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Drott, J., Fomichov, V., Starkhammar, H., Börjeson, S., Kjellgren, K. I. & Berterö, C. (2019). Oxaliplatin-Induced Neurotoxic Side Effects and Their Impact on Daily Activities. Cancer Nursing
Open this publication in new window or tab >>Oxaliplatin-Induced Neurotoxic Side Effects and Their Impact on Daily Activities
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2019 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Oxaliplatin (OXA) is frequently used in the treatment of patients with colorectal cancer, and OXA-induced neurotoxic side effects are common. Reports on real-time patient-reported neurotoxic side effects and impact on the patient's daily activities are sparse in existing studies. Objective: The aim of this study was to identify and assess patient-reported OXA-induced neurotoxic side effects and their impact on the patient's daily activities, during and after chemotherapy. Methods: In a multicenter prospective longitudinal study, 46 chemo-naïve patients with colorectal cancer treated with postoperative adjuvant OXA-based chemotherapy were monitored during treatment and at 3-, 6-, 9-, and 12-month follow-ups. Patients were recruited from September 2013 to June 2016. In total, 370 Oxaliplatin-Associated Neurotoxicity Questionnaire responses were available for analysis. A mobile phone-based system was used to receive real-time assessments. Results: All patients reported neurotoxic side effects and impact on daily activities during treatment. The side effects changed in character and body location over time and had an impact on the daily activities. Conclusions: The high prevalence of OXA-induced neurotoxic side effects significantly interfered with the patients' daily activities. We found significant differences between baseline data and follow-up time points for neurotoxicity, and the patients had not returned to baseline after 1 year. Implications for Practice: The real-time assessment using mobile phone technology seems to be a valuable tool for monitoring patient-reported neurotoxicity and interventions for tailored care. Effectively identifying neurotoxicity and its impact on the patient's daily activities is important in supportive cancer care.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
Keywords
Cancer nursing; Chemotherapy; Colorectal cancer; Daily activities, mHealth; Neurotoxicity; Patient-reported outcomes; Symptom control
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-154883 (URN)10.1097/ncc.0000000000000674 (DOI)
Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2019-03-05
Drott, J., Starkhammar, H., Kjellgren, K. I. & Berterö, C. (2018). Neurotoxic Side Effects Early in the Oxaliplatin Treatment Period in Patients With Colorectal Cancer. Oncology Nursing Forum, 45(6), 690-697
Open this publication in new window or tab >>Neurotoxic Side Effects Early in the Oxaliplatin Treatment Period in Patients With Colorectal Cancer
2018 (English)In: Oncology Nursing Forum, ISSN 0190-535X, E-ISSN 1538-0688, Vol. 45, no 6, p. 690-697Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To identify and describe experiences of patients with colorectal cancer (CRC) who have neurotoxic side effects early in the oxaliplatin treatment period, and how neurotoxicity affects their daily lives.

PARTICIPANTS & SETTING: 10 patients with stage II-III CRC were included. All were treated with adjuvant oxaliplatin postoperatively and assessed neurotoxicity via a platform-independent mobile phone-based system. Patients were recruited from two hospitals in southern Sweden from November 2013 to August 2014.

METHODOLOGIC APPROACH: Qualitative interview study conducted through open-ended, face-to-face, qualitative interviews. Thematic analysis was used.

FINDINGS: A main theme was identified.

IMPLICATIONS FOR NURSING: Nurses have an obligation to communicate the importance of early detection of neurotoxicity. Mobile phone technology seems to be a valuable tool for monitoring patient-reported neurotoxicity to improve communication and supportive care.

Place, publisher, year, edition, pages
Pittsburgh, PA, United States: Oncology Nursing Society, 2018
Keywords
chemotherapy, colorectal cancer, daily life, neurotoxicity, qualitative methodology
National Category
Cancer and Oncology Nursing
Identifiers
urn:nbn:se:liu:diva-154815 (URN)10.1188/18.ONF.690-697 (DOI)000459360700005 ()30339148 (PubMedID)2-s2.0-85055071697 (Scopus ID)
Note

Funding agencies: Swedish Cancer Society; Division of Nursing Science, Department of Medical and Health Sciences at Linkoping University

Available from: 2019-02-28 Created: 2019-02-28 Last updated: 2019-04-10Bibliographically approved
Bengtsson, U., Kjellgren, K., Hallberg, I., Lindwall, M. & Taft, C. (2016). Improved blood pressure control using an interactive mobile phone support system. The Journal of Clinical Hypertension, 18(2), 101-108
Open this publication in new window or tab >>Improved blood pressure control using an interactive mobile phone support system
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2016 (English)In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Vol. 18, no 2, p. 101-108Article in journal (Refereed) Published
Abstract [en]

This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone-based self-management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self-management system comprises modules for (1) self-reports of BP, pulse, lifestyle, symptoms, and well-being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self-reports. Daily use of the support system significantly reduced BP (systolic BP -7 mm Hg, diastolic BP -4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self-management support system may be a useful tool in clinical practice to help patients self-manage their hypertension.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-124014 (URN)10.1111/jch.12682 (DOI)26456490 (PubMedID)
Available from: 2016-01-18 Created: 2016-01-18 Last updated: 2018-01-10
Hallberg, I., Ranerup, A. & Kjellgren, K. I. (2016). Supporting the self-management of hypertension: Patients' experiences of using a mobile phone-based system. Journal of Human Hypertension, 30(2), 141-146
Open this publication in new window or tab >>Supporting the self-management of hypertension: Patients' experiences of using a mobile phone-based system
2016 (English)In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 30, no 2, p. 141-146Article in journal (Refereed) Published
Abstract [en]

Globally, hypertension is poorly controlled and its treatment consists mainly of preventive behavior, adherence to treatment and risk-factor management. The aim of this study was to explore patients’ experiences of an interactive mobile phone-based system designed to support the self-management of hypertension. Forty-nine patients were interviewed about their experiences of using the self-management system for 8 weeks regarding: (i) daily answers on self-report questions concerning lifestyle, well-being, symptoms, medication intake and side effects; (ii) results of home blood-pressure measurements; (iii) reminders and motivational messages; and (iv) access to a web-based platform for visualization of the self-reports. The audio-recorded interviews were analyzed using qualitative thematic analysis. The patients considered the self-management system relevant for the follow-up of hypertension and found it easy to use, but some provided insight into issues for improvement. They felt that using the system offered benefits, for example, increasing their participation during follow-up consultations; they further perceived that it helped them gain understanding of the interplay between blood pressure and daily life, which resulted in increased motivation to follow treatment. Increased awareness of the importance of adhering to prescribed treatment may be a way to minimize the cardiovascular risks of hypertension.

Place, publisher, year, edition, pages
Nature Publishing Group, 2016
Keywords
Interface · Discontinuous coefficients problems · Initial boundary value problems · Well-posedness · Conservation · Stability · Interface conditions · High order accuracy · Summation-by-parts operators
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-121488 (URN)10.1038/jhh.2015.37 (DOI)000370448900012 ()25903164 (PubMedID)
Available from: 2015-09-22 Created: 2015-09-22 Last updated: 2017-12-04Bibliographically approved
Drott, J., Starkhammar, H., Kjellgren, K. & Berterö, C. (2016). The trajectory of neurotoxic side effects' impact on daily life: a qualitative study. Supportive Care in Cancer, 24(8), 3455-3461
Open this publication in new window or tab >>The trajectory of neurotoxic side effects' impact on daily life: a qualitative study
2016 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 8, p. 3455-3461Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

The purpose of this study was to explore the experiences of oxaliplatin-induced neurotoxic side effects among patients with colorectal cancer (CRC) and how these side effects influenced their daily lives over time.

METHODS:

To assess neurotoxic side effects, ten patients were repeatedly interviewed. The patients were recruited from two hospitals in south of Sweden, had stage II-III CRC, and had been treated with adjuvant oxaliplatin postoperatively, from November 2013 to October 2015. They had received FOLFOX and XELOX, with a mean total dose of 791 mg oxaliplatin. After completed chemotherapy, at 3, 6, and 12 months into the post-treatment phase, 25 interviews were conducted and thematic analysis was used according to Braun and Clarke.

RESULTS:

Oxaliplatin-induced neurotoxicity affects patients in several ways in the long term. Four themes were identified: Expectation of cure, Dubiety, Normalization, and Learn to live with neurotoxicity. The findings of this study describe the trajectory of neurotoxicity and its impact on these patients' life situation. The findings confirmed that neurotoxicity is multi-faceted and that the experience of it changes over time.

CONCLUSION:

The desire to survive stimulates adaptations and strategies to manage daily life, and patients learn to live with the neurotoxic side effects. This study provides evidence that these patients need individual attention and support during the trajectory of neurotoxic side effects. Current care provision is inadequate due to a lack of knowledge of the ways in which neurotoxicity impacts the patient's daily life. This study provides insights that could be used to develop a more person-centered care.

Keywords
Adjuvant chemotherapy; Colorectal cancer; Neurotoxicity; Oxaliplatin; Qualitative interviews; Thematic analysis
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-126626 (URN)10.1007/s00520-016-3179-1 (DOI)000378884400030 ()26992409 (PubMedID)
Note

Funding agencies:We thank all patients for their participation in this study. We also thank the Swedish Cancer Society, the Department of Oncology and Surgery, Linkoping University Hospital, and the Division of Nursing Science at the Department of Medical and Health Sciences for the financial support. Further thanks go to all the health professionals in the oncology clinics who were involved in the study in different ways.

Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2018-05-15
Drevenhorn, E., Bengtson, A., Nyberg, P. & Kjellgren, K. (2015). Assessment of hypertensive patients self-care agency after counseling training of nurses. Journal of the American Association of Nurse Practitioners, 27(11), 624-630
Open this publication in new window or tab >>Assessment of hypertensive patients self-care agency after counseling training of nurses
2015 (English)In: Journal of the American Association of Nurse Practitioners, ISSN 2327-6886, E-ISSN 2327-6924, Vol. 27, no 11, p. 624-630Article in journal (Refereed) Published
Abstract [en]

PurposeThe aim of the study was to assess hypertensive patients self-care agency and any correlation with the patients lifestyle changes and the nurses degree of patient centeredness after counseling training. Data sourcesNurses in the intervention group (IG; n = 19) working at nurse-led clinics at health centers were trained in patient centeredness (motivational interviewing) and the stages of change model and included 137 patients. Nurses in the control group (CG; n = 14) included 51 patients. The Exercise of Self-Care Agency (ESCA) instrument was used. There was a significant difference from baseline to the 2-year follow-up in the ESCA score (IG, p = .0001). An increase in ESCA score was correlated with an increased level of physical activity after 2 years (IG, p = .0001; CG, p = .040). ConclusionsThe counseling training gave an increase in the patients self-care agency scores, which was significantly correlated with increased physical activity. Implications for practiceIn clinical practice it is important for nurses to be patient centered in their counseling to affect patients self-care agency in a positive direction.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2015
Keywords
Counseling; hypertension; self-care; patient-centered care; advanced practice nursing; international; Sweden
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-123068 (URN)10.1002/2327-6924.12222 (DOI)000363926700006 ()25731140 (PubMedID)
Available from: 2015-12-04 Created: 2015-12-03 Last updated: 2017-12-01
Berglund, H., Hasson, H., Kjellgren, K. & Wilhelmson, K. (2015). Effects of a continuum of care intervention on frail older persons life satisfaction: a randomized controlled study. Journal of Clinical Nursing, 24(7-8), 1079-1090
Open this publication in new window or tab >>Effects of a continuum of care intervention on frail older persons life satisfaction: a randomized controlled study
2015 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 7-8, p. 1079-1090Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: The aim of this study was to analyse effects of a comprehensive continuum of care (intervention group) on frail older persons life satisfaction, as compared to those receiving usual care (control group). The intervention included geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older persons own homes. Background: Improvements in older persons subjective well-being have been shown in studies including care planning and coordination by a case manager. However, effects of more complex continuum of care interventions on frail older persons life satisfaction are not well explored. DesignRandomised controlled study. Methods: The validated LiSat-11 scale was used in face-to-face interviews to assess older persons life satisfaction at baseline and at three, six and 12 months after the baseline. The odds ratio for improving or maintaining satisfaction was compared for intervention and control groups from baseline to three-month, three- to six-month as well as six- to 12-month follow-ups. Results: Older persons who received the intervention were more likely to improve or maintain satisfaction than those who received usual care, between 6 and 12 month follow-ups, for satisfaction regarding functional capacity, psychological health and financial situation. Conclusions: A comprehensive continuum of care intervention comprising several components had a positive effect on frail older persons satisfaction with functional capacity, psychological health and financial situation. Relevance to clinical practice: Frail older persons represent a great proportion of the persons in need of support from the health care system. Health care professionals need to consider continuum of care interventions impact on life satisfaction. As life satisfaction is an essential part of older persons well-being, we propose that policy makers and managers promote comprehensive continuum of care solutions.

Place, publisher, year, edition, pages
Wiley, 2015
Keywords
care planning; case management; continuum of care; interprofessional collaboration; life satisfaction; older persons; randomised controlled study
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117370 (URN)10.1111/jocn.12699 (DOI)000351633800019 ()25293644 (PubMedID)
Note

Funding Agencies|Vardalinstitutet, The Swedish Institute for Health Sciences

Available from: 2015-04-24 Created: 2015-04-24 Last updated: 2017-12-04
Zetterqvist, A., Aronsson, P., Hägg, S., Kjellgren, K., Reis, M., Tobin, G. & Booth, S. (2015). On the pedagogy of pharmacological communication: a study of final semester health science students. BMC Medical Education, 15
Open this publication in new window or tab >>On the pedagogy of pharmacological communication: a study of final semester health science students
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2015 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 15Article in journal (Refereed) Published
Abstract [en]

Background: There is a need to improve design in educational programmes for the health sciences in general and in pharmacology specifically. The objective of this study was to investigate and problematize pharmacological communication in educational programmes for the health sciences. Methods: An interview study was carried out where final semester students from programmes for the medical, nursing and specialist nursing in primary health care professions were asked to discuss the pharmacological aspects of two written case descriptions of the kind they would meet in their everyday work. The study focused on the communication they envisaged taking place on the concerns the patients were voicing, in terms of two features: how communication would take place and what would be the content of the communication. A phenomenographic research approach was used. Results: The results are presented as outcome spaces, sets of categories that describe the variation of ways in which the students voiced their understanding of communication in the two case descriptions and showed the qualitatively distinct ways in which the features of communication were experienced. Conclusions: The results offer a base of understanding the students perspectives on communication that they will take with them into their professional lives. We indicate that there is room for strengthening communication skills in the field of pharmacology, integrating them into programmes of education, by more widely implementing a problem-based, a case-oriented or role-playing pedagogy where final year students work across specialisations and there is a deliberate effort to evoke and assess advanced conceptions and skills.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2015
Keywords
Pharmacology; Education; Communication; Phenomenography; Case description
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-122654 (URN)10.1186/s12909-015-0467-2 (DOI)000363449600003 ()26502921 (PubMedID)
Note

Funding Agencies|Department of Pedagogical; County Council Ostergotland [LIO-198671]; Mellon Foundation at the Faculty of Humanities, University of the Witwatersrand, South Africa

Available from: 2015-11-16 Created: 2015-11-13 Last updated: 2017-12-01
Berglund, H., Blomberg, S., Dunér, A. & Kjellgren, K. (2015). Organizing integrated care for older persons: strategies in Sweden during the past decade. Journal of Health Organisation & Management, 29(1), 128-151
Open this publication in new window or tab >>Organizing integrated care for older persons: strategies in Sweden during the past decade
2015 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 29, no 1, p. 128-151Article in journal (Refereed) Published
Abstract [en]

Purpose - The purpose of this paper is to describe and analyse ways of organizing integrated care for older persons in Sweden during the past decade. Design/methodology/approach - The data consist of 62 cases of development work, described in official reports. A meta-analysis of cases was performed, including content analysis of each case. A theoretical framework comprising different forms of integration (co-ordination, contracting, co-operation and collaboration) was applied. Findings - Co-operation was common and collaboration, including multiprofessional teamwork, was rare in the cases. Contracting can be questioned as being a form of integration, and the introduction of consumer choice models appeared problematic in inter-organization integration. Goals stated in the cases concerned steering and designing care, rather than outcome specifications for older persons. Explicit goals to improve integration in itself could imply that the organizations adapt to strong normative expectations in society. Trends over the decade comprised development of local health care systems, introduction of consumer choice models and contracting out. Research limitations/implications - Most cases were projects, but others comprised evaluations of regular organization of integrated care. These evaluations were often written normatively, but constituted the conditions for practice and were important study contributions. Practical implications - Guiding clinical practice to be aware of importance of setting follow-up goals. Social implications - Awareness of the risk that special funds may impede sustainable strategies development. Originality/value - A theoretical framework of forms of integration was applied to several different strategies, which had been carried out mostly in practice. The study contributes to understanding of how different strategies have been developed and applied to organize integrated care, and highlights some relationships between integration theory and practice.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2015
National Category
Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-115360 (URN)10.1108/JHOM-04-2013-0082 (DOI)000355690400009 ()25735557 (PubMedID)2-s2.0-84923383894 (Scopus ID)
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2017-12-04Bibliographically approved
Aronsson, P., Booth, S., Hägg, S., Kjellgren, K., Zetterqvist, A., Tobin, G. & Reis, M. (2015). The understanding of core pharmacological concepts among health care students in their final semester. BMC Medical Education, 15(1), Article ID 235.
Open this publication in new window or tab >>The understanding of core pharmacological concepts among health care students in their final semester
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2015 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 15, no 1, article id 235Article in journal (Refereed) Published
Abstract [en]

Background

The overall aim of the study was to explore health care students´ understanding of core concepts in pharmacology.

Method

An interview study was conducted among twelve students in their final semester of the medical program (n = 4), the nursing program (n = 4), and the specialist nursing program in primary health care (n  = 4) from two Swedish universities. The participants were individually presented with two pharmacological clinically relevant written patient cases, which they were to analyze and propose a solution to. Participants were allowed to use the Swedish national drug formulary. Immediately thereafter the students were interviewed about their assessments. The interviews were audio-recorded and transcribed verbatim. A thematic analysis was used to identify units of meaning in each interview. The units were organized into three clusters: pharmacodynamics, pharmacokinetics, and drug interactions. Subsequent procedure consisted of scoring the quality of students´ understanding of core concepts. Non-parametric statistics were employed.

Results

The study participants were in general able to define pharmacological concepts, but showed less ability to discuss the meaning of the concepts in depth and to implement these in a clinical context. The participants found it easier to grasp concepts related to pharmacodynamics than pharmacokinetics and drug interactions.

Conclusion

These results indicate that education aiming to prepare future health care professionals for understanding of more complex pharmacological reasoning and decision-making needs to be more focused and effective.

Place, publisher, year, edition, pages
BioMed Central, 2015
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-123977 (URN)10.1186/s12909-015-0522-z (DOI)000367434000001 ()26715297 (PubMedID)
Funder
Östergötland County Council, LIO-198671
Note

Also funded by Sahlgrenska Academy, (V 2011/437)

Available from: 2016-01-15 Created: 2016-01-15 Last updated: 2017-11-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2764-3095

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