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  • 1.
    Anderberg, Peter
    et al.
    Blekinge Institute of Technology.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institute.
    Stjernberg, Louise
    The Swedish Red Cross University College. Region of Blekinge.
    Bohman, Doris
    Blekinge Institute of Technology.
    Analyzing Nursing Students' Relation to Electronic Health and Technology as Individuals and Students and in Their Future Career (the eNursEd Study): Protocol for a Longitudinal Study2019In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 8, no 10, article id e14643Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The nursing profession has undergone several changes in the past decades, and new challenges are to come in the future; patients are now cared for in their home, hospitals are more specialized, and primary care will have a key role. Health informatics is essential in all core competencies in nursing. From an educational perspective, it is of great importance that students are prepared for the new demands and needs of the patients. From a societal point of view, the society, health care included, is facing several challenges related to technological developments and digitization. Preparation for the next decade of nursing education and practice must be done, without the advantage of certainty. A training for not-yet-existing technologies where educators should not be limited by present practice paradigms is desirable. This study presents the design, method, and protocol for a study that investigates undergraduate nursing students' internet use, knowledge about electronic health (eHealth), and attitudes to technology and how experiences of eHealth are handled during the education in a multicenter study.

    OBJECTIVE: The primary aim of this research project is to describe the design of a longitudinal study and a qualitative substudy consisting of the following aspects that explore students' knowledge about and relation to technology and eHealth: (1) what pre-existing knowledge and interest of this area the nursing students have and (2) how (and if) is it present in their education, (3) how do the students perceive this knowledge in their future career role, and (4) to what extent is the education capable of managing this knowledge?

    METHODS: The study consists of two parts: a longitudinal study and a qualitative substudy. Students from the BSc in Nursing program from the Blekinge Institute of Technology, Karlskrona, Sweden, and from the Swedish Red Cross University College, Stockholm/Huddinge, Sweden, were included in this study.

    RESULTS: The study is ongoing. Data analysis is currently underway, and the first results are expected to be published in 2019.

    CONCLUSIONS: This study presents the design of a longitudinal study and a qualitative substudy. The eHealth in Nursing Education eNursEd study will answer several important questions about nursing students' attitudes toward and use of information and communications technology in their private life, their education, and their emerging profession. Knowledge from this study will be used to compare different nursing programs and students' knowledge about and relation to technology and eHealth. Results will also be communicated back to nursing educators to improve the teaching of eHealth, health informatics, and technology.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14643.

  • 2.
    Antoniadou, Irini
    et al.
    Karolinska universitetssjukhuset.
    Soltannia, Marjan
    Karolinska universitetssjukhuset.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Care Sciences and Society, Sweden.
    Mattsson, Janet
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska universitetssjukhuset.
    Moving from Participation towards Partnership in Nursing Care2019In: Anaesthesia & Surgery Open Access Journal, Vol. 1, no 3, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background: Meeting with health care gets short before and after the operation. The difficulty at the day surgery is that preparation and information take place in close proximity to the operation. Health professionals must not only take care of the child during the medical visit, but also of the accompanying parent, too. Parents’ participation in the perioperative care, sometimes unable to attend.

    Aim: This study aims to investigate how parental involvement in the perioperative a process can be facilitated.

    Method: A qualitative design based on observations and interviews with semi structured questions with open answers. Results: The results conveyed involvement in the child’s perioperative process in diverse ways and to a different depth. This is highlighted in the theme Allowed with the under themes Security and Being accepted. However, the theme Exclusion with the under-theme Rejection revealed a non-caring approach where no caring relation could be established. Quotes from the transcribed material are used to highlight the results.

    Conclusion: The study’s findings confirm earlier studies in the perspective that information is of central importance in enabling parents to be involved in the perioperative process. The results showed that parents’ involvement in the perioperative process is a prerequisite for creating safety in the child and reducing concerns in connection with the operation. Parental involvement may be hindered by a conventional approach that does not include the child’s perspective.

  • 3.
    Backman, Sara
    et al.
    School of Chemical Science and Engineering, Fiber, and Polymer Technology, Royal Institute of Technology (KTH), Stockholm.
    Björling, Gunilla
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Anaesthesia and Intensive Care, Stockholm.
    Johansson, Unn-Britt
    Sophiahemmet University College, Stockholm.
    Lysdahl, Michael
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Anaesthesia and Intensive Care, Stockholm.
    Markström, Agneta
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Anaesthesia and Intensive Care, Stockholm.
    Schedin, Ulla
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Anaesthesia and Intensive Care, Stockholm.
    Aune, Ragnhild E
    School of Industrial Technology and Management, Materials Science and Engineering, Royal Institute of Technology (KTH), Stockholm.
    Frostell, Claes
    Karolinska Institutet, Department of Anesthesia, Surgical Services and Intensive Care, Karolinska University Hospital, Stockhol.
    Karlsson, Sigbritt
    School of Chemical Science and Engineering, Fiber, and Polymer Technology, Royal Institute of Technology (KTH), Stockholm.
    Material wear of polymeric tracheostomy tubes: A six-month study2009In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 119, no 4, p. 657-664Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objectives were to study long-term material wear of tracheostomy tubes made of silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU) after 3 and 6 months of clinical use.

    STUDY DESIGN: The study has a prospective and comparative design.

    METHODS: Nineteen patients with long-term tracheostomy, attending the National Respiratory Center in Sweden, were included, n = 6 with Si tubes, n = 8 with PVC tubes, and n = 5 with PU tubes. The tubes were exposed to the local environment in the trachea for 3 and 6 months and analyzed by scanning electron microscopy, attenuated total reflectance Fourier transform infrared spectroscopy, and differential scanning calorimetry.

    RESULTS: All tubes revealed severe surface changes. No significant differences were established after 3 or 6 months of exposure between the various materials. The changes had progressed significantly after this period, compared to previously reported changes after 30 days of exposure. The results from all analyzing techniques correlated well.

    CONCLUSIONS: All tubes, exposed in the trachea for 3-6 months, revealed major degradation and changes in the surface of the material. Polymeric tracheostomy tubes should be changed before the end of 3 months of clinical use.

  • 4.
    Björling, Gunilla
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Anaesthesia and Intensive Care, National Respiratory Centre, Stockholm, Sweden.
    Long-term tracheostomy: How to do it2009In: Breathe: continuing medical education for respiratory professionals, ISSN 1810-6838, Vol. 5, no 3, p. 204-213Article in journal (Refereed)
    Abstract [en]

    The overall aim for long-term tracheostomy care is to help those with respiratory failure to achieve a high-quality active life. A long-term tracheostomy does not necessarily mean an increased need for hospital care. With an optimally fitted tracheostomy tube, patient and staff education and regular follow-ups, serious complications can be avoided. This article describes predictors of good long-term tracheostomy care, such as tube selection, indications of change and follow-up.

  • 5.
    Björling, Gunilla
    Institutionen för kliniska vetenskaper, Danderyds sjukhus.
    Long-Term Tracheostomy: Outcome, Cannula care, and Material Wear2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Do people with long-term tracheostomy need hospital care? Which cleaning method is most appropriate for decontamination of inner cannulae? Are tracheostomy tubes changed for rational reasons? There is clearly a lack of evidence based research in this field and the clinical guidelines available are often based on local practice. A tracheostomy is a created opening in trachea to facilitate breathing. It is a direct entry to the deeper airways, e.g. for micro-organisms causing a potential risk for lung infections. Indications for long-term tracheostomy can be, e.g. upper airway obstruction, malformations, or chronic hypoventilation, when ventilation via nasal mask is not possible. The research of the present thesis was conducted at the National Respiratory Centre (NRC) at Danderyd Hospital in Stockholm, Sweden. This unit opened in 1982, with the expressed goal of supporting outpatients with long-term tracheostomy. The overall aims of the thesis were to evaluate the outcome of patients with long-term tracheostomy and to conduct evidence based studies concerning their care. A comparison was made for the number of days in hospital care during the 2-year periods before and after the tracheostomy was established. The life expectancy of the general population and the observed life span of a cohort of tracheostomized patients from the start of NRC in 1982 were also compared. Interestingly enough, the need for hospital care was unchanged despite of the tracheostomy. The patients  observed life spans were remarkably high and for many patients not lower than the life expectancy of Swedish people in general. To find a practical and safe decontamination method for inner cannulae we compared two different cleaning methods; detergent followed by chlorhexidine-alcohol, or detergent alone. Samples for bacterial culture were taken before and after cleaning and the numbers of bacteria colonies were counted. The effectiveness of both cleaning methods was greater than expected and the results showed a nearly total elimination of organisms. Thus, the methods investigated were equivalent in achieving decontamination. The duration of use in our unit for polymeric tracheostomy tubes, i.e. silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU) was determined and compared. We found, that Si tubes were used for longer periods (three months) than tubes made of PU or PVC (both two months). Whether or not surface changes could be observed on the tracheostomy tubes after 30 days , three and six months  exposure in the trachea were investigated in collaboration with the Royal Institute of Technology and Sophiahemmet University College in Stockholm, Sweden. The analyzing methods were Scanning Electron Microscopy, Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy, and Differential Scanning Calorimetry. All tubes, except one, showed changes in the surface after 30 days  exposure. The surface changes had progressed significantly after three and six months' exposure, compared to the changes detected after 30 days. The SF-36 questionnaire and a study specific questionnaire were used to describe the patients  health-related quality of life and experiences of long-term tracheostomy. The results show that all patients were satisfied with their tracheostomy and demonstrated a numerically mean mental health status score above that of the general population. In summary, long-term tracheostomy does not increase the need for hospital care nor does it reduce a patient s life span. Cleaning the tracheostomy inner cannula with detergent and water is sufficient to achieve decontamination. Si tracheostomy tubes are used longer compared to those made of PVC or PU. The polymeric material investigated suffered evident surface changes after 30 days  use. Clinical use of polymeric tracheostomy tubes beyond three months cannot be recommended, as we found extensive surface changes and degradation of the polymeric chains. All patients were, in general content, with their tracheostomy. The findings from the present thesis contribute to making the care of long-term tracheostomized patients  evidence based.

  • 6.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Material Wear of Medical Technical Products: Impact on patient safety2018Conference paper (Refereed)
    Abstract [en]

    The use of a central venous catheters (CVC) always involves an increased risk of infection and thrombotic complications, subsequently increasing patient suffering, prolonged care and health care related costs. One contributing cause of infection is that the surface of the catheter is quickly colonized by bacteria, forming a biofilm, hard to reach by and/or resistant to antibiotics and the patient’s immune defense system. Catheter related thrombosis may also promote colonization of microbes on the fibrin sheet at the surface, and at the same time impact on CVC functionality by lumen occlusion or, in a rare worst-case scenario – cause life threatening embolic events. Coatings with silver or metal alloys can reduce the risk for complications. Our research group have previously identified a correlation between material degradation in medical devices used in patients and exposure time and infections. This talk will discuss the impact of material degradation of different types of CVCs used for patients undergoing chemotherapy against breast cancer.  The results from an evaluation study of a anti infectious noble metal alloy coated CVC compared with an uncoated CVC for tolerability (Adverse Events, AEs), performance and noble metal durability on the surface will also be discussed.

  • 7.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care.
    När doktorn ljuger – vem kan vi då lita på?2016In: Aftonbladet, article id 4 marsArticle in journal (Other (popular science, discussion, etc.))
  • 8.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet.
    Aune, R.
    The Norwegian University of Science and technology, Trondheim, Norway.
    Strömberg, E.
    KTH.
    Lindberg, J.
    Karolinska Institutet.
    Burgstaller, C.
    Transfercenter fur Kunststofftechnik GMBH, Vienna, Austria.
    Egizabal, A.
    Fundaction Tecnalia Research & Innovation, TECNALIA, Madrid, Spain.
    Liljegren, A.
    Karolinska Institutet.
    Ehlen, B.
    Boukje.com Consulting BV, Amsterdam, Netherlands.
    Grønberg, B. H.
    St Olav hospital, Trondheim, Norway.
    Vermeiren, P.
    Health Leads BV, Amsterdam, Netherlands.
    Namy, P.
    SIMTEC EURL, Paris, France.
    Mancini, T.
    Universita Degli Studi di Roma La Sapienza, Rome, Italy.
    Karlsson, S.
    KTH.
    Vullum-Bruer, F.
    The Norwegian University of Science and technology, Trondheim, Norway.
    Frostell, C.
    Karolinska Institutet.
    Risk Evaluation of Therapy Medical Devices and Implants for Increased Patient Safety: REMISS Horizon 2020 Research and Innovation Action2017Conference paper (Refereed)
    Abstract [en]

    Current knowledge in the area of medical devices remains insufficiently complete, and many of the established test methods and international standards (ISO (International Organization for Standardization) standards) open up to individual interpretation on how the test should be performed and the results reported. Treating long-term diseases such as cancer imposes a stringent sequence of various treatments on patients. For instance, cancer may be treated with radiation and chemotherapy; the latter in many treatment protocols requiring the implantation of an intravascular catheter during a prolonged period of time. To maximize the effect of such measures, as well as issues related to the patient Health Related Quality of Life (HRQoL), integrated and validated methodologies are needed as decisional basis for appropriate risk management and patient safety with regard to clinical use of intravascular catheters.

    The ambition of the REMISS project is to: Establish integrated and validated methodologies for risk management of the clinical use of intravascular catheters with respect to the clinical service lifetime, improved patient treatment, safety and HRQoL. This is assumed to reduce patient suffering due to complications associated with material deployment and degradation associated side effects for e.g. cancer patients receiving treatment with chemotherapeutical drugs using an intravascular catheter.

    The main vision is to improve the standards for eliminating side effects (complications) caused by deployment from and degradation of intravascular catheters, as well as loss of performance due to material-drug-biological system interactions, compared to the current state-of-the-art. Realising the project goals the rate of catheter-associated complications can be lowered by 40-50%, which in turn will improve patient treatment, safety and HRQoL, as well as health care related costs.

    Package integrally developed methodologies, predictive models, databases, and other project findings, as a potential product with a holistic coverage. It is believed that commercialisation of (selected) results will be the best option in order to create sustainable availability of this service based on continued research on intravascular catheters according to integrated and validated methodologies.REMISS answer the call NMBP-12-2017 Development of a Reliable Methodology for Better Risk Management of Engineered Biomaterials Advanced Therapy Medicinal Products and/or Medical Devices Marcy, P. Central venous access: techniques and indications in oncology. European Society of Radiology, 2008; 18; 2333-44 Maki DG, et al The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006: 81 (9): 1159-71. Frostell, C., Björling, G., Strömberg, E., Karlsson, S., and Aune, R. E., Tracheal Implants Revisited, The Lancet (2017), 389(10075) pp.1191

  • 9.
    Björling, Gunilla
    et al.
    Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, National Respiratory Centre, Stockholm.
    Axelsson, Sara
    School of Chemical Science and Engineering, Fibre and Polymer Technology, Royal Institute of Technology (KTH), Stockholm.
    Johansson, Unn-Britt
    Sophiahemmet University College, Stockholm.
    Lysdahl, Michael
    Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, National Respiratory Centre, Stockholm.
    Markström, Agneta
    Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, National Respiratory Centre, Stockholm.
    Schedin, Ulla
    Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, National Respiratory Centre, Stockholm.
    Aune, Ragnhild E
    School of Industrial Technology and Management, Materials Science and Engineering, Royal Institute of Technology (KTH), Stockholm.
    Frostell, Claes
    Department of Anaesthesiology and Intensive Care Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm.
    Karlsson, Sigbritt
    School of Chemical Science and Engineering, Fibre and Polymer Technology, Royal Institute of Technology (KTH), Stockholm.
    Clinical use and material wear of polymeric tracheostomy tubes2007In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 117, no 9, p. 1552-1559Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objectives were to compare the duration of use of polymeric tracheostomy tubes, i.e., silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU), and to determine whether surface changes in the materials could be observed after 30 days of patient use.

    METHODS: Data were collected from patient and technical records for all tracheostomized patients attending the National Respiratory Center in Sweden. In the surface study, 19 patients with long-term tracheostomy were included: six with Bivona TTS Si tubes, eight with Shiley PVC tubes, and five with Trachoe Twist PU tubes. All tubes were exposed in the trachea for 30 days before being analyzed by scanning electron microscopy (SEM) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR). New tubes and tubes exposed in phosphate-buffered saline were used as reference. RESULTS: Si tubes are used for longer periods of time than those made of PVC (P<.0001) and PU (P=.021). In general, all polymeric tubes were used longer than the recommended 30-day period. Eighteen of the 19 tubes exposed in patients demonstrated, in one or more areas of the tube, evident surface changes. The morphologic changes identified by SEM correlate well with the results obtained by ATR-FTIR.

    CONCLUSIONS: Si tracheostomy tubes are in general used longer than those made of PVC and PU. Most of the tubes exposed in the trachea for 30 days suffered evident surface changes, with degradation of the polymeric chains as a result.

  • 10.
    Björling, Gunilla
    et al.
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Anaesthesia and Intensive Care, Stockholm.
    Belin, Anna-Lisa
    Department of Microbiology, Karolinska University Hospital, Stockholm.
    Hellström, Carina
    Department of Infection Control, Clinical Microbiology, Uppsala University, Uppsala.
    Schedin, Ulla
    National Respiratory Centre, Division of Anaesthesia and Intensive Care, Danderyd Hospital, Stockholm.
    Ransjö, Ulrika
    Department of Infection Control, Clinical Microbiology, Uppsala University, Uppsala.
    Alenius, Martin
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Anaesthesia and Intensive Care, Stockholm.
    Johansson, Unn-Britt
    Sophiahemmet University College, Stockholm.
    Tracheostomy inner cannula care: A randomized crossover study of two decontamination procedures2007In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 35, no 9, p. 600-605Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Today several methods for decontaminating inner cannulae exist. These methods are not based on scientific data, but often on local clinical tradition. This study compares two different decontamination methods. The aim was to find a practical and safe decontamination method. It is a randomized, single-blinded, comparative crossover study.

    METHODS: Fifty outpatients with long-term tracheostomy with an inner cannula were consecutively included and randomly allocated to begin with one of two different treatment sequences: detergent and chlorhexidine-alcohol (A) or detergent (B). Samples for bacterial culture were taken before and after decontamination, and the number of bacteria colonies was counted.

    RESULTS: Before decontamination, the inner cannulae grew high numbers of bacteria, which were parts of the normal flora of the upper respiratory tract and did not differ significantly between the two sequences (AB; BA). The primary variable was the culture count value after chlorhexidine-alcohol/detergent (A) and detergent (B). The effects of both methods were larger than expected, and the results showed a nearly total elimination of organisms. The equivalence criterion, ratio of mean colony counts (A/B) >0.8, was met at a significance level of P<0.001.

    CONCLUSIONS: Cleaning the tracheostomy inner cannula with detergent and water is sufficient to achieve decontamination.

  • 11.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. KI.
    Fossum, Maren
    NTNU.
    Aune, Ragnhild
    NTNU.
    Cytostatika-inducerad materialnedbrytning av subkutana venportar: En preliminär jämförande in-vitro och in-vivostudie2017Conference paper (Refereed)
  • 12.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet, Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Danderyd Hospital.
    Johansson, Dorota
    Bactiguard AB, Stockholm; Tullinge, SE-146 21, Sweden .
    Bergström, Linda
    Bactiguard AB, Stockholm; Tullinge, SE-146 21, Sweden .
    Jalal, Shah
    Karolinska Institutet, Division of Clinical Microbiology, Department of Laboratory Medicine.
    Kohn, Ivar
    Department Anesthesia and Intensive Care, Karolinska University Hospital Huddinge.
    Frostell, Claes
    Karolinska Institutet, Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Danderyd Hospital.
    Kalman, Sigridur
    Department Anesthesia and Intensive Care, Karolinska University Hospital Huddinge, CLINTEC, Karolinska Institutet.
    Tolerability and performance of BIP endotracheal tubes with noble metal alloy coating: a randomized clinical evaluation study2015In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 15, p. 1-10, article id 174Article in journal (Refereed)
    Abstract [en]

    Background

    Hospital acquired infections worsen the outcome of patients treated in intensive care units and are costly. Coatings with silver or metal alloys may reduce or alter the formation of biofilm on invasive medical devices. An endotracheal tube (ETT) is used to connect the patient to a ventilator and coated tubes have been tested in relation to bacterial colonization and respiratory infection. In the present study, we aimed to evaluate and compare a coated and uncoated ETT for patient symptoms and local tracheal tolerability during short term clinical use. Degree of bacterial colonization was also described.

    Methods

    A silver-palladium-gold alloy coating (‘Bactiguard®’Infection Protection, BIP) has been extensively used on urinary tract catheters and lately also on central venous catheters. We performed a randomised, single-blinded, controlled, first in man, post Conformité Européenne (EC) certification and CE marking study, focused on Bactiguard® coated ETTs (BIP ETT). Thirty patients at a tertiary university hospital scheduled for upper abdominal elective surgery with an expected duration of anaesthesia of at least 3 h were randomised; BIP ETT (n = 20) or standard ETT (n = 10). The tolerability was assessed with a modified version of Quality of Life Head and Neck Module, QLQ-H&N35 and by inspection of the tracheal mucosa with a fibre-optic bronchoscope before intubation and at extubation. Adverse Events (AE) and bacterial adherence were also studied. Statistical evaluations were carried out with the Fisher’s Exact Test, the Clopper-Pearson method, as well as a Proportional Odds Model.

    Results

    Differences between groups were identified in 2 of 8 patient related symptoms with regard to tolerability by QLQ-H&N35 (cough, p = 0.022 and dry mouth, p = 0.014 in the treatment group.). No mucosal damage was identified with bronchoscopy. A low level of bacterial colonization with normal flora, equal between groups, was seen after short-term of intubation (median 5 h). No serious Adverse Events related to the use of an ETT were observed. The results should be treated with caution due to statistical confounders, a small study size and large inter-individual variability in bacterial adhesion.

    Conclusions

    The new device BIP ETT is well tolerated and has good clinical performance during short-term intubation. Studies with larger sample sizes and longer intubation periods (>24 h) in the ICU-setting are needed and can now be planned in order to identify possible differences in clinical outcomes.

  • 13.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Johansson, Dorota
    Bactiguard, Stockholm.
    Bergström, Linda
    Bactiguard, Stockholm.
    Strekalovsky, Anton
    Karolinska University Hospital.
    Sanchez, Javier
    Karolinska Institutet / Bactiguard, Stockholm.
    Frostell, Claes
    Karolinska Institutet.
    Kalman, Sigridur
    Karolinska University Hospital / Karolinska Institutet.
    Evaluation of central venous catheters coated with a noble metal alloy - A randomized clinical pilot study of coating durability, performance and tolerability2018In: Journal of Biomedical Materials Research. Part B - Applied biomaterials, ISSN 1552-4973, E-ISSN 1552-4981, Vol. 106, no 6, p. 2337-2344Article in journal (Refereed)
    Abstract [en]

    The use of Central Venous Catheters (CVCs) commonly results in complications. Coatings with silver or metal alloys can reduce the risk associated with the use of CVC. We have evaluated the durability of a noble metal coated CVC (the Bactiguard Infectious Protection, BIP CVC) and compared with an uncoated CVC for clinical tolerability (Adverse Events, AEs) and performance, in order to create a baseline for a large future study. Patients undergoing major surgery, randomised at a 2:1 ratio to BIP CVC (n = 22) or standard CVC (n = 12), were catheterized 9 - 12 days, respectively. Adverse events, microbial colonization and metal release were measured.

    FINDINGS: There were no AEs in the BIP CVC-group, but 5 AEs occurred in 4 patients (1 patient had 2 AEs) in the standard CVC-group, p = 0.011 (whereof 3 were catheter related). The BIP CVC showed an initial release of coating metals in blood (gold, silver and palladium), which rapidly decreased and were far below Permitted Paily Exposure (PDE) for chronical use. The levels of silver concentration were far below those needed to develop microbial resistance. The performance was equal, and there was no difference concerning microbial colonization, for the two CVCs.

    CONCLUSION: In this pilot study the BIP CVC had significantly lower AEs and showed a comparable performance to the standard CVC. The coating was durable throughout the study length (up to 16 days) and toxicological evaluation showed good safety margins. Larger studies are needed.

  • 14.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Johansson, Dorota
    Bactiguard.
    Sanchez, Javier
    Karolinska Institutet / Bactiguard.
    Frostell, Claes
    Karolinska Institutet.
    Bergström, Linda
    Bactiguard.
    Kalman, Sigridur
    Karolinska Institutet.
    Evaluation of Tolerability and Performance of BIP Central Venous Catheter with a noble metal alloy coating: A Clinical Tolerability Study2017Conference paper (Refereed)
  • 15.
    Björling, Gunilla
    et al.
    Department of Nursing, Karolinska Institutet, Danderyd University Hospital.
    Johansson, Unn-Britt
    Sophiahemmet University College.
    Andersson, G
    Respiratory Unit, Division of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd University Hospital.
    Schedin, Ulla
    Respiratory Unit, Division of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd University Hospital.
    Markström, A
    Respiratory Unit, Division of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd University Hospital.
    Frostell, C
    Department of Anesthesia and Intensive Care, Karolinska University Hospital Huddinge, Stockholm.
    A retrospective survey of outpatients with long-term tracheostomy2006In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 4, p. 399-406Article in journal (Refereed)
    Abstract [en]

    Background:  The Respiratory Unit (RU) at Danderyd University Hospital opened in 1982, with the expressed goal of supporting outpatients with long-term tracheostomy. The primary aim of this retrospective study in tracheostomized patients was to compare the need for hospital care in the 2-year period before and after the tracheostomy.

    Methods:  Data were collected from patient medical records at the RU, from the National Board of Health and Welfare, Sweden and from the Official Statistics of Sweden. The subjects were RU patients in 1982 (Group 1, n = 27) and in 1997 (Group 2, n = 106) with long-term tracheostomy surviving at least 4 years after the tracheostomy.

    Results:  Both groups had few and unchanged needs for hospital care after tracheostomy. They spent ≥ 96% of their time out of hospital. In 1997, (group 2) the number of patients, diagnoses and need for home mechanical ventilation had increased. Life expectancy was assessed for patients in Group 1. Data showed that they lived as long as an age-matched and gender-adjusted control cohort.

    Conclusions:  Long-term tracheostomy may not increase the need for hospital care and does not reduce life expectancy. These clinical observations were made in a setting where patients had regular access to a dedicated outpatient unit.

  • 16.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College.
    Samuelsson, Bodil
    Livskvalitet hos äldre människor med utvecklingsstörning2001Report (Other academic)
    Abstract [sv]

    Syftet med skriften var att ta fram en rapport om dagsläget när det gäller internationell forskning om äldre med intellektuella funktionshinder. Forskningen som redovisas är inriktad mot livskvalitet, d v s det positiva åldrandet. Resultatet redovisas med följande indelning: Livskvalitet - boende. Livskvalitet - livsstil. Livskvalitet - social förmåga. Livskvalitet - fritid. Hälsa. Åldrande föräldrar till intellektuellt funktionshindrade.

  • 17.
    Fossum, Maren
    et al.
    Norwegian University of Science and Technology, Trondheim, Norway / KTH.
    Strömberg, Emma
    KTH.
    Sanchez, Javier
    Karolinska Institutet.
    Rotstein, Samuel
    Karolinska Institutet.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet.
    Aune, Ragnhild E
    Norwegian University of Science and Technology, Trondheim, Norway.
    Preliminary In-Vitro Study of Surface Altera1ons of Subcutaneous Venous Access Ports Exposed to Antineoplastic Drugs and Whole Blood2015In: TMS 2015, 144th Annual Meeting & Exhibition: Supplemental Proceedings, John Wiley & Sons, 2015, p. 645-652Conference paper (Refereed)
  • 18.
    Fossum, Maren
    et al.
    Norwegian University of Science and Technology, Trondheim, Norway.
    Tunc, Zozan
    KTH.
    Strömberg, Emma
    KTH.
    Frostell, Claes
    Karolinska Institutet.
    Liljegren, Annelie
    Karolinska Institutet.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Aune, Ragnhild
    Norwegian University of Science and Technology, Trondheim, Norway.
    In-vitro and In-vivo Exposure of Intravascular Catheters to Cytostatic Drugs2018Conference paper (Refereed)
  • 19.
    Frostell, Claes
    et al.
    Danderyd Hospital, Karolinska Institutet.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Danderyd Hospital, Karolinska Institutet.
    Strömberg, Emma
    KTH.
    Karlsson, Sigbritt
    KTH.
    Aune, Ragnhild E
    Norwegian University of Science and Technology, Trondheim, Norway.
    Tracheal implants revisited2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 389, no 10075, p. 1191-Article in journal (Other (popular science, discussion, etc.))
  • 20.
    Hallberg, David
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. University of Douala, Douala, Cameroon.
    Kimario, T. D.
    Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Mtuya, C.
    Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Msuya, M.
    Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Factors affecting HIV disclosure among partners in Morongo, Tanzania2019In: International Journal of Africa Nursing Sciences, E-ISSN 2214-1391, Vol. 10, p. 49-54Article in journal (Refereed)
    Abstract [en]

    Background: Human immunodeficiency virus (HIV) remains a major concern globally and locally. Married couples and those in stable relationships account for the highest percentage of new HIV and acquired immune deficiency syndrome (AIDS) infections. The rate of HIV disclosure among couples is low and affected by both known and unknown factors. The aim of this study was to describe the reasons for HIV status (non)disclosure among partners in Morongo. Methods: A sampling containing two stages was used in this quantitative, exploratory, and descriptive study to select the 100 participants. The location was a Care and Treatment Clinic in the Morogoro municipality. Results: The participants had a moderate level of knowledge about the importance of HIV serostatus disclosure. Female genital mutilation was the most mentioned (44%) custom affecting disclosure. The participants’ level of knowledge about their partner's HIV status was also moderate (28%). Nitty-six percent had not disclosed due to fear of divorce and 98% due to fear of loss of financial support. Cultural factors such as traditional practices (95%) were also a major reason that hindered disclosure. Conclusions: Interventions to address the negative attitudes are necessary to promote HIV disclosure and, in turn, better adherence to psychological adjustment therapy and reduction in the risk of HIV transmission among couples.

  • 21.
    Kako, F
    et al.
    Kllimanjaro Christian Medical University College, Tanzania.
    Msuya, Maryclina
    Kllimanjaro Christian Medical University College, Tanzania.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet.
    Study on Factors Influencing Participation to Continuous Professional Development Among Nurses Working at Mawenzi Regional Hospital in Moshi Municipal Council, Tanzania2015In: Abstract Book Human Rights and Health and the Astrid Janzon Symposium: The Swedish Red Cross University College, Stockholm 26-27th November 2015 : Oral sessions and Poster sessions, 2015, p. 26-Conference paper (Refereed)
  • 22.
    Kimario, T
    et al.
    Kllimanjaro Christian Medical University College, Tanzania.
    Msuya, Maryclina
    Kllimanjaro Christian Medical University College, Tanzania.
    Chuck Mtutuya, Christina
    Kllimanjaro Christian Medical University College, Tanzania.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. KI.
    Factors Affecting Hiv Disclosure Among Partners Attending Care and Treatment at a Regional Hospital in Tanzania2015Conference paper (Refereed)
  • 23.
    Manninen, Katri
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet; Karolinska Universitetssjukhuset.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Ethical Coffee Room: ett EU-projekt om etiska frågor och diskussioner i verksamhetsförlagd utbildning för sjuksköterskestudenter2019Other (Other (popular science, discussion, etc.))
    Abstract [sv]

    Projektet Simulation in Ethics, SimE, syftar till att öka den etiska kompetensen hos sjuksköterskestudenter i Norden och Baltikum. Projektet pågår under åren 2017-2019 i samarbete mellan Röda Korsets Högskola, Turku University of Applied Sciences (Finland) och Riga Medical College of the University of Latvia (Lettland)  och är finansierat av EU och Interregional Central Baltic Programme.

    I projektet ingår att planera och genomföra tre kurser: Basic Theories of Ethics (2 ECTS), Ethical Coffee Room (1 ETCS) and Simulation in Ethics (3ECTS) som görs gemensamt av de tre partnerorganisationer. Kurserna finns på en digital plattform med web-seminarier och diskussionsforum som resurs för studenterna. Språket är engelska. I kurs 1 ges grunderna i etik och etiska teorier och begrepp. Kurs 2 handlar om att tillämpa och diskutera teoretiska kunskaper och erfarenheter i etik i en autentisk miljö i den verksamhetsförlagda utbildningen. I kurs 3 genomförs simuleringar där studenterna aktivt medverkar i simuleringsscenarier med efterföljande etisk reflektion. Gemensamma kurser i etik bidrar till en mer harmoniserad utbildning och kompetens inom regionen och främjar mobilitet av arbetskraft och bättre patientvård. Efter avslutat projekt kommer allt kursmaterial inklusive en handbok att finnas fritt tillgängligt och kunna användas av alla utbildningar inom hälso- och sjukvård. Röda Korsets Högskola har huvudansvaret för kurs 2 och vi har under våren genomfört en pilot-testning av den, Ehtical Coffee Room, i termin 3 med gott resultat.

  • 24.
    Mattsson, Janet
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Östlund, Britt
    KTH.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Williamsson, Anna
    KTH.
    Eriksson, Andrea
    KTH.
    Interprofessional Learning for Enhanced Patient Safety: Biomedical Engineering Students and Nursing Students in Joint Learning Activities2019In: Journal of Research in Interprofessional Practice and Education, ISSN 1916-7342, E-ISSN 1916-7342, Vol. 9, no 1Article in journal (Refereed)
    Abstract [en]

    Background: In the last decade, research has highlighted the importance of interprofessional approaches to education and practice. Collaboration between medical practice and engineering has been identified as particularly relevant to developing accountable models for sustainable healthcare and overcoming increased specialization leading to professional barriers. This study aims to analyze insights and understanding expressed by nursing students and biomedical engineering students following a joint learning activity regarding a medical device used in the hospital setting.

    Method: A qualitative approach deriving from a phenomenological view examined an interprofessional learning activity where the focus was on active integration and knowledge exchange.

    Conclusion: The activity was expressed as a positive opportunity for getting insights into perspectives from other professional groups as well as insights into the importance of a system perspective in patient safety. The learning and insights listed in the evaluations included ideas about how the two professional groups could collaborate in the future.

  • 25.
    Mlay, Immuclate P
    et al.
    Kilimanjaro Christian Medical University College.
    Msuya, Maryclina
    Kllimanjaro Christian Medical University College, Tanzania.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet.
    Knowledge, Attitude and Practice on Breast Cancer Screening Among Women of Child Bearing Age at KCMC Referral Hospital in Moshi Urban, Kilimanjaro Region – Tanzania2015In: Abstract Book Human Rights and Health and the Astrid Janzon Symposium: The Swedish Red Cross University College, Stockholm 26-27th November 2015 : Oral sessions and Poster sessions, 2015, p. 27-Conference paper (Refereed)
  • 26.
    Mollel, M.W.
    et al.
    Kllimanjaro Christian Medical University College, Tanzania.
    Msuya, Maryclina
    Kllimanjaro Christian Medical University College, Tanzania.
    Sabuni, S.J.
    Kllimanjaro Christian Medical University College, Tanzania.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinaska Institutet.
    Knowledge, Attitude and Practice on the Use of Helmets Among Commercial Motorcyclists in Moshi Town, Tanzania: A Cross Sectional Study2015In: Abstract Book Human Rights and Health and the Astrid Janzon Symposium: The Swedish Red Cross University College, Stockholm 26-27th November 2015 : Oral sessions and Poster sessions, 2015, p. 25-Conference paper (Refereed)
  • 27.
    Moore, Alastair J
    et al.
    Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Cetti, Edward
    Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Haj-Yahia, Saleem
    Department of Thoracic Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Carby, Martin
    Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Björling, Gunilla
    Division of Anaesthesia and Intensive Care, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm.
    Karlsson, Sigbritt
    Fibre and Polymer Technology, School of Chemical Science and Engineering, Royal Institute of Technology, Stockholm.
    Shah, Pallav
    Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Goldstraw, Peter
    Department of Thoracic Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Moxham, John
    Department of Respiratory Medicine, Kings College Hospital, London, United Kingdom.
    Jordan, Simon
    Department of Thoracic Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Polkey, Michael I
    Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Unilateral extrapulmonary airway bypass in advanced emphysema2010In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 89, no 3, p. 899-906Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Gas trapping in emphysema results in resting and dynamic hyperinflation. We tested the hypothesis that a direct connection between the lung parenchyma and the atmosphere could increase expiratory flow and thereby potentially improve dyspnea through the relief of gas trapping.

    METHODS: Ex vivo we studied 7 emphysematous lungs and 3 fibrotic lungs (as controls) and measured expiratory flow before and after airway bypass insertion during a forced maneuver in an artificial thorax. Pilot studies were conducted in vivo in 6 patients with advanced emphysema using a size 9 endotracheal tube as a bypass surgically placed through the chest wall into the upper lobe.

    RESULTS: In the ex vivo emphysematous lungs the volume expelled during a forced expiratory maneuver increased from 169 to 235 mL (p < 0.05). In the in vivo group 4 patients retained the bypass tube for 3 months or more; total lung capacity was reduced, and the forced expiratory volume in 1 second increased by 23% (mean percent predicted at baseline versus 3 months, 24.4% versus 29.5%).

    CONCLUSIONS: An extrapulmonary airway bypass increases expiratory flow in emphysema. This may be a useful approach in hyperinflated patients with homogeneous emphysema.

  • 28.
    Nahlen Bose, Catarina
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
    Elfstrom, Magnus L.
    Mälardalen University, Academy of Health, Care and Social Welfare, Eskilstuna/Västerås.
    Persson, Hans
    Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured2015In: Cardiology Research, ISSN 1923-2829, E-ISSN 1923-2837, Vol. 6, no 2, p. 239-248Article in journal (Refereed)
    Abstract [en]

    Background: Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.

    Method: One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.

    Results: A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.

    Conclusions: This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.

  • 29.
    Nahlen Bose, Catarina
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet.
    Elfström, M. L.
    Mälardalen University.
    Persson, H.
    Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Implementation of coping effectiveness training in patients with chronic heart failure: participants evaluations indicate psychosocial benefits2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no S1, p. S10-S10Article in journal (Other academic)
  • 30.
    Nahlen Bose, Catarina
    et al.
    Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet / Sophiahemmet University.
    Elfström, Magnus L.
    Academy of Health, Care and Social Welfare, Mälardalen University.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet.
    Persson, Hans
    Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet.
    Saboonchi, Fredrik
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, p. 704-713Article in journal (Refereed)
    Abstract [en]

    Introduction: Emotional distress in patients with chronic heart failure (CHF) predicts mortality, hospital readmission and quality of life. The patient's avoidant coping style and beliefs about the disease have been linked to emotional distress in CHF. However, the pattern and transmitting effects of these variables are indefinite.

    Aim: This study aimed to examine the links between and the potential mediating role of illness perceptions and avoidant coping style on depression and anxiety in patients with CHF.

    Method: Self-assessment data from 103 patients with CHF were subjected to path analysis in two hypothesised models. The outcome measures were coping styles, illness perception, anxiety and depression.

    Results: Avoidant coping had a direct adverse effect on anxiety and depression. The perception of symptom burden and personal control, significantly mediated the effect between avoidant coping and anxiety and depression.

    Conclusions: Avoidant coping style appears to influence not only emotional distress, but also a malignant symptom perception and low sense of control over the illness.

  • 31.
    Nahlen Bose, Catarina
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
    Persson, Hans
    Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
    Ljunggren, Gunnar
    Public Healthcare Services Committee Administration, Stockholm County Counsil; Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Medical Management Centre.
    Elfström, Magnus L.
    Mälardalen University, Academy of Health, Care and Social Welfare.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet; Department of Clinical Neuroscience, Division of Insurance Medicine, Administration.
    Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure: a randomized controlled trial2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 7, p. 537-548Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF).AIMS:To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined.

    METHODS: Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months).

    RESULTS: No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036).

    CONCLUSION: CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.

  • 32.
    Nürnberg Damström, D.
    et al.
    Institution of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Saboonchi, Fredrik
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    Sackey, P. V.
    Institution of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Stockholm,.
    Björling, Gunilla
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    A preliminary validation of the Swedish version of the critical-care pain observation tool in adults2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, ISSN 0001-5172, Vol. 55, no 4, p. 379-386Article in journal (Refereed)
    Abstract [en]

    Background: Assessing pain in critically ill patients can be complicated, especially for those unable to communicate. A recently developed pain assessment tool, the Critical-Care Pain Observation Tool (CPOT), has been shown to be a reliable tool for pain assessment in the Intensive Care Unit (ICU). The aim of the study was to validate the Swedish version of the CPOT.

    Methods: Conscious and unconscious adults were observed during two procedures: one non-nociceptive procedure (NNP) (arm- and face wash) and one nociceptive procedure (NP) (turning). In total, there were 240 patient assessments pre-, per- and post-procedure performed by two independent staff members at rest, during and 15 min after the different procedures. Measures of interrater reliability, internal consistency and discriminant validity of the CPOT were obtained to examine the properties of the Swedish version of CPOT.

    Results: The results provide indications of good agreement between the independent raters (ICC=0.84). There was an adequate discriminant validity of the Swedish version of CPOT established by a significant peak for CPOT scores during the NP (per-procedure). There was also a consistent pattern of significant correlations between CPOT and the mean artery pressure (ρ=0.32–0.45).

    Conclusion: The Swedish version of the CPOT is a suitable instrument for assessing pain in critically ill adults. The overall reliability and validity measures converge with findings from previous studies of the CPOT, but in order to achieve enhanced generalizability of the CPOT, we encourage further evaluation of CPOT in broader groups of critically ill patients.

  • 33.
    Östlund, Britt
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. KTH.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences.
    Mattsson, Janet
    The Swedish Red Cross University College, Department of Health Sciences.
    Stridh, Sara
    The Swedish Red Cross University College, Department of Health Sciences.
    Sahlström, Madeleine
    The Swedish Red Cross University College, Department of Health Sciences.
    Technology in Health Care: A new research and teaching subject in collaboration between nursing science and engineering2017Conference paper (Refereed)
    Abstract [en]

    Today, health care systems face a number of challenges related to technological developments. This work in progress is a new Swedish initiative for collaboration between nursing science and engineering focusing digitization, demographics and participation. The initiative aims at understanding how digitization affects patients and health care professionals and the role of engineers and how this collaboration proactively contributes to systems that support caring and nursing. The presentation expects input on the programs substance and boundaries and whether this initiative is fruitful to create sustainable health care systems.

  • 34.
    Östlund, Britt
    et al.
    KTH.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences.
    Stridh, Sara
    The Swedish Red Cross University College, Department of Health Sciences.
    Sahlström, Madeleine
    The Swedish Red Cross University College, Department of Health Sciences.
    Mattsson, Janet
    The Swedish Red Cross University College, Department of Health Sciences.
    Digitizing Health Care in Collaboration Between Nursing and Engineering: Two cases of strategic learning and implementationof robots in the homes of elderly people2018In: International Journal On Advances in Life Sciences, ISSN 1942-2660, E-ISSN 1942-2660, Vol. 10, no 1 & 2, p. 11-22Article in journal (Refereed)
    Abstract [en]

    Digitization exceeds the limits of healthcare meetings, which gives renewed relevance to examine the collaboration between engineers and nurses. Caring for people is no longer just something going on in the hospital but at new arenas at home and in the middle of people's everyday lives. In caring situations nurse's responsibility is, unlike the physician, to make observations and to follow in detail the patient's caring needs, and where engineers provide technological devices to support and monitor the course of the disease. When digitizing the caring situation person-centered care gets a new meaning. For engineers the understanding of how technology is contextualized and domesticated becomes even more important to make applications and systems work outside laboratories. This paper presents two cases of interaction between engineers and nurses aimed at improving the implementation of robots and sensorsin elderly people ́s homes; and learning how to improve patient safety in hospitals.The result shows that conflicting epistemologies, differences in professional languages and lack of joint learning opportunities are factors that create obstacles for interactions. The conclusionsreject the idea of linear innovation processes and showthat successful ccollaborationtake more than just adding two and two together. Especially digitization is breaking up traditional barriers and hierarchies. For nurses to be proactive requires knowledge about technological developments and the ability toparticipate in design and innovation processes. For engineers a more thorough understanding of caring situations and users will contribute to a more reliable provision of digitalsolutions and point at new ideas leading up to innovations. The main output of the paper is that it is deepening the understanding of what factors leading to successfulcollaborations between nursing and engineering and what are the missing links.

1 - 34 of 34
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