Twenty-first century transformations have taken place within the framework ofglobalisation of the economy, the spread of information technology and global migrationresulting in increased cultural diversity in many societies. This qualitative studyinvestigated perspective transformation in 18 research students, from Australia, HongKong SAR, and Sweden, participating in an international online course by using Mezirow’stheory of perspective transformation and Kiely’s six forms of transformativechange (intellectual, moral, political, cultural, personal, and spiritual). The approach tolearning facilitated global networking and a commitment to support growth in thestudents’ research practice. Validating the link between research students’ learningexperiences and perspective transformation theory encourages educators to developfuture online educational materials to promote cognitive flexibility and reflexivity andincrease students’ cultural awareness to inform their research practices.

BackgroundIn endoscopic care, favourable patient experiences before, during and after a colonoscopy are essential for the patient's willingness to repeat the procedure. To ensure that significant experiences are measured, patients should be involved in creating the measurement instruments. Thus, the aim of the present study was to develop a colonoscopy-specific PREM by (1) operationalising patient experiences before, during and after a colonoscopy procedure and (2) evaluating its content validity.MethodsThe colonoscopy-specific PREM was developed in two stages: (1) operationalisation with item generation and (2) content validity testing. A previously developed conceptual model, based on a systematic literature review that illustrates patients' (n = 245) experiences of undergoing a colonoscopy, formed the theoretical basis. To assess the degree to which the PREM reflected patients' experiences before, during and after a colonoscopy procedure, content validity was tested-through face validity with healthcare professionals (n = 4) and cognitive interviews with patients (n = 14) having experienced a colonoscopy. Content validity index (CVI) was calculated to investigate the relevance of the items.ResultsThe Patient Experience Colonoscopy Scale (PECS) is a colonoscopy-specific PREM consisting of five different constructs: health motivation, discomfort, information, a caring relationship and understanding. Each construct was defined and generated into a pool of items (n = 77). After face-validity assessment with healthcare professionals, a draft 52-item version of the PECS was ready for content validity testing by the patients. During cognitive interviews the patients contributed valuable insights that led to rewording and removal of items. Results from the CVI suggest that the PECS and its content are relevant (I-CVI range 0.5-1, S-CVI/Ave = 0.86). The final PECS consists of 30 items representing a colonoscopy-specific PREM.ConclusionThe PECS is a new 30-item PREM instrument designed for adult elective colonoscopy patients after they have undergone the procedure. Each item in the PECS derives from a conceptual model based on a systematic literature review. Patients and healthcare professionals were involved in developing the PECS, which measures colonoscopy-specific patient experiences before, during and after the procedure. The content validity testing positively contributed to the development of the PECS. Psychometric properties need to be evaluated further.

BACKGROUND: Thoracoabdominal aortic aneurysms (TAAA) pose significant risks of morbidity and mortality. Considering the evolving techniques for TAAA intervention and the growing interest in quality of life (QoL) outcomes for decision-making, we aimed to evaluate the impact of patient and perioperative characteristics on short-, medium-, and long-term post-operative QoL in TAAA repair patients.

METHODS: A systematic search was conducted in CINAHL, APA PsycINFO, EMBASE, Medline and Cochrane to identify primary research studies evaluating QoL post TAAA surgery, published in English or Swedish between 01 January 2012 and 26 September 2022. A narrative synthesis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of evidence was assessed using the Critical Appraisal Skills Programme and Joanna Briggs Institute checklists.

RESULTS: Eight studies of low or moderate quality with 455 patients were included. Preoperative QoL in TAAA patients was lower compared to the general population. While there is an initial short-term improvement in post-operative QoL, patients fail to reach baseline levels even after seven years, with physical activity and functioning domains being particularly affected. Experiencing post-operative complications, including paraplegia and cardiovascular events, negatively impacts post-operative QoL. Patients with uncomplicated postoperative status had improved QoL. Prolonged hospital stay negatively affects physical functioning.

CONCLUSIONS: Individuals with TAAA are likely to have lower baseline QoL compared to the general population. Following TAAA repair, post-operative QoL may remain lower than baseline levels, persisting over the long-term. Comorbidities, post-operative complications, and hospitalisation duration appear to exert adverse effects on post-operative QoL.

Introduction: An increasing population and a shortage of identified potential organ donors are causing the waiting list fororgan transplants to grow continuously. Donation after circulatory death (DCD) is a method aimed at meeting the demandfor transplantable organs. However, it presents new challenges in nursing care, and there is a lack of studies investigatingnurses’ attitudes and knowledge of DCD.Objective: The objective of this study was to determine and describe intensive care nurses’ (ICNs’) knowledge, attitudes,and views on DCD before a national implementation in Sweden.Method: This study utilized a cross-sectional mixed-method design. A convenience sampling method was employed, targetingICNs working in four intensive care units in Sweden. A study-specific tool comprising fixed and free-text questions was developed.Fifty-one ICNs participated. Data were analyzed descriptively, and correlation analysis was performed using Spearman’scorrelation. Free-text answers were qualitatively assessed and analyzed. An integrated analysis was conducted to synthesizethe quantitative and qualitative findings.Results: Fifty-three percent reported limited knowledge about DCD. Nurses with previous education on DCD had significantlyhigher knowledge (r=.380, p=.006), were more engaged with the public debate on organ donation (r =.423, p=.002),and considered the ethical aspects of DCD more thoroughly (r=.386, p=.022). The qualitative analysis identified four keycategories: The importance of the team, the need for ethical discussions, increased knowledge of DCD, and unanswered questions andunmet needs. The integrated analysis underscored the need for targeted education, clear guidelines, and ongoing ethical discussionsto prepare ICU nurses for DCD.Conclusion: Nurses educated in organ donor care had better knowledge and a more positive attitude toward DCD implementation.The study also highlights the importance of interprofessional teamwork in DCD implementation. The findings suggest that education on DCD could improve the identification and implementation of DCD donors, addressing the globalshortage of transplantable organs.

Introduction: To minimize the risk of developing foot-ulcers, persons with diabetes are given the advice to daily inspect their feet and to apply skincare formulations. However, commercially available skincare products have rarely been developed and evaluated for diabetes foot care specifically. The primary aim of this randomized controlled trial (RCT) is to evaluate the effects in reducing foot xerosis in persons with diabetes without footulcers using two skincare creams containing different humectants (interventions) against a cream base nonhumectant (comparator). Secondary outcomes are to evaluate differences on skin barrier integrity, lowmolecular weight biomarkers and skin microbiota, microcirculation including transcutaneous oxygen pressure, degree of neuropathy, and HbA1c between intervention-comparator creams. Methods: Two-armed double-blind RCT, registered in ClinicalTrials.gov Identifier: NCT06427889. With 80 % power, two-tailed significance of 2.5 % in each arm, 39 study persons is needed in each arm, total 78 persons, 98 including dropouts, to be able to prove a reduction of at least one category in the Xerosis Severity Scale with the intervention creams compared to the comparator. In one arm, each participant will treat one foot with one of the intervention creams (Oviderm (R) or Canoderm (R)), while the opposite foot will be treated with the comparator cream (Decubal (R) lipid cream), twice a day. If needed, participants are enrolled after a wash-out period of two weeks. The participants will undergo examinations at baseline, day 14 and day 28. Discussion: This RCT evaluate the potential effects of humectants in skin creams against foot xerosis in persons with diabetes.

Aim: The aim was to identify planned and completed preventive interventions among older persons with oral health problems receiving municipal health care. A further aim was to determine the correspondence between oral health problems and planned preventive interventions among older persons with oral health problems receiving municipal health care. Design: Cross-sectional register study. Methods: Oral health data from the Swedish national quality registry, Senior Alert, were extracted for 4,024 older persons (>= 65 years) receiving municipal health care in a county in Southern Sweden. Data were statistically analysed. Results: A large majority of older persons (97.4%) with assessed oral health problems had at least one planned preventive intervention, and approximately three quarters of the planned interventions were completed. There seemed to be a mismatch between type of oral health problems and preventive interventions as not all older persons had a planned preventive intervention related to their specific oral health problem.

BackgroundAlthough dietary adjustments are recommended frequently for bowel symptoms, evidence of diet's impact on bowel function is lacking. The aim was to develop a patient-reported outcome instrument, for children with and without Hirschsprung's disease (HD), to explore experiences of dietary effects on bowel function.MethodsChildren with and without HD and their parents participated. Questionnaire items regarding the impact of diet on bowel function originated from focus group discussions. Specific food items, reported in the literature or in focus groups to cause bowel functional effects, were listed requesting each item's effect size and effect type. Content validity was tested within two separate semistructured interviews. A pilot test was performed. Assessing comprehension, relevance and wording clarity structurally, revisions were made accordingly. Children's bowel function was assessed through the validated Rintala Bowel Function Score.ResultsA total of 13 children with and without HD, median age 7 (range 2-15) years, and 18 parents participated in the validation. Each question's relevance had been ranked highly early in the validation process but most questions needed refining for improving clarity and comprehension. Wordings regarding bowel symptoms and emotions connected to food in particular were perceived to be sensitive and complex. Specifically wording regarding some bowel symptoms (gases, pain) and parental stress emotions (guilt, ambivalence) were, consistent with participants' opinions, subjected to multiple step revisions. Following the validation process, which included two semistructure interviews with different participants and then a pilot test with a third cohort, a full track overview of changes and rewording made in all steps of the validation process was presented. The final questionnaire then comprised 13 questions assessing foods' significance for bowel function, emotions, social impact and 90 specific food items' possible effects and effect sizes on bowel function.ConclusionsThe Diet and Bowel Function questionnaire, enabling answering by children, was developed and the content validated qualitatively. This report presents insights into the whole validation process, declaring reasons for the selected question- and answering options, and their wordings. The Diet and Bowel Function questionnaire can be used as a survey questionnaire to enhance understanding of dietary effects on bowel function in children, and its results can be supportive in improving dietary-treatment programs.

AIM: Identify and describe areas of concern focusing on day-to-day variations during the first month after surgery for patients recovering from colorectal cancer surgery.

DESIGN: A multi-method design was applied using diaries and interviews.

METHOD: Data was collected using semi-structured diaries kept 1 month after surgery by seven patients recovering from colorectal cancer surgery. Also, face-to-face interviews were conducted 1 month after surgery. Data from the diaries constituted a framework for the following directed content analysis of interviews.

FINDINGS: Low levels of pain were experienced but caused reduced mobility and tiredness. Practical matters in daily living were restricted, while social life could be hampered by a frequent need to defecate. Appetite and consequently the ability to eat and drink was the most prominent concern, due to changes in taste and ability to tolerate food. Worries were mainly related to changes in bowel movements. No Patient or Public Contribution.

Background: Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication.

Aim: to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication.

Methods: A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life.

Results: In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy.

Conclusion: Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness perception, and self-efficacy over time. For example, more tailored information regarding secondary prevention could be provided to strengthen self-management to further improve quality of life in patients with intermittent claudication.

Introduction: Social determinants of health impact health, and migrants are exposed to an inequitable distribution of resources that may impact their health negatively, leading to health inequality and social injustice. Migrant women are difficult to engage in health-promotional activities because of language barriers, socioeconomic circumstances, and other social determinants. Based on the framework of Paulo Freire, a community health promotion program was established in a community-academic partnership with a community-based participatory research approach.

Aim: The aim of this study was to describe how a collaborative women's health initiative contributed to migrant women's engagement in health promotion activities.

Materials and methods: This study was part of a larger program, carried out in a disadvantaged city area in Sweden. It had a qualitative design with a participatory approach, following up on actions taken to promote health. Health-promotional activities were developed in collaboration with a women's health group, facilitated by a lay health promoter. The study population was formed by 17 mainly Middle Eastern migrant women. Data was collected using the story-dialog method and the material was analyzed using thematic analysis.

Result: Three important contributors to engagement in health promotion were identified at an early stage of the analysis process, namely, the group forming a social network, the local facilitator from the community, and the use of social places close to home. Later in the analysis process, a connection was made between these contributors and the rationale behind their importance, that is, how they motivated and supported the women and how the dialog was conducted. This therefore became the designated themes and were connected to all contributors, forming three main themes and nine sub-themes.

Conclusion: The key implication was that the women made use of their health knowledge and put it into practice. Thus, a progression from functional health literacy to a level of critical health literacy may be said to have occurred.