Search

Abstract Background Oral and pharyngeal swallowing dysfunction are common complications in acute stroke patients. This primary aim of this study was to determine whether oral neuromuscular training improves swallowing function in participants with swallowing dysfunction after stroke. A secondary aim was to assess how well results of the timed water-swallow test (TWST) correspond with swallowing dysfunction diagnosed by videofluoroscopy (VFS). Methods This was an intention-to-treat two-centre prospective randomized open-label study with blinded-evaluators (PROBE) design. At 4 weeks after stroke onset, participants with swallowing dysfunction were randomized to 5 weeks of continued orofacial sensory-vibration stimulation with an electric toothbrush or additional oral neuromuscular training with an oral device (Muppy®). Participants were examined with TWST, a lip-force test, and VFS before (baseline), after 5 weeks’ treatment (the end-of-treatment), and 12 months after treatment (follow-up). The baseline VFS results were compared with the TWST results. The primary endpoint was changes in swallowing rate assessed using TWST, from baseline to the end of training and from baseline to follow-up based on intention-to-treat analyses. The secondary endpoint was the corresponding changes in lip-force between baseline, the end of treatment, and follow-up. Results The participants were randomly assigned as controls (n = 20) or for intervention with oral neuromuscular training (n = 20). After treatment, both groups had improved significantly (intervention, P

Mohammadhossein Hajiebrahimi,1,2 Ci Song,3 David Hägg,1 Therese M-L Andersson,4 Reginald Villacorta,5 Marie Linder1 1Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; 2Department of Statistics and Epidemiology, Public Health Faculty, Golestan University of Medical Sciences, Gorgan, Iran; 3Janssen GCSO, Stockholm, Sweden; 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 5Market Access Department, Janssen Pharmaceuticals, Horsham, PA, USACorrespondence: Mohammadhossein Hajiebrahimi Email mohammadhossein.hajiebrahimi@synergusrwe.comPurpose: To assess the relative risk of metabolic risk factors in patients stratified by psoriasis severity compared with population controls.Patients and Methods: A retrospective cohort study was conducted using national Swedish registers. Adult patients with psoriasis were selected if they had a dispensing of anti-psoriasis prescription (2007– 2013) and at least one diagnosis within five years before the dispensing date. The patients with psoriasis were matched 1:10 to controls from the general population on birth year, sex, and county. The cohort was further divided into three disease severity groups (mild, moderate, or severe) based on their dispensed anti-psoriasis medication. Subjects were followed from the index date until censoring. We applied flexible parametric modeling to understand the risks of the incident comorbidities hypertension, hypercholesterolemia, and diabetes mellitus among patients with psoriasis from 6 months through 10 years. Hazard ratios and predicted risk (ie, 1 minus the survival probability) of comorbidities were reported.Results: The hazard of hypertension, hypercholesterolemia, and diabetes mellitus is higher among psoriasis patients compared with population controls, and the hazard ratio increases with psoriasis severity. For example, HRs of hypertension for patients with mild, moderate, and severe psoriasis are 1.29 (95% CI: 1.27– 1.32), 1.35 (95% CI: 1.32– 1.38), and 1.73 (95% CI: 1.64– 1.82), respectively. The predicted risk of hypertension, hypercholesterolemia, and diabetes mellitus among patients with severe psoriasis at year ten was 0.58 (95% CI: 0.56, 0.59), 0.33 (95% CI: 0.32, 0.35), and 0.21 (95% CI: 0.20, 0.23), respectively, while it was 0.42 (0.41, 0.43), 0.23 (0.22, 0.23), 0.11 (0.10, 0.11) among controls, respectively. The predicted risk at year ten was similar among patients with mild or moderate psoriasis.Conclusion: The HRs and predicted risks of metabolic risk factors are higher among patients with psoriasis compared with matched controls and are more prominent among the severe psoriasis group.Keywords: psoriasis severity, predicted risk, survival probability, population-based, metabolic risk factors

Ann Hägg-Martinell,1,2 Charlotta Tegnestedt,1 Joacim Larsen1 1Department of Health Sciences, Red Cross University College, Huddinge, Sweden; 2Department of Clinical Sciences Danderyd Hospital, Karolinska Institute, Stockholm, SwedenCorrespondence: Ann Hägg-Martinell Tel +46 8 587 516 25Email ann.hagg.martinell@rkh.seIntroduction: In a global context of an increasing and aging population, along with environmental changes, nurses play an important role in relieving suffering among vulnerable people and groups in society. Sustainability in nursing contributes to sustainable development through providing an environment that is not detrimental to/protects present and future generations′ opportunities for good health. There is a global shortage of nurses, and it has been shown that, locally, every fifth newly graduated nurse considers leaving their new profession five years after graduation. The aim was to describe how nursing students’ thought about a sustainable professional life as nurses before their graduation.Materials and Methods: A qualitative design with a written data set was used, and a thematic analysis was performed. One hundred five students (80 women and 25 men) in semester six out of six of the nursing education program participated. Results: The analysis resulted in three themes: 1) to have an ethical foundation that guides the individual nurse in protecting the nursing care and developing the nursing care for their patients; 2) to be in a listening, reflexive and supportive workplace enabling a professional nurse to continuously grow and learn and 3) to be a proud professional nurse with integrity, not risking with their own health or personal professional development.Conclusion: The nursing students describe their thoughts on the requirements for having a sustainable professional life as nurses as having a strong inner ethical compass to help guide, protect and develop the nursing care for the patients. In addition, it requires a workplace with a reflexive and supporting culture. However, the nursing students also put their own health and the opportunities for professional growth at the top of their priorities, and if these conditions are lacking, they will switch to another workplace.Keywords: nurse students, sustainability, professional life, thematic analysis

Abstract Background/objective To reproduce the methods and results of the study by Alobeid et al. (2018) in which the efficacy of tooth alignment using conventional labial and lingual orthodontic bracket systems was assessed. Materials/methods We used the identical experimental protocol and tested (i) regular twin bracket (GAC-Twin [Dentsply]) and lingual twin bracket systems (Incognito [3M]), (ii) together with NiTi 0.014” wires (RMO), and (iii) a simulated malocclusion with a displaced maxillary central incisor in the x-axis (2 mm gingivally) and in the z-axis (2 mm labially). Results The method described by Alobeid et al. (2018) is not reproducible, and cannot be used to assess the efficacy of tooth alignment in labial or lingual orthodontic treatment. Major flaws concern the anteroposterior return of the Thermaloy-NiTi wire ligated with stainless steel ligatures. The reproduced experimental setting showed that a deflected Thermaloy-NiTi wire DOES NOT move back at all to its initial stage (= 0 per cent correction) because of friction and binding (see supplemented video), neither with the tested labial nor with the lingual brackets. Furthermore, an overcorrection of up to 138 per cent, which the authors indicate for some labial bracket-wire combinations and which deserves the characterization “irreal”, stresses the inappropriateness of the method of measurement.Further flaws include: a) incorrect interpretation of the measurement results, where a tooth tripping around (overcorrection) is interpreted as a better outcome than a perfect 100 per cent correction; b) using a statistical test in an inappropriate and misleading way; c) uncritical copying of text passages from older publications to describe the method, which do not correspond to this experimental protocol and lead to calculation errors; d) wrong citations; e)differences in table and bar graph values of the same variable; f) using a lingual mushroom shaped 0.013” Thermaloy-NiTi wire which does not exist; g) drawing uncritical conclusions of so called "clinical relevance" from a very limited in vitro testing. Conclusions Clinical recommendations based on in vitro measurements using the Orthodontic Measurement and Simulation System (OMSS) should be read with caution.

Ann Hägg-Martinell, 1, 2 Håkan Hult, 3 Peter Henriksson, 2 Anna Kiessling 2 1Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden; 2Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm; 3Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, SwedenCorrespondence: Ann Hägg-MartinellDepartment of Clinical Sciences Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm SE-141 21, SwedenTel +46 70 755 59 15Email ann.hagg.martinell@rkh.seIntroduction: A common focus in many studies, in the short-term perspective, is to evaluate students’ workplace learning and its outcome. However, the outcome can be perceived differently depending on when it was evaluated. The aim of this study was to explore student nurses’ learning activities in an acute internal medicine unit and the nurses perceived learning outcome in a long-term perspective.Material and Methods: Repetitive ethnographic observations were performed in an internal medicine care unit at a teaching hospital in Sweden between 2011 and 2013. Four student nurses and supervisors were repetitively observed. Two years later retrospective interviews were performed with four nurses who had performed workplace learning, as students, in this unit during the observation period. An inductive comparative analysis involving all interviews and observational data was applied.Results: Three themes were identified: To handle shifting situations – illustrating how student nurses learnt to adapt to shifting situations, to manage stress, to create structure and space for learning and to deal with hierarchies; To build relationships – illustrating how student nurses learnt to collaborate and to interact with patients; To act independently – illustrating how student nurses trained to act independently in the unit, took responsibility, and prioritized in this complex context.Conclusion: Learning activities in a complex acute medical unit setting were characterized by a high workload and frequent stressful situations, and a demand on students to interact, to take responsibility, and to prioritize. To learn in such a stressful context, have in a long-term perspective, a potential to develop students’ embodied understanding of and in practice, making them more prepared to work and independently apply their nursing expertise in similar contexts as graduated nurses.Keywords: students nursing, nursing education research, clinical clerkship, ethnography

Objectives: The aim was to explore how the time to the first fall and 6-month fall incidence relates to rapidly and easily collected data in persons with acute stroke. Methods: Out of consecutively admitted patients with stroke at three stroke units, 284 with at least one follow-up were included in this prospective cohort study. During 6 months following discharge, participants reported falls using a diary and monthly phone calls. Data about participants’ characteristics, functions, and activities were collected during hospital stay and analyzed in relation to time to first fall by Cox regression and fall incidence by negative binomial regression. Results: Use of ⩾9 medications, paresis in arms, paresis in legs (National Institutes of Health Stroke Scale), impaired protective reactions in sitting (Postural Reactions Test), and limitations in self-care (Barthel Index) were decisive risk factors for time to first fall. Limitations in mobility (Step Test, 30-s Chair Stand Test) were decisive risk factors for high fall incidence (p

BackgroundThe design and conduct of research to develop, test, and evaluate complex health care interventions is challenging. Although the existing literature describes key challenges associated with the design and conduct of definitive (evaluation) trials, there is a lack of information concerning specific challenges associated with the intervention development phase and setup of feasibility studies. In particular, the literature is scarce concerning the challenges associated with conducting digital health care research, such as research on internet-administered interventions and research using digital features to support the execution of study procedures (eg, recruitment, consent, retention, and data collection and management). This study is conducted in the context of the intervention development and feasibility study setup phases of an internet-administered, guided, low-intensity cognitive behavioral therapy–based intervention for parents of children previously treated for cancer. ObjectiveThe aim of this study is to explore the challenges experienced during the development phase of the internet-administered intervention and digital features to support the execution of the study procedures and a feasibility study setup. MethodsTo explore the key challenges experienced, we conducted a document analysis of written records from all study meetings held by the research team (meeting minutes) between June 7, 2018, and January 10, 2020, guided by a thematic analysis approach. Furthermore, discussion groups with members of the research team were held to develop a more detailed understanding of the key challenges experienced. Methods and results are reported in accordance with the relevant items from the Standards for Reporting Qualitative Research checklist. ResultsSix main themes were identified: decision-making and communication, expertise, external constraints, flexibility, planning and scheduling, and technical constraints. ConclusionsSignificant challenges were experienced during the intervention development and setup phases of the feasibility study. Implications are discussed to inform future design, conduct, and planning of internet-administered intervention development and feasibility studies, especially within the context of digital health care research.

Purpose: The purpose of this paper is to describe and analyze the foundation of higher education policies that have promoted entrepreneurship in Sweden since the mid-1990s. Design/methodology/approach: To do this, the authors use Bacchi's (1999) "What's the problem?" approach. A central assumption of which is that perceptions of a problem affect how its solution looks. Bacchi's approach is described as a type of discourse analysis. Findings: The authors show that problem definition within policies regarding the role and importance of entrepreneurship within higher education has explicitly been directed toward equipping individuals to develop action-orientated skills in the field of entrepreneurship. The equipment of action-oriented skills has implicitly been directed to individuals' personal initiatives to meet explicit social and collective problems, fueling a neoliberal development and fostering an enterprising culture. The authors also show how policy creates a discourse, which may be characterized as "useful, unreflective citizens." Research limitations/implications: The study addresses the implicit steering that is being exercised through policies. This steering needs to be questioned and problematized in order to avoid blindly following the implied course of action. Originality/value: The study contributes to current understanding of how entrepreneurship in higher education is both governed explicitly and implicitly, by policy, through the creation of new norms in society.