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  • 1.
    Blomberg, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Wengström, Yvonne
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Sundberg, Kay
    Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Browall, Maria
    Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden; School of Life Sciences, University of Skövde, Skövde, Sweden.
    Isaksson, Ann-Kristin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hälleberg Nyman, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langius-Eklöf, Ann
    Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden.
    Symptoms and self-care strategies during and six months after radiotherapy for prostate cancer: Scoping the perspectives of patients, professionals and literature2016In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 21, p. 139-145Article in journal (Refereed)
    Abstract [en]

    Purpose: Under-diagnosed and uncontrolled symptoms in patients with prostate cancer during radiotherapy can have a negative impact on the individual's quality of life. An opportunity for patients to report their symptoms systematically, communicate these symptoms to cancer nurses and to receive self-care advice via an application in an Information and Communication Technology-platform could overcome this risk. The content in the application must precisely capture symptoms that are significant to both patients and health care professionals. Therefore, the aim of the study was to map and describe symptoms and self-care strategies identified by patients with prostate cancer undergoing radiotherapy, by health care professionals caring for these patients, and in the literature.

    Methods: The study combines data from interviews with patients (n ¼ 8) and health care professionals (n ¼ 10) and a scoping review of the literature (n ¼ 26) focusing on the period during and up to 6 months after radiotherapy.

    Results: There was a concordance between the patients, health care professionals, and the literature on symptoms during and after radiotherapy. Urinary symptoms, bowel problems, pain, sexual problems, fatigue, anxiety, depression, cognitive impairment and irregular symptoms were commonly described during the initial treatment period. Self-care strategies were rarely described in all three of the sources.

    Conclusions: The results show which symptoms to regularly assess using an Information and Communication Technology-platform for patients with newly-diagnosed prostate cancer during radiotherapy. The next step is to evaluate the efficacy of using the platform and the accuracy of the selected symptoms and self-care advice included in a smartphone application.

  • 2.
    Christiansen, Mats
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Langius-Eklöf, Ann
    Karolinska Institutet, Stockholm, Sweden.
    Lindström, Veronica
    Karolinska Institutet, Stockholm, Sweden.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Hälleberg Nyman, Maria
    Örebro University, School of Health Sciences.
    Wengström, Yvonne
    Karolinska Institutet, Stockholm, Sweden.
    Sundberg, Kay
    Karolinska Institutet, Stockholm, Sweden.
    High acceptability of a smartphone application for daily symptom reporting and management during radiotherapy for prostate cancer2016Conference paper (Refereed)
  • 3.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Philipson, Anna
    Örebro University, School of Health Sciences.
    Hagberg, Lars
    Örebro University Hospital. Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Hälleberg-Nyman, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Cost-effectiveness of a systematic e-assessed follow up of postoperative recovery after day surgery: a multicentre randomized controlled trial2017Conference paper (Refereed)
  • 4.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Philipsson, Anna
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Hälleberg Nyman, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial2017In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1039-1046Article in journal (Refereed)
    Abstract [en]

    Background: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphonebased application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.

    Methods: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.

    Results: The mean cost for health-care consumption during 2 weeks after surgery was estimated at e37.29 for the intervention group and e60.96 for the control group. The mean difference was e23.66 (99% confidence interval 46.57 to0.76; P¼0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of e4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P¼0.75). The probability of the intervention being cost-effective was 71%.

    Conclusions: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective toolin providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.

    Clinical trial registration:NCT02492191

  • 5.
    Eldh, Ann Catrine
    et al.
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Hälleberg Nyman, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Forsman, Henrietta
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Hommel, Ami
    Lunds universitet, Lund, Sweden.
    Rycroft-Malone, Jo
    Bangor University, Bangor, UK.
    Wallin, Lars
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Onset prevention of incontinence in orthopaedic nursing and rehabilitation: a multifaceted undertaking2015In: Researching Complex Interventions in Health: The State of the Art, 2015Conference paper (Refereed)
  • 6.
    Gustafsson, Margareta
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gustafsson, Dan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hälleberg-Nyman, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden .
    Bergentz, Gunnar
    Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden .
    Norlin, Rolf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden .
    Identifying clinically relevant groups of hip fracture patients at risk of adverse outcomes by using classification tree analysis2012In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 17, no 1, p. 38-47Article in journal (Refereed)
    Abstract [en]

    Aim: To identify groups of hip fracture patients at risk of adverse utcome by investigating interactions between previously reported risk factors.

    Methods: A consecutive sample of 338 hip fracture patients was included at admission to the orthopaedic department and followed up 4 months later. Outcomes measured were mortality, failure to regain pre-injury mobility and failure to return home. Data were collected about previously reported risk factors for adverse outcomes in those respects.

    Results: The highest risk of death occured in males living in institutions for the elderly before the fracture (48%). Lowest risk of death had patients admitted from their own home, without malignancy and below 80 years of age (1%). The overall risk of failure to regain pre-injury mobility at the 4 month follow up was 30%. In patients walking independently before the fracture and age above 85 years, the risk increased to 88%. In patients walking with devices before the fracture, the risk of being confined to bed or wheelchair increased from 10% to 20% if the patient was confused. Confusion also increased the risk of relocation from their own home to an institution for the elderly from 19% to 53%.

    Conclusion: The results of the study can help nurses in making realistic discharge plans based on risk analyses, employing more than just age as risk factor. Using this information nurses can meet the patient’s individual needs in an improved way.

  • 7.
    Hälleberg Nyman, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Institutionen för neurobiologi, vårdvetenskap och samhälle (NVS), Karolinska Institutet, Stockholm, Sweden.
    Forsman, Henrietta
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Hommel, Ami
    Department of Orthopaedics, Skåne University Hospital, Lund/Malmö, Sweden.
    Rycroft-Malone, Jo
    Centre for Health Related Research, School of Healthcare Sciences, Bangor University, Bangor, UK.
    Wallin, Lars
    Institutionen för neurobiologi, vårdvetenskap och samhälle (NVS), Karolinska Institutet, Stockholm, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Eldh, Ann Catrine
    Institutionen för neurobiologi, vårdvetenskap och samhälle (NVS), Karolinska Institutet, Stockholm, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Identifying the knowledge to translate: the example of urinary incontinence in older people2015In: Nordic Conference on Implementation of Evidence-Based Practice, 2015Conference paper (Refereed)
    Abstract [en]

    Background: While urinary incontinence (UI) is a common and worrying issue among older people, promoting the use of evidence to prevent UI onset has rarely been studied. An earlier study that was conducted in nursing homes suggests that UI can be better assessed and managed, but the prevention of UI onset requires attention to the issue by staff within acute care settings. Aim: To report on the internal facilitators’ (IF) transition, identifying the 'know-do gap' between evidence and practice in UI prevention in orthopaedic care.

    Methods: The Onset PrevenTion of Incontinence in Orthopaedic Nursing and rehabilitation (OPTION) pilot was carried out in two Swedish orthopaedic units of different size and location. The pilot project included a programme to support nursing and rehab staff to facilitate knowledge translation (KT). Five IFs were interviewed at baseline, and one and three months after the intervention was completed, and non-participant observations were performed during the KT-intervention. Interviews and observations were triangulated, depicting when and how the IFs identified the present, local UI practice, the evidence on UI, and the know-do gap in preventing UI onset in older patients undergoing hip surgery.

    Results: Preliminary results indicate that before the study, neither the IFs nor their fellows at the units were aware that they could prevent UI onset. Rather, through mapping their context and matching the evidence provided by the dialogue with the experts in the KTintervention, the IFs became aware of which practice was evidence based and which evidence to implement, and how to facilitate KT and promote evidence use.

    Conclusion: The OPTION pilot indicates that KT can be promoted by tailored implementation strategies and tailoring evidence, supported by IFs awareness and understanding of the local know-do gap, and strategies to overcome barriers and promote use of evidence.

  • 8.
    Hälleberg Nyman, Maria
    et al.
    Örebro University, School of Health Sciences.
    Forsman, Henrietta
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Ostaszkiewicz, Joan
    School of Nursing and Midwifery, Deakin University, Melbourne, Australia.
    Hommel, Ami
    Faculty of health and Society, Department of Care, Science, Malmö University, Malmö, Sweden; Department of Orthopaedics, Skåne University Hospital, Lund, Sweden.
    Eldh, Ann Catrine
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Urinary incontinence and its management in patients aged 65 and older in orthopaedic care: what nursing and rehabilitation staff know and do2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 21-22, p. 3345-3353Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe what nursing and rehabilitation staff know and do with regards to urinary incontinence and risk of urinary incontinence in patients 65 years or older undergoing hip surgery.

    Background: Urinary incontinence is a common but often neglected issue for older people. Despite the existence of evidence-based guidelines on how to assess, manage and prevent UI, there are indications that these guidelines are not applied in hospital care.

    Design: A qualitative study with descriptive design was conducted in two orthopaedic units.

    Methods: 46 interviews and 36 observations of care were conducted from January to October 2014 and analysed with qualitative content analysis.

    Results: Enrolled nurses performed most of the care related to bladder function, with focus on urinary catheterisation and preventing urinary tract infection and urinary retention. Registered nurses' role in urinary matters mainly comprised documentation, while the rehabilitation staff focused on making it possible for the patient to be independent in toileting. The nursing staff considered urinary incontinence a common condition for older people and that it was convenient for the patients to have an indwelling catheter or incontinence pad/pant, although they acknowledged some of the risks associated with these procedures.

    Conclusions: Urinary incontinence is not a priority in orthopaedic care, and urinary incontinence guidelines are not applied. Further, attitudes and actions are mainly characterised by a lack of urinary incontinence knowledge and the nursing and rehabilitation staff do not take a team approach to preventing and managing UI.

    Relevance and clinical practive: An increased focus on knowledge on urinary incontinence and evidence-based guidelines is needed. To secure evidence-based practice, the team of nursing and rehabilitation staff and managers must be aligned and work actively together, also including the patient in the team.

  • 9.
    Hälleberg Nyman, Maria
    et al.
    Örebro University, School of Health Sciences. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Forsman, Henrietta
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Wallin, Lars
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ostaszkiewicz, Joan
    Centre for Quality and Patient Safety Research, Barwon Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, Australia.
    Hommel, Ami
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden; Department of Orthopaedics, Skåne University Hospital, Lund, Sweden.
    Eldh, Ann Catrine
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care: A process evaluation of an implementation intervention in the orthopaedic context2018In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS, AND OBJECTIVES: The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery.

    METHODS: A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed.

    RESULTS: Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit.

    CONCLUSION: To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.

  • 10.
    Hälleberg Nyman, Maria
    et al.
    Örebro University, School of Health Sciences.
    Frank, Catharina
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Langius-Eklöf, Ann
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Sundberg, Kay
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Patients' Perspective on Participation in Care With or Without the Support of a Smartphone App During Radiotherapy for Prostate Cancer: Qualitative Study2017In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 5, no 7, article id e107Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with prostate cancer are often cared for as outpatients during radiotherapy, which can be an aggravating circumstance for patient participation. There is a need to evaluate whether an interactive smartphone app could enable participation in care, specifically during treatment for prostate cancer. The interactive app (Interaktor) used in this study is developed in codesign with patients and health care professionals; it includes daily reports of symptoms, a risk assessment model, evidence-based self-care advice, along with the provision of immediate access to clinicians.

    OBJECTIVE: The aim of this study was to explore how patients with prostate cancer perceived their participation with or without the support of the smartphone app during radiotherapy.

    METHODS: A total of 28 prostate cancer patients receiving adjuvant radiotherapy were interviewed about their perceived participation in their own care. All the patients interviewed in this study participated in an intervention study where the control group received standard care that comprised having access to a contact nurse to turn to with any concerns during their treatment. In addition to standard care, the patients in the intervention group received the app downloaded in a smartphone. The patients' age ranged between 57 and 77 years; 17 patients used the smartphone app. The interviews were analyzed with directed qualitative content analysis.

    RESULTS: The four dimensions of patient participation, which include mutual participation, fight for participation, requirement for participation, and participation in getting basic needs satisfied, were confirmed as valid perspectives in the interviews with the patients with prostate cancer, irrespective of whether they used the smartphone app. However, the patients who had used the smartphone app described it as a facilitating factor, especially for mutual participation.

    CONCLUSIONS: Using innovative ways to communicate with patients, such as an interactive app for symptom management with contact with health care in real time, can successfully help achieve increased patient participation in care.

  • 11.
    Hälleberg Nyman, Maria
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Association Between Functional Health Literacy and Postoperative Recovery, Health Care Contacts, and Health-Related Quality of Life Among Patients Undergoing Day Surgery Secondary Analysis of a Randomized Clinical Trial2018In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 153, no 8, p. 738-745Article in journal (Refereed)
    Abstract [en]

    Importance: Day surgery puts demands on the patients to manage their own recovery at home according to given instructions. Low health literacy levels are shown to be associated with poorer health outcomes.

    Objective: To describe functional health literacy levels among patients in Sweden undergoing day surgery and to describe the association between functional health literacy (FHL) and health care contacts, quality of recovery (SwQoR), and health-related quality of life.

    Design, Setting, and Participants: This observational study was part of a secondary analysis of a randomized clinical trial of patients undergoing day surgery and was performed in multiple centers from October 2015 to July 2016 and included 704 patients.

    Main Outcomes and Measures: The primary end point was SwQoR in the FHL groups 14 days after surgery. Secondary end points were health care contacts, EuroQol-visual analog scales, and the Short Form (36) Health Survey in the FHL groups.

    Results: Of 704 patients (418 [59.4%] women; mean [SD] age with inadequate or problematic FHL levels, 47 [16] years and 49 [15.1], respectively), 427 (60.7%) reported sufficient FHL, 223 (31.7%) problematic FHL, and 54 (7.7%) inadequate FHL. The global score of SwQoR indicated poor recovery in both inadequate (37.4) and problematic (22.9) FHL. There was a statistically significant difference in the global score of SwQoR (SD) between inadequate (37.4 [34.7]) and sufficient FHL (17.7 [21.0]) (P < .001). The patients with inadequate or problematic FHL had a lower health-related quality of life than the patients with sufficient FHL in terms of EuroQol-visual analog scale scores (mean [SD], 73 [19.1], 73 [19.1], and 78 [17.4], respectively; P = .008), physical function (mean [SD], 72 [22.7], 75 [23.8], and 81 [21.9], respectively; P < .001), bodily pain (mean [SD], 51 [28.7], 53 [27.4], and 61 [27.0], respectively; P = .001), vitality (mean [SD], 50 [26.7], 56 [23.5], and 62 [25.4], respectively; P < .001), social functioning (mean [SD], 73 [28.2], 81 [21.8], and 84 [23.3], respectively; P = .004), mental health (mean [SD], 65 [25.4], 73 [21.2], and 77 [21.2], respectively; P < .001), and physical component summary (mean [SD], 41 [11.2], 42 [11.3], and 45 [10.1], respectively; P = .004). There were no differences between the FHL groups regarding health care contacts.

    Conclusions and Relevance: Inadequate FHL in patients undergoing day surgery was associated with poorer postoperative recovery and a lower health-related quality of life. Health literacy is a relevant factor to consider for optimizing the postoperative recovery in patients undergoing day surgery.

    The full text will be freely available from 2019-04-25 16:03
  • 12.
    Hälleberg-Nyman, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Urinary catheter policies for short-term bladder drainage in hip surgery patients2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients.

    In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation.

    In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.

    List of papers
    1. A prospective study of nosocomial urinary tract infection in hip fracture patients
    Open this publication in new window or tab >>A prospective study of nosocomial urinary tract infection in hip fracture patients
    2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2531-2539Article in journal (Refereed) Published
    Abstract [en]

    Aim.  To investigate risk factors and consequences of nosocomial urinary tract infection in hip fracture patients. Background.  Nosocomial urinary tract infection is a well-known problem in hip fracture patients. There are several risk factors for nosocomial urinary tract infection described in the literature.

    Design.  Prospective observational study with a descriptive and comparative design.

    Methods.  Hip fracture patients were included consecutively between April 2006-March 2007. Excluded were those under 50, having an indwelling urinary catheter, signs of cognitive impairment or additional severe physical problems at the time of admission. To verify nosocomial urinary tract infection, a urine specimen was taken at admission and discharge. Patients with and without nosocomial urinary tract infection were compared.

    Results.  The study included 86 hip fracture patients, of whom 45 (52·3%) contracted nosocomial urinary tract infection in hospital. Earlier reported risk factors for nosocomial urinary tract infection were not confirmed in this study, with one exception: diabetes. All diabetic patients in the study contracted urinary tract infections. Patients receiving cloxacillin as antibiotic prophylaxis for wound infection contracted UTI less often than other patients. There were no statistical differences between groups with regard to urinary tract infection frequency four months after fracture or with regard to mortality after one year.

    Conclusion.  Diabetes was the only previously known risk factor for nosocomial urinary tract infection confirmed among hip fracture patients in this study. Cloxacillin as antibiotic prophylaxis for surgery seemed to offer a certain protection against nosocomial urinary tract infection. Relevance to clinical practice.  Nurses in clinical practice should be aware of the risk of urinary tract infections in hip fracture patients and especially in hip fracture patients with diabetes. Patients given cloxacillin as antibiotic prophylaxis seem less likely to contract nosocomial urinary tract infection.

    Keywords
    hip fracture, nosocomial urinary tract infection, nurses, nursing, risk factors, urinary catheterisation
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-16578 (URN)10.1111/j.1365-2702.2011.03769.x (DOI)000293748900015 ()21733026 (PubMedID)2-s2.0-80051575875 (Scopus ID)
    Available from: 2011-08-15 Created: 2011-08-15 Last updated: 2017-12-08Bibliographically approved
    2. A randomised controlled trial on the effect of clamping the indwelling urinary catheter in patients with hip fracture
    Open this publication in new window or tab >>A randomised controlled trial on the effect of clamping the indwelling urinary catheter in patients with hip fracture
    2010 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 3-4, p. 405-413Article in journal (Refereed) Published
    Abstract [en]

    Aim. To investigate the effect of clamping the urinary catheter before its removal in patients with hip fracture. Background. Difficulties to return to normal bladder function after removal of the urinary catheter are frequent in patients with hip fracture. Clamping the urinary catheter before removal is proposed to shorten the amount of time required to return to normal bladder function. Design. A randomised controlled trial was conducted at the orthopaedic clinic at a Swedish university hospital. Methods. Patients with hip fracture aged >= 50 without a urinary catheter, without cognitive impairment or additional severe physical problems at the time of admission (n = 113) were included. They were randomly assigned either to have their urinary catheter clamped before removal or to have their catheter removed with free drainage. Blinding was not possible because of the nature of the study. The primary outcome was the amount of time required to return to normal bladder function. Secondary outcomes were need for re-catheterisation and length of hospital stay. All patients were analysed in accordance with the intention-to-treat principle. Results. The median time required to return to normal bladder function was six (Q(1) 4-Q(3) 8) hours in the clamped catheter group and four (Q(1) 3-Q(3) 7.25) hours in the free drainage group. There were no significant differences between the groups regarding the time required to regain normal bladder function (p = 0.156), the number of patients requiring re-catheterisation (p = 0.904) and the mean time in hospital (p = 0.777). Conclusion. This randomised trial did not show any advantage or disadvantage with clamping the urinary catheter before removal. Relevance to clinica practice. Clamping is an additional task for the nursing staff in the removal of the indwelling urinary catheter. Therefore, when considering the present results, it seems that clamping the indwelling urinary catheters in patients with hip fracture is not indicated.

    Keywords
    clamping, hip fractures, nursing, randomised controlled trial, urinary catheterisation
    National Category
    Nursing
    Research subject
    Caring Sciences w. Medical Focus
    Identifiers
    urn:nbn:se:oru:diva-13035 (URN)10.1111/j.1365-2702.2009.03050.x (DOI)000273599200013 ()20500280 (PubMedID)2-s2.0-74549155751 (Scopus ID)
    Note

    Funding Agencies:

    Department of Orthopaedics Orebro University Hospital  Centre for Assessment of Medical Technology, Orebro County Council  

    Available from: 2011-01-03 Created: 2011-01-03 Last updated: 2017-12-11Bibliographically approved
    3. Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis
    Open this publication in new window or tab >>Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background:  Hip surgery is associated with a risk for postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). Presently, there is limited knowledge whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery.

    Objectives: The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness.

    Design: Randomised controlled trial with cost-effectiveness analysis.

    Setting: The study was carried out at an orthopaedic department at a Swedish university hospital.

    Method: One hundred seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge.

    Results: Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (p = 0.618).  The patients in the intermittent catheterisation group were more often catheterised (p <0.001) and required more bladder scans (p <0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p <0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods.

    Conclusions: In the perspective of cost-effectiveness both indwelling and intermittent methods could be appropriate in clinical praxis. Both methods have advantages and disadvantages but by not using indwelling catheterisation routinely in this patient group unnecessary catheterisations might be avoided.

    Keywords
    Cost-effectiveness, hip arthroplasty, hip fractures, intermittent catheterisation, indwelling catheterisation, nursing, randomised controlled trial, urinary tract infection
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-22507 (URN)
    Note

    Note: This manuscript is published as an article: DOI 10.1016/j.ijnurstu.2013.05.007

    In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, 1589-1598

    Available from: 2012-04-12 Created: 2012-04-12 Last updated: 2017-10-17Bibliographically approved
    4. An issue but of varying impact: a descriptive study of hip surgery patients’ experiences of bladder emptying and urinary catheterisation
    Open this publication in new window or tab >>An issue but of varying impact: a descriptive study of hip surgery patients’ experiences of bladder emptying and urinary catheterisation
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: The capacity of bladder emptying in connection with hip surgery is affected by pain, medication and confinement to bed. In connection with such surgery urinary catheterisation is often performed, either intermittent or indwelling. Hip surgery patients' experiences of urinary catheterisation and urination have not been studied before.

    Objectives: The aim of the study was to describe patients' experiences of bladder emptying and urinary catheterisation in connection with hip surgery.

    Design: A qualitative study with descriptive design was conducted among hip surgery patients.

    Setting: The study was carried out at an orthopaedic department at a university hospital in Sweden.

    Participants: Purposive sample of 30 hip surgery patients, 17 with fractures and 13 with osteoarthritis.

    Method: Face-to-face interviews were conducted and analysed with inductive qualitative content analysis.

    Results: The main category "An issue but of varying impact" illustrated the patients' experiences of bladder emptying and urinary catheterisation. The findings are reported under five generic categories: ability to urinate, catheter is convenient, bothersome bladder emptying, intrusion upon dignity and concern about complications. Irrespectively of whether the patients were able to urinate or were catheterised, bladder emptying was not as usual. It was described as uncomplicated and experienced as being positive if the patients were able to urinate by themselves or when catheterisation was experienced as convenient. Some patients did not want to be catheterised, approving it only reluctantly. Independently of the method for bladder emptying, the patients in our study would choose the same method next time.

    Conclusions: The patients undergoing hip surgery seem to experience bladder emptying as an issue but of varying impact. Both bladder emptying through micturition and bladder emptying through catheterisation are described in positive as well as negative terms.

    Keywords
    Bladder emptying, Hip arthroplasty, Hip fractures, Nursing, Patient experiences, Qualitative research, Urinary catheterization
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-22509 (URN)
    Available from: 2012-04-12 Created: 2012-04-12 Last updated: 2017-10-17Bibliographically approved
  • 13.
    Hälleberg-Nyman, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langius-Eklöf, Ann
    Division of Nursing, Karolinska institutet, Stockholm, Sweden.
    Isaksson, Ann-Kristin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    An issue but of varying impact: a descriptive study of hip surgery patients’ experiences of bladder emptying and urinary catheterisationManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The capacity of bladder emptying in connection with hip surgery is affected by pain, medication and confinement to bed. In connection with such surgery urinary catheterisation is often performed, either intermittent or indwelling. Hip surgery patients' experiences of urinary catheterisation and urination have not been studied before.

    Objectives: The aim of the study was to describe patients' experiences of bladder emptying and urinary catheterisation in connection with hip surgery.

    Design: A qualitative study with descriptive design was conducted among hip surgery patients.

    Setting: The study was carried out at an orthopaedic department at a university hospital in Sweden.

    Participants: Purposive sample of 30 hip surgery patients, 17 with fractures and 13 with osteoarthritis.

    Method: Face-to-face interviews were conducted and analysed with inductive qualitative content analysis.

    Results: The main category "An issue but of varying impact" illustrated the patients' experiences of bladder emptying and urinary catheterisation. The findings are reported under five generic categories: ability to urinate, catheter is convenient, bothersome bladder emptying, intrusion upon dignity and concern about complications. Irrespectively of whether the patients were able to urinate or were catheterised, bladder emptying was not as usual. It was described as uncomplicated and experienced as being positive if the patients were able to urinate by themselves or when catheterisation was experienced as convenient. Some patients did not want to be catheterised, approving it only reluctantly. Independently of the method for bladder emptying, the patients in our study would choose the same method next time.

    Conclusions: The patients undergoing hip surgery seem to experience bladder emptying as an issue but of varying impact. Both bladder emptying through micturition and bladder emptying through catheterisation are described in positive as well as negative terms.

  • 14.
    Hälleberg-Nyman, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langius-Eklöf, Ann
    Karolinska Institutet, Stockholm, Sweden.
    Isaksson, Ann-Kristin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Patients' experiences of bladder emptying in connection with hip surgery: an issue but of varying impact2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 12, p. 2686-2695Article in journal (Refereed)
    Abstract [en]

    Aim: To describe patients' experiences of bladder emptying and urinary catheterization in connection with hip surgery.

    Background: The capacity of bladder emptying in connection with hip surgery is affected by pain, medication and confinement to bed. In connection with such surgery urinary catheterization is often performed, either intermittent or indwelling. Hip surgery patients' experiences of urinary catheterization and urination have not been studied before.

    Design: A qualitative study with descriptive design was conducted among hip surgery patients.

    Methods: Thirty face-to-face interviews were conducted from October 2009-March 2010 and analysed with inductive qualitative content analysis.

    Results: The main category An issue but of varying impact' illustrated the patients' experiences of bladder emptying and urinary catheterization. Five generic categories were identified: ability to urinate, catheter is convenient, bothersome bladder emptying, intrusion on dignity and concern about complications. Irrespectively of whether the patients were able to urinate or were catheterized, the bladder emptying situation was not as usual. It was described as uncomplicated and experienced as being positive if the patients were able to urinate by themselves or when catheterization was experienced as convenient. Some patients did not want to be catheterized, approving it only reluctantly. Independently of the method for bladder emptying, the patients in our study would choose the same method next time.

    Conclusions: The patients undergoing hip surgery seem to experience bladder emptying as an issue but of varying impact. Both bladder emptying through micturition and bladder emptying through catheterization are described in positive and negative terms.

  • 15.
    Hälleberg-Nyman, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langius-Eklöf, Ann
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Urology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Norlin, Rolf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.
    Hagberg, Lars
    Centre for Health Care Science, Örebro County Council, Örebro, Sweden.
    Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, p. 1589-1598Article in journal (Refereed)
    Abstract [en]

    Background Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery.

    Objectives The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness.

    Design Randomised controlled trial with cost-effectiveness analysis.

    Setting The study was carried out at an orthopaedic department at a Swedish University Hospital.

    Methods One hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge.

    Results Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (absolute difference 2.4%, 95% CI −6.9–11.6%) The patients in the intermittent catheterisation group were more often catheterised (p < 0.001) and required more bladder scans (p < 0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p < 0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods.

    Conclusions Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group.

  • 16.
    Hälleberg-Nyman, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langius-Eklöf, Ann
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, sweden.
    Johansson, Jan-Erik
    Norlin, Rolf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hagberg, Lars
    Vårdvetenskapligt forskningscentrum, Universitetssjukhuset, Örebro, sweden.
    Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysisManuscript (preprint) (Other academic)
    Abstract [en]

    Background:  Hip surgery is associated with a risk for postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). Presently, there is limited knowledge whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery.

    Objectives: The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness.

    Design: Randomised controlled trial with cost-effectiveness analysis.

    Setting: The study was carried out at an orthopaedic department at a Swedish university hospital.

    Method: One hundred seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge.

    Results: Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (p = 0.618).  The patients in the intermittent catheterisation group were more often catheterised (p <0.001) and required more bladder scans (p <0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p <0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods.

    Conclusions: In the perspective of cost-effectiveness both indwelling and intermittent methods could be appropriate in clinical praxis. Both methods have advantages and disadvantages but by not using indwelling catheterisation routinely in this patient group unnecessary catheterisations might be avoided.

  • 17.
    Hälleberg-Nyman, Maria
    et al.
    Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.
    Johansson, Jan-Erik
    Department of Urology, Örebro University Hospital,Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences. Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    A randomised controlled trial on the effect of clamping the indwelling urinary catheter in patients with hip fracture2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 3-4, p. 405-413Article in journal (Refereed)
    Abstract [en]

    Aim. To investigate the effect of clamping the urinary catheter before its removal in patients with hip fracture. Background. Difficulties to return to normal bladder function after removal of the urinary catheter are frequent in patients with hip fracture. Clamping the urinary catheter before removal is proposed to shorten the amount of time required to return to normal bladder function. Design. A randomised controlled trial was conducted at the orthopaedic clinic at a Swedish university hospital. Methods. Patients with hip fracture aged >= 50 without a urinary catheter, without cognitive impairment or additional severe physical problems at the time of admission (n = 113) were included. They were randomly assigned either to have their urinary catheter clamped before removal or to have their catheter removed with free drainage. Blinding was not possible because of the nature of the study. The primary outcome was the amount of time required to return to normal bladder function. Secondary outcomes were need for re-catheterisation and length of hospital stay. All patients were analysed in accordance with the intention-to-treat principle. Results. The median time required to return to normal bladder function was six (Q(1) 4-Q(3) 8) hours in the clamped catheter group and four (Q(1) 3-Q(3) 7.25) hours in the free drainage group. There were no significant differences between the groups regarding the time required to regain normal bladder function (p = 0.156), the number of patients requiring re-catheterisation (p = 0.904) and the mean time in hospital (p = 0.777). Conclusion. This randomised trial did not show any advantage or disadvantage with clamping the urinary catheter before removal. Relevance to clinica practice. Clamping is an additional task for the nursing staff in the removal of the indwelling urinary catheter. Therefore, when considering the present results, it seems that clamping the indwelling urinary catheters in patients with hip fracture is not indicated.

  • 18.
    Hälleberg-Nyman, Maria
    et al.
    Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.
    Johansson, Jan-Erik
    Department of Urology, Örebro University Hospital, Örebro, Sweden.
    Persson, Katarina
    Örebro University, School of Health and Medical Sciences.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences.
    A prospective study of nosocomial urinary tract infection in hip fracture patients2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2531-2539Article in journal (Refereed)
    Abstract [en]

    Aim.  To investigate risk factors and consequences of nosocomial urinary tract infection in hip fracture patients. Background.  Nosocomial urinary tract infection is a well-known problem in hip fracture patients. There are several risk factors for nosocomial urinary tract infection described in the literature.

    Design.  Prospective observational study with a descriptive and comparative design.

    Methods.  Hip fracture patients were included consecutively between April 2006-March 2007. Excluded were those under 50, having an indwelling urinary catheter, signs of cognitive impairment or additional severe physical problems at the time of admission. To verify nosocomial urinary tract infection, a urine specimen was taken at admission and discharge. Patients with and without nosocomial urinary tract infection were compared.

    Results.  The study included 86 hip fracture patients, of whom 45 (52·3%) contracted nosocomial urinary tract infection in hospital. Earlier reported risk factors for nosocomial urinary tract infection were not confirmed in this study, with one exception: diabetes. All diabetic patients in the study contracted urinary tract infections. Patients receiving cloxacillin as antibiotic prophylaxis for wound infection contracted UTI less often than other patients. There were no statistical differences between groups with regard to urinary tract infection frequency four months after fracture or with regard to mortality after one year.

    Conclusion.  Diabetes was the only previously known risk factor for nosocomial urinary tract infection confirmed among hip fracture patients in this study. Cloxacillin as antibiotic prophylaxis for surgery seemed to offer a certain protection against nosocomial urinary tract infection. Relevance to clinical practice.  Nurses in clinical practice should be aware of the risk of urinary tract infections in hip fracture patients and especially in hip fracture patients with diabetes. Patients given cloxacillin as antibiotic prophylaxis seem less likely to contract nosocomial urinary tract infection.

  • 19.
    Langius-Eklöf, Ann
    et al.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Christiansen, Mats
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Lindström, Veronica
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Hälleberg Nyman, Maria
    Örebro University, School of Health Sciences.
    Wengström, Yvonne
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Sundberg, Kay
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Adherence to Report and Patient Perception of an Interactive App for Managing Symptoms During Radiotherapy for Prostate Cancer: Descriptive Study of Logged and Interview Data2017In: JMIR cancer, ISSN 2369-1999, Vol. 3, no 2, article id e18Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients undergoing radiotherapy for prostate cancer experience symptoms related to both the cancer itself and its treatment, and it is evident that patients with prostate cancer have unmet supportive care needs related to their disease. Over the past decade, there has been an increase in the amount of research within the field of mobile health and the use of apps as tools for managing illness. The main challenge is to develop a mobile technology to its full potential of being interactive in real time. The interactive app Interaktor, which aims to identify and manage symptoms in real time includes (1) a function for patients' assessment of the occurrence, frequency, and distress of symptoms; (2) a connection to a monitoring Web interface; (3) a risk assessment model that sends alerts via text message to health care providers; (4) continuous access to evidence-based self-care advice and links to relevant websites for more information; and (5) graphs for the patients and health care providers to view the history of symptom reporting.

    OBJECTIVE: The aim of the study was to investigate user behavior, adherence to reporting, and the patients' experiences of using Interaktor during radiotherapy for localized advanced prostate cancer.

    METHODS: The patients were instructed to report daily during the time of treatment and then for an additional 3 weeks. Logged data from patients' use of the app were analyzed with descriptive statistics. Interview data about experiences of using the app were analyzed with content analysis.

    RESULTS: A total of 66 patients participated in the study. Logged data showed that adherence to daily reporting of symptoms was high (87%). The patients used all the symptoms included in the app. Of the reports, 15.6% generated alerts to the health care providers. Overall, the patients found that it was easy and not particularly time-consuming to send a daily report, and many described it as becoming a routine. Reporting symptoms facilitated reflection on their symptoms and gave them a sense of security. Few technological problems were reported.

    CONCLUSIONS: The use of Interaktor increased patients' sense of security and their reflections on their own well-being and thereby served as a supportive tool for the self-management of symptoms during treatment of prostate cancer. Some further development of the app's content might be beneficial for future use.

  • 20.
    Langius-Eklöf, Ann
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Yvonne, Wengström
    Karolinska Institutet, Stockholm, Sweden.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Hälleberg Nyman, Maria
    Örebro University, School of Health Sciences.
    Browall, Maria
    Högskolan i Skövde, skövde, Sweden.
    Sundberg, Kay
    Karolinska Institutet, Stockholm, Sweden.
    En interaktiv applikation för mobil och läsplatta: ett patientstöd med focus på personcentrerad, säker och kostnadseffektiv vård2015In: Omsorg: Nordisk tidsskrift for Palliativ Medisin, ISSN 0800-7489, Vol. 4, p. 53-59Article in journal (Refereed)
  • 21.
    Olsen, Lars André
    et al.
    Högskolen i Ålesund, Ålesund, Norge.
    Hälleberg Nyman, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Säker läkemedelsberäkning: dos, styrka, mängd2015Book (Other (popular science, discussion, etc.))
  • 22.
    Sundberg, Kay
    et al.
    Department of NVS, Division of Nursing, Karolinska Institutet, Huddinge, Stockholm, Sweden; Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden.
    Wengström, Yvonne
    Department of NVS, Division of Nursing, Karolinska Institutet, Huddinge, Stockholm, Sweden; Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Hälleberg-Nyman, Maria
    Örebro University, School of Health Sciences.
    Frank, Catharina
    Department of NVS, Division of Nursing, Karolinska Institutet, Huddinge, Stockholm, Sweden.
    Langius-Eklöf, Ann
    Department of NVS, Division of Nursing, Karolinska Institutet, Huddinge, Stockholm, Sweden.
    Early detection and management of symptoms using an interactive smartphone application (Interaktor) during radiotherapy for prostate cancer2017In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 25, no 7, p. 2195-2204Article in journal (Refereed)
    Abstract [en]

    Purpose: Patients undergoing radiotherapy for prostate cancer suffer from a variety of symptoms which influence health-related quality of life. We have developed an application (Interaktor) for smartphones and tablets for early detection, reporting and management of symptoms, and concerns during treatment for prostate cancer. The study evaluates the effect on symptom burden and quality of life when using the application for real-time symptom assessment and management during radiotherapy for localized prostate cancer.

    Methods: A non-randomized controlled study was used at two university hospitals in Sweden where 64 patients constituted a control group and 66 patients made up an intervention group. The intervention group was asked to report symptoms via the application daily during the treatment as well as 3 weeks after. The EORTC QLQ-C30 and its module PR25 and the Sense of Coherence questionnaire were administered at three time points in both groups.

    Results: The intervention group rated significantly lower levels of fatigue and nausea at the end of radiotherapy. Moreover, they had significantly less burden in emotional functioning, insomnia, and urinary-related symptoms at the end of treatment as well as 3 months later compared with the control group. In the multivariate analyses, with education and sense of coherence as covariates, the intervention group still significantly rated emotional functioning (p = 0.007), insomnia (p = 0.017), and urinary-related symptoms (p = 0.008) as better than the control group at T2.

    Conclusion: Study findings suggest that Interaktor could be an efficient mHealth tool for facilitating supportive care needs during cancer treatment.

  • 23.
    Sundberg, Kay
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Wengström, Yvonne
    Karolinska Institutet, Stockholm, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hälleberg-Nyman, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langius-Eklöf, Ann
    Karolinska Institutet, Stockholm, Sweden.
    Developing and evaluating an interactive ICT-application: a methodological challenge2014In: Nordic Conference in Nursing Research 2014, 2014Conference paper (Refereed)
1 - 23 of 23
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