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Trollhättan, Sweden

Boman A.,University College West | Povlsen L.,Nordic School of Public Health | Dahlborg-Lyckhage E.,University College West | Hanas R.,NU Hospital Group | Borup I.,Nordic School of Public Health
Health and Social Care in the Community | Year: 2013

The purpose of this grounded theory study was to explore and discuss how fathers involved in caring for a child with type 1 diabetes experienced support from Swedish paediatric diabetes teams (PDTs) in everyday life with their child. Eleven fathers of children with type 1 diabetes, living in Sweden and scoring high on involvement on the Parental Responsibility Questionnaire, participated. Data were collected from January 2011 to August 2011, initially through online focus group discussions in which 6 of 19 invited fathers participated. Due to high attrition, the data collection continued in eight individual interviews. A semi-structured interview guide was used, and the fathers were asked to share experiences of their PDT's support in everyday life with their child. A simultaneous and constant comparison approach to data collection and analysis allowed the core category to emerge: the tension between general recommendations and personal experience. This core category illuminates how the fathers experienced tension between managing their unique everyday life with their child and balancing this to meet their PDT's expectations with regard to blood glucose levels. The core category was supported by two categories: the tension between the fathers'and their PDT's knowledge, whereby fathers reported discrepancies between their PDT's medical knowledge and their own unique knowledge of their child; and the tension between the fathers'and their PDT's goals, whereby the fathers identified differences between the familys' and their PDT's goals. As a dimension of the core category, fathers felt trust or distrust in their PDT. We conclude that to achieve high-quality support for children with diabetes and to enhance their health and well-being, involved fathers' knowledge of their unique family situation needs to be integrated into the diabetes treatment. © 2012 Blackwell Publishing Ltd.

Enander R.,Lidkoping Hospital SkaS Hospital Group | Gundevall C.,Kungsbacka Hospital | Stromgren A.,Kungsbacka Hospital | Chaplin J.,Gothenburg University | Hanas R.,NU Hospital Group
Pediatric Diabetes | Year: 2012

Aim: Carbohydrate counting (CC) is widely used in insulin pumps. The primary objectives of this study were improvement of HbA1c and meal-related plasma glucose (PG) levels when using CC. Methods: Forty patients with pump treatment, aged 13.8±3.4yr (range 5.0-19.5) and diabetes duration 8.0±3.8 (1.8-16.8) years completed a 1-yr multi-center study. HbA1c at start was 7.6±0.9% Diabetes Control and Complications Trial (DCCT), 59±10mmol/mol International Federation for Clinical Chemistry and Laboratory Medicine (IFCC). They were randomized into (A) control group, (B) manual CC, and (C) CC with a bolus calculator in the pump for calculations. (B) and (C) received education in CC while (A) received equal hours of traditional dietary education. Glucose meters were downloaded at visits and the standard deviation (PG-SD) calculated. PG measurements from before and 2 h after meals were registered separately. Results: We found no difference in HbA1c between the groups. Group C had a non-significant decrease in PG-SD (p=0.056) compared to start, and a significantly higher number of post-meal PG between 4 and 8mmol/L at 12months compared to group A (55.3% vs. 30.6%, p=0.014). The frequency of hypoglycemia was reduced for the whole study group (p=0.01), but with no significant difference between groups. (A) significantly increased their basal-insulin dosage at 12months. In (C), all subjects wanted to continue CC after the study. The insulin:carbohydrate ratio correlated significantly to the insulin-dose/24h (p=0.003) and the correction factor to the insulin-dose/24h (p=0.035) and age (p<0.001). Conclusions: We conclude that CC using a bolus calculator may help decrease PG-fluctuations and increase post-meal PG values within target. © 2012 John Wiley & Sons A/S.

Prytz M.,NU Hospital Group | Prytz M.,Gothenburg University | Angenete E.,Sahlgrenska University Hospital | Angenete E.,Gothenburg University | And 3 more authors.
International Journal of Colorectal Disease | Year: 2014

Purpose: Local recurrences are more common after abdominoperineal excision (APE) than after anterior resection of rectal cancer. Extralevator APE was introduced to address this problem. This prospective registry-based population study aims to investigate the efficacy of extralevator APE (ELAPE) in improving short-term oncological outcome. Methods: All Swedish patients operated with any kind of abdominoperineal excision and registered in the Swedish Rectal Cancer Registry 2007-2009 were included (n=1,397) and analyzed with emphasis on the perineal part of the operation. Short-term perioperative and oncological results were collected from the registry. Results: Extralevator APE did not result in fewer intraoperative perforations or involved circumferential resection margins as compared to standard APE for the entire group. Intraoperative perforations were significantly fewer for patients with low tumours (≤4 cm) (ELAPE: n=28/386 versus APE: n=9/58) (p=0.043) and for early (T0-T2) T-stages (ELAPE: n=3/172 versus APE: n=6/75) (p=0.025). There were significantly more post-operative wound infections for ELAPE than for APE (n=106 (20.4 %) versus n=25 (12.0 %), p=0.011). Conclusions: The short-term results indicate that selective use of extralevator APE can be warranted, for example, for subgroups with low tumours. In conclusion, selective use of the extralevator APE is advocated as not all patients seem to benefit from the technique, and there are significantly more short-term complications after extralevator APE. © 2014 The Author(s).

Kvist J.,Linkoping University | Kartus J.,NU Hospital Group | Karlsson J.,Sahlgrenska University Hospital | Forssblad M.,Karolinska Institutet
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2014

Purpose The purpose of the study was to analyze the baseline variables and clinical outcomes for almost 24,000 patients entered into the Swedish National ACL Register between January 2005 and December 2012. Methods The register consists of 2 parts: 1 section in which surgeons report baseline and surgical data and 1 section in which patients report the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EQ-5D score before and 1, 2, and 5 years after surgery. Results By December 2012, 23,744 patients had been entered into the surgeons' part of the register. The female-male ratio in the register is 42:58. The mean age at primary anterior cruciate ligament (ACL) reconstruction was 26 years (SD, 11 years) and 28 years (SD, 9 years) for the female and male patients, respectively. The ACL injury occurred during soccer in 36% of the female patients and 49% of the male patients. In 2012, 95% of the primary ACL reconstructions were performed using hamstring tendon autografts. For patients who had a minimum of 5 years' follow-up, the revision rate was 3.3% and the contralateral reconstruction rate was 3.8%. On all follow-up occasions up to 5 years, patients who had undergone revision had a significantly (P <.001) poorer outcome than those who had undergone primary unilateral ACL reconstructions in all KOOS and EQ-5D dimensions. On all follow-up occasions, smokers obtained significantly poorer scores than nonsmokers in terms of both the KOOS (P <.008) and the EQ-5D (P <.024). Conclusions Soccer is the most common cause of injury in both female and male patients, and patients undergoing revisions fare less well than those undergoing primary unilateral ACL reconstructions, as well as bilateral reconstructions. Furthermore, smokers fare less well than nonsmokers. The cumulative risk of an ACL revision or contralateral ACL reconstruction during a 5-year period is approximately 7%. For patients aged younger than 19 years, the cumulative risk is significantly higher. Level of Evidence Level II, retrospective prognostic study. © 2014 by the Arthroscopy Association of North America.

Johansson I.,NU Hospital Group | Karlson B.W.,Astra Zeneca R and D | Grankvist G.,University west | Brink E.,University west | Brink E.,Gothenburg University
European Journal of Cardiovascular Nursing | Year: 2010

Background: Disturbed sleep has been linked to increased morbidity, mortality and depression and worsened health-related quality of life in patients with chronic illness. Few studies of readjustment after coronary artery disease have explicitly focused on sleep disturbance. Aim: To explore associations between disturbed sleep, fatigue, anxiety and depression, and to assess to what extent fatigue four months post-MI could be explained. Method: The sample included 204 consecutive patients, ≤ 80 years of age who answered questionnaires about disturbed sleep, fatigue, anxiety and depression four months after MI. Results: The variables anxiety, depression and disturbed sleep were all associated with fatigue. The regression model accounted for 46% of the variance in fatigue with depression and disturbed sleep as predictors. Infarct size measured by conventional biochemical markers, left ventricle ejection fraction and history of previous MI were not correlated with disturbed sleep, fatigue, anxiety or depression. Conclusions: From knowledge about associations between disturbed sleep, fatigue, anxiety and depression after MI, cardiac nurses could be trained to observe such symptoms. Optimal care for sleep disturbance may include actions to reduce anxiety and depression as well as self-care advices about sleep hygiene in order to improve sleep quality and reduce fatigue. © 2009 European Society of Cardiology.

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