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Background: At the beginning of the 21st century, international adoptions of children with cleft lip and/or palate increased dramatically in Sweden. Many children arrived partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. To date, the speech development of internationally adopted (IA) children has been described up to age 7–8 years, but later development remains unstudied. Aims: To investigate speech development between ages 5 and 10 years in children born with cleft lip and palate (CLP) adopted from China and to compare them with non‐adopted (NA) children with CLP. A secondary aim was to compare the frequencies of secondary palatal surgery and number of visits to a speech and language pathologist (SLP) between the groups. Methods & Procedures: In a longitudinal study, 23 IA children from China were included and matched with 23 NA children born in Sweden. Experienced SLPs blindly reassessed audio recordings from routine follow‐ups at ages 5 and 10 years. Velopharyngeal function (VPF) was assessed with the composite score for velopharyngeal competence (VPC‐Sum) for single words and rated on a three‐point scale (VPC‐Rate) in sentence repetition. Target sounds in words and sentences were phonetically transcribed. Per cent correct consonants (PCC) were calculated at word and sentence levels. For in‐depth analyses, articulation errors were divided into cleft speech characteristics (CSCs), developmental speech characteristics (DSCs) and s‐errors. Information on secondary palatal surgery and number of visits to an SLP was collected. Outcomes & Results: VPF differed significantly between the groups at both ages when assessed with VPC‐Sum, but not with VPC‐Rate. Regardless of the method for assessing VPF, a similar proportion in both groups had incompetent VPF but fewer IA than NA children had competent VPF at both ages. IA children had lower PCC at both ages at both word and sentence levels. More IA children had CSCs, DSCs and s‐errors at age 5 years, and CSCs and s‐errors at age 10. The development of PCC was significant in both groups between ages 5 and 10 years. The proportion of children receiving secondary palatal surgery did not differ significantly between the groups, nor did number of SLP visits. Conclusions & Implications: CSCs were more persistent in IA children than in NA children at age 10 years. Interventions should target both cleft and DSCs, be comprehensive and continue past the pre‐school years. WHAT THIS PAPER ADDS: What is already known on this subject: At the beginning of the 21st century, IA children with cleft lip and/or palate arrived in Sweden partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. Studies up to age 7–8 years show that adopted children, compared with NA peers, have poorer articulation skills, demonstrate both cleft‐related and developmental articulation errors, and are more likely to have velopharyngeal incompetence. Several studies also report that adopted children more often require secondary palatal surgery due to fistulas, dehiscence or velopharyngeal incompetence compared with NA peers. What this paper adds to existing knowledge: This longitudinal study provides additional knowledge based on longer follow‐ups than previous studies. It shows that the proportion of children assessed to have incompetent VPF was similar among IA and NA children. It was no significant difference between the groups regarding the proportion that received secondary palatal surgery. However, fewer IA children were assessed to have a competent VPF. Developmental articulation errors have ceased in most IA and all NA children at age 10 years, but significantly more adopted children than NA children still have cleft‐related articulation errors. What are the potential or actual clinical implications of this work?: Speech and language therapy should target both cleft‐related and developmental articulation errors. When needed, treatment must be initiated early, comprehensive, and continued past the pre‐school years, not least for adopted children. [ABSTRACT FROM AUTHOR]

Introduction: Early recognition of pain in children is crucial, and their self-report is the primary source of information. However, communication about pain in healthcare settings can be challenging. For non-verbal communication regarding different symptoms, children prefer digital tools. The electronic Faces Thermometer Scale (eFTS) utilizes a universal design with colors, face emojis, and numbers on an 11-point scale (0-10) for pain assessment. The aim of this study was to establish content validity of the eFTS for pain assessments in children. Methods: A mixed methods design was used. The study took place at a university hospital in eastern Sweden, involving 102 children aged 8-17 years who visited outpatient clinics. Participants were presented with 17 pictures representing varying pain levels and asked to assess hypothetical pain using the eFTS. A think-aloud approach was employed, prompting children to verbalize their thoughts about assessments and the eFTS. Quantitative data were analyzed using descriptive and comparative statistics, together with a qualitative approach for analysis of think-aloud conversations. Results: A total of 1,734 assessments of hypothetical pain using the eFTS were conducted. The eFTS differentiated between no pain (level 0-1) and pain (level 2-10). However, no clear agreement was found in the differentiation between hypothetical pain intensity levels (level 2-10). The analysis revealed that children utilized the entire scale, ranging from no pain to high pain, incorporating numbers, colors, and face emojis in their assessments. Discussion: The variability in assessments was influenced by prior experiences, which had an impact on the statistical outcome in our study. However, employing the think-aloud method enhances our understanding of how children utilize the scale and perceive its design, including the incorporation of emotion-laden anchors. Children express a preference for using the eFTS to assess their pain during hospital visits. [ABSTRACT FROM AUTHOR]

The aim was to explore why registered nurses (RNs) in Sweden choose to quit their jobs in hospitals, also in relation to experienced patient safety. Previous research has shown that nurse turnover, especially in hospital settings, is a serious challenge for society and health care globally. Insufficient staffing of RNs is linked to poorer patient outcomes and a general patient safety at risk. It is, therefore, important to continually explore how nurses describe their reasons for quitting their jobs. The study was conducted using a qualitative descriptive design, based on 11 semistructured interviews with RNs. The analysis generated four categories describing the results: Feeling that the profession is not valued; Psychological and physical symptoms related to work; An insufficient and unsupportive organization; and Unsatisfying leadership and teamwork. Specifically, the RNs participating in this study described a range of reasons for quitting, where the feeling of not being valued and treated as a respected and autonomous profession was a common thread throughout the results. RNs experienced that, overall, the insufficient work conditions, also resulting in lower patient safety, ultimately led to their decision to quit. The findings highlight the crucial need for employers to develop working conditions for RNs, to make sure that the profession is valued according to professional standards and provide the potential for autonomous nursing practice. To reduce nurse turnover, and instead attract and retain nurses, leadership and management in nursing need to be adjusted to meet the demands of a modern academic profession. [ABSTRACT FROM AUTHOR]

Background: According to shortage of registered nurses, organisational and leadership aspects grounded in person-centrered approach, are highlighted to ensure high quality of care. Therefore, it is interesting to develop knowledge regarding registered nurses working environment. Aim: The aim of the study was to investigate registered nurses' reason to end their employment at a university hospital setting (internal medicine, emergency department). Method: Qualitative content analysis with an inductive methodological approach was used to analyse registered nurses' experiences regarding their former employment. Inclusion criteria; all nurses (n = 55) who ended employment during one year (first of July 2020-30th of June 2021) were invited, and 38 semi-structured interviews were conducted. Results: Three categories were identified: Limited organisational support, Lack of visible leadership, and Limited healthy working environment, followed by six subcategories: Longing for organisational support, Being a tile in a box, Need for professional relationship, Limitation of supportive leadership, Imbalance of work versus personal life, and Ethical stress. Conclusion: To improve registered nurses working environment and commitment to work, balance between time at work and personal life is significant. Therefore, organisational support and leadership skills grounded in a person-centred approach are crucial to develop a healthy working environment. A person-centred leadership could improve collaboration and shared decision-making in partnership with those involved, managers, nurses, and team members. [ABSTRACT FROM AUTHOR]

There is growing evidence of the positive effects of constraint-induced movement therapy (CIMT) for infants at high risk of unilateral cerebral palsy (UCP) when provided by parents with in-person coaching/supervision from occupational therapists during home visits. The aim of this study is to investigate whether Baby-mCIMT (modifiedCIMT) can be as effective if parents are coached/supervised remotely. In this case-control study, we recruited 20 infants and re-used 18 controls, 4–8-month-old infants in both groups at high risk of UCP. The same protocol regarding inclusion criteria, data collection, and training volume was used in both groups. The training was conducted for two 6-week periods, separated by a 6-week break, consisting of daily 30 min sessions conducted by parents, supported by therapist coaching once a week. The primary outcome was measured using the Hand Assessment for Infants (HAI). There was no difference in the change of HAI units (p = 0.803) or that of the affected-hand raw score (p = 0.942) between the two groups. The remote coaching method was well received by parents. In conclusion, this demonstrates that remote coaching/supervision is as effective as the in-person approach, requiring less time and effort for both families and healthcare providers. [ABSTRACT FROM AUTHOR]

Aim: To explore young adults' experiences of living with type 1 diabetes in the transition to adulthood, including experiences of the transfer from paediatric to adult care. Design: A qualitative approach was used. Method: Ten young adults, six women and four men, aged 19–29 years, participated. Participants were recruited at their regular diabetes clinic from spring 2021 to spring 2022. Semi‐structured interviews were transcribed and analysed using qualitative content analysis. Findings: Dreaming of being nurtured towards self‐reliance was the overarching theme. Personal experiences of the transition to adulthood, including the transfer from paediatric to adult care, were described in terms of struggling to find balance in daily life, dealing with feelings of being different, being gradually supported to achieve independence, and wishing to be approached as a unique person in healthcare. Conclusion: In healthcare, it is important to emphasize not only diabetes‐related factors but also emotional and psychosocial aspects of life connected to the transition to adulthood, including the transfer to adult care. The young adults wished to be seen as unique persons in healthcare during their emerging adulthood and should therefore be supported to achieve self‐reliance through personal preparations for new challenges and for the consequences of transitioning to adulthood. Specialist nurses can provide appropriate knowledge and leadership. Implications for the Profession: These findings can guide nurse specialists in support for emerging adults to achieve self‐reliance and indicate the importance of person‐centred care when experiencing transition and transfer. Reporting Method: The study adhered to EQUATOR guidelines, and the COREQ checklist for qualitative studies was used as the reporting method. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to describe circumstances concerning access for patients and relatives to take part in patient health and safety in a hospital setting. Design: This study used a qualitative descriptive design and was conducted at a Swedish university hospital. Method: The 79 complaints reported by patients and relatives included in this study were registered between January 2017 and June 2019. These complaints were classified as concerning access to healthcare services. Data were analysed using qualitative content analysis. Results: The overarching theme, struggling for access as a human being in the healthcare system, encompassed three themes describing patients' and relatives' needs. The three themes were (1) navigating through the healthcare organization, (2) making sense of self and what is going on and (3) being acknowledged as having needs. Conclusion: Patients and relatives continuously participate in various ways in healthcare to promote health and prevent patient harm. Our findings contribute important knowledge about the meaning of access from a broad healthcare system perspective. Access was restricted in terms of appropriateness in how patients' needs were met. This restriction of access risked the deterioration of patient health and safety. Impact: Patients and relatives play an active part in patient health and safety, although their attempts are sometimes hindered. Restrictions in the appropriateness of access prevented patients and relatives from taking part in patient health and safety, which appeared to mean that they had to adapt and expend effort to the point that it negatively affected their health and everyday life. These findings concern all patients, relatives and healthcare professionals in hospital‐associated settings. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Oral cancer is a severe and potentially fatal disease usually starting in the squamous epithelium lining the oral cavity. Together with oropharyngeal carcinoma, it is the fifth to sixth most common malignancy worldwide. To limit the increase in the global oral cancer incidence over the past two decades, the World Health Assembly adopted a resolution urging member states to integrate preventive measures such as engagement and training of dental personnel in screening, early diagnosis, and treatment into their national cancer control programs. Aim: The aim of this study was to investigate if dental hygienists (DHs) and dentists (Ds) in general dental practice care can be entrusted to perform brush sampling of oral potentially malignant disorders (OPMDs), and to evaluate their level of comfort in performing brush biopsies. Methods: Participants were five DHs and five Ds who received one day of theoretical and clinical training in oral pathology to identify OPMDs (leukoplakia [LP], erythroplakia [EP], and oral lichen planus [OLP]), and perform brush sampling for PAP cytology and high‐risk human papillomavirus (hrHPV) analysis. Results: Out of 222 collected samples, 215 were adequate for morphological assessment and hrHPV analysis. All the participants agreed that sample collection can be incorporated in DHs and Ds routine clinical duties, and most of them reported that sample collection and processing was easy/quite easy. Conclusion: Dentists and DHs are capable of collecting satisfactory material for cytology and hrHPV analysis. All the participating DHs and Ds were of the opinion that brush sampling could be handled routinely by DHs and Ds in GDP. [ABSTRACT FROM AUTHOR]

Background Effective antimicrobial treatment is key for survival in bloodstream infection (BSI), but the impact of timing of treatment remains unclear. Our aim was to assess the association between time to appropriate antimicrobial treatment and 30-day mortality in BSI patients. Methods This was a retrospective cohort study using electronic health record data from a large academic center in Sweden. Adult patients admitted between the years 2012 and 2019, with onset of BSI at the emergency department or general wards, were included. Pathogen-antimicrobial drug combinations were classified as appropriate or inappropriate based on reported in vitro susceptibilities. To avoid immortal time bias, the association between appropriate therapy and mortality was assessed with multivariable logistic regression analysis at pre-specified landmark times. Results We included 10 628 BSI-episodes, occurring in 9192 unique patients. The overall 30-day mortality was 11.8%. No association in favor of a protective effect between appropriate therapy and mortality was found at the 1, 3 and 6 hours landmark after blood culture collection. At 12 hours, the risk of death increased with inappropriate treatment (adjusted odds ratio 1.17 [95% confidence interval {CI}, 1.01–1.37]) and continued to increase gradually at 24, 48, and 72 hours. Stratifying by high or low SOFA score generated similar odds ratios, with wider confidence intervals. Conclusions Delays in appropriate antimicrobial treatment were associated with increased 30-day mortality after 12 hours from blood culture collection, but not at 1, 3, and 6 hours, in BSI. These results indicate a benchmark for providing rapid microbiological diagnostics of blood cultures. [ABSTRACT FROM AUTHOR]

To explore the experiences of being a family with one member suffering from severe traumatic brain injury (STBI) up to 7 years earlier through narrative family interviews. There are few studies where a family as a unit, including persons with STBI, are interviewed together. This study used a family systems research approach following a qualitative interpretative design. Therefore, 21 families with a total of 47 family members were interviewed. Qualitative content analysis was used to reveal categories with sub-categories and a theme. "From surviving STBI towards stability, through the unknown, into a new everyday life and a new future as a family" characterized the implicit message. The results revealed two categories both with three subcategories. The first category characterized the rapid change from a normal everyday life to one of uncertainty and finally to one of stability, and the second category described how it is to adapt as a family after STBI. Long-term experiences of STBI show the importance for the whole family of belonging to a context, having a job, and having something to belong to as a way to achieve stability. Families' feelings of loneliness and lack of treatment and support are challenges for professionals when trying to involve families in care and rehabilitation. A sense of belonging, having a purpose and a social network are important within families. Professionals can provide information and can help to eliminate misunderstandings for individuals with severe traumatic brain injury and their families. It is important for rehabilitation professionals to undertake a thorough family assessment. This assessment will support families become involved in the process of rehabilitation. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical usability of PURPOSE T among registered nurses in Sweden. Background: Pressure ulcers are an adverse event and a problem worldwide. Risk assessment is a cornerstone, and a first step in pressure ulcer prevention is to identify possible risk patients and/or pressure ulcers. There are many pressure ulcer risk assessment instruments; however, they are not updated and/or evidence‐based. PURPOSE T has been psychometrically evaluated in the UK and in Sweden with good inter‐rater and test–retest reliability, and convergent validity was reported as moderate. Design: A descriptive study design with a qualitative approach. Methods: A total of six focus group interviews with 29 registered nurses were conducted. They were recruited from May 2018 to November 2018 from a university hospital and two nursing homes in Sweden. Data analysis was performed as described by Krueger. The study adheres to the COREQ guidelines. Results: Four categories were identified: "An efficient risk assessment instrument performed at the bedside," "Deeper understanding and awareness of risk factors," "Benefits compared to the Modified Norton Scale" and "Necessity of integration of PURPOSE T in the electronic health record and team collaboration." Conclusion: The registered nurses acknowledged an overall positive perception of PURPOSE T´s clinical usability. Future research is needed to evaluate the feasibility of PURPOSE T. Relevance to Clinical Practice: PURPOSE T has the potential to replace outdated pressure ulcers risk assessment instruments that are used today. [ABSTRACT FROM AUTHOR]

The relationship between sleep duration and sleepiness has seen much research, but no data are available on the association between polysomnographically (PSG) determined total sleep time (TST) (or other PSG variables) and subjective sleepiness during the subsequent day in individuals in their habitual life situation. The purpose of the present study was to study the association between TST and sleep efficiency (SE) (and other PSG variables) and next-day sleepiness at 7 times of the day. A large population-based group of women (N = 400) participated. Daytime sleepiness was measured with the Karolinska Sleepiness Scale (KSS). The association was studied through analysis of variance (ANOVA), as well as regression analyses. For SE there was a significant difference in sleepiness across groups with >90%, 80%-89.99%, and <80% SE (F = 7.2, p < .001, eta2 = 0.04), with lowest sleepiness in the first group. In contrast, TST groups of <6 h, 6-6.99 h, and ≥7 h did not differ significantly. In addition, a pronounced U-shape (eta2 > 0.45) was seen for both analyses, with maximum sleepiness at bedtime (≈ 7.5 KSS units). A multiple regression analysis, including all PSG variables (adjusted for age and BMI), showed that SE was a significant predictor (β = 0.16, p < .05) of mean sleepiness, even after depression, anxiety, and subjective sleep duration were entered, but this was eliminated by subjective sleep quality. It was concluded that high SE is modestly associated with lower next-day sleepiness in women in a real-life context, but that TST is not. [ABSTRACT FROM AUTHOR]

Postexercise heart-rate (HR) recovery (HRR) indices have been associated with running and cycling endurance-exercise performance. The current study was designed (1) to test whether such a relationship also exists in the case of cross-country skiing (XCS) and (2) to determine whether the magnitude of any such relationship is related to the intensity of exercise before obtaining HRR indices. Ten elite male cross-country skiers (mean ± SD; 28.2 ± 5.4 y, 181 ± 8 cm, 77.9 ± 9.4 kg, 69.5 ± 4.3 mL · min–1 · kg–1 maximal oxygen uptake [VO2max]) performed 2 sessions of roller-skiing on a treadmill: a 2 × 3-km time trial and the same 6-km at an imposed submaximal speed followed by a final 800-m time trial. VO2 and HR were monitored continuously, while HRR and blood lactate (BLa) were assessed during 2 min immediately after each 6-km and the 800-m time trial. The 6-km time-trial time was largely negatively correlated with VO2max and BLa. On the contrary, there was no clear correlation between the 800-m time-trial time and VO2, HR, or BLa. In addition, in no case was any clear correlation between any of the HRR indices and performance time or VO2max observed. These findings confirm that XCS performance is largely correlated with VO2max and the ability to tolerate high levels of BLa; however, postexercise HRR showed no clear association with performance. The homogeneity of the group of athletes involved and the contribution of the arms and upper body to the exercise preceding determination of HRR may explain this absence of a relationship. [ABSTRACT FROM AUTHOR]

Structured reflective writing during clinical placement has been shown to be valuable for students' learning and for their personal and professional development. The aim of this study was to examine clinical supervisors' experiences of midwifery students' daily written reflections on their practice at birthing units. A qualitative study was performed, and data were analysed using content analysis. In total 17 midwives working as clinical supervisors in the South of Sweden were interviewed using both focus groups and individual interviews. One main category 'A process for mutual professional growth', three categories and seven subcategories emerged from the analyses. The supervisors' experience was that reflective writing facilitated individualized supervision and initiated a loop of reflection. The way students wrote their reflections affected the feedback and was an aid for the supervisor to be active and flexible. The process of using written reflections was considered as a tool for following the progress of the students and the process of learning but also developed the midwife in her supervisory as well as in her professional role. The supervisors called for more time allotted, better organizational support, and clearer instructions for how to write feedback. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whetherdaily mobile-phone delivered messages with training instructions during three months increase physical activity and overall mobility in patients soon after stroke or transient ischemic attack. Design: Randomised controlled trial with intention-to-treat analyses. Setting: University hospital. Data collection from November 2016 until December2018. Subjects: Seventy-nine patients (mean (SD) age 63.9 (10.4) years, 29 were women) were allocated to either intervention (n = 40) or control group (n = 39). Participants had to be independent (modified Ranking Scale ⩽2) and able to perform the six-minute walking test at discharge from the hospital. Interventions: The intervention group received standard care and daily mobile phone instructional text messages to perform regular outdoor walking and functional leg exercises. The control group received standard care; that is, primary care follow-up. Main measures: Walking performance by six-minute walking test (m), lower body strength by five times chair-stand test (s), the short physical performance battery (0–12 points) and 10-metres walk test (m/s) were assessed at baseline and after three months. Results: The estimated median difference in the six-minute walking test was in favour of the intervention group by 30 metres (95% CI, 55 to 1; effect size 0.64; P = 0.037) and in the chair-stand test by 0.88 seconds (95% CI, 0.02 to 1.72; effect size 0.64; P = 0.034). There were no differences between groups on the short physical performance battery or in 10-metres walking time. Conclusions: Three months of daily mobile phone text messages with guided training instructions improved composite mobility measures; that is, walking performanceand lower body strength. Clinical Trial Registry: The study is registered with ClinicalTrials.gov, number NCT02902367. [ABSTRACT FROM AUTHOR]

Background: Timely identification of patients with palliative care needs is a prerequisite for being able to carry out effective and equal palliative care. The Supportive and Palliative Care Indicators Tool (SPICT) identifies patients likely to benefit from a palliative approach. Aim: The main objective was to describe the translation, cross‐cultural adaptation and content validation process of the SPICT‐SE. In this process, the prefinal SPICT‐SE was tested in focus group interviews to explore how the tool was perceived and interpreted by healthcare professionals in a Swedish healthcare context. Methods: In this qualitative descriptive study, the translation, cross‐cultural adaptation and content validation process of the SPICT‐SE was based on a recommended method for cross‐cultural adaptation of self‐report measures. The process included two independent forward translations, a synthesis, and one independent back‐translation. An expert committee consolidated all the versions and developed the prefinal version of the SPICT‐SE. The prefinal version of the SPICT‐SE was tested in four focus group interviews with physicians and nurses engaged in inpatient or outpatient care in south‐west Sweden. A thematic analysis of the transcribed interviews was performed. The SPICT‐SE was then revised to the final version. Results: In the thematic analysis, four themes were constructed that together described how the SPICT‐SE was perceived and interpreted by healthcare professionals: The mindset is familiar and relevant; the tool needs to be adjusted in order to be clearer; the purpose and consequences of the tool are ambiguous; and the tool supports a palliative approach. Conclusion: The SPICT‐SE has now been successfully translated, culturally adapted and content validated in a Swedish healthcare context. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to explore personal experiences of pain in people with motor neuron disease. Materials and methods: Sixteen participants were individually interviewed on one occasion concerning their experiences of presentation, consequences, and management of pain. Qualitative content analysis with researcher triangulation was used to synthesize and interpret data. Results: Four themes emerged as the result of the analysis: (1) The multiple faces of pain, (2) The thin line between experience of pain and no pain, (3) The negative effects of pain on role functioning (4) Successful coping with pain requiring personal effort and competent engagement. The important findings were the experiences of unpredictability of pain breakthroughs, the efforts required to manage pain, consequences for activity and quality of life, and the suffering induced by diminishment and neglect of pain from both patients and staff. Conclusions: Pain in motor neuron disease seems to have certain and multiple characteristics, which is why there is a need to develop and implement pain assessment methods adapted to this population. Such methods may help make pain more predictable, and increase the possibilities to provide effective and individually tailored pain treatment. Pain is a common, but often neglected, ailment in motor neuro disease, which deserves more attention from health care. Staff should provide information about the pain being possible to treat successfully with medication, by contrast to the possibility of curing the disease itself. Pain assessments should be implemented during the entire course of the disease, covering a time frame long enough to cover characteristic fluctuations of pain. Whenever possible, facilitate the performance of painful activities of daily living as much as possible to make room for engagement in other personally valued activities of importance for individual quality of life. [ABSTRACT FROM AUTHOR]

Patient accessible electronic health records have been launched in many countries, and generally, health-care professionals have had strong initial concerns related to the areas patient contact, documentation practices and quality of care. Especially, oncology care was discussed in media when launching patient accessible electronic health records in Sweden. However, few studies have investigated clinician-perceived effects several years after the launch. A survey covering these areas, as well as supposed effects for patients, was distributed to oncology health-care professionals 6 years after the launch of patient accessible electronic health records and answered by N = 176. Results show that patient accessible electronic health records have had small effects within the covered areas, and that the area most affected was documentation practices. Very few significant differences could be found between physicians and nurses. A comparison with results from interviews and surveys conducted shortly after the launch of patient accessible electronic health records clearly indicates that the experienced negative effects are not as big as originally feared. [ABSTRACT FROM AUTHOR]

Aims and objective: To explore and describe healthcare practitioners' experiences of postoperative pain management to patients undergoing planned lumbar spine surgery by identifying the healthcare practitioners' behaviours, attitudes and strategies. Background: Poorly managed postoperative pain continues to cause suffering and prolong hospital care and may affect individual and team practitioners' strategies and attitudes. The impact of these strategies and attitudes needs greater understanding. Design: Descriptive qualitative study. Methods: In‐depth interviews were conducted at a university hospital in Sweden during January–March 2016 with 9 healthcare practitioners (ages: 29–61 years; gender: male 3 and female 6; professions: medical doctor 3, registered nurse 3 and physiotherapist 3; professional experience: 1.5 months to 25 years). The interviews were analysed using Braun and Clarke's thematic analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research COREQ. Results: The interviews revealed healthcare practitioners' attitudes and strategies. Three themes were identified: (a) Connecting with the person was recognised as the key component in postoperative pain management; (b) Professionalism: a balancing act, accentuated health care practitioners' duality in being both vulnerable and strong in delicate care situations; and (c) Collaboration: being constantly responsive, the necessity for healthcare practitioners to be constantly responsive to their environment. Conclusions: The findings pinpoint the need for healthcare organisations to build structures enabling practitioners to deliver adequate pain management in acknowledging the practitioners' delicate situation when facing patients in pain. Relevance to clinical practice: Given the global need for postoperative pain management, our findings have international relevance. Preconceived expectations on specific pain need to be depicted and postoperative pain taken seriously to protect the patient as well as the healthcare practitioners. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine how background noise and hearing aid experience affect the robust relationship between working memory and speech recognition. Design: Matrix sentences were used to measure speech recognition in noise. Three measures of working memory were administered. Study sample: 148 participants with at least 2 years of hearing aid experience. Results: A stronger overall correlation between working memory and speech recognition performance was found in a four-talker babble than in a stationary noise background. This correlation was significantly weaker in participants with most hearing aid experience than those with least experience when background noise was stationary. In the four-talker babble, however, no significant difference was found between the strength of correlations between users with different experience. Conclusion: In general, more explicit processing of working memory is invoked when listening in a multi-talker babble. The matching processes (cf. Ease of Language Understanding model, ELU) were more efficient for experienced than for less experienced users when perceiving speech. This study extends the existing ELU model that mismatch may also lead to the establishment of new phonological representations in the long-term memory. [ABSTRACT FROM AUTHOR]

Purpose: To describe the rehabilitation experience and outcome of treatment with bone-anchored prostheses in individuals with bilateral transfemoral amputations (TFAs) treated in Sweden over a period of 25 years. Method: Hospital records were reviewed for all patients with traumatic bilateral TFAs treated until 2015. The use of prostheses, walking aids and wheelchairs was noted. Results: The cohort comprised 12 patients (nine men and three women with a mean age 35 years at treatment) and the median follow-up time was seven years (1–20). At baseline, 9/12 used prostheses and 3/12 did not. The main means of locomotion was in a wheelchair without wearing prostheses (n = 8/12) or in a wheelchair in combination with prosthetic walking supported by walking aids (n = 4/12). All prosthetic users had problems with sitting comfort. At follow-up, 11/12 patients used prostheses, while one did not. The means of locomotion was prosthetic walking in 3/12 cases, a combination of a wheelchair and prosthetic walking in 4/12, a wheelchair while wearing prostheses but not walking in 4/12 and a wheelchair without wearing prostheses in 1/12. Three patients walked unsupported by walking aids. Seven patients had no problem with prosthetic sitting comfort (n = 3 had small problems). Conclusions: Bone-anchored prostheses in patients with bilateral TFAs resulted in more prosthesis use during everyday locomotion, due hypothetically to improved comfort while wearing prostheses. The results further underline the importance of other assistive devices such as wheelchairs and walking aids used in combination with prostheses in this group of patients facing severe functional limitations. This study provides an insight into the details of the rehabilitation and outcome in patients with traumatic bilateral transfemoral amputations treated with bone-anchored prostheses in Sweden. The treatment can lead to a large amount of prosthetic use, but most patients will also use a range of assistive devices including full-length prostheses, stubbies, walking aids and wheelchairs after treatment. The importance of sitting in comfort while wearing prostheses should not be underestimated in patients with bilateral transfemoral amputations. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the variation of registered nurses' conceptions of the professional work in contemporary somatic health care. Background: The turnover of registered nurses has consistently been high in recent years. This implies that competence is at risk of disappearing from patient care, which might lead to an increase in organisational costs and a decreased quality of care. Therefore, management at all levels within healthcare organisations is trying to find ways to make use of available nursing resources more efficiently. This could imply new views on nurses' professional work in future. Design: Qualitative design with a phenomenographic approach. Methods: Semistructured interviews with registered nurses in somatic care. Result: Four descriptive categories emerged: registered nurse as an expert in nursing, registered nurse as a close collaborator to the patients, registered nurse as a coordinator and leader and registered nurse as an administrator. Conclusions: The registered nurses' conception of their work is being experts in nursing and having a key role in leading the care forward. They perceive that they are important in coordinating the care to guarantee that the patient receives the right competence. Registered nurses perceive their work to be most important when working in close interaction with the patients, whereas the organisation is perceived as an obstacle to achieve this. Relevance to clinical practice: This result may be a contribution to understand what registered nurses conceive is their work. The result can also help identifying factors influencing registered nurses intent to stay. Thus, it is of importance for managers to involve the professionals in the development of clinical care, as well as allowing professionals to influence higher‐level organisational changes to ensure quality in care and patient safety. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore ambulance nurses' (ANs) experiences of non‐conveying patients to alternate levels of care. Background: Increases in ambulance utilisation and in the number of patients seeking ambulance care who do not require medical supervision or treatment during transport have led to increased nonconveyance (NC) and referral to other levels of care. Design: A qualitative interview study was conducted using an inductive research approach. Methods: The study was conducted in a region in the middle of Sweden during 2016–2017. Twenty nurses were recruited from the ambulance departments in the region. A conventional content analysis was used to analyse the interviews. The study followed the COREQ checklist. Results: The ANs experienced NC as a complex and difficult task that carried a large amount of responsibility. They wanted to be professional, spend time with the patient and find the best solution for him or her. These needs conflicted with the ANs' desire to be available for assignments with a higher priority. The ANs could feel frustrated when they perceived that ambulance resources were being misused and when it was difficult to follow the NC guidelines. Conclusion: If ANs are expected to nonconvey patients seeking ambulance care, they need a formal mandate, knowledge and access to primary health care. Relevance to clinical practice: This study provides new knowledge regarding the work situation of ANs in relation to NC. These findings can guide future research and can be used by policymakers and ambulance organisations to highlight areas that need to evolve to improve patient care. [ABSTRACT FROM AUTHOR]

Background: Patients with acute coronary occlusion (ACO) may not only have ischemia-related ST-segment changes but also changes in the QRS complex. It has recently been shown in dogs that a greater ischemic QRS prolongation (IQP) during ACO is related to lower collateral flow. This suggests that greater IQP could indicate more severe ischemia and thereby more rapid infarct development. Therefore, the purpose was to evaluate the relationship between IQP and measures of myocardial injury in patients presenting with acute ST-elevation myocardial infarction (STEMI).Methods: Seventy-seven patients with first-time STEMI were retrospectively included from the recently published SOCCER trial. All patients underwent a cardiac magnetic resonance (CMR) examination 2-6 days after the acute event. Infarct size (IS), myocardium at risk (MaR), and myocardial salvage index (MSI) were assessed and related to IQP. IQP measures assessed were; computer-generated QRS duration, QRS duration at maximum ST deviation, absolute IQP and relative IQP, all derived from a pre-PCI, 12-lead ECG.Results: Median absolute IQP was 10 ms (range 0-115 ms). There were no statistically significant correlations between measures of IQP and any of the CMR measures of myocardial injury (absolute IQP vs IS, r = 0.03, p = 0.80; MaR, r = -0.01, p = 0.89; MSI, r = -0.05, p = 0.68).Conclusions: Unlike previous experimental studies, the IQP was limited in patients presenting at the emergency room with first-time STEMI and no correlation was found between IQP and CMR variables of myocardial injury in these patients. Therefore, IQP does not seem to be a suitable biomarker for triaging patients in this clinical context. [ABSTRACT FROM AUTHOR]

Introduction: Lymphoedema may cause complex problems that can strongly influence patients' health‐related quality of life (HRQoL). The main purpose of this study was to investigate the impact of lymphoedema on HRQoL in patients with varying forms of lymphoedema. Methods: The Lymphoedema Quality of Life Inventory (LyQLI), measuring three domains, physical, psychosocial and practical, and the Short Form 36 Health Survey Questionnaire (SF‐36), measuring eight health domains, were sent to 200 lymphoedema patients. Out of those who answered both questionnaires, 88 patients had lymphoedema secondary to cancer treatment and they additionally received the Functional Assessment of Cancer Therapy Scale‐General (FACT‐G). The relation between continuous variables and the three domains were analysed by Spearman's correlation coefficients, and Kruskal–Wallis test was used to analyse categorical variables. Results: Altogether 129 patients completed the LyQLI and SF‐36 and 79 of them also completed FACT‐G. Twenty per cent had a high mean score (≥2.0) in at least one domain of the LyQLI, thus having a low HRQoL. Lower HRQoL was found in the practical domain of LyQLI in patients with lower limb lymphoedema compared to patient with lymphoedema in upper limb or head/neck (p = 0.002) and in patients working part‐time compared to patients working full‐time (p = 0.005). The impact on HRQoL tended to decrease with age, with a significant correlation in the psychosocial domain (rs = 0.194, p = 0.028). Compared with the general Swedish population, patients with lymphoedema scored significantly lower in general health (p = 0.006), vitality (p = 0.002) and social functioning (p = 0.025) assessed by the SF‐36. From a cancer‐specific view, HRQoL was similar to other Swedish studies using the FACT‐G. Conclusions: This study indicates that about 20% of the patients with lymphoedema had major impact on their HRQoL. More effort and research is needed to identify, understand and support groups of patients with severe lymphoedema‐related problems. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe how older patients experience the healthcare chain and information given before, during and after colorectal cancer surgery. Background: Most persons with colorectal cancer are older than 70 years and undergo surgery with subsequent enhanced recovery programmes aiming to quickly restore preoperative function. However, adaptation of such programmes to suit the older patient has not been made. Design: Qualitative descriptive study. Method: Semi‐structured interviews were conducted on 16 patients undergoing colorectal cancer surgery at a Swedish University Hospital. The inductive content analysis was employed. Results: During the period of primary investigation and diagnosis, a paucity of information regarding the disease and management, and lack of help in coping with the diagnosis of cancer and its impact on future life, leads to a feeling of vulnerability. During their stay in hospital, the patient's negative perception of the hospital environment, their need for support, and uncertainty and anxiety about the future are evident. After discharge, rehabilitation is perceived as lacking in structure and individual adaptation, leading to disappointment. Persistent difficulty with nutrition delays recovery, and confusion regarding division of responsibility between primary and specialist care leads to increased anxiety and feelings of vulnerability. Information on self‐care is perceived as inadequate. Furthermore, provided information is not always understood and therefore not useful. Conclusion: Information before and after surgery must be tailored to meet the needs of older persons, considering the patient's knowledge and ability to understand. Furthermore, individual nutritional requirements and preoperative physical activity and status must be taken into account when planning rehabilitation. Relevance to clinical practice: Patient information must be personalised and made understandable. This can improve self‐preparation and participation in the own recovery. Special needs must be addressed early and followed up. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate incidence of falls and different baseline variables and their association with falling during hospitalization in a stroke unit among patients with acute stroke. Design: Prospective observational study. Setting: A stroke unit at a university hospital. Subjects: A consecutive sample of stroke patients, out of which 504 were included, while 101 declined participation. Methods: The patients were assessed a mean of 1.7 days after admission and 3.8 days after stroke onset. Main measures: The primary end-point was any fall, from admission to the stroke unit to discharge. Factors associated with falling were analysed using univariable and multivariable Cox hazard regression analyses. Independent variables were related to function, activity and participation, as well as personal and environmental factors. Results: In total, 65 patients (13%) fell at least once. Factors statistically significantly associated with falling in the multivariable analysis were male sex (hazard ratio (HR): 1.88, 95% confidence interval (CI): 1.13-3.14, P = 0.015), use of a walking aid (HR: 2.11, 95% CI: 1.24-3.60, P = 0.006) and postural control as assessed with the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS). No association was found with age, cognition or stroke severity, the HR for low SwePASS scores (=24) was 9.33 (95% CI: 2.19-39.78, P = 0.003) and for medium SwePASS scores (25-30) was 6.34 (95% CI: 1.46-27.51, P = 0.014), compared with high SwePASS scores (=31). Conclusion: Postural control, male sex and use of a walking aid are associated with falling during hospitalization after acute stroke. [ABSTRACT FROM AUTHOR]

Background: Personalised care planning is argued for but there is a need to know more about what the plans actually contain. Aim: To describe the content of person-centred health, plans documented at three healthcare levels for patients with acute coronary syndrome. Design: Patients with acute coronary syndrome aged under 75 years and admitted to two coronary care units at a university hospital were enrolled in the study. This retrospective descriptive study documented 89 person-centred health plans at three healthcare levels: hospital, outpatient and primary care. In total, 267 health plans were reviewed and a quantitative content analysis conducted. The health plans included commonly formulated goals, patients’ own resources and support needed. Results: The health plan goals were divided into three categories: lifestyle changes, illness management and relational activities. The most frequently reported goal for better health was increased physical activity, followed by social life/leisure activities and return to paid professional work. In order to reach the goals, patients identified three ways: own resources, family and social support and healthcare system, in total three categories. The most frequently reported own capability was self-motivation. Spouses and children were important sources of family and social support. The most frequently reported healthcare support was cardiac rehabilitation. Conclusion: In traditional care and treatment plans devised by health professionals, patient goals often comprise behavioural changes. When patients identify their own goals and resources with the help of professionals, they include maintaining social relations and being able to return to important activities such as work. [ABSTRACT FROM AUTHOR]

Background: Active patient participation is a patient safety priority for health care. Yet, patients and their preferences are less understood. The aim of the study was to explore hospitalised patients' preferences on participation in their care and safety activities in Sweden. Methods: Exploratory qualitative study. Data were collected over a four-month period in 2013 and 2014. Semi-structured interviews were conducted with 20 patients who were admitted to one of four medical wards at a university hospital in Sweden. Data were analysed using thematic analysis. Results: Nine men and eleven women, whose median age was 72 years (range 22-89), were included in the study. Five themes emerged with the thematic analysis: endorsing participation; understanding enables participation; enacting patient safety by participation; impediments to participation; and the significance of participation. This study demonstrated that patients wanted to be active participants in their care and safety activities by having a voice and being a part of the decision-making process, sharing information and possessing knowledge about their conditions. These factors were all enablers for patient participation. However, a number of barriers hampered participation, such as power imbalances, lack of patient acuity and patient uncertainty. Patients' participation in care and patient safety activities seemed to determine whether patients were feeling safe or ignored. Conclusion: This study contributes to the existing literature with fundamental evidence of patients' willingness to participate in care and safety activities. Promoting patient participation begins by understanding the patients' unique preferences and needs for care, establishing a good relationship and paying attention to each patient's ability to participate despite their illness. [ABSTRACT FROM AUTHOR]

Background In recent years, analyses of cleft palate speech based on phonetic transcriptions have become common. However, the results vary considerably among different studies. It cannot be excluded that differences in assessment methodology, including the recording medium, influence the results. Aims To compare phonetic transcriptions from audio and audio/video recordings of cleft palate speech by means of outcomes of per cent correct consonants (PCC) and differences in consonant transcriptions. Methods & Procedures Thirty-two 3-year-olds born with cleft palate were audio and audio/video recorded while performing a single-word test by picture naming. The recordings were transcribed according to the International Phonetic Alphabet. The transcriptions from the audio and the audio/video recordings were analysed with regard to PCC, differences in the use of phonetic consonant symbols and the use of diacritics. Outcomes & Results PCC was higher when the calculation was based on transcriptions from audio recordings than when based on audio/video recordings. No such differences were seen when age-appropriate consonant processes were scored as correct. Consonants were not excluded as often in the transcriptions from audio/video recordings as they were in the transcriptions from audio recordings, and more target consonants were transcribed as dental/alveolar in the transcriptions from audio/video recordings and palatal/velar/uvular in the transcriptions from audio recordings than vice versa. Further, interdental articulation, linguolabial articulation and audible nasal air leakage were more common in the transcriptions from audio/video recordings than in those from audio recordings. All these differences were statistically significant. Conclusions & Implications Phonetic transcription is influenced to some extent by visual cues. However, as long as age-appropriate articulatory and phonological simplification processes are scored as correct when evaluating consonant production in the speech of young children born with cleft palate using phonetic transcription, the recording medium does not seem to affect the results. [ABSTRACT FROM AUTHOR]

Conclusion: There was a high prevalence of Fusobacterium necrophorum (FN) in patients with chronic tonsillitis in the age group 15-23 years. This indicates that FN might play an important role in the pathogenesis of chronic tonsillitis in this age group, which is also the age group in which chronic or recurrent tonsillitis is most common. Objectives: The role of FN in patients with acute and chronic tonsillitis is unclear. Thus, this study investigated the occurrence of FN in tonsils of patients with chronic tonsillitis. The aim of the study was to determine the prevalence of FN in patients that underwent tonsillectomy due to chronic tonsillitis. This study also investigated if FN was found at different areas in the tonsils. Method: One hundred and twenty-six consecutive patients undergoing tonsillectomy due to chronic tonsillitis were included from the ENT clinics at Sunderby Hospital and Gäallivare Hospital, Sweden. Both children and adults were included to encompass various age groups (age =2-57 years). Culture swabs were taken from three different levels of the tonsils - the surface, the crypts, and the inner core of the tonsils. Selective agar plates for detecting FN were used for culture. Culture was also made for detecting b-hemolytic streptococci, Haemophilus influenzae, and Arcanobacterium. Results: FN was the most common pathogen (19%). The highest prevalence of FN was found in the age group 15-23 years (in 34% of the patients). FN was detected both at the surface and in the core of the tonsils. Furthermore, in the few patients where FN was not detected in all three areas, FN was always detected at the tonsillar surface, in spite of being an anaerobic bacterium. Streptococci group G and C also occurred most frequently (30%) in the same age group as FN (15-23 years), whereas Streptococci group A was more evenly spread among the age groups. [ABSTRACT FROM AUTHOR]

Conclusion: The incidence of taste disturbance after stapes surgery is high (61.9%), whereas the majority (94.8%) recovers within 1 year. More severe surgical nerve trauma caused more disturbance, implying that the nerve should be handled carefully during surgery. Objectives: Patients operated on for otosclerosis seem more often to complain about post-operative taste disturbance than those operated on for chronic otitis media, although the chorda tympani nerve more seldom becomes maltreated in stapedotomy. These observations seem paradoxical. It is unclear to what extent a post-operative taste disturbance affects the quality-of-life. This study aims to shed light on the occurrence of post-operative taste disturbances, on possible prognostic factors, and to what extent post-operative taste disturbance impairs the quality-of-life. Methods: One hundred and thirty-four adults undergoing primary stapedotomy were included. Questionnaires on taste disturbance and quality-of-life (SF-36) were answered before and after surgery, until 1 year post-operatively. Results: Eighty-three (61.9%) study persons reported post-operative taste disturbance. Seven (5.2%) reported persisting disturbance at 1 year. Surgically more traumatized chorda tympani nerves correlated with more severe taste disturbance post-operatively than less traumatized. Taste disturbance at 1 year post-operatively correlate with a decrease of the physical function domain in the SF-36. [ABSTRACT FROM AUTHOR]

Aim To explore how patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode. Background Acute abdominal pain is one of the most common conditions to present in the acute care setting. Little is known about how patients' fundamental care needs are managed from presentation to post discharge. Design A multi-stage qualitative case study using the Fundamentals of Care framework as the overarching theoretical and explanatory mechanism. Methods Repeated reflective interviews were conducted with five adult patients over a 6-month period in 2013 at a university hospital in Sweden. The interviews ( n = 14) were analysed using directed content analysis. Results Patients' experiences across the acute care episode are presented as five patient narratives and synthesized into five descriptions of the entire hospital journey. The patients talked about the fundamentals of care and had vivid accounts of what they meant to them. The experiences of each of the patients were influenced by the extent to which they felt engaged with the health professionals. The ability to engage or build a rapport was identified as a central component across the fundamental care elements, but it varied in visibility. Conclusion Consistent pain management, comfort, timely and accurate information, choice and dignity and relationships were identified as essential fundamental care needs of patients experiencing acute abdominal pain regardless of setting, diagnosis, or demographic variables. These were variously achieved and the patients' narratives raised areas for improvement in several areas. [ABSTRACT FROM AUTHOR]

Background Older people with cognitive impairment represent a large group of patients in acute care settings. Research show that these acute care environments can be unsafe and even unfriendly for frail older patients. Research and clinical experience show that being a nurse in acute/specialised medical facilities means to work in a high-speed, technologically complex and demanding environment. When caring for older patients with cognitive impairment, nurses' workload and responsibilities have been shown to increase. This is largely dependent on how easily it is to connect with and help patients understand what to do, and what is best for them. Aim This study aimed to illuminate meanings of caring for older patients with cognitive impairment in acute care settings as experienced by nursing staff. Method A purposeful sample of thirteen nurses experienced in caring for older people with cognitive impairment in acute care settings participated in the study. Narrative interviews were conducted during autumn 2012 and interpreted using a phenomenological hermeneutic method. Findings Caring for older, acutely ill cognitively impaired patients was found to be very complex. The meanings of caring for these older patients seemed to change depending on the nurses' perceptions of the patients and the gap between what they could do (real) and wanted to do (ideal) in providing care for them. The greater this gap was felt to be and the more care was perceived as meaningless, the more serious was the threat to nurses' personal-professional integrity which could be at risk, compromised or harmed. Conclusion The comprehensive understanding indicates that being a nurse and having to care for older patients in acute care settings means providing nursing care in an environment that does not support possibilities to protect and develop nurses' personal-professional integrity. [ABSTRACT FROM AUTHOR]

Objective To investigate risk factors for acute coronary syndrome (ACS) in patients with new-onset rheumatoid arthritis (RA). Methods We performed a nested case-control study of patients with incident RA included in the Epidemiological Investigation of RA study. Cases with ACS were identified using Swedish national health registers and matched with up to 5 controls without ACS, based on incidence density-based sampling. Information on potential exposures (clinical disease activity, serologic features, genetic markers, comorbidities, pharmacotherapies, and sick leave) was collected from medical charts and register-based sources. Results We identified 138 cases and 624 controls. Smoking, history of myocardial infarction, and >50 days of sick leave the year following RA onset were associated with an increased risk of ACS. Area under the curve measurements of C-reactive protein level, erythrocyte sedimentation rate, Disease Activity Score in 28 joints (DAS28), and global health in the upper tertile during the first year and the complete followup period were both strongly associated with an increased risk of ACS. Treatment with disease-modifying antirheumatic drugs did not alter the ACS risk, nor did the presence of rheumatoid factor (RF) or shared epitope alleles, whereas high anti-citrullinated protein antibody (ACPA) levels were borderline significantly associated with ACS risk. Conclusion In this study of risk factors for ACS in incident RA, clinical markers of inflammatory activity, disease activity, and total number of days of sick leave and disability pension during the first year following RA onset were identified as ACS risk factors. We found no association with RF, which was previously linked to cardiovascular disease risk in RA, but there was a borderline significant association with high ACPA levels. [ABSTRACT FROM AUTHOR]

Conclusion: Recurrent respiratory papillomatosis (RRP) patients with high surgical treatment frequency (≥ 1/year, HF) were significantly younger and had a more widespread laryngeal disease compared to a low frequency treated group (< 1 treatment/year, LF). This study confirms the existence of a clinical RRP group, not primarily related to HPV sub-type, but more care-intensive and in need of more vigilant follow-up. Objectives: RRP is associated with high morbidity due to its influence on breathing and voice. The purpose of this study was to characterize RRP patients in northern Sweden and investigate possible predictor factors affecting therapeutic needs. Method: Patients from the regional referral area (northern Sweden) were categorized for age, disease duration, juvenile or adult onset, profile of disease development, number of surgical sessions in relation to disease duration, laryngeal deposition of papilloma, gender, and HPV sub-types, in order to identify patients with increased need for frequent surgical treatment. Results: The median age of the RRP patients (n = 48) was 44.5 years; 34 (71%) were males and 14 (29%) females, most were infected with HPV 6. Patients with high surgical treatment frequency/year were significantly younger and showed more widespread papillomatous vegetation in the larynx, compared to the low frequency treated group. [ABSTRACT FROM AUTHOR]

The article discusses the population based cohort study that determined possible association between inter-hospital variation in using guideline recommended treatments and acute myocardial infarction clinical outcomes in Sweden and Great Britain, based on clinical registries. Findings discussed include higher between hospital variation in 30 day mortality for acute myocardial infarction in Great Britain, associated and partly attributed to greater variation in practice in British hospitals.

Aim The aim was to assess clinical inflammatory parameters, cytokine levels and bacterial counts in samples from implant crevicular fluid in cases with untreated peri-implantitis. Material and Methods Several bacterial species known to up-regulate pro-inflammatory cytokines have been associated with peri-implantitis. The Luminex magnet bead technology was used to study cytokines in crevicular fluid. The checkerboard DNA-DNA hybridization method was used to study bacterial counts in samples from 41 implants (41 individuals). Results Profuse bleeding and suppuration was found in 25/41 (61.0%) of the implants. The reliability of duplicate cytokine processing was high. In the presence of profuse bleeding, higher pg/ml levels of IL-1β ( p = 0.02), IL-8 ( p = 0.04), TNF-α ( p = 0.03) and VEGF ( p = 0.004) were found. Higher concentrations of IL-1β were found in the presence of suppuration, and if Escherichia coli ( p = 0.001) or Staphylococcus epidermidis ( p = 0.05) could be detected. Conclusion Profuse bleeding and/or suppuration in untreated peri-implantitis can be associated with higher concentrations of IL-1β, IL-8, TNF-α and VEGF in peri-implant crevicular fluid. A higher concentration of IL-1β in peri-implant crevicular fluid was found in samples that were positive for E. coli or S. epidermidis. [ABSTRACT FROM AUTHOR]

Senior citizens get around, to a large extent, as pedestrians, and safe walking is desirable for senior citizens allowing them to stay mobile, independent and healthy in old age. Senior citizens are over-represented in injury statistics, and fall-related injuries are common. The aim of this study was to investigate fall-related injuries including healthcare costs among senior citizen pedestrians injured when walking in public outdoor environments and to describe their self-reported causes and suggested preventive strategies. The data were based on a combination of information from injury data and a questionnaire. Three hundred senior citizens attended one emergency department after sustaining injuries from pedestrian falls; 60% suffered nonminor injuries, mostly fractures. One-fifth of the pedestrians were hospitalised for an average of 8 days with an indirect hospital cost of 6.2 million EUR (55 million SEK). Environmental factors such as ice were the most commonly described cause of the injury incident. Forty per cent of the respondents indicated that the municipality was responsible for the cause of the injury incident. Fewer respondents mentioned their own responsibility as a preventive strategy. Thirty per cent described a combination of improvements such as better road maintenance, changes in human behaviour and use of safety products as preventive strategies. It is of great importance to highlight general safety, products and preventive strategies to minimise injury risks, so that pedestrians can safely realise the known health benefits of walking and thereby limit healthcare costs. [ABSTRACT FROM AUTHOR]

Objective:To investigate the predictors of maternal milk feeds (MMFs) in extremely preterm (EPT) infants during neonatal stay.Study Design:Maternal characteristics, obstetrical data and infant characteristics were correlated to MMFs in 97 EPT infants during the first 6 weeks of life and at hospital discharge.Result:High MMFs (>90%) at second week predicted sustained MMFs the first 6 weeks of life; nonuniversity education and non-Nordic origin were unfavorable predictors. The proportion of MMFs the first 6 weeks of life and maternal age were positively associated with MMFs at discharge, whereas overweight was an unfavorable predictor. High MMFs at second week, assisted reproduction technology and employment were predictive factors for exclusive MMFs at discharge.Conclusion:High MMFs at week 2 promote sustained MMFs in EPT infants and exclusive MMFs at discharge. Mothers who are either young, overweight, non-Nordic or without university education may need special interventions to establish successful lactation. [ABSTRACT FROM AUTHOR]

Aim To evaluate the clinical treatment effects of a glycine powder air-polishing or ultrasonic device on peri-implant mucositis. Materials and methods Thirty-seven patients with one implant diagnosed with peri-implant mucositis (probing depth ≥4 mm (0.2N) and bleeding on probing ( BOP) (primary outcome)) were randomly assigned to treatment with either glycine powder air-polishing ( GPAP) or ultrasonic ( US) debridement. Treatment was performed at baseline and at 3 and 6 months. Professional supra gingival cleaning was performed at 9 and 12 months. Oral hygiene instructions were reinforced at each visit. Results At 12 months there was a statistically significant reduction in mean plaque score, bleeding on probing and number of periodontal pockets ≥4 mm within the treatment groups compared to baseline. The percentages of diseased sites were significantly reduced for both groups. Conclusions Treatment with a glycine powder air-polishing or an ultrasonic device is effective in non-surgical treatment of peri-implant mucositis. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of this study was to examine whether or not vaginal elasticity or lack of lubrication is associated with deep or superficial dyspareunia. We investigated gynecological cancer survivors treated with radiation therapy. Methods. In a population-based study with 616 women answering a questionnaire (participation rate 78%) and who were treated with radiotherapy for gynecological cancer, we analyzed information from 243 women (39%) who reported that they had had intercourse during the previous six months. Analyses included log-binomial regression (relative risks) and multiple imputations by chained equations in combination with Bayesian Model Averaging, yielding a posterior probability value. Age range of this cancer recurrent-free group of women was 29-80. Results. Dyspareunia affected 164 of 243 of the women (67%). One hundred thirty-four women (55%) reported superficial pain, 97 women (40%) reported deep pain, and 87 women (36%) reported both types of dyspareunia. The relative risk (RR) of deep dyspareunia was 1.87 (CI 1.41-2.49) with impaired vaginal elasticity compared to normal vaginal elasticity. Age and lower abdominal swelling were separate risk factors for deep dyspareunia. However, effects remain after adjusting for these factors. Conclusion. The relative risk of deep dyspareunia was almost twice as high with impaired vaginal elasticity compared to normal vaginal elasticity. If we wish to treat or even prevent deep dyspareunia in women with gynecological cancer, we may use our knowledge of the pathophysiology of deep dyspareunia and increasingly provide dilators together with instructions on how to use them for stretching exercises in order to retain vaginal elasticity. Results highlight the need for studies with more precise questions distinguishing superficial from deep dyspareunia so that in the future we may be able to primarily try to avoid reduced vaginal elasticity and secondarily reduce the symptoms. [ABSTRACT FROM AUTHOR]

Background The association between low birth weight and adult disease is well known. Less is known on long-term effects of high birth weight. Objective This study aims to investigate whether a high birth weight increases risk for adult metabolic disease. Methods Swedish term single births, 1973-1982 ( n = 759 999), were studied to age 27.5-37.5 years using Swedish national registers. Hazard ratios ( HRs) were calculated in relation to birth weight for type 2 diabetes, obesity, hypertension and dyslipidaemia. Results Men with birth weights between 2 and 3 standard deviation score ( SDS) had a 1.9-fold increased risk ( HR 1.91, 95% confidence interval [ CI] 1.25-2.90) of type 2 diabetes, whereas those with birth weights above 3 SDS had a 5.4-fold increased risk ( HR 5.44, 95% CI 2.70-10.96) compared to men with birth weights between −2 and 2 SDS. The corresponding HRs for women were 0.60 (95% CI 0.40-0.91) and 1.71 (95% CI 0.85-3.43) for birth weights 2-3 SDS and >3 SDS, respectively. Men with birth weights between 2 and 3 SDS had a 1.5-fold increased risk ( HR 1.47, 95% CI 1.22-1.77) of obesity. The corresponding risk for women was 1.3-fold increased ( HR 1.32, 95% CI 1.19-1.46). For men and women with birth weights above 3 SDS, the risks of adult obesity were higher, HR 2.46 (95% CI 1.63-3.71) and HR 1.85 (95% CI 1.44-2.37), respectively. Conclusions A high birth weight, particularly very high, increases the risk of type 2 diabetes in male young adults. The risk of obesity increases with increasing birth weight in both genders. [ABSTRACT FROM AUTHOR]

Aim To evaluate the 1-year outcome of Minimally Invasive Single Implant Treatment (M.I.S.I.T.) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile. Materials and Methods Periodontally healthy non-smoking patients with a failing tooth in the anterior maxilla (15-25) were selected. All were in need of a single implant and demonstrated high risk for aesthetic complications given mid-facial recession at the failing tooth and/or a buccal bone dehiscence and/or a thin-scalloped gingival biotype. Patients without mid-facial recession ( NRG) received flapless tooth extraction and ridge preservation using a collagen-enriched bovine-derived xenograft, flapless installation of a bone condensing implant with variable-thread design (4-6 months later), a provisional screw-retained crown and connective tissue graft ( CTG) inserted in the buccal mucosa (3 months later) and a permanent crown (3 months later). Patients with mid-facial recession ( RG) were treated similarly, yet they received a CTG at the time of ridge preservation. All patients were treated by an experienced periodontist using a microsurgical approach. Primary outcome variables included papillary and mid-facial recession. Clinical parameters, pink ( PES) and white aesthetic score ( WES) were considered secondary outcome variables. Results Fifty patients (25 females, 25 males; mean age 39, range 19-81; 42 in NRG and 8 in RG) met the selection criteria and consented to the treatment. Forty-seven could be examined at 12 months and all implants survived. Mean bone loss amounted to 0.48 mm (range 0.00-1.80) at 12 months. Papillary recession was minimal in both groups at 12 months (mean ≤ 0.3 mm), as was mid-facial recession in the NRG (mean 0.1 mm). Twelve patients in the NRG even demonstrated coronal migration of the mucosal margin following CTG and needed adaptation of the provisional crown to induce soft tissue retraction. Due to CTG at the time of ridge preservation in the RG, mid-facial soft tissue gain amounted to 0.9 mm at 12 months, hereby eliminating 2/3rd of the initial recession. PES and WES were favourable pointing to 10.9/14 and 8.2/10 respectively. Conclusion This short-term prospective study offers a proof of principle of M.I.S.I.T. in patients with a high aesthetic risk profile. [ABSTRACT FROM AUTHOR]

Introduction: Positive safety and a teamwork climate in the training environment may be a precursor for successful teamwork training. This pilot project aimed to implement and test whether a new interdisciplinary and team-based approach would result in a positive training climate in the operating theatre. Method: A 3-day educational module for training the complete surgical team of specialist nursing students and residents in safe teamwork skills in an authentic operative theatre, named Co-Op, was implemented in a university hospital. Participants' ( n = 22) perceptions of the 'safety climate' and the 'teamwork climate', together with their 'readiness for inter-professional learning', were measured to examine if the Co-Op module produced a positive training environment compared with the perceptions of a control group ( n = 11) attending the conventional curriculum. Results: The participants' perceptions of 'safety climate' and 'teamwork climate' and their 'readiness for inter-professional learning' scores were significantly higher following the Co-Op module compared with their perceptions following the conventional curriculum, and compared with the control group's perceptions following the conventional curriculum. Conclusion: The Co-Op module improved 'safety climate' and 'teamwork climate' in the operating theatre, which suggests that a deliberate and designed educational intervention can shape a learning environment as a model for the establishment of a safety culture. [ABSTRACT FROM AUTHOR]

Background and aim When a child is diagnosed with type 1 diabetes, it is a complex and challenging situation for the whole family. The management of the disease places substantial demands on the family and they need to change their daily life. The short- and long-term impact on the family has rarely been described; therefore, the aim of this study was to describe and compare the disease impact on parents and children in terms of health-related quality of life ( HRQOL) at diagnosis and 1 year subsequent to the child's diagnosis with type 1 diabetes. A further aim was to describe and compare the parents' satisfaction with the care received. Method Sixty-nine children and their parents were included. Parents independently filled in the Peds QL™ Family Impact Module and the Peds QL™ Health Care Satisfaction Generic Module. The Peds QL™ 3.0 Diabetes Module was filled in by parents and children over the age of 5. Results Mothers reported a lower HRQOL than fathers both at the time of diagnosis (p = 0.003) and 1 year later (p = 0.041). For diabetes-specific HRQOL, children aged 5-7 years and their parents reported more worry than children and parents in older age groups (p = 0.037). Children aged 8-12 and 13-18 years reported a higher treatment adherence than mothers (p = 0.011 and p = 0.039, respectively); no differences were found between children and fathers. Both parents expressed overall satisfaction with the child's health care. Conclusion The family is affected during the first year after their child is diagnosed with type 1 diabetes. Both parents and the youngest children estimated a high degree of worry. The diabetes team needs to be aware of this and to take it into consideration. [ABSTRACT FROM AUTHOR]

Aim To evaluate the effect of surgical treatment of experimental peri-implantitis at implants with different surface characteristics using different anti-infective procedures. Material and methods Four implants with different surface characteristics (A: TiOblast, B: OsseoSpeed, C: AT-I, D: TiUnite) were installed in a randomized order in each side of the mandible in 6 labrador dogs 3 months after tooth extraction. Experimental peri-implantitis was induced 3 months later. Surgical treatment of peri-implantitis was performed. The implants were cleaned with gauze soaked in either saline (control) or chlorhexidine (test). Clinical and radiographical examinations were performed and microbiological samples were taken during a 6-month period after surgery. Biopsies were obtained and prepared for histological analysis. Results Clinical signs of soft tissue inflammation were reduced after surgical therapy in most test and control sites. While the analysis of bone level alterations in radiographs together with histological and microbiological assessments of resolution of peri-implantitis lesions failed to demonstrate statistically significant differences between test and control procedures, the evaluations disclosed significant differences between implant D and implants A, B and C on treatment outcome. Conclusion It is suggested that (i) the local use of chlorhexidine has minor influence on treatment outcome, (ii) resolution of peri-implantitis following surgical treatment without the adjunctive use of local and systemic antimicrobial agents is possible and (iii) the results are influenced by implant surface characteristics. [ABSTRACT FROM AUTHOR]

BackgroundAlthough cannabis abuse (CA) is known to be associated with schizophrenia, the causal nature of this association is unclear, with prodromal effects complicating its interpretation.MethodFrom Swedish national registry databases, we used a co-relative case–control design with full-sibling, half-sibling and first-cousin comparisons, alongside a general Swedish population sample. Using ICD codes, 5456 individuals with an initial diagnosis of schizophrenia (2000–2010) were matched with five schizophrenia-free controls. We further identified first-cousin, half-sibling and full-sibling pairs discordant for CA and statistically extrapolated results for discordant monozygotic (MZ) twins.ResultsWithin the general Swedish population, CA was strongly associated with later schizophrenia [odds ratio (OR) 10.44, 95% confidence interval (CI) 8.99–12.11]. This association was substantially attenuated both by increasing temporal delays between CA exposure and schizophrenia diagnosis and by controlling for increasing degrees of familial confounding. Extrapolated discordant MZ pairs suggested that fully controlling for confounding familial factors reduced the association between CA and later schizophrenia to more modest levels (ORs of approximately 3.3 and 1.6 with 3- and 7-year temporal delays respectively). Opiate, sedative, cocaine/stimulant and hallucinogen abuse were also strongly associated with subsequent schizophrenia in the general population. After controlling for familial confounding, only cocaine/stimulant exposure remained associated.ConclusionsCA has an appreciable causal impact on future risk for schizophrenia. However, population-based estimates of cannabis–schizophrenia co-morbidity substantially overestimate their causal association. Predictions of the cases of schizophrenia that might be prevented by reduced cannabis consumption based on population associations are therefore likely to be considerably overestimated. [ABSTRACT FROM PUBLISHER]

It is necessary to carry out randomised clinical cancer trials ( RCTs) in order to evaluate new, potentially useful treatments for future cancer patients. Participation in clinical trials plays an important role in determining whether a new treatment is the best therapy or not. Therefore, it is important to understand on what basis patients decide to participate in clinical trials and to investigate the implications of this understanding for optimising the information process related to study participation. The aims of this study were to (1) describe motives associated with participation in RCTs, (2) assess if patients comprehend the information related to trial enrolment, and (3) describe patient experiences of trial participation. Questionnaires were sent to 96 cancer patients participating in one of nine ongoing clinical phase 3 trials at the Department of Oncology, Uppsala University Hospital in Sweden. Eighty-eight patients completed the questionnaire (response rate 92%); 95% of these were patients in adjuvant therapy and 5% participated in clinical trials on palliative care. Two main reasons for participation were identified: personal hope for a cure and altruism. Patients show adequate understanding of the information provided to them in the consent process and participation entails high patient satisfaction. [ABSTRACT FROM AUTHOR]

Few studies have explored older people’s expected future quality of life (QoL), despite evidence that perceptions of one’s future influence healthy aging. Research on this topic should embrace a range of potential influences, including perceptions of one’s neighborhood and region. This study examined expected QoL in a random sample of the population of Dalarna, a Swedish region. A self-completion questionnaire assessed demographic characteristics, current neighborhood and regional evaluations, self-evaluations, expectations for the future, and current and expected QoL. In total, 786 people aged ≥65 years participated. A sequential multiple regression model explained 44% of the variance in older people’s expected QoL, with self-reported health (sr2 = .03), Expected Regional Opportunity (sr2 = .03), and Perceived Regional Status (sr2 = .02) having the strongest associations with expected QoL. Research on the importance of one’s neighborhood to QoL in older people should encompass people’s perceptions of their region, to better inform social policy for healthy aging. [ABSTRACT FROM PUBLISHER]