To Örebro University

Immersive virtual reality (IVR) has been increasingly integrated into stroke rehabilitation albeit the effectiveness across different outcome domains remains unclear. This study aimed to review evidence from randomized controlled trials evaluating the effects of IVR, used alone or in combination with conventional rehabilitation, on motor-, functional-, and participation-related outcomes after stroke. Ovid MEDLINE, Embase, Cochrane Library and CINAHL were screened up to April 2025 to identify eligible randomized controlled trials (RCTs). A systematic literature search was conducted. Randomized controlled trials including adults with stroke and evaluating immersive virtual reality interventions were eligible. Studies using non-immersive VR, non-randomized designs, or not reporting motor, functional, or participation outcomes were excluded. Meta-analyses were performed where data were sufficiently homogeneous; otherwise, outcomes were summarized descriptively. Risk of bias was assessed using standardized appraisal tools, and certainty of evidence was evaluated using the GRADE approach. Out of 3,574, we included 34 RCTs involving post-acute, subacute and chronic stroke survivors, with a total of1200 participants. Meta-analyses showed IVR, most commonly delivered in combination with conventional rehabilitation, to be associated with improvements in upper extremity motor impairment, particularly measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE). Small but significant effects were also found for selected gait parameters. In contrast, effects on functional performance, balance, and quality of life were inconsistent and could not be robustly quantified. The overall certainty of evidence ranged from low to very low, primarily due to heterogeneity, methodological limitations, and small sample sizes. In conclusion, IVR appears to be a promising and safe supplement to conventional stroke rehabilitation, particularly for improving motor impairment. However, evidence remains limited and inconsistent across functional outcomes. More well-designed, adequately powered trials with standardized interventions and clinically meaningful outcome measures are needed to clarify the role of IVR in stroke rehabilitation. PROSPERO (Registration number: CRD420250639792).

Background

Working as a neonatal nurse requires advanced clinical skills and the ability to support stressed and anxious parents. However, little is known about how newly employed nurses are onboarded into this complex care environment. This study aimed to map onboarding practices for newly hired nurses in Swedish neonatal units.

Methods

A national cross-sectional survey was sent to all nurse managers in Swedish neonatal units (n = 37). Eighteen managers participated (response rate 53%). Quantitative data were analyzed descriptively, and free-text responses were analyzed using inductive content analysis.

Results

All responding units reported hiring newly graduated nurses. The typical onboarding period was 10–12 weeks. Structured mentorship programs were reported by 11 units, while competency assessment tools were used in a minority of units. Free-text responses described a competent neonatal nurse as someone who works proactively, understands the rationale behind interventions, and anticipates deterioration.

Conclusion

Onboarding practices vary substantially across units. Common elements include extended introductions and structured mentorship, whereas formal specialist education is less emphasized.

Background: Clinical practice is essential for student nurse anesthetists to integrate theory with practical skills; however, the demanding clinical environment can impact both stress and learning outcomes. Responsibilities and expectations differ across healthcare systems, and research in the Swedish context remains limited. Addressing this gap is essential for understanding how clinical practice contributes to the development of professional readiness and competence. This study, therefore, aimed to describe the learning experiences of students and newly graduated nurse anesthetists, with a focus on the clinical learning environment and the stress it entails.

Methods: A convergent parallel mixed-methods design was used. In the quantitative strand, student nurse anesthetists were recruited using convenience sampling to complete a web-based survey that included the two instruments, "Clinical Learning Environment Supervision and Nurse Teacher evaluation scale" and "Perceived Stress Scale" (with 10 items). Data were analyzed with descriptive statistics, while free-text answers were analyzed using summative content analysis and word frequencies. In the qualitative strand, newly graduated nurse anesthetists were recruited using purposive sampling to participate in individual semi-structured interviews. Data were analyzed with content analysis. After separate analysis, the pillar integration process was used to integrate quantitative and qualitative data.

Results: The analysis included data from 63 surveys (63/225, 28%) and 13 interviews. The integration of data from both strands yielded two divergent themes, "An unfamiliar but supportive learning environment" and "Experience of stress," and two convergent themes, "Supervisors, a facilitator to learning" and "Dynamic learning situations."

Conclusion: Despite the challenges of adapting to new knowledge contexts, participants reported high satisfaction with the clinical learning environment, as shown by elevated scores in the Clinical Learning Environment Supervision and Nurse Teacher evaluation scale. Clinical supervisors played a pivotal role in supporting learning, and the environment's pedagogical flexibility enabled both individual and collaborative approaches. Although stress levels varied, the average Perceived Stress Scale score remained low.

INTRODUCTION: Emergency department visits are common following bariatric surgery and may be partially preventable. Health literacy and general self-efficacy are factors that may influence health-seeking behaviors in these patients. This study aimed to assess whether health literacy and general self-efficacy are associated with an increased frequency of emergency department visits after bariatric surgery.

METHODS: Patients who underwent bariatric surgery at a single hospital from 2018 to 2020 were evaluated for their health literacy and general self-efficacy levels before surgery. Data on emergency department visits within the patient's residential region were evaluated over a three-year period, with repeated emergency department visits for abdominal pain as the primary outcome.

RESULTS: During the follow-up period, 69 of 231 patients (29.9%) had at least one emergency department visit for abdominal pain, and 20 patients (8.7%) had three or more visits. Inadequate functional health literacy (OR 5.56, 95% CI 1.80-17.19, p = 0.003) and inadequate communicative and critical health literacy (OR 10.48, 95% CI 3.13-35.08, p < 0.001) were both significantly associated with an increased risk of repeated emergency department visits over the three-year period. No significant association was found between low general self-efficacy and the frequency of emergency department visits.

CONCLUSIONS: Inadequate health literacy is associated with an increased risk of repeated emergency department visits for abdominal pain following bariatric surgery.

Bakgrund:

Företagshälsovården (FHV) är en expertresurs i arbetsmiljöfrågor och kan ge stöd och bidra med kunskap till sina kunder i deras systematiska arbetsmiljöarbete. Samverkan mellan de olika professionerna i FHV kan vara avgörande för kvaliteten på den service som ges till kunden. 

Syfte:

Syftet med studien var att utforska erfarenheter av interprofessionell teamsamverkan bland medarbetare i FHV i Sverige.

Metod:

Fem fokusgruppsdiksussioner (FGD) genomfördes under februari och mars 2024 på fyra olika hälsor i Svealand. Antalet deltagare varierade mellan tre och tio och representerade nio olika professioner inom FHV. En semistrukturerad intervjuguide användes vid FGD som spelades in och transkirberades. Reflexiv tematisk analys enligt Braun och Clarke genomfördes. 

Resultat:

Analysen ledde fram till det övergripande teamt FHV-teamet är dynamiskt och flexibelt, och tre huvudteman samt fem underteman. Möjligheten att arbeta tillsammans bidrar till kunskapsutveckling. Förutsättningar för teamsamverkan påverkas av tid, avstånd och stöd från den egna chefen och organisationen. Olika syn på evidensbaserad praktik och brist på utbildning i FHV kan bli barriärer som motverkar teamsamverkan. Den egna arbetsmiljön påverkas positivt av samarbetet med att utveckla hälsosamma arbetsplatser hos kunderna.

Konklussion:

Att känna varandra och ha samsyn ökar möjligheterna för teamsamverkan. Avstånd och brist på tid kan vara hinder för teamsamverkan. Genom en välfungerande teamsaverkan kan FHV möta kundernas behov av stö i arbetet med att utveckla hälsosamma arbetsplatser. Teamsamverkan är hälsofrämjade för medarbetarna i FHV.

Purpose: This study explores student nurse anesthetists' (SNAs) learning in the operating room during the coronavirus 2019 pandemic.

Design: An explorative design with semistructured interviews was used.

Methods: Thirteen former SNAs and 12 clinical supervisors (8 of whom were included in the final analysis) were recruited from 6 counties in Sweden. Participants were purposively recruited. Inclusion criterion for former SNAs was having completed the nurse anesthesia program in the fall of 2020 to spring 2022; and for nurse anesthetists, those who have experience in supervising SNAs. The interviews were analyzed with thematic analysis.

Findings: The analysis identified one theme and five subthemes. The theme was that student learning was in focus despite an ongoing pandemic. Every learning situation contributed, and learning was triggered by the challenges. Both the SNAs and the supervisors exhibited resilience by accepting the situation and striving to do their absolute best in a nonoptimal learning environment. Over time, learning and supervision returned to normal.

Conclusions: During the pandemic, learning was ongoing despite stress, fear, and other challenging factors. Students' learning appears to have been prioritized. The study highlights that nurse anesthetists and SNAs were resilient, resourceful, and able to find new ways to keep learning going. 

After bariatric surgery, adherence to lifestyle recommendations is crucial. Health literacy and self-efficacy may impact recovery after surgery. In this multicentre study performed in three hospitals in Sweden, we evaluated any relation between preoperative health literacy and general self-efficacy on the one side and weight loss, health-related quality of life, length of stay, and complications up to 2 years after bariatric surgery on the other. Of 686 included patients, 56% (n = 382) had limited functional health literacy, 42% (n = 278) had limited communicative and critical health literacy, and 40% (n = 266) reported low general self-efficacy. Preoperative functional, communicative and critical health literacy, and general self-efficacy were not associated with the degree of weight loss at 1 or 2 years after surgery. However, limited health literacy and low general self-efficacy scores were associated with both reduced quality of life and obesity-related problems postoperatively. Further, a higher proportion of those with inadequate health literacy had a prolonged length of stay. Although patients with limited health literacy and self-efficacy may experience similar maximum weight loss after bariatric surgery as other patients, they still might have reduced health-related quality of life in terms of obesity-related problems. Increased awareness of this association as well as patient-centered support before and after bariatric surgery may be of benefit.

Health literacy (HL) is a critical determinant of health, as it affects health behavior and outcomes, in addition to equity in health. This study aimed to translate, culturally adapt, and validate the Swedish version of HLS19-Q12 (HLS19-Q12-SE). The HLS19-Q12 is a widely used instrument that consists of 12-items and is often used to assess HL in Europe. A convergent mixed-methods design was applied, including cognitive interviews (n = 8) and psychometric testing with a survey sample (n = 374) and test-retest group (n = 28). The instrument was forward and backwards translated and culturally adapted. Data was analyzed using confirmatory and exploratory factor analysis, correlation testing, and reliability assessments. Cognitive interviews explored the clarity, interpretation, and contextual relevance of the items. Participants found the HLS19-Q12-SE clear and easy to understand, though some reported difficulties with unfamiliar health situations and uncertainty of the term "health information." Based on the interviews, the examples for one of the items were culturally adapted. Psychometric testing showed good feasibility, no floor or ceiling effects on scale level, and moderate positive correlations with other HL instruments, supporting internal and external validity. Structural validity was confirmed, and internal consistency and test-retest reliability were satisfactory. However, ceiling effects were observed at the dichotomous item level, and correlations with self-rated health and social status were low. The HLS19-Q12-SE is a reliable and valid instrument for assessing general HL in Sweden. While psychometric properties were strong overall, future research should address ceiling effects on item level and explore the instrument's performance in more diverse populations.