Interprofessional education giving clarity on one's own professional role and knowledge of other professions would most likely benefit patients and family caregivers.
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http://dx.doi.org/10.1089/jpm.2012.0622DOI Listing
September 2013

Objective evaluation by reflectance spectrophotometry can be of clinical value for the verification of blanching/non blanching erythema in the sacral area.

Int Wound J 2014 Aug 24;11(4):416-23. Epub 2013 Mar 24.

Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden; Department of Nursing, Sophiahemmet University, Stockholm, Sweden.

Early detection of non blanching erythema (pressure ulcer category I) is necessary to prevent any further skin damage. An objective method to discriminate between blanching/non blanching erythema is presently not available. The purpose of this investigation was to explore if a non invasive objective method could differentiate between blanching/non blanching erythema in the sacral area of patients undergoing hip fracture surgery. Seventy-eight patients were included. The sacral area of all patients was assessed using (i) conventional finger-press test and (ii) digital reading of the erythema index assessed with reflectance spectrophotometry. The patients were examined at admission and during 5 days postsurgery. Reflectance spectrophotometry measurements proved able to discriminate between blanching/non blanching erythema. The reliability, quantified by the intra-class correlation coefficient, was excellent between repeated measurements over the measurement period, varying between 0·82 and 0·96, and a significant change was recorded in the areas from day 1 to day 5 (P < 0·0001). The value from the reference point did not show any significant changes over the same period (P = 0·32). An objective method proven to identify early pressure damage to tissue can be a valuable tool in clinical practice.
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http://dx.doi.org/10.1111/iwj.12044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950345PMC
August 2014

Design, application and impact of quality improvement 'theme months' in orthopaedic nursing: a mixed method case study on pressure ulcer prevention.

Int J Nurs Stud 2013 Apr 26;50(4):527-35. Epub 2013 Feb 26.

Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden.

Background: While there is growing awareness of quality problems in healthcare systems, it remains uncertain how best to accomplish and sustain improvement over time.

Objective: To report on the design and application of quality improvement theme months in orthopaedic nursing, and evaluate the impact on pressure ulcer as an example.

Design: Retrospective mixed method case study with time series diagrams.

Setting: An orthopaedic department at a Swedish university hospital.

Method: The interventions were led by nursing teams and focused on one improvement theme at a time in two-month cycles, hence the term 'improvement theme months'. These included defined objectives, easy-to-use follow-up measurement, education, changes to daily routines, "reminder months" and data feedback. The study draws on retrospective record data regarding one of the theme topics, pressure ulcer risk assessment and prevalence, in 2281 orthopaedic admissions during January 2007-October 2010 through point prevalence measurement one-day per month. Data were analysed in time series diagrams and through comparison to annual point prevalence data from mandatory county council-wide measurements prior to, during and after interventions from 2003 to 2010. By using document analysis we reviewed concurrent initiatives at different levels in the healthcare organisation and related them to the improvement theme months and their impact.

Results: The 46 monthly point prevalence samples ranged from 28 to 66 admissions. Substantial improvements were found in risk assessment rates for pressure ulcers both in the longitudinal follow-up (p<0.001) and in the annual county council-wide measurements. A reduction in pressure ulcer rate was observed in the annual county council-wide measurements. In the longitudinal data, wider variation in the pressure ulcer rate was seen (p<0.067); however, there was a significant decrease in pressure ulcer rates during the final ten-month period in 2010, compared to the baseline period in 2007 (p=0.004). Improvements were moderate the first years and needed reinforcement to be maintained.

Conclusions: The theme month design and the way it was applied in this case showed potential, contributing to reduced pressure ulcer prevalence, as a way to conduct quality improvement initiatives in nursing. For sustainable improvement, multi component interventions are needed with regular monitoring and reminder efforts.
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http://dx.doi.org/10.1016/j.ijnurstu.2013.02.002DOI Listing
April 2013

Prevalence of antibiotic-resistant bacteria in residents of nursing homes in a Swedish municipality: healthcare staff knowledge of and adherence to principles of basic infection prevention.

Scand J Infect Dis 2012 Sep 10;44(9):641-9. Epub 2012 Jun 10.

Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sophiahemmet University College, Stockholm, Sweden.

Background: The aims of this study were to investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in residents living in Swedish nursing homes, and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors, and/or staff's adherence to guidelines for infection control.

Methods: Five hundred and sixty residents from 9 nursing homes on a total of 67 wards participated in the study and had microbiological cultures taken. Faecal samples were obtained from 495 residents (88.3%). ESBL-positive residents were followed for 2 y with repeated sampling. Two hundred and ninety-six [corrected] staff members were interviewed and observed regarding familiarity with and adherence to infection control guidelines.

Results: No resident was positive for MRSA or VRE. Fifteen of the residents were found to be ESBL-positive. Residents living on wards where ESBL-positive residents were identified had been treated more frequently with antibiotics (42%), compared to those on wards where no residents with ESBL were found (28%; p = 0.02). ESBL-positive Escherichia coli isolates from residents living in adjacent rooms were found to be closely genetically related when analysed by pulsed-field gel electrophoresis, indicating transmission between residents. Staff adherence to infection control guidelines sometimes revealed shortcomings, but no significant differences regarding compliance to the guidelines could be found.

Conclusion: Carriage of resistant bacteria was uncommon and only ESBL-producing Enterobacteriaceae were identified in Swedish nursing homes. Usage of antibiotics was higher on wards where ESBL-positive residents were detected and there was an indication of transmission of ESBL between residents.
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http://dx.doi.org/10.3109/00365548.2012.671956DOI Listing
September 2012

Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics.

J Adv Nurs 2012 Apr 20;68(4):767-82. Epub 2011 Jul 20.

Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.

Aim: This paper is a report of a study to describe to what extent Registered Nurses, with a few days of education in motivational interviewing based communication, used motivational interviewing in smoking cessation communication at nurse-led chronic obstructive pulmonary disease clinics in primary health care.

Background:   For smokers with chronic obstructive pulmonary disease the most crucial and evidence-based intervention is smoking cessation. Motivational interviewing is often used in healthcare to support patients to quit smoking.

Method: The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. Data were collected from March 2006 to April 2007. The nurses' smoking cessation communication was analysed using the Motivational Interviewing Treatment Integrity scale. To get an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five indicating best adherence to Motivational Interviewing.

Results: Evocation', 'collaboration', 'autonomy-support' and 'empathy' averaged between 1·31 and 2·23 whereas 'direction' scored five in all consultations. Of communication behaviours, giving information was the most frequently used, followed by 'closed questions', 'motivational interviewing non-adherent' and 'simple reflections'. 'Motivational int erviewing adherent', 'open questions' and 'complex reflections' occurred rarely. There were no important individual or group-level differences in any of the ratings between the first and the third consultations.

Conclusion: In smoking cessation communication the nurses did not employ behaviours that are important in motivational interviewing.
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http://dx.doi.org/10.1111/j.1365-2648.2011.05766.xDOI Listing
April 2012

Health-related quality of life in patients with atrial fibrillation undergoing pulmonary vein isolation, before and after treatment.

Eur J Cardiovasc Nurs 2010 Mar 13;9(1):45-9. Epub 2009 Oct 13.

Department of Cardiology Karolinska University Hospital, Stockholm, Sweden.

Background: Atrial fibrillation (AF) is the most common arrhythmia and many AF patients experience a significantly impaired health-related quality of life (HRQOL). AF is also associated with a high risk of stroke and death. Many pharmacologic treatments for AF are ineffective and may have adverse effects. New methods, such as pulmonary vein isolation (PVI), have been developed to treat AF.

Aims: The aim of this study was to investigate the HRQOL issues in severe symptomatic AF patients before and after pulmonary vein isolation.

Methods: Forty patients treated with PVI were included of which 36 concluded the study with the self-reported HRQOL questionnaires before and once after PVI. A standardized control group was used.

Results: Compared to the control group the HRQOL before PVI was significantly lower in all domains except for bodily pain. The preoperative scores were compared with the scores obtained at the follow-up. All subscales of the SF-36 significantly improved after the PVI except for bodily pain, which remained unaltered.

Conclusion: HRQOL is improved in AF patients with severe symptoms after PVI intervention.
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http://dx.doi.org/10.1016/j.ejcnurse.2009.09.002DOI Listing
March 2010

An exploration of the theoretical concepts policy windows and policy entrepreneurs at the Swedish public health arena.

Health Promot Int 2009 Dec 9;24(4):434-44. Epub 2009 Oct 9.

Division of Social Medicine, Department of Public Health Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.

In John Kingdon's Policy Streams Approach policy formation is described as the result of the flow of three 'streams', the problem stream, the policy stream and the politics stream. When these streams couple, a policy window opens which facilitate policy change. Actors who promote specific solutions are labelled policy entrepreneurs. The aim of this study was to test the applicability of the Policy Streams Approach by verifying whether the theoretical concepts 'policy windows' and 'policy entrepreneurs' could be discernable in nine specified cases. Content analyses of interviews and documents related to child health promoting measures in three Swedish municipalities were performed and nine case studies were written. The policy processes preceding the municipal measures and described in the case studies were scrutinized in order to find statements related to the concepts policy windows and policy entrepreneurs. All conditions required to open a policy window were reported to be present in eight of the nine case studies, as was the most important resource of a policy entrepreneur, sheer persistence. This study shows that empirical examples of policy windows and policy entrepreneurs could be identified in child health promoting measures in Swedish municipalities. If policy makers could learn to predict the opening of policy windows, the planning of public health measures might be more straightforward. This also applies to policy makers' ability to detect actors possessing policy entrepreneur resources.
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http://dx.doi.org/10.1093/heapro/dap033DOI Listing
December 2009
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