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Hjortswang, Henrik
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Publications (10 of 47) Show all publications
Lovén Wickman, U., Yngman Uhlin, P., Hjortswang, H., Wenemark, M., Stjernman, H., Riegel, B. & Hollman Frisman, G. (2019). Development of a self-care questionnaire for clinical assessment of self-care in patients with inflammatory bowel disease: A psychometric evaluation. International Journal of Nursing Studies, 89
Open this publication in new window or tab >>Development of a self-care questionnaire for clinical assessment of self-care in patients with inflammatory bowel disease: A psychometric evaluation
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2019 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89Article in journal (Refereed) Published
Abstract [en]

Background

Patients with inflammatory bowel disease have lifelong needs to learn how to manage their symptoms and life situation. The range of actions that patients take in order to manage daily life and maintain health is referred to as self-care. Assessment of self-care in patients with inflammatory bowel disease could allow targeted support and education by health careprofessionals. There are no existing measures assessing self-care in patients with inflammatory bowel disease.

Objectives

The aim was to develop and evaluate the self-care questionnaire for assessment of self-care among patients with inflammatory bowel disease.

Methods

Qualitative and quantitative methods were used to develop the inflammatory bowel disease self-care questionnaire. The development and evaluation process was performed in three phases: (1) item generation based on interviews with patients with inflammatory bowel disease (n = 20), (2) content validation in a panel of experts (n = 6) and patients (n = 100) assessed with the content validity index, cognitive interviews and quantifying and ranking the items to determine the usability of the questionnaire, and (3) final evaluation through a pilot study (n = 93) with test-retest evaluation (n = 50). An expert review group of three nurses and one physician continuously discussed the result during the development process.

Results

A total of 91 patients with Crohn's disease and 102 with ulcerative colitis participated. The final self-care questionnaire consists of 22 items. Assessment of content validity indicated that the items were adequate and easy to understand. Test-retest reliability was confirmed with intraclass correlations above 0.6 after a three week interval, for all items except one.

Conclusion

An inflammatory bowel disease-specific self-care questionnaire was developed using structured methods. The evaluation indicated good validity and reliability. The questionnaire may be a useful tool to assess the ability of patients with inflammatory bowel disease to perform routine self-care.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Content validity; Inflammatory bowel disease; Nursing; Reliability; Questionnaire development; Self-care; Swedish version
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-153966 (URN)10.1016/j.ijnurstu.2018.08.016 (DOI)000454965700001 ()30316054 (PubMedID)2-s2.0-85054459236 (Scopus ID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden (FORSS) [371201, 464691, 554261, 599461]; County Council of Kalmar

Available from: 2019-01-22 Created: 2019-01-22 Last updated: 2019-02-01Bibliographically approved
Pihl Lesnovska, K., Hollman Frisman, G., Hjortswang, H. & Börjeson, S. (2016). Critical situations in daily life as experienced by patients with inflammatory bowel disease. Gastroenterology Nursing, 39(3), 195-203
Open this publication in new window or tab >>Critical situations in daily life as experienced by patients with inflammatory bowel disease
2016 (English)In: Gastroenterology Nursing, ISSN 1042-895X, Vol. 39, no 3, p. 195-203Article in journal (Refereed) Published
Abstract [en]

Crohn disease and ulcerative colitis, collectively known as inflammatory bowel disease (IBD), are chronic and have a fluctuating clinical course that impacts daily life. Daily life with a chronic disease involves thinking and worrying about the limitations that chronic disease causes. Knowledge about how patients who suffer from IBD manage critical incidents in daily life is lacking. The aim of the study was to describe how patients living with IBD experience critical incidents in daily life in relation to their disease and symptoms. Thirty adult patients were interviewed focusing on critical incidents in daily life. Data were analyzed using the critical incident technique. The study comprised 224 critical incidents and was grouped into 21 subcategories and 5 categories: losing bowel control, having a body that smells, being unable to meet own and others' expectations, not being believed or seen, and experiencing frustration due to side effects and ineffective treatment. These categories formed one main area describing the overall result "The bowels rule life." The uncertain nature of IBD created critical incidents in which the bowel ruled life, causing patients to avoid social interaction. It also placed considerable demands on the family and sometimes had a negative effect on the afflicted person's career.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-126621 (URN)10.1097/SGA.0000000000000211 (DOI)000380804500004 ()26870902 (PubMedID)
Note

Funding agencies: We acknowledge funding from the County Council of Ostergotland.

Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2017-11-01Bibliographically approved
Rendek, Z., Falk, M., Grodzinsky, E., Wahlin, K., Kechagias, S., Svernlöv, R. & Hjortswang, H. (2016). Effect of oral diclofenac intake on faecal calprotectin. Scandinavian Journal of Gastroenterology, 51(1), 28-32
Open this publication in new window or tab >>Effect of oral diclofenac intake on faecal calprotectin
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2016 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 1, p. 28-32Article in journal (Refereed) Published
Abstract [en]

Background. NSAIDs are a known source of increased faecal calprotectin (FC) levels. Currently, there is a lack of knowledge about how long it takes for an increased FC level to return to normal after NSAID intake. Objective. The aim was to investigate how oral diclofenac intake affects FC levels and assess how long it takes for an increased FC level to return to normal after oral diclofenac intake. Material and methods. Thirty healthy volunteers received diclofenac 50 mg three times daily for 14 days. Participants provided a stool sample on Days 0, 2, 4, 7, 14 during intake and Days 17, 21, 28 after discontinuation. FC levels were then followed at 7-day intervals until normalization. Results. During diclofenac intake, eight participants (27%) had FC levels exceeding the upper limit of normal (median, 76 mu g/g; range, 60-958 mu g/g), corresponding to 8.3% of measurements. FC was not constantly increased and became normal in most participants during diclofenac intake. FC levels were on average significantly higher during intake (M = 9.5, interquartile range (IQR) = 13.4) than on baseline (M = 7.5, IQR = 0.0), p = 0.003. After discontinuation, two participants had increased FC on Days 17 and 21, respectively. No significant differences in FC levels were found between baseline and measurements after discontinuation. Two weeks after discontinuation, all participants had normal FC levels. Conclusions. Short-term oral diclofenac intake is associated with increased FC levels. However, the likelihood of an increased test result is low. Our results suggest that 2 weeks of diclofenac withdrawal is sufficient to get an uninfluenced FC test result.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
Keywords
intestinal inflammation; proton pump inhibitors; NSAIDs; non-steroidal anti-inflammatory agents; diclofenac; calprotectin
National Category
Physiology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-127586 (URN)10.3109/00365521.2015.1066421 (DOI)000373621900005 ()26200803 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland, Sweden

Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2018-03-22
Lovén Wickman, U., Yngman Uhlin, P., Hjortswang, H., Riegel, B., Stjernman, H. & Hollman Frisman, G. (2016). Self-care among patients with Inflammatory Bowel Disease: An interview study. Gastroenterology Nursing, 39(2), 121-128
Open this publication in new window or tab >>Self-care among patients with Inflammatory Bowel Disease: An interview study
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2016 (English)In: Gastroenterology Nursing, ISSN 1042-895X, Vol. 39, no 2, p. 121-128Article in journal (Refereed) Published
Abstract [en]

Inflammatory bowel disease (IBD) is a chronic disease of unknown etiology. The disease occurs early in life and the burden of symptoms is significant. Patients need to perform self-care to handle their symptoms, but knowledge about what kind of self-care patients do is limited and these individuals need to learn how to manage the symptoms that arise. The aim of this study was to explore self-care among patients with IBD. Twenty adult patients with IBD, 25-66 years of age, were interviewed. Data were analyzed by performing a qualitative content analysis. Four categories with 10 subcategories emerged from the analysis of the interviews. The self-care patients perform consists of symptom recognition (subcategories: physiological sensations and psychological sensations), handling of symptoms (subcategories: adapting the diet, using medical treatment, stress management, and using complementary alternative medicine), planning life (subcategories: planning for when to do activities and when to refrain from activities), and seeking new options (subcategories: seeking knowledge and personal contacts). Self-care consists of symptom recognition, handling life through planning, and accommodating the existing situation with the ultimate goal of maintaining well-being. Being one step ahead facilitates living with IBD. A decision to actively participate in care of a chronic illness is a prerequisite for self-care. Healthcare professionals must consider patients' potential for and desire for self-care when giving advice on self-care activities. Doing so may help people better cope with IBD.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-126617 (URN)10.1097/SGA.0000000000000120 (DOI)000377983500007 ()26166423 (PubMedID)
Note

Funding agencies: Medical Research Council of Southeast Sweden-FORSS; County Council of Kalmar; Florence Nightingale Foundation; Ruth and Richard Juhlins foundation

Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2017-05-03Bibliographically approved
Lovén Wickman, U., Riegel, B., Yngman Uhlin, P., Hjortswang, H. & Hollman Frisman, G. (2016). Self-care of inflammatory bowel disease may be associated with better well-being. In: : . Paper presented at 11th Congress of ECCO - Inflammatory Bowel Diseases, MArch 16-19, Amsterdam, The Netherlands.
Open this publication in new window or tab >>Self-care of inflammatory bowel disease may be associated with better well-being
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2016 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-126623 (URN)
Conference
11th Congress of ECCO - Inflammatory Bowel Diseases, MArch 16-19, Amsterdam, The Netherlands
Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2018-12-11
Krarup, A. L., Peterson, E., Ringstroem, G., Toernblom, H., Hjortswang, H. & Simren, M. (2015). The Short Health Scale A Simple, Valid, Reliable, and Responsive Way of Measuring Subjective Health in Patients With Irritable Bowel Syndrome. Journal of Clinical Gastroenterology, 49(7), 565-570
Open this publication in new window or tab >>The Short Health Scale A Simple, Valid, Reliable, and Responsive Way of Measuring Subjective Health in Patients With Irritable Bowel Syndrome
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2015 (English)In: Journal of Clinical Gastroenterology, ISSN 0192-0790, E-ISSN 1539-2031, Vol. 49, no 7, p. 565-570Article in journal (Refereed) Published
Abstract [en]

Goals:To evaluate validity, reliability, and responsiveness of the Short Health Scale (SHS) in irritable bowel syndrome (IBS) patients.Background:Subjective health assessment is central when treating patients with IBS. The Short Health Scale is a quick 4-item questionnaire covering most aspects of subjective health that has been validated for inflammatory bowel disease.Study:To test validity, 451 patients with IBS (mean age, 38 y; 81% females) completed the SHS and questionnaires assessing IBS symptom severity (IBS-SSS), gastrointestinal (GI)-specific anxiety (VSI), and quality of life (IBSQOL). To evaluate reliability and responsiveness to changes, the questionnaires were repeated after 2 weeks in 18 patients, and after 12 weeks in 212 patients who had completed a patient-education program.Results:Validity was documented with (1) gradually increasing mean scores for all 4 SHS items with increasing IBS-SSS (Pless than0.0001), and (2) correlations between the 4 SHS items and the corresponding items from the other subjective health assessment tools [item 1 (symptom burden): =0.67, item 2 (daily function): =-0.44 to -0.46, item 3 (disease-related worry): =-0.51 to 0.57, item 4 (general well-being): =-0.34 to -0.46, Pless than0.0001]. Reliability was confirmed (Spearman greater than0.7 and intraclass correlations greater than0.7). Responsiveness was good with responders to the patient-education program (IBS-SSS reduction 50 points) having significant reductions in 3 of the SHS items (Pless than0.05), and borderline change for the fourth SHS item (P=0.06).Conclusions:SHS is a health measure that shows promising evidence of validity, reliability, and responsiveness in IBS patients. It is quickly completed and evaluated, which supports its usefulness in the busy clinical practice.

Place, publisher, year, edition, pages
Lippincott, Williams andamp; Wilkins: No Hybrid Open Access, 2015
Keywords
irritable bowel syndrome; validation; reliability; responsiveness; questionnaire; subjective health assessment
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120643 (URN)10.1097/MCG.0000000000000209 (DOI)000358209900005 ()25216385 (PubMedID)
Note

Funding Agencies|Swedish Medical Research Council [13409, 21691, 21692]; Marianne and Marcus Wallenberg Foundation, University of Gothenburg; Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg; Faculty of Medicine, University of Gothenburg; Abbvie; Ferring; Danone; AstraZeneca

Available from: 2015-08-20 Created: 2015-08-20 Last updated: 2017-12-04
Lovén Wickman, U., Yngman-Uhlin, P., Hjortswang, H., Riegel, B., Stjernman, H. & Hollman Frisman, G. (2014). Self-care among patients with Inflammatory Bowel Disease - an interview study. In: : . Paper presented at 9th Congress of ECCO - Inflammatory Bowel Diseases, 20-22 February 2014, Copenhagen, Denmark.
Open this publication in new window or tab >>Self-care among patients with Inflammatory Bowel Disease - an interview study
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2014 (English)Conference paper, Oral presentation with published abstract (Other academic)
National Category
Clinical Medicine Nursing
Identifiers
urn:nbn:se:liu:diva-109059 (URN)
Conference
9th Congress of ECCO - Inflammatory Bowel Diseases, 20-22 February 2014, Copenhagen, Denmark
Available from: 2014-08-04 Created: 2014-08-04 Last updated: 2015-04-08
Pihl Lesnovska, K., Börjeson, S., Hjortswang, H. & Hollman Frisman, G. (2014). What do patients need to know? Living with inflammatory bowel disease. Journal of Clinical Nursing, 23(11-12), 1718-1725
Open this publication in new window or tab >>What do patients need to know? Living with inflammatory bowel disease
2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 11-12, p. 1718-1725Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To explore the need for knowledge as expressed by patients diagnosed with inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease has a major impact on physical and emotional well-being, placing considerable demands on patients' management of daily activities. Although inflammatory bowel disease patients' level of knowledge about their disease has been previously studied, it is necessary to learn more about their self-expressed needs.

DESIGN: The study was designed to explore patients' need for knowledge; therefore, an inductive method was chosen.

METHODS: Thirty patients with inflammatory bowel disease were interviewed. Content analysis was used to describe their need for knowledge.

RESULTS: The analysis generated three categories and eight subcategories: (1) knowledge related to the course of the disease (subcategories: understanding causal relationships between symptoms and the disease, complications related to the disease and understanding treatment), (2) knowledge related to managing everyday life (subcategories: behaviour that enhances well-being and managing social life) and (3) difficulty understanding and assimilating information (subcategories: shifting knowledge needs, help to understand information and reasons for wanting or not wanting knowledge).

CONCLUSION: Knowledge needs were related to what to expect when living with inflammatory bowel disease in order to manage everyday life. There was a great variation in the need for knowledge, which was greatest immediately following diagnosis and during relapse.

RELEVANCE TO CLINICAL PRACTICE: It is important for healthcare providers to ascertain the patients' individual knowledge needs and together with them formulate an individual care plan that gives the patient the necessary knowledge to manage their health and social life.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
content analysis, Crohn's disease, knowledge need and ulcerative colitis
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-97578 (URN)10.1111/jocn.12321 (DOI)000335443800027 ()24004406 (PubMedID)
Available from: 2013-09-17 Created: 2013-09-17 Last updated: 2017-12-06
Befrits, R., Wikman, O., Blomquist, L., Hjortswang, H., Hammarlund, P., Bajor, A., . . . Blom, H. (2013). Anemia and iron deficiency in inflammatory bowel disease: an open, prospective, observational study on diagnosis, treatment with ferric carboxymaltose and quality of life. Scandinavian Journal of Gastroenterology, 48(9), 1027-1032
Open this publication in new window or tab >>Anemia and iron deficiency in inflammatory bowel disease: an open, prospective, observational study on diagnosis, treatment with ferric carboxymaltose and quality of life
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2013 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 48, no 9, p. 1027-1032Article in journal (Refereed) Published
Abstract [en]

Objective. Iron deficiency and anemia are being increasingly recognized as a complication of inflammatory bowel disease (IBD). The aim of this study was to observe, in a non-interventional way, how Swedish gastroenterologists adhere to guidelines in IBD outpatients treated with intravenous ferric carboxymaltose (FCM), and the result of treatment. Material and methods. Altogether 394 IBD patients (Crohns disease (CD) 60%, ulcerative colitis (UC) 40%) from 14 centers were included. Group A (n = 216) was observed from November 2008 and group B (n = 178) from March 2010. Time of observation ranged from 12 to 29 months. Results. S-Ferritin (mmol/l) and transferrin saturation (T-Sat; %) were recorded at baseline in 62% and 50% in group A. Median values for Hb, ferritin and T-Sat at baseline were 111 g/l, 10 mu mol/l and 10%, respectively, and 134 g/l, 121 mmol/l and 20% after iron treatment (p andlt; 0.001 for all three parameters). Similar results were found in group B. Approximately three-quarters of all patients had only one iron infusion during the study period. Median time to reinfusion was 6 (1-25) months. Only previously described infusion reactions occurred in 27 (7%) patients. Conclusions. Adherence to European guidelines was rather poor and needs to be improved. The effect on iron parameters of intravenous FCM was significant, and resulted in a ferritin level that indicates an effect on the iron stores. The effect was mostly sustained for a year since only one-quarter of the patients were given repeated iron infusions. No unforeseen safety concerns emerged during the observation period.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
anemia, ferric carboxymaltose, inflammatory bowel disease, iron
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97439 (URN)10.3109/00365521.2013.819442 (DOI)000323490200004 ()
Note

Funding Agencies|Vifor Pharma Nordiska AB, Kista, Sweden||

Available from: 2013-09-12 Created: 2013-09-12 Last updated: 2017-12-06
Vigren, L., Tysk, C., Ström, M., Kilander, A. F., Hjortswang, H., Bohr, J., . . . Sjoberg, K. (2013). Celiac disease and other autoimmune diseases in patients with collagenous colitis. Scandinavian Journal of Gastroenterology, 48(8), 944-950
Open this publication in new window or tab >>Celiac disease and other autoimmune diseases in patients with collagenous colitis
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2013 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 48, no 8, p. 944-950Article in journal (Refereed) Published
Abstract [en]

Background and aims. Collagenous colitis (CC) is associated with autoimmune disorders. The aim of the present study was to investigate the relationship between CC and autoimmune disorders in a Swedish multicenter study. Methods. Patients with CC answered questionnaires about demographic data and disease activity. The patients files were scrutinized for information about autoimmune diseases. Results. A total number of 116 CC patients were included; 92 women, 24 men, median age 62 years (IQR 55-73). In total, 30.2% had one or more autoimmune disorder. Most common were celiac disease (CeD; 12.9%) and autoimmune thyroid disease (ATD, 10.3%), but they also had Sjogrens syndrome (3.4%), diabetes mellitus (1.7%) and conditions in skin and joints (6.0%). Patients with associated autoimmune disease had more often nocturnal stools. The majority of the patients with associated CeD or ATD got these diagnoses before the colitis diagnosis. Conclusion. Autoimmune disorders occurred in one-third of these patients, especially CeD. In classic inflammatory bowel disease (IBD), liver disease is described in contrast to CC where no cases occurred. Instead, CeD was prevalent, a condition not reported in classic IBD. Patients with an associated autoimmune disease had more symptoms. Patients with CC and CeD had an earlier onset of their colitis. The majority of the patients with both CC and CeD were smokers. Associated autoimmune disease should be contemplated in the follow-up of these patients.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
autoimmune disease; celiac disease; collagenous colitis; inflammatory bowel disease; microscopic colitis; thyroid disease
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103409 (URN)10.3109/00365521.2013.805809 (DOI)000322850500007 ()
Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2017-12-06
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