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  • 1.
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Good care is necessary for patients with a healed diabetic foot ulcer to avoid new ulceration2024In: Leczenie Ran, ISSN 1733-4101, Vol. 21, no 1, p. 1-2Article in journal (Other academic)
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  • 2.
    Annersten Gershater, Magdalena
    Malmö högskola, Faculty of Health and Society (HS).
    Prevention of foot ulcers in patients with diabetes mellitus2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Amputation in patients with diabetes mellitus preceded by a foot ulcer is a serious complication. Patients with the highest risk of developing a foot ulcer are often found in home nursing settings. The overall aim was to focus on how registered nurses are working with prevention of foot ulcers in patients with diabetes mellitus in outpatient settings: - to identify factors related to short term outcome of foot ul-cers in patients treated in a multi-disciplinary system until healing was achieved. - to assess what was documented by registered nurses regarding diabetes care in a Swed-ish municipality’s home nursing service; to what extent nursing actions were planned for, performed and evaluated according to the goals of metabolic control, treatment and prevention of complications.- to explore registered nurses’ professional work with foot ulcer prevention in home nursing settings. - to explore whether participant driven group information has an impact on ulceration in a patient group with previ-ous diabetes foot ulcer. Study I used logistic regression analysis to identify factors related to outcome in a cohort of 2480 consecutive patients with diabetic foot ulcer at a multidisciplinary foot clinic. Results: Healed primarily: 65% (n=1617), 9% (n=250) after minor am-putation, 8% (n=193) after major amputation and 17% (n=420) died unhealed. Primary healing was related to co- morbidity, duration of diabetes, extent of periph-eral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity was related to amputation. In neuro-ischemic/ischemic ul-cers amputation was related to co morbidity, peripheral arterial disease and type of ulcer. Study II was a cross sectional assessment of all nursing records of patients with dia-betes (N=172) in a municipality’s home nursing setting and analyzed with manifest content analysis. Results: The overall standard of nursing records was insufficient. Evaluation of blood glucose was documented in 61% (n=105) of the records, weight was documented in 6% (n=10), blood pressure in 10% (n=17) and ongoing foot ul-cers were documented in 21% (n=36). Study III was a qualitative interview study of 15 registered nurses from four munici-palities, analyzed with manifest content analysis. Results: Registered nurses in home nursing settings worked mainly through health care assistants. The nurses used lead-ership and education as the main tools to enable the nursing process. They mainly relied on experience based competence. Study IV was a randomized controlled trial comparing participant driven education in group with standard information, in patients with diabetes and previous foot ul-cers. An interim analysis was made 6 months after intervention of 131 included pa-tients. Results: After 6 months follow up, 58% (n=57) of the 98 evaluated patients had not developed a new foot ulcer. There was no statistical difference between the two interventions. The most common reasons for ulceration were plantar stress ulcer and minor external trauma. Five patients had deceased and 10 had withdrawn con-sent to participate. Conclusion: Patients with diabetes and high risk of developing foot ulcer constitute a fragile group that needs special foot protective attention. This requires a well edu-cated staff in the home nursing organization. In the future patient education should target low risk patients.

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  • 3.
    Annersten Gershater, Magdalena
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    The use of clinical guidelines during the treatment of diabetic foot ulcers in four Nordic countries2016In: EWMA Journal, ISSN 1609-2759, Vol. 16, no 2, p. 23-26Article in journal (Refereed)
    Abstract [en]

    Since 2003 clinical guidelines disseminated aimed at the reduction of the rates of amputation and ulceration of the diabetic foot. A guideline has no value until after it has been implemented. This study aimed to explore this implementation in four Nordic countries.

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  • 4.
    Annersten Gershater, Magdalena
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Apelqvist, Jan
    Skåne University Hospital.
    Elderly individuals with diabetes and foot ulcer have a probability for healing despite extensive comorbidity and dependency2021In: Expert review of pharmacoeconomics & outcomes research, ISSN 1473-7167, E-ISSN 1744-8379, Vol. 21, no 2, p. 277-284Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Limited scientific evidence for prevention and treatment of diabetic foot ulcers in elderly with comorbidities.

    AIM: To explore patient-related factors and outcomes in patients ≥75 years with diabetes and a foot ulcer.

    METHOD: Sub-analysis of consecutively presenting patients ≥75 years (N = 1008) from a previous study on 2,480 patients with diabetic foot ulcer treated in a multidisciplinary system until healing. Patient characteristics: age - 81(75-96); diabetes type 2-98.7%; male/female - 49/51%; living with a spouse - 47%; nursing home 16%; or with home nursing 64%.

    RESULT: Primary healing was achieved in 54%, minor amputation 8%, major amputation 9%, auto-amputation 2%, and 26% of the patients died unhealed. Among the oldest (88-96 years), 31% healed without any amputation. Extensive comorbidities were frequent: neuropathy 93%, visual impairment 73%, cardiovascular disease 60%, cerebrovascular disease 34%, and severe peripheral disease in 29% of the patients. Out of patients (80%) living in institutions or dependent on home nursing, 56% healed without amputation, compared to 44% of patients living in their own home without any support from social services or home nursing.

    CONCLUSION: Healing without major amputation was achieved in 84% of surviving patients ≥75 years, despite extensive comorbidity and dependency.

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  • 5.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Apelqvist, Jan
    Prévention des ulcères du pied diabétique [Prevention of diabetic foot ulcers]2009In: Journal des Plaies et Cicatrisations, ISSN 1268-8924, Vol. XIV, no 71, p. 37-40Article in journal (Other academic)
    Abstract [en]

    ARTICLE IN FRENCH. Foot problems in people with diabetes are common,expensive and life-threatening. Eightyfive per cent of all amputations in diabetic patients are preceded by an ulcer, deteriorated to a severe infection or gangrene. The complexity of diabetes foot ulcers necesitates an intrinsic knowledge of underlying pathophysiology and a multi-factorial approach to achieve an effective strategy with regard to prevention and treatment. The most important factors related to development of foot ulcers are peripheral neuropathy, minor foot trauma, foot deformity and decreased tissue perfusion. The International Working Group for the Diabetic Foot Consensus Group has suggested a simple risk classification with regard to prevention of diabetes related amputations and foot ulcers. Identification of the high risk patient can only be detected from a history and clinical examination of the feet, as many foot ulcers in diabetes can potentially be prevented by regular foot inspections, access to foot care for non ulcer pathology and use of adequate foot wear. The feet of diabetic patients should be inspected at every visit to primary health care and specialist care providers and also at every visit from home care service. Assessment of the feet, education to the patient to eprform daily inspections, washing the feet daily, use of foot cream, and use of appropriate shoes requires a multidisciplinary approach including appropriate education of involved health care professionals and patients.

  • 6.
    Annersten Gershater, Magdalena
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Apelqvist, Jan
    Skånes universitetssjukhus .
    Alm-Roijer, Carin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Re-ulceration is common in persons with diabetes and healed foot ulcer after participant-driven education in group: A randomized controlled trial.2022In: Advances in wound care, ISSN 2162-1918, Vol. 12, no 3, p. 117-126Article in journal (Refereed)
    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.

  • 7.
    Annersten Gershater, Magdalena
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Brenner, Josefin
    Department of Health and Social Care, Home Care Kungsparken, Malmö Municipality, Västra Kanalgatan 4, Malmö 211 41, Sweden.
    Nordberg, Malin
    Department of Health and Social Care, Malmö Municipality, Villa Vikhem, Vikhems bygata 100, Staffanstorp 245 46, Sweden.
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Nurse assistants' perception of caring for older persons who are dying in their own home: An interview study.2024In: BMC Palliative Care, E-ISSN 1472-684X, Vol. 23, no 1, article id 70Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As the proportion of older persons in society increases, there is a growing trend towards providing end-of-life care in their homes. Palliative care is a complex and knowledge-demanding form of care, and nurse assistants are those who work closest to the older person at the end-of-life in their own homes. However, nurse assistants sometimes have low educational and insufficient levels of knowledge in palliative care, which can affect the quality of care they provide. Moreover, nurse assistants' experiences are relatively unexplored in this context. The purpose of the study was to illuminate nurse assistants' experiences in caring for dying older persons at home.

    METHOD: An empirical, qualitative interview study was conducted with 14 nurse assistants with experience of palliative care in homecare. The material was analyzed using thematic content analysis.

    RESULTS: From the nurse assistant's experiences, one main theme emerged: doing everything possible for the dying older person despite challenges. Moreover, three sub-themes emerged: making a difference at a crucial time, death awakens emotions, and balancing personal and professional relationships. The nurse assistants' saw their role primarily as relieving symptoms but also focusing on next of kin. The following are described as essential parts of their role: carrying out practical nursing tasks, focusing on the physical environment, working alone and seeking help from colleagues due to a physical distance to the other members of the multidisciplinary team. The nurse assistants experienced a lack of support as there was no structured guidance or debriefing available in difficult emotional situations. Furthermore, they disclosed that they were left alone to deal with their feelings.

    CONCLUSION: This study demonstrates that nurse assistants strive to provide comprehensive care for dying older persons despite facing obstacles from their working conditions and work organization. They lack supervision and education in palliative care, but they rely on their experience-based knowledge to a large extent and provide care according to the four cornerstones of palliative care.

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  • 8.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Forbes, Angus
    Are we failing vulnerable older people with diabetes in care homes?2013In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 10, no 1, p. 5-5Article in journal (Other (popular science, discussion, etc.))
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  • 9.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Forbes, Angus
    Identity and relationships are central to the construction of patient centred care2013In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 10, no 3, p. 78-78Article in journal (Other (popular science, discussion, etc.))
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  • 10.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Forbes, Angus
    Life in transition: recognising critical phases in the diabetes life course which need diabetes specialist nurse support2014In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 11, no 2, p. 37-37Article in journal (Other academic)
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  • 11.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Forbes, Angus
    Sharing innovations to maximise patient benefit2012In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 9, no 3, p. 69-69Article in journal (Other (popular science, discussion, etc.))
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  • 12.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Forbes, Angus
    The need to grow our own: research is a priority for diabetes nursing2013In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 10, no 2, p. 45-45Article in journal (Other (popular science, discussion, etc.))
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  • 13.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Frid, Anders
    Apelqvist, Jan
    Treatment satisfaction with insulin glargine in patients with diabetes mellitus in a university hospital clinic in Sweden2009In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 6, no 1, p. 17-22Article in journal (Refereed)
    Abstract [en]

    Background: Few studies evaluate patients' perspectives when a new drug is introduced to treat chronic diseases such as diabetes mellitus. The clinical role of a new insulin treatment, in terms of the relationship between higher cost and better treatment outcomes (as defined from the patient perspective) has been discussed. We sought to explore patient satisfaction with a new insulin treatment (insulin glargine). At its launch in 2002/3 it was purported to provide constant, peakless insulin release following once- or twice-daily administration, thus leading to fewer hypoglycaemic episodes while providing metabolic control equivalent to that achieved with NPH human basal insulin. Aims: To investigate the indications used for prescription of a new drug and its clinical effects on glycosylated haemoglobin (HbA1c) levels, perceived hypoglycaemic events and patient satisfaction. Methods: The Diabetes Treatment Satisfaction Questionnaire (Status Version, DTSQ-s), which measures satisfaction with treatment regimen, and perceived frequency of hyperglycaemia and hypoglycemia, was circulated to all living patients who had ever started treatment with insulin glargine at the Department of Endocrinology at Malmö University Hospital. Medical records of 913 patients were assessed for HbA1c levels at 0 and 12 months after starting insulin glargine therapy. Results: Completed questionnaires were returned by 615 of 960 patients (64%) who had ever started insulin glargine. The main indications for starting treatment were physicians' or nurses' initiatives, desire for fewer fluctuations and improved metabolic control. HbA1c levels fell by 0.41% for patients with type 1 diabetes and by 0.68% for those with type 2 diabetes. The mean DTSQ-s score was 28.45 for satisfaction, whereas the mean perceived hypoglycaemic/hyperglycaemic events score was 3. Conclusion: Treatment satisfaction was very high and perceived frequency of hypoglycaemia/hyperglycaemia was very low. The indications for treatment of insulin glargine are being followed in accordance with national recommendations..

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  • 14.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Löndahl, Magnus
    Nyberg, Per
    Larsson, Jan
    Thörne, Johan
    Eneroth, Magnus
    Apelqvist, Jan
    Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study2009In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 52, no 3, p. 398-407Article in journal (Refereed)
    Abstract [en]

    AIMS/HYPOTHESIS: We sought to identify factors related to short-term outcome of foot ulcers in patients with diabetes treated in a multidisciplinary system until healing was achieved. METHODS: Consecutively presenting patients with diabetes and worst foot ulcer (Wagner grade 1-5, below ankle) (n = 2,511) were prospectively followed and treated according to a standardised protocol until healing was achieved or until death. The number of patients lost to dropout was 31. The characteristics of the remaining 2,480 patients were: 1,465 men, age 68 +/- 15 years (range 18-96), type 1 diabetes 18%, type 2 diabetes 82% and insulin-treated 62%. RESULTS: The healing rate without major amputation in surviving patients was 90.6% (n = 1,867). Sixty-five per cent (n = 1,617) were healed primarily, 9% (n = 250) after minor amputation and 8% after major amputation; 17% (n = 420) died unhealed. Out of 2,060 surviving patients, 1,007 were neuroischaemic (48.8%). In a multiple regression analysis, primary healing was related to co-morbidity, duration of diabetes, extent of peripheral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity were related to amputation. Amputation in neuroischaemic ulcers was related to co-morbidity, peripheral vascular disease and type of ulcer. Age, sex, duration of diabetes, neuropathy, deformity and duration of ulcer or site of ulcer did not have an evident influence on probability of amputation. CONCLUSIONS/INTERPRETATION: Patients with diabetic foot ulcer suffer from multi-organ disease. Factors related to outcome are correspondingly complex.

  • 15.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Pilhammar, Ewa
    Alm Roijer, Carin
    Prevention of foot ulcers in patients with diabetes in home nursing: a qualitative interview study2013In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 10, no 2, p. 52-57Article in journal (Refereed)
    Abstract [en]

    Summary Diabetes mellitus and foot ulcer increase the risk of amputation, and prevention of foot ulcers are therefore important. Patients with diabetes and other concomitant diseases are often cared for in a home nursing service and the registered nurses (RNs) have the opportunity to practise preventive care to avoid foot ulcers. How prevention of foot ulcer is performed in home nursing settings has not been previously described. The objective of this study was to explore RNs’ professional work with foot ulcer prevention in home nursing settings for patients with diabetes mellitus. Qualitative interviews were analysed, using manifest content analysis. The setting was four municipalities in Sweden (large and small cities, and rural areas). Fifteen RNs actively working in a home nursing service with more than two years’ experience were recruited. The participants were all women, had worked as RNs for 3–41 years (median 25), and in home nursing for 2–18 years (median 8). The results showed that the RNs work through leadership, coordination, education and evaluation. Health care assistants perform most of the nursing actions to prevent foot ulcers such as assessment of feet, off-loading, nutrition and hygiene. The RNs have medical and nursing responsibility but without the formal tools to execute this fully. The RNs’ formal education was some years back and they relied mostly on experience-based knowledge. It was concluded that patient assessment and nursing actions to prevent foot ulcers are mostly performed by health care assistants. The RNs need to be given formal responsibility in their role as leaders and educators, and need more education in pedagogy and leadership. Eur Diabetes Nursing 2013; 10(2): 52–57 Key words diabetes; diabetic foot ulcer; education; elderly; foot care; foot health; nursing; home care; pressure ulcer; prevention

  • 16.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Pilhammar, Ewa
    Alm-Roijer, Carin
    Malmö högskola, Faculty of Health and Society (HS).
    Documentation of diabetes care in home nursing service in a Swedish municipality: a cross-sectional study on nurses’ documentation2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 220-226Article in journal (Refereed)
    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.

  • 17.
    Annersten Gershater, Magdalena
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Pilhammar, Ewa
    Apelqvist, Jan
    Alm-Roijer, Carin
    Malmö högskola, Faculty of Health and Society (HS).
    Patient education for the prevention of diabetic foot ulcers. Interim analysis of a randomised controlled trial due to morbidity and mortality of participants2011In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 8, no 3, p. 102-107bArticle in journal (Refereed)
    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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  • 18.
    Annersten Gershater, Magdalena
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Holmberg, C. Nagorny
    Novo Nordisk Scandinavia AB, Malmö, Sweden..
    Grahn, M.
    Malmö City, Malmö.
    Andersson, M.
    Hlth & Med Care Management, Grp Off, Reg Skane, Malmö, Sweden..
    Diabetes prevalence is rising among young residents in Malmö, Sweden2021In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 64, no SUPPL 1, p. 161-161Article in journal (Other academic)
  • 19.
    Annersten Gershater, Magdalena
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Elgzyri, Targ
    Endocrinology Department Skåne University Hospital Malmö Sweden.
    Changes in daily nursing needs and self‐care capability of people with diabetes after in‐hospital treatment for foot complications: A descriptive study2024In: Nursing Open, E-ISSN 2054-1058, Vol. 11, no 5Article in journal (Refereed)
    Abstract [en]

    Aim: A limited number of studies discuss the changes in patients' self-care skills and needs for assisted self-care after discharge from in-patient treatment due to diabetes foot ulcer-related complications. The aim of this study was to examine the ability to perform self-care and needs for assisted nursing interventions at hospital discharge, compared to pre-admission, for people with diabetes admitted and treated for foot ulcer-related complications.

    Design: Retrospective patient record study.

    Methods: A retrospective assessment was done on the medical records of a total of 134 patients with diabetes consecutively admitted to a specialist in-patient unit due to foot ulcer complications, between 1 November 2017 and 30 August 2018. Data on daily self-care needs and home situations at admission and discharge were recorded.

    Results: The median age was 72 years (38-94), 103 (76.9%) were men and 101 (73.7%) had diabetes type 2. The median length of admission was 10 days (2-39). Infection was the most common cause of admission (51%), with severe ischaemia in 6%, and a combination of both in 20% of patients. Surgical treatment was performed in 22% and vascular intervention in 19% of patients. The percentage of patients discharged to their home without assistance was 48.1% compared to 57.5% before admission, discharge to home with assistance was 27.4% versus 22.4% before admission and 9.2% were discharged to short-term nursing accommodation versus 6% before admission. Three patients died during their stay in hospital. The need for help with medications increased from 14.9% of patients at admission to 26.7% at discharge and for mobility assistance from 23.1% to 35.9%. Social services at home were increased in 21.4% of patients at discharge.

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  • 20.
    Annersten, Magdalena
    et al.
    University Hospital of Lund.
    Frid, Anders
    University Hospital of Lund.
    Insulin pens dribble from the tip of the needle after injection2000In: Practical Diabetes International, ISSN 1357-8170, E-ISSN 1528-252X, Vol. 17, no 4, p. 109-111Article in journal (Refereed)
    Abstract [en]

    Aim. To study different insulin pens regarding leakage from the tip of the needle after injection. Patients and method. Six pens were tested; Saline Pen 3.0 ml (Lilly), B-D Pen 3.0 ml, NovoLet 1.5 and 3.0 ml, NovoPen 1.5 and 3.0 ml. Twenty volunteers were injected with sterile saline and the needle was withdrawn after 1, 3, 5, or 7 s respectively. Any dribble was collected on a filter paper and weighed. The procedure was videotaped. Results. There was a minimum of dribbling from the 1.5 ml pens. Eight out of 20 NovoPen 3.0 ml and B-D Pen 3.0 ml, 16 out of 20 NovoLet 3.0 ml, and 19 out of 20 Saline Pen (Lilly) dribbled after a 7 s hold-in time. The 8 B-D Pen 3.0 ml had leaked 4.0 mg (2.4±18.8), the 8 NovoPen 3.0 ml 4.7 mg (3.8±6.7), the 16 NovoLet 3.0 ml 5.0 mg (3.1±16.6) and the 19 Saline Pen 3.0 ml had leaked 9.2 mg (4.9±19.1). Conclusion. There is a clinically significant leakage of fluid from the needle tip even after 7 s hold-in time. Patients should be taught to hold the needle in for at least 10 s to be assured they get the intended dose.

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  • 21.
    Annersten, Magdalena
    et al.
    Department of Endocrinology, Malmö,University Hospital, Malmö.
    Frid, Anders
    Department of Endocrinology, Malmö,University Hospital, Malmö.
    Dahlberg, Gunnel
    Department of Endocrinology, Malmö,University Hospital, Malmö.
    Högberg, Margareta
    Department of Endocrinology, Malmö,University Hospital, Malmö.
    Apelqvist, Jan
    Department of Endocrinology, Malmö,University Hospital, Malmö.
    Structured diabetes education in Sweden: a national inquiry involving 583 nurses working with diabetes patients in hospitals and primary care facilities.2006In: Practical Diabetes International, ISSN 1357-8170, E-ISSN 1528-252X, Vol. 23, no 3, p. 138-141Article in journal (Refereed)
    Abstract [en]

    The overall goals for the treatment of diabetes are to prevent acute and long-term complications and maintain a good quality of life. The St Vincent Declaration and the Swedish National Guidelines for the Treatment of Diabetes Mellitus describe patient education in self-treatment as a prerequisite for the achievement of these goals. This survey aimed to evaluate the presence of structured patient education (in advance planned education), its organisation, staffing and goals, and the results in out-patient diabetes care in Sweden.A questionnaire consisting of 35 open and closed questions was mailed to 1250 diabetes educated nurses working in hospitals and primary health care in the entire country.Responses were received from 583 (47%) nurses. Structured diabetes patient education was performed by 486 nurses. It was usually organised by nurses and performed in co-operation with doctors (55%), dietitians (38%), chiropodists (36%), and social workers (9%). The sessions took place individually at pre-scheduled visits (80%), or as group education (26%). Fifty-one percent described explicit goals for the education, most commonly: general knowledge about diabetes, improved metabolic control and increased safety. The structured education was evaluated by 51% of which the HbA[1]c level at the next scheduled visit was the most frequently used evaluation method (44%), followed by home monitored blood glucose values (37%) and a structured evaluation form (17%). The goals had been achieved to a great or quite great extent by 67% of the responding nurses.To the extent that structured patient education takes place, nurses are usually responsible for its performance. It takes place individually as well as in groups. Many nurses lack evident goals for the education and sufficient evaluation methods.It was concluded that there is confusion about the content of structured education vs information activity.

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  • 22.
    Annersten, Magdalena
    et al.
    Öresund Diabetes Team AB.
    Wredling, Regina
    Karolinska Institutet; Danderyd University Hospital.
    How to write a research proposal2006In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 3, no 2, p. 102-105Article in journal (Other academic)
    Abstract [en]

    A structured written research proposal is a necessary requirement when making anapplication for research funding or applying to an ethics committee for approval of aresearch project. A proposal is built up in sections of theoretical background; aimand research questions to be answered; a description and justification of the methodchosen to achieve the answer; awareness of the ethical implications of the research;experience and qualifications of the team members to perform the intended study; abudget and a timetable.This paper describes the common steps taken to prepare a writtenproposal as attractively as possible to achieve funding

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  • 23.
    Elgzyri, Targ
    et al.
    Skane Univ Hosp, Dept Endocrinol, Malmo, Sweden..
    Apelqvist, Jan
    Skane Univ Hosp, Dept Endocrinol, Malmo, Sweden..
    Lindholm, Eero
    Skane Univ Hosp, Dept Endocrinol, Malmo, Sweden..
    Örneholm, Hedvig
    Skane Univ Hosp, Dept Orthopaed Surg, Malmo, Sweden..
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene2021In: SAGE Open Medicine, E-ISSN 2050-3121, Vol. 9, article id 20503121211029180Article in journal (Refereed)
    Abstract [en]

    Background: Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods: Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3-234) weeks. Results: Four hundred and seventy-six patients were included. The median age was 73 (35-95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3-234) weeks; for auto-amputated, 48 (10-228) weeks; for minor amputated, 48 (6-234) weeks; and for major amputation, 32 (3-116) weeks. Conclusion: Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.

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  • 24.
    Grill-Wikell, Heidi
    et al.
    Öresund Diabetes Team AB.
    Annersten, Magdalena
    Öresund Diabetes Team AB.
    Frid, Anders
    Clinic of Endocrinology, University Hospital MAS, Malmö, Sweden.
    Pain in connection with capillary blood test at different sites in the palm2005In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 2, no 2, p. 65-68Article in journal (Refereed)
    Abstract [en]

    There are studies suggesting that fear of blood and injury is associated with less frequent self-testing; by reducing pain when measuring blood glucose the number of measurements can probably increase. The aim of this study was to investigate whether or not there were any differences regarding pain at different test sites in the palm. Twenty type 1 diabetes subjects pricked themselves at four different sites in the palm in the non-dominant hand in a randomised order with the Freestyle® punction device loaded with BD Microfine+ lancets. Pain was evaluated by the subjects using the Pain-O-Meter®. The result (n=80) showed no statistically significant difference in pain score between the investigated sites. The level of sensory pain was reported: shooting (n=36), no pain (n=27), searing (n=8), soaring (n=5), pressing (n=2), aching (n=1) and burning (n=1); 86% (n=69) of the pricked sites were experienced as no pain at all. This study shows that pain in connection with capillary blood test is low as measured by the Pain-O-Meter. There are no significant differences in the pain experienced at different sites in the palm. More studies need to be done using different punction devices and more sites need to be investigated

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  • 25.
    Hellstrand Tang, Ulla
    et al.
    Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University Hospital, Gothenburg.
    Scandurra, Isabella
    Centre of Empirical Research in Information Systems, Örebro University, Örebro.
    Sundberg, Leif
    Gothenburg Diabetes Association, Gothenburg.
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zügner, Roland
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University Hospital, Gothenburg.
    Patients’ Expectations of Evidence-Based Service at the Pharmacy Regarding Information on Self-Care of the Feet for Persons with Diabetes at Risk of Developing Foot Ulcers – A Cross-Sectional Observational Study in Sweden2023In: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 17, p. 3557-3576Article in journal (Refereed)
    Abstract [en]

    Purpose: Self-care of the feet is one of the cornerstones in the prevention of diabetic foot ulcers (DFU). Often, individuals with diabetes seek help at the pharmacy, but it is still unclear whether the service meets their expectations and needs. The aims were to explore patients' expectations of support from the pharmacy regarding self-care of their feet and explore how patients with diabetes felt that they managed the self-care of their feet.

    Patients and methods: The included participants (n = 17), aged 70 ± 9 years, answered surveys regarding their expectations of support from the pharmacy related to self-care of the feet and how they felt that they managed the self-care of their feet. By using software, MyFoot Diabetes, they assessed their risk of developing DFU (ranging from 1 = no risk to 4 = DFU). In addition, a healthcare professional assessed the risk grade.

    Results: Sixteen patients had not received any information from the pharmacy regarding how to take care of their feet. Several suggestions for ways the pharmacy could help patients with diabetes to take care of their feet were registered. They included having the necessary skills and competence, giving advice regarding self-care, giving information regarding the products they market and have for sale and giving advice on ointments/creams. The participants gave several examples of how they self-managed their feet: by wearing shoes indoors and outdoors, wearing socks and compression stockings as often as possible, being physically active, inspecting their feet, being aware of the fact that their feet have no problems, washing, moisturising their feet, cutting their nails and finally seeking help to prevent DFU.

    Conclusion: The participants thought that they should receive competent information from the personnel at the pharmacy to improve the self-care of their feet, eg, being given information about which ointments/creams to use.

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  • 26.
    Kumlien, Christine
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Skane Univ Hosp, Dept Cardiothorac & Vasc Surg, Malmo, Sweden..
    Acosta, Stefan
    Skane Univ Hosp, Dept Cardiothorac & Vasc Surg, Malmo, Sweden.;Lund Univ, Dept Clin Sci, Malmo, Sweden..
    Björklund, Sebastian
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University, Biofilms Research Center for Biointerfaces.
    Lavant, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University, Biofilms Research Center for Biointerfaces.
    Lazer, Victoria
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Engblom, Johan
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University, Biofilms Research Center for Biointerfaces.
    Ruzgas, Tautgirdas
    Malmö University, Biofilms Research Center for Biointerfaces. Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Research priorities to prevent and treat diabetic foot ulcers-A digital James Lind Alliance Priority Setting Partnership2022In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 39, no 11, article id e14947Article in journal (Refereed)
    Abstract [en]

    Aim To establish outcomes of a priority setting partnership between participants with diabetes mellitus and clinicians to identify the top 10 research priorities for preventing and treating diabetic foot ulcers (DFUs). Methods Due to the COVID-19 pandemic, the James Lind Alliance Priority Setting Partnership process was adapted into a digital format which involved a pilot survey to identify understandable uncertainties with high relevance for participants tested by calculating the content validity index; a main survey answered by 53 participants living with diabetes and 49 clinicians; and a final digital workshop to process and prioritise the final top 10 research priorities. Results The content validity index was satisfactory for 20 out of 25 uncertainties followed by minor changes and one additional uncertainty. After we processed the 26 uncertainties from the main survey and seven current guidelines, a list of 28 research uncertainties remained for review and discussion in the digital workshop. The final top 10 research priorities included the organisation of diabetes care; screening of diabetes, impaired blood circulation, neuropathy, and skin properties; vascular surgical treatment; importance of self-care; help from significant others; pressure relief; and prevention of infection. Conclusion The top 10 research priorities for preventing and treating DFUs represent consensus areas from persons living with diabetes and clinicians to guide future research. These research priorities can justify and inform strategic allocation of research funding. The digitalisation of James Lind Alliance methodology was feasible.

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  • 27. Mehica, Leila
    et al.
    Annersten Gershater, Magdalena
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Alm Roijer, Carin
    Diabetes and infected foot ulcer: a survey of patients' perceptions of care during the preoperative and postoperative periods2013In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 10, no 3, p. 91-95Article in journal (Refereed)
    Abstract [en]

    Diabetic foot ulcer is a serious threat to the extremities and to the individual's survival. The most common risk factors for amputation are deep infection, plantar ulcer and gangrene. The aim of this study was to measure inpatients' perception of health care quality, and to identify the health care needs of people with diabetes and infected foot ulcers during the preoperative and postoperative periods. The study design was empirical with a quantitative approach. The short form of the Quality of care from the Patient's Perspective (Mini QPP) was used. The results are described in four categories related to the Mini QPP model: medical technology; physical-technical conditions; identity-oriented approach; and socio-cultural atmosphere. The study participants (n=30) expressed a need for continuous information, a secure and comfortable physical environment, shared decision making, and better quality of pain management. More research about how to improve information, the environment, shared decision making, and pain control would be desirable.Eur Diabetes Nursing 2013; 10(3): 91–95

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  • 28.
    Nilsson, Mari-Louise
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bengtsson, Mariette
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Registered Nurses' experiences of caring for persons with dementia expressing their sexuality2022In: Nursing Open, E-ISSN 2054-1058, Vol. 9, no 3, p. 1723-1730Article in journal (Refereed)
    Abstract [en]

    Background: Sexuality is an integral part of human beings and persons living with dementia still perceive negative attitudes from caregivers in this regard. Aim: This study aimed to explore registered nurses' experiences of caring for persons with dementia living in nursing homes and expressing their sexuality. Methods: A qualitative inductive design was adopted; data were collected through semi-structured interviews and analysed through content analysis. Results: The analysis reflected three categories. (1) Dealing with different reactions and responding to nursing staff and relatives: The registered nurses experienced discomfort, insecurity, frustration, distress and embarrassment when confronted with sexual expressions in people with dementia. (2) Caring with a focus on the person: The registered nurses expressed the importance of protecting the integrity of the person and consequently their right to sexual expressions. (3) Needing more competence development: The registered nurses expressed the need to educate and inform not only themselves but also the nursing staff and relatives.

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  • 29.
    Rosvall, Annica
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Cardio-Thoracic and Vascular Surgery, Skåne University Hospital, 205 02 Malmö, Sweden.
    Toth, Ervin
    Lund Univ, Skane Univ Hosp, Dept Gastroenterol, S-20502 Malmo, Sweden..
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Patient-Reported Experience Measures for Colonoscopy: A Systematic Review and Meta-Ethnography2022In: Diagnostics, ISSN 2075-4418, Vol. 12, no 2, article id 242Article, review/survey (Refereed)
    Abstract [en]

    Patient experience is defined as a major quality indicator that should be routinely measured during and after a colonoscopy, according to current ESGE guidelines. There is no standard approach measuring patient experience after the procedure and the comparative performance of the different colonoscopy-specific patient-reported experience measures (PREMs) is unclear. Therefore, the aim was to develop a conceptual model describing how patients experience a colonoscopy, and to compare the model against colonoscopy-specific PREMs. A systematic search for qualitative research published up to December 2021 in PubMed, Cochrane, CINAHL, and PsycINFO was conducted. After screening and quality assessment, data from 13 studies were synthesised using meta-ethnography. Similarities and differences between the model and colonoscopy-specific PREMs were identified. A model consisting of five concepts describes how patients experience undergoing a colonoscopy: health motivation, discomfort, information, a caring relationship, and understanding. These concepts were compared with existing PREMs and the result shows that there is agreement between the model and existing PREMs for colonoscopy in some parts, while partial agreement or no agreement is present in others. These findings suggest that new PREMs for colonoscopy should be developed, since none of the existing colonoscopy-specific PREMs fully cover patients' experiences.

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  • 30.
    Rosvall, Annica
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Toth, Ervin
    Lund Univ, Skane Univ Hosp, Dept Gastroenterol, Lund, Sweden..
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Skane Univ Hosp, Dept Cardiothorac & Vasc Surg, Malmö, Sweden..
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Development and content validity testing of a colonoscopy-specific patient-reported experience measure: the Patient Experience Colonoscopy Scale (PECS)2024In: Journal of Patient-Reported Outcomes, E-ISSN 2509-8020, Vol. 8, no 1, article id 32Article in journal (Refereed)
    Abstract [en]

    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.

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  • 31.
    Rosvall, Annica
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Toth, Ervin
    Skane Univ Hosp, Dept Gastroenterol, Malmo, Sweden..
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Cardio-Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Patients' Experiences Before, During, and After a Colonoscopy Procedure A Qualitative Study2021In: Gastroenterology Nursing, ISSN 1042-895X, E-ISSN 1538-9766, Vol. 44, no 6, p. 392-402Article in journal (Refereed)
    Abstract [en]

    Although colonoscopy is a common examination, there is limited research focusing on how patients experience this procedure. It is important that a colonoscopy is tolerated, as it may lead to lifesaving diagnostics and treatment. This study aims to explore adult patients' experience of undergoing a colonoscopy regarding the time prior to, during, and after the procedure. This was a qualitative study with individual interviews (n = 24) and a purposeful sample that was analyzed using thematic analysis. The analysis revealed four themes. The first, "making up one's mind," describes how the participants gathered information and reflected emotionally about the forthcoming procedure. The hope of clarification motivated them to proceed. In the theme "getting ready," self-care was in focus while the participants struggled to follow the instructions and carry out the burdensome cleansing. The next theme, "going through," illuminates' experiences during the colonoscopy and highlights the importance of feeling involved and respected. The last theme, "finally over," is characterized by experiences of relief, tiredness, and a desire for clarity. The healthcare professionals' ability to meet the participants' needs is vital, given that the experiences are highly individual. These findings contribute to a variegated image of how patients experience the process of undergoing a colonoscopy.

  • 32.
    Rämgård, Margareta
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Grahn, M.
    Municipal Malmo, Unit Stat & Anal, Malmo, Sweden..
    Schölin, T.
    Avdelningen Reg Utveckling, Malmo, Sweden..
    Holmberg, C. Nagorny
    Novo Nordisk Scandinavia AB, Med Affairs, Malmo, Sweden..
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Inequalities in diabetes type 2 prevalence in the multicultural city Malmo, Sweden2021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no S3Article in journal (Other academic)
    Abstract [en]

    Background

    Type-2 diabetes is a progressive disease and very much linked to health equity prerequisites and poverty. Its long-term complications include cardiovascular diseases, blindness, amputation and kidney failure. The aim of the study was to explore diabetes type 2 (T2D) prevalence in Malmö, a socioeconomically diverse and multicultural city with a relatively young population.

    Methods

    The study is a part of the Cities Changing Diabetes project related to the 14 geographical developing areas CTC (Community That Care) in Malmö. The whole city has been divided into 14 areas based on socioeconomical homogeneity as well as shared local area affiliation. Results are obtained from the Patient Administrative System (ICD E11 code) in regional health care as well as from Statistics Sweden.

    Results

    The prevalence of T2D was 4.3% in 2018. It has increased since 2011 mostly noticeable for residents between 18 and 64 years of age. There are considerable differences in T2D prevalence by CTC-areas where the highest observed prevalence rate was 6.4% and the lowest was 2.6%. The areas with the lower prevalence rates have a high level of education as well as high average household income. The opposite is observed in the areas with the highest prevalence rates where the residents have lower educational level as well as low average income. Two of the three CTC-areas with the highest T2D prevalence rates consists of a younger population as compared to the city in general whereas the third consists of the oldest population in the city.

    Conclusions

    The prevalence of T2D has increased during the last decade in Malmö. There are significant differences in T2D prevalence within the city related to contextual and socioeconomic factors. The highest T2D prevalence occurs in the area with the lower income and lower level of education.

    Key messages 

    • Promotive actions need to be specifically targeted at younger populations in the city of Malmö to prevent the increase in type-2 diabetes and its complications.
    • Contextual factors need to be taken into consideration in the development of sustainable primary and secondary preventive actions for type-2 diabetes in community care and the health care system.
  • 33.
    Zdravkovic, Slobodan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Grahn, M.
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Annersten Gershater, Magdalena
    Are recently arrived migrants at higher risk of developing diabetes in Scania, Sweden?2020In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, no s5, article id ckaa166.1107Article in journal (Other academic)
    Abstract [en]

    Background: The world is facing increased migration as well as increased diabetes prevalence including earlier disease debut than ever before. Sedentary lifestyle and obesity constitute risk factors for development of diabetes type 2, the most common diabetes type among adults. It is thus important to increase the awareness of diabetes prevalence and of those being at risk for the disease. The aim was to focus on self-reported diabetes and weight in recently arrived migrants (RAM) in comparison with the rest of the population of Scania.

    Methods: A cross-sectional study was used to collect data through random sampling using a self-administrated questionnaire. 10 000 questionnaires in Arabic were sent to adult RAM in Scania born in Syria or Iraq and 10 000 questionnaires to a random sample of the Scania population as a control group. The overall response rate was 32.8 %, 3461 were male and 3105 were female and the overall mean age was 44.7 (range 22 -70).

    Results: 170 RAM and 147 controls reported diabetes, 741 RAM and 585 controls reported a body mass index (BMI) ≥ 30 kg/m2. A significantly higher prevalence of self-reported diabetes was observed among RAM (6.2% compared to 4.9%, p-value = 0.02). In comparison with age, significantly (p-value < 0.05) higher prevalence was present in RAM as compared to the control group in all age categories except the age category 65-80 where the difference was borderline significant (p-value = 0.056). With regard to BMI no significant difference was observed between the RAM and the control group having diabetes, but independently of diabetes the prevalence of BMI 25-30 kg/m2 and BMI ≥ 30 kg/m2 was significantly higher in RAM (p-value < 0.01).

    Conclusions: Self-reported diabetes is more prevalent in RAM as compared to a control group representing the rest of the population in Scania. Considerably large amount of the respondents in both groups are overweight or obese and are therefore to be considered at risk for developing diabetes type 2.

    Key messages 

    Self-reported diabetes in Scania is more prevalent in RAM from Iraq and Syria than in the rest of the population in Scania.Health care services need to address that a large number of the population in Scania is being overweight or obese, which is even more prominent in RAM from Iraq and Syria.

  • 34.
    Zdravkovic, Slobodan
    et al.
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Jonsson, C.
    Digitalisering IT & MT, VO Data & Analys, Lund, Region Skane, Sweden..
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ericsson, A.
    Novo Nordisk Scandinavia AB, Natl Market Access, Malmo, Sweden..
    Grahn, M.
    Unit Stat & Anal, Malmo, Sweden..
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Dozet, A.
    Dept Hlth Care Governance, Lund, Region Skane, Sweden..
    Health care costs for residents diagnosed with diabetes type 2 in Malmo, Sweden between 2011 and 20182021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no S3Article in journal (Other academic)
    Abstract [en]

    Background

    During the last decade, type 2 diabetes (T2D) prevalence has increased worldwide, especially among children and young adults. Diabetes is a chronic disease that if not diagnosed in time can lead to serious health complications and put pressure on the societal resources. The aim of this study was to evaluate the economic impact of the increased T2D prevalence in Malmö over time on the regional health care organization.

    Methods

    A longitudinal population-based study in Malmö, within the Cities Changing Diabetes project. Data was collected from the Patient Administrative System in Region Skåne, classifying T2D by the ICD E11 code. The health care cost (HCC) has been adjusted by the Consumer Price Index (CPI) to 2020 prices.

    Results

    The prevalence of T2D increased from 2,5% in 2011 to 4,3% in 2018. The increase in T2D prevalence was most noticeable for residents 18 - 64 years. The overall HCC for treating residents with T2D was approximately €47,2 million in 2011 and €90,7 million in 2018. The HCC in 2018 was higher for males than for females (€54,6 million vs €36,2 million). In 2018, the cost was €49,9 million for those 18 - 64 years and €40,5 million for those being 65 years or older. The overall HCC increased during the study period (3,3 times for those 18 - 64 years and 1,4 times for those being 65 years or older). For the age group 18 - 64 the HCC per resident was €5 000 in 2011 and €5 300 in 2018. The HCC per resident for all age groups, has not changed markedly, from €6 200 in 2011 to €6 100 in 2018 as well as the number of health care visits (23 in 2011 and 29 in 2018).

    Conclusions

    The HCC for T2D has increased markedly since 2011. This increase is most noticeable for people under 65 years. The overall HCC for these patients and its change over time puts an increased strain on the health care provider Region Skåne, mainly due to increased prevalence.

    Key messages 

    • The overall HCC during 2011 – 2018 has increased 2 times for residents with T2D and 1.5 times for residents without T2D. This increase is likely to continue if the current trend remains.
    • The main driving force behind the increase in HCC over time is the increase in T2D prevalence and not in HCC per resident.
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