oru.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Publications (10 of 111) Show all publications
Alm, F., Lundeberg, S., Stalfors, J., Nerfeldt, P. & Ericsson, E. (2018). Improving pain management after pediatric tonsil surgery – an ongoing project. In: : . Paper presented at 14th Congress of the European Society of Pediatric Otorhinolaryngology, Stockholm, Sweden, June 2-5, 2018.
Open this publication in new window or tab >>Improving pain management after pediatric tonsil surgery – an ongoing project
Show others...
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

The National Tonsil Surgery Register in Sweden collects perioperative data from health care professionals and patient reported outcome measures 30 days and 6 months after surgery. Since 2009, patient-reported outcome measures, include questions related to pain.

Objective: To illustrate the process of improvements, efforts, and the use of a quality register in pain, and pain management after tonsil surgery in Sweden.

Method: Quantitative and qualitative research.

Results: Registry data indicated unrelieved postoperative pain with a high proportion of health care contacts. This resulted in the implementation of the Swedish National Guidelines (2013), and patient information published on the website www.tonsilloperation.se. The guidelines recommend multimodal pain treatment with paracetamol combined with COX-inhibitors, and if necessary, oral clonidine rather than opioids as rescue analgesics. A national survey (2015) showed that Swedish ENT-professionals’ opinions of, and the ENT-departments adherence to the guidelines were good. According to the national registry data (2017), the implementation has resulted in longer use of post-operative analgesic and fewer contacts with healthcare. Simultaneously, registry data showed that operating methods and techniques, age, and indication for surgery affect the pain outcome. Results from age-oriented pain diaries and qualitative interviews (2017-2018) capture the children’s and caregivers’ perspectives on pain, and pain treatment. Preliminary results show that type of pain treatment affects the quality of the postoperative care and recovery.

Conclusion: Pain management after tonsil surgery has been, and still is, a challenge for ENT-professionals and constant improvements are necessary.

National Category
Medical and Health Sciences Other Medical Sciences not elsewhere specified
Research subject
Anaesthesiology; Oto-Rhino-Laryngology; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-69767 (URN)
Conference
14th Congress of the European Society of Pediatric Otorhinolaryngology, Stockholm, Sweden, June 2-5, 2018
Available from: 2018-10-22 Created: 2018-10-22 Last updated: 2018-10-24Bibliographically approved
Ahlander, B.-M., Engvall, J., Maret, E. & Ericsson, E. (2018). Positive effect on patient experience of video-information given prior to cardiovascular magnetic resonance imaging, a clinical trial. Journal of Clinical Nursing, 27(5-6), 1250-1261
Open this publication in new window or tab >>Positive effect on patient experience of video-information given prior to cardiovascular magnetic resonance imaging, a clinical trial
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. 1250-1261Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on patient anxiety and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy. To evaluate whether additional information has an impact on motion artefacts.

Background: Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases. Although cardiovascular magnetic resonance imaging is considered to be painless, patients may experience anxiety due to the closed environment.

Design: A prospective randomised intervention study, not registered.

Methods: The sample (n = 148) consisted of 97 patients referred for cardiovascular magnetic resonance imaging, randomised to receive either video information in addition to standard text-information (CMR-video/n = 49) or standard text-information alone (CMR-standard/n = 48). A third group undergoing myocardial perfusion scintigraphy (n = 51) was compared with the cardiovascular magnetic resonance imaging-standard group. Anxiety was evaluated before, immediately after the procedure and 1 week later. Five questionnaires were used: Cardiac Anxiety Questionnaire, State-Trait Anxiety Inventory, Hospital Anxiety and Depression scale, MRI Fear Survey Schedule and the MRI-Anxiety Questionnaire. Motion artefacts were evaluated by three observers, blinded to the information given. Data were collected between April 2015–April 2016. The study followed the CONSORT guidelines.

Result: The CMR-video group scored lower (better) than the cardiovascular magnetic resonance imaging-standard group in the factor Relaxation (p =.039) but not in the factor Anxiety. Anxiety levels were lower during scintigraphic examinations compared to the CMR-standard group (p <.001). No difference was found regarding motion artefacts between CMR-video and CMR-standard.

Conclusion: Patient ability to relax during cardiovascular magnetic resonance imaging increased by adding video information prior the exam, which is important in relation to perceived quality in nursing. No effect was seen on motion artefacts.

Relevance to clinical practice: Video information prior to examinations can be an easy and time effective method to help patients cooperate in imaging procedures.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
Keywords
cardiovascular magnetic resonance imaging; myocardial perfusion scintigraphy; nursing; patient experience; patient information; video information
National Category
Radiology, Nuclear Medicine and Medical Imaging Nursing
Research subject
Radiology; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-62679 (URN)10.1111/jocn.14172 (DOI)000428419400085 ()29149455 (PubMedID)2-s2.0-85042274450 (Scopus ID)
Note

Funding Agencies:

Futurum, County Council of Jönköping  

Division of Medical Diagnostics, Region Jönköping county Sweden

Available from: 2017-11-18 Created: 2017-11-18 Last updated: 2018-04-25Bibliographically approved
Nilsson, U., Ericsson, E., Eriksson, M., Idvall, E. & Bramhagen, A.-C. (2018). Psychometric evaluation of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery and postoperative behavior and recovery inchildren undergoing tonsil surgery. Journal of Perioperative Practice
Open this publication in new window or tab >>Psychometric evaluation of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery and postoperative behavior and recovery inchildren undergoing tonsil surgery
Show others...
2018 (English)In: Journal of Perioperative Practice, ISSN 1750-4589Article in journal (Refereed) Epub ahead of print
Abstract [en]

The study comprised a prospective, comparative cross-sectional survey in 143 (of 390) children undergoing tonsil surgery. Parents answered the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS), and children answered the questionnaire Postoperative Recovery in Children (PRiC). The PHBQ-AS had positive correlation with the PRiC and with general health. On day 10 after surgery, up to one-third of the children still reported physical symptoms (PRiC). No gender or age differences concerning the items of behavior (PHBQ-AS) were found. The quality of postoperative recovery (PRiC) in girls was lower, with higher levels of nausea, dizziness, coldness, and headache compared to the boys. Children <6 years of age reported higher levels of dizziness and lower sleep quality and lower general health.

Place, publisher, year, edition, pages
Harrogate : Association for Perioperative Practice, 2018
Keywords
Behavior, Children, Pain, Postoperative recovery, Tonsil surgery
National Category
Medical and Health Sciences Pediatrics
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-67517 (URN)10.1177/1750458918782878 (DOI)29932361 (PubMedID)
Available from: 2018-06-27 Created: 2018-06-27 Last updated: 2018-09-14Bibliographically approved
Alm, F. & Ericsson, E. (2018). Smärta och smärtbehandling i samband med tonsillkirurgi på barn: ett ständigt pågående förbättringsarbete med ett multidisciplinärt ansvar. In: : . Paper presented at Riksförening för Anestesi och Intensivvård (AnIva) vårkongress, Visby, Sweden, May 17-18, 2018.
Open this publication in new window or tab >>Smärta och smärtbehandling i samband med tonsillkirurgi på barn: ett ständigt pågående förbättringsarbete med ett multidisciplinärt ansvar
2018 (Swedish)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Smärta efter tonsillkirurgi på barn har varit och är fortfarande en utmaning för ÖNH-professionen. Trots ett stort antal publikationer inom området saknas nationellt och internationellt konsensus om vad som är den optimala smärtbehandlingen. Registerdata i Sverige visar på hög andel patienter/närstående som kontaktar hälso- och sjukvården efter tonsillkirurgi pga. bristfällig smärtbehandling. Under de senaste åren har flera förbättringsarbeten utförts med implementering av nationella riktlinjer för smärtbehandling och patientinformation på hemsidan tonsilloperation.se. Mot denna bakgrund pågår nu ett forskningsprojekt där smärta och smärtbehandling i samband med tonsillkirurgi utvärderas från professionens, barnets och anhörigas perspektiv. Studier i projektet har visat att den svenska ÖNH-professionens åsikt om och följsamhet till de nationella riktlinjerna är god. Vidare visar analys av registerdata att implementeringen av nationella riktlinjer har gjort avtryck i tonsilloperationsregistrets smärtrelaterade variabler, med längre postoperativ analgetikabehandling och en viss minskning av oplanerade kontakter med hälso- och sjukvård. Samtidigt visar data från registret att operationsmetoder och tekniker, men även patientfaktorer som ålder och indikation för kirurgi, påverkar smärtutfallet. Preliminära resultat från en större kvantitativ datainsamling via åldersanpassade smärtdagböcker och kvalitativa intervjuer med barn och anhöriga visar att återhämtningen efter tonsillkirurgi påverkas av vilken typ av smärtbehandling barnet ordinerats.

National Category
Medical and Health Sciences
Research subject
Anaesthesiology; Oto-Rhino-Laryngology; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-69771 (URN)
Conference
Riksförening för Anestesi och Intensivvård (AnIva) vårkongress, Visby, Sweden, May 17-18, 2018
Available from: 2018-10-22 Created: 2018-10-22 Last updated: 2018-10-23Bibliographically approved
Alm, F., Jaensson, M., Lundeberg, S. & Ericsson, E. (2017). Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team. International Journal of Pediatric Otorhinolaryngology, 101, 123-131
Open this publication in new window or tab >>Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team
2017 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 101, p. 123-131Article in journal (Refereed) Published
Abstract [en]

Background: Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping system have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013.

Objectives The objective of this study was to evaluate the professionals’ opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up.

Method: This descriptive cross-sectional study was based on data from an inter-professional questionnaire, which was validated by an expert group using a content validity index (S-CVI 0.93). The questionnaire was sent to all Swedish ear, nose and throat (ENT) departments (n=49) that the NTRS identified as performing tonsil surgery on children younger than 18 years of age. In each clinic, we asked for responses from staff in each of the following professions: ENT physicians, anesthesia physicians, registered nurse anesthetists, and registered nurses in the ENT departments.

Results: Respondents from 48 ENT departments participated, and 139/163 (85%) completed questionnaires were returned. The guidelines were reported as being clear, ensuring patient safety and providing optimal pharmacological treatment. Treatment was given according to the guidelines: Half of the departments gave pre- or intraoperative treatment with clonidine, betamethasone and high-dose paracetamol (acetaminophen). A multimodal pain approach (paracetamol and COX inhibitors) after hospital discharge was prescribed by all departments after tonsillectomy and, more extensively, after tonsillotomy. One-third of the departments prescribed paracetamol with a higher normal dose for the first three postoperative days. Half of the departments prescribed rescue analgesics, clonidine or opioids after tonsillectomy. None of the departments prescribed codeine or tramadol, drugs that are discouraged in the guidelines. The majority of the departments used the website tonsilloperation.se to provide information to the patients and their caregivers.

Conclusion: The respondents' opinions of and the ENT departments adherence to the Swedish national guidelines were considered to be good. The national implementation process in Sweden has impacted the manner in which ENT departments treat pain after tonsil surgery.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Children, Guidelines, Pain Management, Tonsillectomy, Tonsillotomy
National Category
Otorhinolaryngology Pediatrics
Research subject
Caring Sciences w. Medical Focus; Oto-Rhino-Laryngology; Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-59058 (URN)10.1016/j.ijporl.2017.07.040 (DOI)000413713100022 ()28964282 (PubMedID)2-s2.0-85026786151 (Scopus ID)
Projects
Effective postoperative pain management in children after tonsil surgery: barriers and possible solutions
Note

Funding agencies:

Research Committee at Region Örebro County

Örebro University Hospital Research Foundation OLL674631

Available from: 2017-08-07 Created: 2017-08-07 Last updated: 2017-12-05Bibliographically approved
Ericsson, E., Nilsson, U., Bramhagen, A.-C., Harden, S., Idvall, E. & Eriksson, M. (2017). Experiences of a new self-report instrument for post-operative recovery in children. In: : . Paper presented at XXXIII Congress of the Nordic Association of Otolaryngology, Gothenburg, Sweden, May 31 - June 3, 2017.
Open this publication in new window or tab >>Experiences of a new self-report instrument for post-operative recovery in children
Show others...
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

The objective was to develop and test an instrument that provides children, also of a younger age, with a quality recovery self-report measure after tonsil surgery.

Methods: The development of Postoperative Recovery in Children (PRiC) was influenced by Quality of Recovery-24, for use in adults. It includes 23 items covering different aspects of recovery. PRiC was developed both as a traditional text-based instrument and as a version where each item is illustrated by a photo. It was distributed to 260 children undergoing tonsillotomy or total tonsillectomy in day-surgery, to be answered on post-operative days 1, 4 and 10.

Results: In the photo-version, 27% of the children marked the answers on the instrument themselves, compared to 19% in the text-version (n.s.). Parents of 64% of the children in the photo-group reported that their child participated in answering the questions to a very high degree, compared to 58% in the text-group (n.s.). Some parents described that their children were very proud to fill in the instrument and return them by mail. The questions were mainly described as easy to understand and respond to, especially when illustrated with a photo. Some parents highlighted pain issues and asked for specific questions about what pain medication was given at home. One parent asked for the possibility to respond to the instrument online.

Conclusion: PRiC can serve as a patient-reported outcome measure for children. PRiC can also provide parents with a tool for communicating with their child about post-operative recovery, especially when using the photo version.

National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-58199 (URN)
Conference
XXXIII Congress of the Nordic Association of Otolaryngology, Gothenburg, Sweden, May 31 - June 3, 2017
Projects
PRIC
Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2017-10-18Bibliographically approved
Alm, F. & Ericsson, E. (2017). Pain and pain management after pediatric tonsil surgery. In: : . Paper presented at XXXIII Congress of the Nordic Association of Otolaryngology, Gothenburg, Sweden, May 31 - June 3, 2017.
Open this publication in new window or tab >>Pain and pain management after pediatric tonsil surgery
2017 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Medical and Health Sciences
Research subject
Anaesthesiology; Oto-Rhino-Laryngology; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-69769 (URN)
Conference
XXXIII Congress of the Nordic Association of Otolaryngology, Gothenburg, Sweden, May 31 - June 3, 2017
Available from: 2018-10-22 Created: 2018-10-22 Last updated: 2018-10-23Bibliographically approved
Alm, F., Stalfors, J., Nerfeldt, P. & Ericsson, E. (2017). Patient reported outcome of pain after tonsil surgery: An analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-2016. In: : . Paper presented at Nordic Pediatric Pain Symposium 2017, Stockholm, Sweden, March 30-31, 2017.
Open this publication in new window or tab >>Patient reported outcome of pain after tonsil surgery: An analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-2016
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Tonsil surgery is common surgical procedure in children and cause significant pain under postoperative recovery. The objective of this register study was to explore factors affecting pain after pediatric tonsil surgery, using patient-reported outcomes from questionnaires in the National Tonsil Surgery Registry in Sweden, 30 days after surgery. A total of 32,225 tonsil surgeries on children (aged 1-18 years) during January 2009- November 2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE±A) and 18,321 tonsillotomies with or without adenoidectomy (TT±A). In surgery cases of indication obstruction, the TT±A stopped taking painkillers and returned to normal eating habits sooner, and had less contact with health care services due to pain, compared to TE±A. After TE±A, the indication infection group had more days on analgesics and more contacts with health care services due to pain, compared to the indication obstruction group. TE±A with cold-dissection technique resulted in fewer days on painkillers compared to warm-technique, and reduced the number of contacts with health care services due to pain. Older children were affected by more days of morbidity than the younger ones, but there was no gender difference after adjustment for age, dissection technique and hemostasis technique. Implementation of national guidelines for pain treatment (2013) and patient information on the website tonsilloperation.se seems to have increased the days on analgesics after surgery. Pain after tonsil surgery depends on the surgical procedure and technique, as well as factors such as the patient’s age and surgical indication. More studies including pain interventions are needed to improve the care of tonsillectomy patients.

National Category
Surgery Otorhinolaryngology Nursing
Research subject
Caring Sciences w. Medical Focus; Oto-Rhino-Laryngology; Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-58197 (URN)
Conference
Nordic Pediatric Pain Symposium 2017, Stockholm, Sweden, March 30-31, 2017
Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2017-10-18Bibliographically approved
Alm, F., Stalfors, J., Nerfeldt, P. & Ericsson, E. (2017). Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016. European Archives of Oto-Rhino-Laryngology, 274(10), 3711-3722
Open this publication in new window or tab >>Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016
2017 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 274, no 10, p. 3711-3722Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to describe factors affecting pain after pediatric tonsil surgery, using patient reported pain-related outcome measures (pain-PROMs) from the National Tonsil Surgery Register in Sweden. In total, 32,225 tonsil surgeries on children (1 to\18 years) during 2009–2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE ± A), and 18,321 tonsillotomies with or without adenoidectomy (TT ± A). Adjustments were made for variables included in the register to compensate for contributable factors in the analysis. When compared to TE ± A for surgical indication obstruction, TT ± A resulted in lower pain-PROMs, shorter use of postoperative analgesics, earlier return to regular food intake, and lower risk for contact with health care services due to pain. Children who underwent TE ± A because of obstruction problems stopped taking painkillers and returned to normal eating habits sooner, compared to children who underwent TE ± A for infectious indications. In both indication groups, TE ± A performed with hot rather than cold technique (dissection and haemostasis) generally resulted in higher pain-PROMs. Older children reported more days on analgesics and a later return to regular food intake after TE ± A than younger ones. No clinically relevant difference between sexes was found. Between 2012 and 2016 (pre-and post-implementation of Swedish national guidelines for pain treatment), the mean duration of postoperative analgesic use had increased. In conclusion, TE ± A caused considerably higher ratings of pain-related outcome measures, compared to TT ± A. For TE ± A, cold surgical techniques (dissection and haemostasis) were superior to hot techniques in terms of pain-PROMs. Older children reported higher pain-PROMs after TE ± A than younger ones.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Children, Pain, PROM, Tonsillitis, Tonsillar hypertrophy, Tonsillectomy, Tonsillotomy
National Category
Otorhinolaryngology Anesthesiology and Intensive Care Nursing
Research subject
Anaesthesiology; Oto-Rhino-Laryngology; Nursing Science
Identifiers
urn:nbn:se:oru:diva-59111 (URN)10.1007/s00405-017-4679-4 (DOI)000409888700021 ()28815308 (PubMedID)2-s2.0-85027510091 (Scopus ID)
Note

Funding Agency:

Swedish Association of Local Authorities and Regions

Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2018-08-01Bibliographically approved
Ericsson, E., Nilsson, U., Bramhagen, A.-C., Idvall, E. & Eriksson, M. (2017). Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy. In: : . Paper presented at XXXIII Congress of the Nordic Association of Otolaryngology, Gothenburg, Sweden, May 31 - June 3, 2017.
Open this publication in new window or tab >>Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy
Show others...
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this aspect.

Methods: 238 children (4-12 years) with a history of obstructive problems and/or recurrent tonsillitis were included. 48% were operated with tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery. Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument, Postoperative Recovery in Children (PRiC), which includes 23 items covering different aspects of recovery after tonsil surgery.

Results: Daily life activities (sleeping, eating and playing), and physical (e.g., headache, stomach ache, throat ache, otalgia, dizziness, nausea, defecation, urination) and emotional aspects (sadness, frightening dreams) were affected during the recovery period.

The TE-girls showed higher scores than the boys in many factors. Children above 6 years of age reported higher values for the physical comfort variables while the younger group showed worse emotional states. Postoperative recovery improved from day 1 to 10 in all surgical groups. The TE-group had lower recovery compared to the TT-group (p < 0.01 – 0.001) in most items.

Conclusion: The goal of postoperative management is to minimise or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery after tonsil surgery, and thus, PRiC can serve as a PROM to obtain patient-centred data after tonsil surgery.

National Category
Nursing
Research subject
Caring Sciences w. Medical Focus; Caring sciences
Identifiers
urn:nbn:se:oru:diva-58201 (URN)
Conference
XXXIII Congress of the Nordic Association of Otolaryngology, Gothenburg, Sweden, May 31 - June 3, 2017
Note

 

Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2017-10-18Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8549-9039

Search in DiVA

Show all publications