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  • 1.
    Annersten Gershater, Magdalena
    et al.
    Malmö universitet, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Apelqvist, Jan
    Skånes universitetssjukhus .
    Alm-Roijer, Carin
    Malmö universitet, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Re-ulceration is common in persons with diabetes and healed foot ulcer after participant-driven education in group: A randomized controlled trial.2022Ingår i: Advances in wound care, ISSN 2162-1918, Vol. 12, nr 3, s. 117-126Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To compare the number of ulcer-free days during 24 months in persons with diabetes and a healed foot ulcer below the ankle provided with adjusted therapeutic shoes who were given standard information and participated in participant-driven group education compared with standard information alone.

    METHOD: A randomized controlled trial was designed to evaluate the number of ulcer-free days after participant-driven group education in addition to standard information compared to standard information alone. The number needed to treat (N=174) was not met, as only n=138 persons with diabetes and previously healed foot ulcer were recruited (age median 63 years [34-79], 101 male/37 female).

    RESULT: 138 persons were recruited, of whom 107 (77.5%) completed the study, 7 (5%) dropped out, and 12 (9%) became deceased. No statistically significant difference was found between the intervention group compared to the control group after 6, 18, or 24 months. After 12 months, more patients in the intervention group had developed ulcers. Seventy-seven participants (56%) developed new foot ulcers, irrespective of side and site. Development of one ulcer appeared in 36 participants, two ulcers in 19, and 22 participants developed three ulcers. Forty-eight participants remained ulcer-free (35%) during the 24-month follow-up. Median ulcer-free days until first ulceration were 368 (4-720); until second ulceration, 404 (206-631); and until third ulceration, 660 (505-701). The participants wore prescribed therapeutic shoes during 88% of the follow-up visits.

    CONCLUSION: One third of the participants remained ulcer free for 24 months. Patient-driven education in groups did not give better results than standard information in this underpowered study. The present study illustrates the challenges to perform comparative preventive studies in this group of patients with extensive comorbidity. Further studies are needed to evaluate interventions on ulceration in persons with a healed foot ulcer.

  • 2.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Fakulteten för hälsa och samhälle (HS).
    Pilhammar, Ewa
    Alm-Roijer, Carin
    Malmö högskola, Fakulteten för hälsa och samhälle (HS).
    Documentation of diabetes care in home nursing service in a Swedish municipality: a cross-sectional study on nurses’ documentation2011Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, nr 2, s. 220-226Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To assess what was documented by Registered Nurses regarding diabetes care in a Swedish municipality's home nursing service; to what extent diabetes-related nursing actions were planned for, performed and evaluated according to the goals of metabolic control, treatment and prevention of complications. Design: Cross-sectional study. Subjects: Registered Nurses' documentation of patients with diabetes mellitus (n = 172). Main outcome measurers: Number of recorded different nursing actions planned, performed and evaluated. Result: The overall standard of records was insufficient. Evaluation of blood glucose levels and metabolic control was documented in 61% of the records; weight was documented in 4% of the records. Blood pressure was recorded in 10%. Ongoing foot ulcers were documented in 21%. Patient education or actions to prevent foot ulcers was not recorded. Tablet and insulin administration were well recorded. The nursing process was not followed. Study limitation: Updated medicine lists were missing in many files, this might have resulted in an underestimation of the number of included records. Conclusion: The Registered Nurses are responsible for a vulnerable patient group suffering from multi-organ disease unable to maintain their own diabetes self-care. Insufficient documentation may lead to impaired quality of care. We suggest that improved documentation routines include a structure of planning, performing and evaluation of metabolic control (blood glucose measurements, Hba1c, weight and nutrition status), complications (regular blood pressure measurements, protective foot care) and education of health care assistants in assisted diabetes self-care.

  • 3.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Fakulteten för hälsa och samhälle (HS).
    Pilhammar, Ewa
    Apelqvist, Jan
    Alm-Roijer, Carin
    Malmö högskola, Fakulteten för hälsa och samhälle (HS).
    Patient education for the prevention of diabetic foot ulcers. Interim analysis of a randomised controlled trial due to morbidity and mortality of participants2011Ingår i: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 8, nr 3, s. 102-107bArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study was designed to explore whether participant-driven patient education in group sessions, compared to provision of standard information, will contribute to a statistically significant reduction in new ulceration during 24 months in patients with diabetes and high risk of ulceration. This is an interim analysis after six months. A randomised controlled study was designed in accordance with CONSORT criteria. Inclusion criteria were: age 35–79 years old, diabetes mellitus, sensory neuropathy, and healed foot ulcer below the ankle; 657 patients (both male and female) were consecutively screened. A total of 131 patients (35 women) were included in the study. Interim analysis of 98 patients after six months was done due to concerns about the patients’ ability to fulfil the study per protocol. After a six-month follow up, 42% had developed a new foot ulcer and there was no statistical difference between the two groups. The number of patients was too small to draw any statistical conclusion regarding the effect of the intervention. At six months, five patients had died, and 21 had declined further participation or were lost to follow up. The main reasons for ulcer development were plantar stress ulcer and external trauma. It was concluded that patients with diabetes and a healed foot ulcer develop foot ulcers in spite of participant-driven group education as this high risk patient group has external risk factors that are beyond this form of education. The educational method should be evaluated in patients with lower risk of ulceration. Eur Diabetes Nursing 2011; 8(3): 102–107

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  • 4.
    Hylén, Mia
    et al.
    Malmö universitet, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Akerman, Eva
    Idvall, Ewa
    Malmö universitet, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Alm-Roijer, Carin
    Malmö universitet, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Patients´ experiences of pain in the intensive care - The delicate balance of control.2020Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 76, nr 10, s. 2660-2669Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To explore the patients´ experiences of pain when being cared for in the intensive care.

    DESIGN: An exploratory, qualitative design was chosen.

    METHOD: Interviews were performed with patients (October 2015-March 2017) within a week of post-intensive care (N = 16). Thematic analysis was used as method for analysis.

    RESULTS: The findings generated two themes - a lack of control and to struggle for control. Pain was described as overwhelming, both in body and mind and generating the experience of a lack of control, with feelings of incapacitation, isolation, and having their needs unmet. Feeling in control of the pain and thus in control of the situation was experienced as a constant struggle. Well-planned care, finding ways to handle the pain and good communication were all helpful in this struggle.

    CONCLUSION: The participants recalled their experience of pain in the ICU and control seems to be crucial for how pain is experienced. They experienced a lack of control due to not only the pain but also the treatment, which can be avoided by the nurse continuously evaluating and individualising the care. Balanced care, meeting the patients' needs and good communication helps the patient feel more in control when experiencing pain.

    IMPACT: The experience of pain is dependent on control for the intensive care patient. The nurse may help them gain control and thereby handle the experience of pain through including the patient, striving for better communication and implementing individualised care that continuously assesses and treats pain.

  • 5.
    Hylén, Mia
    et al.
    Malmö universitet, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Alm-Roijer, Carin
    Malmö universitet, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Idvall, Ewa
    Malmö universitet, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Åkerman, Eva
    To assess patients pain in intensive care: developing and testing the Swedish version of the Behavioural Pain Scale2019Ingår i: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 52, s. 28-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The Behavioural Pain Scale has previously been translated into Swedish and psychometrically tested. One of the domains- 'compliance with ventilation'- did not show equally as good psychometric proprieties as the other domains, which led to the question whether a development of that domain would be beneficial. This study aimed to develop the domain of 'breathing pattern' in the Swedish version of the Behavioural Pain Scale and then test the instrument for discriminant validity, inter-rater reliability and criterion validity. Method: The domain 'breathing pattern' was developed and included when the Swedish version of the Behavioural Pain Scale was psychometrically tested in 360 paired assessments. Results: The instrument showed discriminant validity through a significant positive change on the scale before and during turning and inter-rater reliability with an absence of significant disagreement on the scale between the paired assessments. The developed domain had a better result in discriminant validity than the original domain. The instrument also showed higher sensitivity in discriminating pain compared to assessment without an instrument. Conclusion: The Swedish version of the Behavioural Pain Scale, with a developed domain for 'breathing pattern' showed to be a reliable instrument for pain assessment in the adult intensive-care patient. (C) 2019 Elsevier Ltd. All rights reserved.

  • 6.
    Hylén, Mia
    et al.
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Åkerman, Eva
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Alm-Roijer, Carin
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Idvall, Ewa
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Behavioral Pain Scale - translation, reliability, and validity in a Swedish context2016Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, nr 6, s. 821-828Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Assessing pain in the intensive care unit (ICU) is challenging. Due to intubation and sedation, communication can be limited. International guidelines recommend assessing pain with instruments based on behavioral parameters when critically ill patients are unable to self-report their pain level. One of the recommended instruments, the Behavioral Pain Scale (BPS), has shown good validity and reliability in international studies. The aim of this study was to translate and adapt the BPS for critically ill intubated and non-intubated patients in a Swedish ICU context and to assess inter-rater reliability and discriminant validity. Methods: The BPS (both for intubated and non-intubated patients) was translated and adapted into Swedish using a translation method consisting of ten steps. The Swedish version was then tested for inter-rater reliability and discriminant validity on 20 critically ill patients (10 intubated and 10 non-intubated) before and directly after a potentially painful procedure (repositioning Results: The Swedish version of the BPS showed inter-rater reliability with a percentage agreement of 85% when tested on a sample of critically ill patients. The instrument also showed discriminant validity between assessments at rest and after repositioning Conclusion: Results of the Swedish version of the BPS support its use in critically ill patients who cannot self-report their pain level. Still, additional studies are needed to further explore its reliability and validity in the Swedish ICU context

  • 7. Nilsson, Ulrica G.
    et al.
    Ivarsson, Bodil
    Alm-Roijer, Carin
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Svedberg, Petra
    the SAMMI-study group,
    The desire for involvement in healthcare, anxiety and coping in patients and their partners after a myocardial infarction2013Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, nr 5, s. 461-467Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a lack of data about the information preferences of patients and their partners after a myocardial infarction. Aim: This paper explores anxiety, depression, coping and the desire to be actively involved in care in relation to age, gender and education level in myocardial infarction patients and partners. Methods: One hundred and twenty-eight patients and their partners answered the Swedish version of the Krantz Health Opinion Survey, the Hospital Anxiety and Depression Scale, and the Mastery Scale one year after the patient’s myocardial infarction. Results: More active roles in decision-making during care were desired by females, younger patients and partners, and patients and partners with higher education levels. Female partners reported more anxiety than male partners, and female patients reported more depression than male patients. No differences between groups were detected in coping; overall coping was rated high. Conclusions: Secondary prevention should consist of person-centred support to both the patients and their partners, since factors such as age, gender and education level can influence information preferences during patient care.

  • 8. Nilsson, Ulrica
    et al.
    Svedberg, Petra
    Fridlund, Bengt
    Alm-Roijer, Carin
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Thylén, Ingela
    SAMMI-study group,
    Sex knoxledge i males and females recovering from a myocardial infarction: a brief communication2012Ingår i: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 21, nr 4, s. 486-494Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this article was to explore sexual knowledge in persons who had suffered from myocardial infarction (MI). Seventy-six Swedish persons completed the "Sex after MI Knowledge Test" questionnaire. Overall, 53% of the men and 45% of the women scored maximum in the test. In a comparison between sexes, the men scored significantly more often a correct answer compared to the women for two out of the 25 items. The levels of correct answers were less then 50% for 14 out of the 25 items in both sexes. In conclusion we found that people who had suffered MI had poor levels of knowledge about sex and that there were some differences concerning lesser knowledge among the females in comparison to males. In regard to application, using a validated instrument facilitates an interactive communication between the patient and health care professionals, and opens up for a tailored education in line with the patient's and his or her partner's needs.

  • 9. Svedberg, Petra
    et al.
    Ivarsson, Bodil
    Nilsson, Ulrica
    Roxberg, Åsa
    Baigi, Amir
    Brunt, David
    Brännström, Margareta
    Fridlund, Bengt
    Persson, Sylvi
    Rask, Mikael
    Alm-Roijer, Carin
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Psychometric evaluation of Swedish version of Krantz health opinion survey2012Ingår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 2, nr 3, s. 181-187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to evaluate the psy- chometric properties of a Swedish version of The Krantz Health Opinion Survey (KHOS). A conven- ience sample of 79 persons (47 men and 32 women) was recruited from The Heart and Lung Patients’ National Association at ten local meeting places in different areas in Sweden. The questionnaire was examined for face and content validity, internal con-sistency and test-retest reliability. The findings showed that the Swedish version of KHOS is accept- able in terms of face and content validity, internal consistency and test-retest reliability over time among 79 individuals >65 years of age and with a cardiac disease. In conclusion, wider evaluations of the psy- chometric use of KHOS for other populations and settings are recommended.

  • 10. Svedberg, Petra
    et al.
    Johansson, Ingela
    Persson, Sylvie
    Roxberg, Åsa
    Fridlund, Bengt
    Alm-Roijer, Carin
    Malmö högskola, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).
    Malm, Dan
    Rask, Mikael
    Nilsson, Ulrica
    Psychometric evaluation of The 25-item Sex after MI Knowledge Test in a Swedish context2012Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, nr 1, s. 203-208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The patients’ sexual life after a myocardial infarction is important for his/her quality of life. In spite of this, many patients are in doubt regarding their sex life after a myocardial infarction (MI) and the sexual information received, and counselling from health care providers has been seen to be insufficient. The purpose of this study was to evaluate the psychometric properties of ‘The 25-item Sex after MI Knowledge Test’ in a Swedish context. A convenience sample was recruited. The scale was translated into Swedish and completed by 79 former patients from The Heart and Lung Patients’ National Association on two occasions, with an interval of 2 weeks. The scale was tested for face and content validity, internal consistency and test–retest reliability. The result in this study indicates that the instrument has good face and content validity and displayed a moderate internal consistency (alpha 0.61). The instrument showed some level of instability in test–retest reliability with 60% of the items presenting moderate or strong agreement between the test and retest. Further studies that use this instrument in larger and more diverse samples are thus needed.

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